Health

Few people have serious health problems when they visit India. If you are careful about the water you drink and what you eat, and stay in reasonably clean hotels, you have a good chance of remaining healthy. The list of potential diseases one can contract can seem frightening, but most people will not encounter anything more than an upset stomach.

There are many qualified doctors in India, especially in the larger cities. It is important to see a doctor immediately if any serious disease is suspected. A good doctor in India will often be better than a doctor in your home country, because Indian doctors are experienced in treating tropical diseases.
There are many health risks in India that would not normally be encountered in Europe or North America. Also, there are still diseases common in India that are rarely found in Western countries. Therefore, protective vaccinations could be considered.

Normal body temperature is 37ºC (98.6ºF). If your temperature goes up more than 2ºC (4ºF) the fever is considered to be high. A normal pulse rate falls between 60 and 100 beats per minute for an adult 80 to 100 beats per minute for children (babies 100 to 140). The pulse rises about 20 beats per minute for every 1ºC (2ºF) of fever.

How fast you breath can also be an indication of illness. A normal adult breathes from 12 to 20 breaths per minute (a child about 30 breaths per minute, babies 40). A fever increases the breath rate.

WARNING If you feel so ill that you feel you must see a doctor but think you are too sick to make it to one, go immediately. Tropical diseases tend to bring on rapid deterioration. Don’t wait until someone tells you (or you feel) that you look like you are very sick. I know this from personal experience.

Good Books to Read
How To Stay Healthy Abroad (earlier editions were called Travellers’ Health), by Dr. Richard Darwood—a good, detailed book about staying healthy while traveling. Different doctors discuss different subjects. Highly informative.

Staying Healthy in Asia, Africa & Latin America, Moon Publications—an informative book about staying healthy in the tropics, written in an easy-to-understand format.

The Traveller’s Health Guide, by Dr. Anthony C. Turner—Dr. Turner is a consultant in tropical and travel medicine, and has written an informative and easy-to-read book.

Travel with Children, Maureen Wheeler, Lonely Planet Press—basic advice about keeping young children healthy while traveling.

Before You Go
Because the dentists in India are generally not so good (except in large cities), plan to have a dental checkup before you leave. Dentists in India often do not have modern equipment, such as X-ray machines, etc., and hygiene is often at a low standard.

You should plan to take your eyeglass prescription if you wear glasses, and if possible, an extra pair of glasses. If you were to lose your glasses in a remote place, they would be difficult to replace.

If you have a particular health problem or have not seen a doctor in a while, plan to have a medical checkup before you leave. Find out from your doctor if there are any precautions you should take.

If you are taking any prescription medicine, make sure you bring enough for the entire trip and longer (people often decide to extend their travels). You may not be able to find sold in India the medicines you need, or to find medicines of the same quality. Ask your pharmacist for the medication’s generic name. In India, most medications are sold under names different than the ones we know in the West.

It is also a good idea to bring medicine for fungal infections, athlete’s foot, etc., if you have this problem.

Immunization
Health books written by doctors I have read suggest receiving an injection against hepatitis A, polio, tetanus, and typhoid. They also suggest carrying pills to prevent malaria.

Few vaccines give 100% protection, so care should still be taken regarding drink, food, and personal hygiene.

For recommendations on what shots to receive, ask a doctor familiar with common Indian diseases and tropical medicine. Few doctors in the West know much about this subject. A doctor at a tropical disease center or one trained in India would be your best option. It is best to receive your vaccinations approximately two weeks before your departure date. This allows time for the vaccines to take effect and gives you time to recover from any side effects.

Hepatitis A A gamma globulin injection is given for infectious hepatitis A, but it does not necessarily prevent the disease. The injection loses potency steadily over a six-month period. For a long-range visit, it is ineffective. If you choose to receive this vaccination, take it just before your departure. Havrix Vaccine is effective up to 10 years, but it is expensive.

Hepatitis B This disease is spread by blood or through sexual contact. You need to take three shots over a minimum of three weeks, and a booster after twelve months.

Cholera The first of two xe "cholera"cholera injections should be taken six months before departure. The second shot should follow six months later. It is unusual to get cholera in India, so considering the side effects of these shots, you may want to highly consider whether to get cholera shots.

Typhoid For protection against xe "typhoid" typhoid, two shots are needed, the first one six weeks before you leave. You can also take oral capsules. Protection from typhoid lasts two or three years.

Polio To prevent polio, take three doses of a live vaccine with a booster every three to five years. A booster should be taken every ten years.

Diphtheria  Diphtheria is a potentially fatal throat infection. You need to take three shots and then a booster every ten years.

Rabies If you are riding a bike, dealing with animals, or going to remote areas, you may want to get rabies shot.

Tetanus Tetanus is a potentially fatal wound infection. You need to take three injections and a booster every ten years.

According to one book I read, the US Health Service announced that shots for cholera are only fifty percent effective. Another source said that cholera shots give poor protection. I have heard that typhoid shots can cause considerable discomfort. Typhoid is more likely gotten in areas with poor sanitation.

At a commercial travel clinic in London a full set of shots costs about £40. Beside your local GP in the UK there are some good vaccinating centers. Some are: London Hospital for Tropical Diseases, 4 St Pancras Way, London (071-637-9899); West London Vaccinating Centre at 53 Gt Cumberland Place, London (071-262-6456); British Airways Travel Clinic at 156 Regent St, London (071-439-9584); Thomas Cook at 45 Berkeley St, London (071-408-4157); and Trailfinders, 194 Kensington High Street, London (071-938-3939). 

In the USA, for the latest advice on what shots to get and what malaria pills to take, contact the Center for Disease Control, Atlanta (404) 332-4555; fax (404) 332-4565; http://www.cdc.gov. This is a really good web site and is definitely worth checking out.

There are several good health information sites on the Internet. You can contact the World Health Organization and the US Centers for Disease Control and Prevention.

Anti-malarial Drugs
If you plan to take pills to prevent xe "malaria" malaria, begin taking them two weeks before departure and continue to take them for at least six weeks after you return. Some types of mosquitoes have built up a resistance to certain malaria pills, so it is important to contact a doctor to find out which pills are best. Anti-malarial pills help, but they are not a hundred percent guarantee that you will not contract malaria.

Often malaria pills cause bad side effects. Often, people stop taking them for this reason. The sure way to avoid malaria is to avoid being bitten by malaria-carrying mosquitoes. If you are careful, use insect repellant (brought from the West—the ones in India are not as effective), and sleep under a mosquito net, it is possible to avoid being bitten by mosquitoes.

I personally have never taken malaria pills and most of the long-time stayers in India don’t take any pills and only a few of them that I know have gotten malaria.

Health Insurance
Health insurance is a good option. Some insurance policies do not cover dangerous activities such as trekking or motorcycling, and many policies insist that you pay for your own care upfront; medical expenses are reimbursed upon your return. A few policies will pay the doctor directly even in a faraway country. Take a photocopy of your policy along with you. Check to see if your policy includes an emergency flight home, an ambulance, or a helicopter lift out of a remote area.

Doctor Warning
Ayurvedic doctors can often be helpful in treating stomach and other diseases. One potential problem with them, however, is that when you go to see them for diarrhea, they will tell you that you have a much greater problem and you need three months (if not ten years) of expensive medicine to cure it. Before purchasing this long-term medicine,I highly recommend that you see a few doctors. I never tell an Ayurvedic doctor what is wrong with me. If they don’t know what is wrong with me by taking my pulse, then they are definitely not qualified to treat a major disorder.

Also if you have a major illness such as malaria, unless you have heard great things about an Ayurvedic doctor, there is a good chance their medicine will be ineffective and they often can do more harm than good. The sooner you treat diseases the easier it is to cure them. When in doubt it is better to go to a regular doctor, who prescribes standard medicine for malaria and other diseases.

Advice for the Plane Journey
When you fly, gases in the body, especially in the intestines, expand and cause discomfort both in the stomach and the ears. Therefore travelers are advised to wear loose-fitting clothing and not to eat much on the aircraft. It is best not to smoke immediately before boarding because there is a slight decrease of oxygen which can accentuate the effects of the carbon monoxide and other gases inhaled from the cigarette. The air in most planes tends to be dry, and people often feel dehydrated while flying. Drink plenty of liquids. Because of the tendency for the intestinal gases to be disturbed, it is best to avoid carbonated drinks.

Be careful of jet lag when you first come off the aircraft. Studies prove that both a person’s reaction time and their ability to make a decision are affected for a day or two after crossing time zones. It is best after arriving to put off important decisions for a few days, and to avoid too many judgment calls. Because you will be crossing several time zones on your way to India if you are traveling from America and Europe, it is best to rest upon arriving for two or three days before moving on with your plans.

Water
Because of the heat, it is good to drink at least two or three litres (quarts) of water a day. In one book on traveler’s health it states that a person should drink half a litre of water for every 10 degrees Fahrenheit. That is, if it is 28ºC (80ºF), you should drink four litres (quarts) of water a day. Healthy urine should be almost clear; a dark yellow color can indicate dehydration. It is best to drink water beyond the point of quenching thirst.

It is advised by Ayurvedic doctors to avoid drinking water for at least one hour after eating. If you drink just after eating, it will extinguish the fire of digestion. You should also not drink just before you eat. Only a small amount of water should be drunk during a meal.

Alcohol, coffee, and black and green teas increase dehydration, not decrease it.

Water As a Source of Disease
It is imperative to be careful about the water in any Third World country. India is no exception. Water is the main carrier of disease in India. Bottled water is easily available. It is a good idea to use bottled or purified water even when brushing your teeth. Tap water will almost assuredly contain bacteria strains to which you are not accustomed, and even if it does not cause disease, it can cause dysentery. Soft drink companies, such as Pepsi or Coke, purify the water they use. If bottled water is unavailable where you are traveling, cold drinks are a good alternative.

If you are in a place where many foreigners are drinking the water, find out where they get their water and drink that. Tap water is not of equal quality from place to place. Water from one source may be safe, and from another source it may be contaminated.

To be safe, it is a good idea to purify water with a portable water purifier, by boiling it, or by treating it chemically. If you choose to boil the water, it must be boiled for at least five minutes to kill bacteria, and fifteen minutes to kill amoebas and giardia.

It is best to filter your water before you boil it. After boiling, fill a sterilized bottle about 2/3 full with the water. Boiling water causes it to lose gases and the taste becomes flat. The water will absorb lost gases in a partially filled bottle, so water will take on its regular flavor again. Hot water, even if not boiled, will kill many disease organisms. Cholera bacillus is killed at 60ºC (140ºF). The container which holds your clean water must also be kept sterilized.

Iodine tablets kill all kinds of germs, but too much iodine is not good for you. It takes 4–8 drops of iodine to purify a litre of water. Mix well, then let the treated water sit for thirty minutes before drinking. If exposed to air or dampness, iodine loses its power.

Chlorine tablets will kill most organisms in water. Chlorine should sit in the water for as long as the package recommends in order to be fully effective. If the water is very cold, you may require more chlorine tablets, and it may take up to thirty minutes instead of the usual average of ten. Chlorine tablets do not kill crypto­sporidiosis, which is one cause of diarrhea. Micropur is a completely tasteless water purification pill not available in India. It kills bacteria, but not all viruses, so it is not totally effective.

You should purchase water purification pills in the West, as they are not usually available in India. If you choose to treat your water chemically, the taste will be altered and it may be difficult to get yourself to drink it. Therefore, many travelers carry packages of Tang or other flavored powders to help overcome the taste. Lime juice and sugar added to the water is also effective in covering the taste of chemically purified water. Many people prefer the taste of iodine to chlorine tablets.

Water purifiers can also be useful. I have a water purifier that first treats the water with iodine to kill the germs, then purifies the water of the iodine. I have read reports by doctors questioning some of the claims about water purification devices. They say that most purifiers will not kill viruses. They consider boiling the water the safest solution.

In hotels or restaurants they will probably tell you that they filter the water. The local water filters remove solids, but do not kill bacteria. Therefore, don’t believe that the water you are drinking in a restaurant is absolutely safe. Often, fruit juices are mixed with tap water.

Avoid the local street vendors and be careful of ice, as you have no idea of the source of the water. Even if the ice is made from purified water, it may then have been transported on a dirty hand-cart or rickshaw, broken up on dirty pavement at the side of the street—I have personally watched this being done—and then offered to the customer as purified ice.

Water is more dangerous during the monsoon season than in the dry season. Green coconuts are a good source of clean water. Green coconuts are available in West Bengal, Orissa, Mumbai, and South India.

Food
It is best to eat boiled foods such as rice, dhal (beans), and boiled vegetables. Fried foods are much more difficult to digest. Food should always be well cooked. Food in India can be dangerous if it cools and is later reheated.

Raw salads and ice creams can be potentially harmful in India. Ice creams may have melted and been refrozen, giving bacteria a chance to enter. Also, frozen milk is hard on the digestion and can cause stomach disorders. Raw salads are dangerous because the vegetables are washed with potentially unclean water. If the water is purified, salads will not usually cause problems.
Foods on display should be avoided, and be careful of restaurants buzzing with flies.

The way meat is processed in India makes eating it risky, and it is much heavier to digest in the hot climate than it would be at home. Best to stick to vegetarian foods. There is virtually no health standard in meat preparation or storage in India. If meat is only half cooked or raw, it is extremely dangerous. While walking through the market or near restaurants, one sometimes smells a strong, disgusting odor. You can assume that it is coming from meat and/or fish. This is nature’s way of warning people that the meat is filled with bacteria and it is rotting. In most holy places in India, meat-eating is banned because it is considered detrimental to spiritual life.

You never know what you are eating at a restaurant. I heard one story about a person who was drinking rose milk with a pretty pink color. He thought it tasted wonderful, so he asked the vendor how the milk got its pink color. The vendor showed him a container of industrial dye. Written in bold letters across the container were the words, “NOT FOR HUMAN CONSUMPTION.” India has few government standards in respects to food.

Papaya is a healthy food to eat. It is easy to digest, rich in vitamins (it has more vitamin C than oranges), helps with digestion, and is soothing to the intestines. It can also help you to have regular bowel movements.

Milk
Drinking milk in India can sometimes be risky, as there are no health standard in relation to milk in India. Raw milk must be boiled to make it safe. Ideally the milk should be brought to the boiling point three times to kill all the germs. It should be drunk as soon as possible after boiling, as germs can come back into the milk. Bad milk can cause tuberculosis, typhoid, dysentery, and other diseases. Because of the way yogurt is processed, it is usually safer than milk, but only if it has been stored properly.

Much of the milk you find in India comes from buffaloes, not cows. Buffalo milk has a higher fat content than cow milk, but it is not considered as healthy as cow milk.

Ice cream can also be risky, because there is no way of knowing whether it has melted and been refrozen (something that happens when there is a power outage) giving germs a chance to get in.

Washing Fruits and Vegetables
Fruits and vegetables should be peeled whenever possible. Many health books recommend that no raw fruits or vegetables should be eaten unless the skins are removed. If you wash fruit with the local tap water, you expose yourself to the same diseases as if you had drunk the water directly.

Ideally, fruits and raw vegetables (such as tomatoes) should be washed with clean, soapy water, then rinsed with treated water or dipped in boiling water. It is a good idea to purchase water purification tablets in your home country and to wash all fruit with treated water.

Drinking Glasses on the Street
Be careful of drinking glasses used for juice, tea, etc., because they are seldom cleaned properly. I have yet to see one cleaned to my standards. Even if it appears clean, you should know that often the vendors have simply rinsed the glass in a bucket of local tap water in which they have also rinsed many other glasses. Drinking from such glasses can give you hepatitis (jaundice) and other diseases. If you like to drink fruit juice from street vendors, it is a good idea to carry your own glass.

Salt
In a hot climate, people tend to perspire more readily. Besides losing fluids, people also lose salt from their bodies. Like water, salt must be replaced to maintain optimum health. The normal European diet contains about ten grams of salt every twenty-four hours. In the tropics, it is better to take in fifteen to twenty-five grams of salt a day, depending on how much physical activity you plan on, and how much time you spend in the sun. It is important that you do not increase your salt intake without also increasing your fluid intake. Extra salt without extra fluids will cause dehydration.

Digestion
A frequent complaint of travelers to India is related to the digestion. Ayurvedic medicine suggests that food items such as lime, ginger, and fresh coriander be mixed with food to help digestion.

It is also a good idea to eat less, as overeating can result in immediate sickness. Do not drink water immediately after eating, but wait for a minimum of one hour, and optimally, two. Do not drink a lot of fluids while eating as this slows the digestive process. Fried foods are difficult to digest and are best avoided. Some people also find raw foods to be indigestible in India.

It is best not to continue eating until you are full. Eat only until your stomach is three-fourths filled. Let your meal digest totally before eating something else—this takes at least four hours. For optimum digestion do not eat between meals . Overeating often causes illness.

Most digestive problems can be cured by short-term fasting. A natural cure for indigestion is to sip water over a period of time. Digestive problems in India can be caused by upsets to the liver. There are Ayurvedic medicines that can help with such problems and increase your ability to digest what you eat.

Ayurvedic Medicine
According to the science of Ayurvedic medicine, by controlling your diet and taking herbal medicines, you can cure or avoid most diseases. Ayurvedic medicine aims not only to cure a disease’s symptoms but to eradicate the cause of the disease. It takes into consideration that each person has a different bodily constitution and should be treated accordingly, even if the details of the disease are the same. People come under three basic categories: Kapha, Pitha, and Vata.

Ayurvedic medicine is much more effective than other kinds of medical treatments for digestive diseases and many of the typical diseases of India. Ayurvedic medicine can cure hepatitis (jaundice); there is no cure according to conventional medicine practiced in the West.
You can also take Ayurvedic medicine to avoid illness. Many diseases in India are caused by the fact that a person’s liver or digestive system does not work properly. You can take Ayurvedic medicine to tone your digestive system. This reduces the amount of undigested food in your system, a cause of illness. If your food is properly digested, you will have sufficient energy to fight disease. Ayurvedic massages can help cure various afflictions.

The main problem with curative Ayurvedic treatment is finding a competent doctor to prescribe and administer it. I suggest you get recommendations before trusting your health to any particular doctor. Only if I had complete faith in an Ayurvedic doctor would I trust him to treat me for a serious disease.

Dr Triguna and his Son
Dr Triguna is an excellent Ayurvedic doctor—one of the best in India. His office is by the Nizamuddin train station in southeast Delhi. He personally helped me at least three times when I was extremely ill. One time my digestion was not working, and I could not eat for five days. After taking his medicine, I was back to normal in ten days. A friend of mine had a bad case of hepatitis (jaundice) and was told at the hospital that there was no known cure for the disease. After his visit to Triguna, he was up and moving after a few days and normal in a week. For instructions on how to get to his office, see the Delhi section.
Work out any question you have before arriving, as he will give you only a minute or two to ask questions. It is important, for example, to ask how long you should take the prescribed medicine for. It is also important to discuss what you should eat or not eat. Also, ask when you should return to see him. With Ayurvedic medicine, it is usually best to take the medicine over a long period of time.

Often the medicine is a powder with a bitter or unpleasant taste. Many people do not take the medicine because of this. If you think it will be too hard for you to swallow the powder, request pills or take it with honey.

Alternative Medicine
The Tibetan Clinic (Men-Tsee-Khang-Exports, 011-621-2604) is located at 13 Jaipur Estate, near the Nizamuddin train station in New Delhi. The doctors there treat people with natural herbal methods and are recommended.

There is a well-known homeopathic doctor named Dr RS Pareek, 4/10 Bagh Farzana, Civil Lines in Agra. He is supposed to be especially effective in treating skin disorders.

Doctors
Indian doctors can be excellent. Doctors in the private clinics and large hospitals can be much better at curing tropical diseases than doctors in America and Europe. As a class, however, it is best to not put all your faith in the doctors in India, unless they are practicing in larger cities. Best to use them only in emergencies.
Before choosing a doctor, it is advisable to get a few recommendations. The doctors recommended by the embassies usually have the best reputation and are the most expensive.
In case of serious illness, it is best to go to a large city for treatment. A real fear about medical treatment in India is the poor sanitation.

See a Doctor Immediately
If you fall ill, do not wait too long before seeing a doctor. A good rule in India is to wait one day for a heavy illness. If you are extremely ill for two days in a row, best to see a doctor as soon as possible. If you think you are too sick to travel to the doctor, you almost certainly need one.

People who have frequently traveled to India are often asked, “My friend (or husband, wife, child, etc.) has been in bed for three days and hasn’t eaten anything. What should I do?” The answer is always “Bring him/her to a doctor.”

Medicine Tip
Most medicines are available without a prescription (but check the sell-by date). Private and Mission hospitals are usually better than state-run hospitals, but may not have as good facilities. The hospitals in the large cities are usually the best, and university or medical schools are usually the best of all. In many hospitals you are expected to pay in advance for services, but charges are much lower than in the West.

You should be careful about the medicines you are offered in India. The same medicine that may have been banned in the West for years can be prescribed to you in India with complete conviction that it is safe.

Hospitals
Hospitals in India are rarely as good as hospitals in the West. Some of them can even be dangerous to your health. On the other hand, Indian doctors can be some of the best in the world. I often go to Indian doctors in America and have usually been satisfied.

If you have a health problem head for the nearest major city. Because there is more money in practicing in large cities, the better doctors practice there. The best doctors often run their own clinics.

A few excellent hospitals are the Christian Medical College Hospital in Vellore, Tamil Nadu, the All India Institute of Medical Sciences and the Apollo Hospital in Delhi, the Breach Candy Hospital in Mumbai, and the Hinduja Hospital (also in Mumbai). In the smaller towns, hospitals run by Christian missionaries are usually the best choice.

Dentist
If you are going to be in India for a while, it is best to visit your dentist at home before your departure. Dentists in Indian are usually not very trustworthy, but in an emergency you may have to see them. If you must see a dentist in India, try to see one that has been trained outside India, or ask for recommendations. For any major work, it is best to see a dentist in a large city, such as Mumbai or Delhi.

Several of my friends have come to India from the US to have dental work done in India. They had their dental work done in Delhi by some excellent dentists and were very satisfied with the work, and the cost was one-fourth of the price of the same work done in the US.

I have gone six times to dentists in India and had varying success. I got a good filling put in once, but another time, a dentist glued a cap on that fell off after a few days. The next dentist glued the cap on properly. Another dentist tried to repair a cracked tooth with no success.

The Delhi Dental Centre (644-4918, 644-2398), C-565 Extension II, has been recommended as a good place to have dental work done. It is best to call for an appointment. Dr Chopra is said to be good.

Rabies
Rabies is a dangerous disease and can kill you. If an animal (dog, monkey, bat, or cat) bites you and draws blood, go to a hospital immediately. Rabies is spread through the animal’s saliva.
In major cities, you can now get one rabies shot, if you do it within 24 hours. It is costly, around Rs 3000 or Rs 4000. Otherwise you have to take five shots over a month with a booster after three months. Taking the one shot is not painful, but taking the shots over a period of time is usually painful.

Cuts
Even the smallest cut in India can become infected. Band-aids do not prevent infection. Immediately clean the wound, and put on an antiseptic. If the cut is large, you may want to consider seeing a doctor. It is best not to wear a Band-aid, which will keep the cut moist and slow healing.

Coral cuts take an especially long time to heal. Clean them thoroughly as small pieces of coral may become embedded in the cut.

It is a good idea to bring a good antiseptic cream from your home country (highly recommended), but Dettol is a good Indian alternative. Observe the healing process closely, and if you see signs of infection, take measures immediately.

Diarrhea
People contract diarrhea for a variety of reasons. If diarrhea is your only symptom, it will often disappear within a few days, especially if you skip a meal or two. Most cases will be gone within forty-eight to seventy-two hours. If diarrhea lasts for more than a week or it is particularly draining, it is best to consult a doctor to ensure that it is not a symptom of a more serious disease. Severe results are more common in children than adults, and left untreated, children can die from the dehydration. Diarrhea that lasts more than ten days or that contains blood should always be taken seriously.

Diarrhea is usually caused by food poisoning. It can be caused by bacteria, viruses, amoebas, salmonella, or cholera organisms.

Drinking large amounts of water is the most important part of any treatment. Most people should drink at least two or three litres a day.

It is also a good idea to take oral rehydration salts (electrolytes). If there is a severe water loss, electrolytes are highly recommended. A substitute for commercially sold electrolytes is a half-teaspoon of salt and three teaspoons of sugar in a litre of water. The main defense against any serious outcome is drinking a good quantity of water, and not just taking antibiotics or antidiarrheal agents. You need to drink at least as much water as you are losing each day. If you are passing a small amount of dark yellow urine you are not drinking enough water.

The cure for diarrhea may be to simply change your diet. You should not take milk products, except yogurt or buttermilk, when you have diarrhea. A good diet is plain rice and curd (yogurt). Mung bean kicharee, a mixture of boiled rice and mung beans, is both nourishing and soothing to the system. It also supplies carbohydrate energy and is easy to digest. Papaya and pomegranate are good fruits to eat. Use ginger, long pepper, coriander, nutmeg, cardamom, and saffron. Eat no fried foods. Fasting for a day will often cure diarrhea.

Isabbael, which come in a brown package, is a good medicine for diarrhea as it helps to stop up your system. Ayurvedic medicines that contain kutaja are also good.

Unless you must take them, antibiotics and other powerful medications should be avoided as often the drug’s side-effects are more dangerous than the disease itself (I have personal experience). In some cases, you haxe "Dysentery" ve no choice but to take antibiotics and such medicines. I read one study that says that streptomycin/sulphatriad (marketed as Streptotriad) was best at curing diarrhea.

Many anti-diarrhea medicines such as codeine-phosphate and loperamide (Imodium, Arret) may be dangerous for children.

Dysentery
Many people think every case of diarrhea is dysentery. Actually, travelers commonly experience diarrhea from traveling or a change in climate and water. This is normal. Dysentery, however, is a potentially severe illness and should be treated by a doctor. If you have blood or mucus in your diarrhea, you may have amoebic or bacillary dysentery. The symptoms of bacillary dysentery are diarrhea, stomach pains, fever, and blood or mucus in the stool. It usually lasts for about a week.

If your symptoms are severe, go to a doctor immediately. A stool test is needed to distinguish the type of dysentery. Norfloxacin or ciprofloxacin are commonly prescribed. These are strong drugs and should only be taken if necessary. They are not recommended for children or pregnant women. (Co-trimoxazole is generally prescribed for children. The amount taken depends on the child’s weight.) A pregnant woman should see a doctor before taking a heavy drug to cure dysentery. A good Ayurvedic doctor can usually cure dysentery easily, as can a doctor experienced in tropical diseases.

Amoebic dysentery is rarer and may take up to three weeks to develop. It is long-lasting and difficult to clear, and if it is left untreated, can infect the liver and cause general health problems.

There is also giardiasis dysentery, which is caused by contaminated water. Symptoms: stool will be watery, frothy, bad-smelling, and yellow. Your stomach will usually be uncomfortable and you will pass a lot of air. This form of dysentery may take several weeks to appear after contacting the parasite, and it is particularly difficult to eradicate. The symptoms may also come and go. Flagyl or Fasigyn cure giardiasis. The antibiotic Tinidazole is also a good remedy. These are heavy drugs, and should be taken only if prescribed by a doctor, following his advice.

Insanitation Diseases
These diseases are caused by shellfish, unwashed foods, contaminated ice creams, food upon which flies have landed, water or milk that has been contaminated by sewage, and infections that have been spread to the kitchen from a toilet. This may happen when vendors or cooks do not wash after using the bathroom.

Typhoid
Typhoid fever is the worst of the insanitation diseases. It is a dangerous stomach infection. After contracting typhoid, symptoms appear within seven days. The disease begins like a cold or the flu, then the fever gradually increases. Watch for headache, fever, body aches, vomiting, sore throat, diarrhea (or sometimes constipation), and abdominal pain. If you have these symptoms, seek medical treatment immediately.

A person afflicted with typhoid will suffer from fevers up to 40ºC (104ºF) or higher. If a person has a pulse of 80 beats per minute or less despite having a high fever, suspect typhoid. In its more advanced stage, typhoid causes a person to weaken, pink spots may appear on the body, dehydration may occur, and the patient may become delirious. He or she may also contract pneumonia or meningitis along with the typhoid.

Typhoid is serious and if left untreated, the patient can die. It is essential to consult a doctor. The patient should be given plenty of water and kept cool.

A typhoid inoculation does not guarantee that you will not contract typhoid, although it will usually help to prevent it.

Cholera
Cholera is a heavy dehydrating disease that causes dramatic fluid losses that for adults can excel half a litre (about a pint) of water an hour in the beginning stages. The average water content of an adult body is about 45 litres; a loss of more than ten per cent is usually fatal. Cholera may be fatal in just nine hours unless the patient is vigorously rehydrated.

Symptoms: sudden onset of an extreme case of diarrhea, muscular cramps, vomiting, weakness. Medical attention is essential. It is important to drink a large amount of water.

If there is a delay in getting to a doctor, take tetracycline (not recommended for pregnant women or children) or ampicillin.

How to Avoid Disease
1. All water should be purified or boiled.
2. All milk should be boiled three times.
3. Beware of ice cream.
4. Mineral water may be refilled from local, unclean sources, so be careful.
5. Food should be well-cooked, recently cooked, and cooked only once.
6. Fruit should be peeled.
7. Do not eat cooked food that has been sitting uncovered.
8. Be careful of fly-infested eating places.
9. Make sure you get enough sleep.

Altitude Sickness
The lack of oxygen at attitudes over 2500m (8250 ft) affects most people because the heart and lungs have to work harder and less oxygen reaches the brain and muscles at high altitudes. Altitude Sickness can occur at 3000m (10,000 ft), but usually occurs at 3500m or higher. Usually the higher the altitude, the worse the symptoms. High altitudes affect people differently. One girl told me that she trekked for days, walking slower than most people. When she trekked at high altitudes she would pass most people and felt good, while other people seemed ill.

Mild symptoms can be treated by resting for a day or two. The best cure for more severe symptoms is to descend to a lower altitude. Ever a drop of 500m can make a difference. Mild symptoms include headache, loss of appetite, dizziness, and lethargy. More severe symptoms include severe headache, breathlessness, loss of coordination, vomiting, severe cough, drowsiness, and loss of consciousness.

To avoid altitude sickness:
1. Ascend slowly. If you have to ascend 1000m (3,300 ft) in a day, it is a good idea to rest for a day before doing so. If you trek up to a high altitude, you will be less affected than if you flew to that altitude because of the body’s ability to gradually adjust.
2. It is best to sleep at an altitude lower than the highest altitude to which you ascended that day. Over 3000m, it is best not to increase the sleeping altitude more than 300m (1000 ft) in a day.
3. Eat light, high carbohydrate foods.
4. Drink extra (but not alcohol).

Hypothermia
Hypothermia occurs when you are exposed to extreme cold. In hypothermia cases, a person’s body loses heat faster than it can produce it. This usually occurs when someone is trekking and it suddenly rains or it is windy. It is important to wear layers of clothes. Also a warm hat is essential as most heat is lost through the head and the feet.

Symptoms: shivering, loss of energy, numb fingers and toes, stumbling, muscle cramps, delirium.
The victim should be taken to a dry, warm place, then changed into warm, dry clothing, and drink a warm liquid (not alcohol) or eat easily digestible food. It is always a good idea to carry rain gear while trekking.

Insects, Bedbugs, and Spiders
Bedbugs usually live in dirty mattresses. If you see spots of blood on the wall or on the sheets of the bed in your hotel room, it is time to find another place to stay. You can use calamine lotion or Stingese spray to relieve the pain if you are bitten.
If a spider bites you, go to a doctor for treatment, as some spiders are poisonous.

Lice are spread by contact with a person who has them—including sharing combs, towels, or bedding. They are found in body hair, clothes, or linens, and can live up to forty-eight hours after separation from their host. They cause itching and general discomfort. There are powders or special shampoos to kill them. Lice especially like dread-locked hair. If you keep your hair in this fashion, you may want to carry a preventative shampoo from your home country, as no good shampoos are available in India.

Malathion lotion (5%) kxe "jaundice" ills lice, but be sure to dilute it because it is otherwise poisonous. Gamma Benzene hexachloride is also good for killing lice. Benzyl Benzoate is good for scabies. Crotamiton cream gets rid of itching and also kills other skin parasites.

Snakes, Scorpions & Poisonous Bites
If you are bitten by a snake, try to get a good description of it so the doctor will know how to treat you. If a snake bites you, if possible, catch the snake, so you will know exactly what kind of snake it was. Snakes do not like light, so if you walk outside at night, shine a light in front of you as you walk. Even if a poisonous snake bites you, often the bite will not be life-threatening. If a snake bites you wrap the wound as you would a sprained ankle and do not move it. Sucking the poison from the wound does not help.

Scorpion bites are extremely painful but rarely fatal. Scorpions will often hide in shoes or clothing. Scorpions usually grab you with their claws (feels like a bee sting, I experienced it) first, then bring their tails around to sting (I didn’t experience the sting). If you have a scorpion on you, do not panic. Remain still and have someone capture the scorpion by wrapping a cloth around it. Do not try to brush a scorpion off with your hand as you will most likely be stung.

A dog or monkey bite can also be dangerous and should be treated immediately by a doctor.

Leeches and Ticks
Leeches are found in wet forests. They attach themselves to your skin and suck blood. Trekkers often get them on their legs. To remove them, burn them with the end of a match or cigarette, or sprinkle them with salt. Do not try to pull them off, since mouth parts will often be left behind and may become infected. If you are bleeding, clean the wound and apply an antiseptic.

Ticks cause skin infections and other diseases. To remove a tick, grab the head with tweezers and pull. Be careful not to press the back of the tick’s body as its innards may enter the wound and increase your chance of getting an infection.

Antibiotics
If you find you are ill, do not take just any antibiotic. Different antibiotics work with different types of infections. It is best to consult a doctor.
Some of the side-effects of antibiotics can be worse than the disease. Overuse of antibiotics will force your body to build up its resistance to the particular antibiotic strain, and it will no longer prove effective for you.

Hepatitis (Jaundice)
Symptoms: nausea, lack of appetite, headache, fatigue, weakness, aches and pains, chills. The eyes and skin turn yellow, and you may experience abdominal pain in your upper abdomen, especially on the right side. Your urine may also turn dark yellow, and your stool may be gray or white. Hepatitis affects the liver. Do not drink alcohol if you have hepatitis because alcohol affects the liver and the liver is already weak. Hepatitis rarely kills people, but it can make life uncomfortable. If you have had hepatitis before, you may be immune to the disease.

There is no cure for hepatitis (jaundice) according to conventional Western medicine. If you go to a good Ayurvedic doctor, however, he may be able to cure you within a week or two. I have personal experience of this. If you contract hepatitis: rest, drink plenty of liquids, and avoid fried foods, which require the liver to work hard for digestion. Mung dhal kicharee is a good food to eat.

Hepatitis A is usually spread by bad water, unwashed raw vegetables, and poor personal hygiene. Hepatitis B, which is more severe and much less common, can be caused by sexual contact or any kind of skin penetration, including blood transfusions, tattoos, a cut while shaving, or a dirty needle.

There are nearly 300 million carriers of Hepatitis B in the world. Hepatitis B can cause long-term health problems.

Hepatitis C is a severe illness, which usually leads to a chronic liver disease. Symptoms may take years to appear, and after contracting it, patients often die within twenty years. It is spread by sex, shared needles or blood transfusions.

Malaria
Symptoms: headache following by fever and profuse perspiration, then chills, then a spiking fever. The symptoms subside then recur, usually in the evenings. Other symptoms are diarrhea and abdominal pains. In general, a person with malaria feels weak and ill. When you recognize your symptoms as malaria, treat it immediately. If you cannot get to a doctor, have a doctor brought to you. Certain types of malaria are fatal, but in India, malaria seldom causes death. Malaria is not a risk above 2000m (7,000 ft). The risk of malaria is reduced in Himachal Pradesh, Sikkim, Jammu, and Kashmir.

The disease develops at least five to ten days after the carrier mosquito bites one. It may take up to a year for symptoms to develop, especially if anti-malaria drugs have been taken. Malaria is detected through a blood test. The symptoms will worsen over time if the disease is not treated. Vivax Malaria, the most common strain of malaria in India, is rarely fatal, but if left untreated, the attacks will become more frequent and will weaken your overall health.

Malaria is caused by a bite from the female anopheles mosquito, which usually bites at night. Between 200 and 300 million people get malaria a year worldwide.

Many doctors say that Paludrine once a day and Maloprim once a week are good preventatives. No pills are entirely effective and many types often cause severe side effects.

Chloroquine and Doxcycline are common malaria medications. They too can have serious side effects if used improperly, so follow the directions. I have seen people who have taken malaria medicine improperly end up in the hospital because of the medicine, not the malaria. Chloroquine is also used to prevent malaria, but there is now a strain of malaria resistant to this drug.

Possible side effects of malaria medicine are sight problems, itching, rashes, and hair loss. An Ayurvedic doctor has told me that taking malaria pills ruins the liver and spleen.

Pregnant women should be especially careful to avoid malaria, as it may also infect the unborn child.

Avoiding Mosquito Bites
The best way to avoid malaria is to avoid the cause, the mosquitoes. Mosquitoes usually begin to bite at dusk. Avoid them by covering your skin and using insect repellent. Also, wear light-colored clothing. Mosquitoes are attracted to scented perfumes.

Aerosols are the best way to put repellent on your clothes. Spraying your clothing helps to avoid mosquitoes biting through the cloth.

Mosquitoes especially like to bite feet and ankles. You should make sure you spray those areas of your body. Repellents containing Deet are effective in stopping mosquitoes from biting. Too much mosquito repellent or Deet can be relatively harmful, but it is better than contracting malaria. Deet lasts a few hours on the skin and can last for weeks on cloth. Putting permethrin on clothing also keeps mosquitoes away.

It is best to bring camping repellent (sportsmen’s formula), as it lasts longer and is more effective. Normal brands may wear off before morning. An America brand called Cutters is the best repellent I have found.

Citronella is billed as a natural way to keep mosquitoes from biting, as is lavender oil. According to some test done, citronella is not considered to be any where near as effective as repellents that contain deet.

Sleeping under a mosquito net is good protection during sleep. Mosquito repellent (permethrin) should be sprayed on the mosquito net. You can also burn a mosquito coil, which is effective. Also, you can use an electric mosquito device, which emits a vapor, usually pyrethroid, that chases away mosquitoes.

Calamine lotion eases the pain of mosquito bites and reduces itching.

Electronic buzzers, which simulate the sound of a male mosquito, have proven useless in experiments according to studies I have read.

Heat Exhaustion and Heatstroke
Both are caused by dehydration and/or salt deficiency. Symptoms: headaches, fatigue, muscle cramps, and loss of energy.

The cure for dehydration is to rest and drink plenty of fluids (water is best). Salt deficiency is cured by taking extra salt (electrolytes). Extra salt in your food is best.

Heatstroke is much more severe and is caused both by a dehydration and being exposed to high temperatures over a period of time. Symptoms: high temperature, overall illness, severe headache, heavy perspiration, delirium, loss of consciousness. One of the first symptoms to watch out for is when the victim begins to wander around with no direction. A victim should be rushed to a hospital, and if that is impossible, should be taken out of the sun and covered with a wet towel or sheet. If the victim is conscious, get them to drink water.

Meningococcal Meningitis
This serious disease affects the brain and can cause death. It is found in Nepal and parts of Northern India. Death occurs within a few hours of contracting the disease. Symptoms: a severe headache, neck stiffness, and fever. Purple spots may appear on the skin.

Trekkers in Nepal should be careful not to contract this disease. It is spread by infected persons through coughing and sneezing. Trekking lodges are a common place to contract this disease.

AIDS and Blood
Some reports say that AIDS is spreading faster in India than anywhere else in the world. Over 30% of the Mumbai prostitutes were found to be HIV positive, and it is becoming worse every year. Some say that over 25% of the blood used in Indian hospitals may be infected with AIDS.

Often the blood in India is not properly tested for AIDS (or other diseases).

Sexual contact, shared needles, and blood transfusions are the most common ways in which people contract AIDS. Vaccinations, acupuncture, and tattooing can also be dangerous. It is best to purchase your own needle and bring it to the hospital if you need a shot. The way blood is taken in Indian hospitals can be extremely unhygienic, and needles are often reused from patient to patient. If you must have a blood transfusion, contact your local embassy, as they may have a list of “clean” blood donors.

Sunburn
When you first arrive in the tropics, it is wise to limit your exposure to the sun until you have gradually adjusted to the climate. For those who are not accustomed to tropical sun, sunburn is a common cause of suffering, even on cloudy days. Expose yourself for only fifteen minutes on the first day, then thirty minutes, an hour, two hours, three hours, then an extra hour per day thereafter. You can also get a severe sunburn at high altitudes, even if it is cold. Use a sunscreen (best brought from your home country), a hat, and sunglasses.

Intestinal Worms
Different worms enter the body in different ways. Some enter through the skin (often through the feet) and others enter through food (usually uncooked meat or unwashed fruit and vegetables). Worms are often not a serious illness, but they can cause long-term health problems. Only a stool test can determine which kind of parasite has infected you.

Othern Health Situations
The head accounts for about twenty-five percent of the body’s heat release area, so it is best not to cover the head unnecessarily when it is hot.

It is best to wear a clean change of clothes every day. In hot weather, avoid wearing nylon.

In tropical countries it is much more important for a mother to breast-feed her child as a preventative against the child’s getting diseases.

Prickly heat is an itchy rash that is especially common in the summer. Washing frequently and wearing loose cotton clothes will help you to avoid it. The use of talcum powders and drying thoroughly after washing also help. Also it is a good idea to dry off any sweat on the body.

After Returning Home
It is not unusual to become ill on the return trip or immediately upon returning home. When you return, therefore, it is advised to take rest for a few days to re-adjust before returning to your normal routine. If you do get sick, know that many doctors in the West have little or no experience in treating tropical diseases. If you need to see a doctor, it is a good idea to go to a tropical disease specialist or a doctor who was trained in India or another tropical country.

If you go to a doctor or hospital, ask to have your stool tested.

In London, the best place to be treated is the Hospital of Tropical Diseases, 4 St, Pancreas Way, London. This hospital has a travel health hot-line to answer travel questions. MASTA, Ross Institute of Tropical Hygiene (071-631-4408), Keppel Street, (Gower Street), London, is a good place. I had a friend who suffered from a digestive problem for a month after returning from India. After going to her regular doctor a number of times with no success, she went to the Hospital of Tropical Diseases. She was cured within a week. If you go to this hospital, be sure to bring extra money, as you may have to purchase a prescription that can be purchased only there.

In the USA, the International Association for Medical Assistance to Travelers, 745 5th Ave, New York 10022, can give advice about what doctors have experience with tropical diseases.
Ayurvedic Health Retreats and Clinic
India is known for its Naturopathy and Ayurvedic health clinic.

Naturopathy’s basic concept is a drugless therapy, where healing comes from within the body itself. It uses a combination of self-control, diet, and exercises. Naturopathy believe that many diseases are caused by waste products in the body and that they can be eliminated by fasting and enemas.

This section was compiled with the help of Caroline Robertson, who traveled around India researching the subject. Some of these places are ones that she recommended. Her husband Rama Prasad was trained as an Ayurvedic doctor for eight years in India and has over ten years of experience practicing. They can be contacted for Ayurvedic treatment at Jeeva Ayurveda, 81 Grasmere Rd, Cremarne, Sydney in Australia (02 9904-4859; email: jeeva@acay.com.au). They do Ayurvedic massage, reiki and other Ayurvedic treatments.

The Institute of Naturopathy and Yogic Sciences (080 839-4926; fax 080 839-6339), Jindal Nagar, Tumkur Rd, Bangalore, has been recommended to me by several people.

The Taj Ayurveda Centre, Calicut can be reserved at any of the Taj numbers such as for: Delhi (332-2333), Mumbai (202-2626), Cochin (371-481), Jaipur (371-616) or Bangalore (225-5055). The center is located at the Taj Residency, 26km from Calicut Airport. It is managed by the Ayushman Ayurvedic Trust, with is affiliated with the Arya Vaidya Pharmacy, which was founded by Arya Vaidyan P.V. Ramavariar in 1943. The facilities is central air-conditioned, has three treatment rooms, a steam room, a yoga room and mediation center. There is also an astrologer at the center.

They use wholistic healing based on the Ayurvedic Sastras. Yoga and meditation is an essential part of treatment. They use the locally grown herb and plants in the area for preparation of the Ayurvedic medicines. Some of the treatments used are emesis (Vamana), purgation (Virechana), oil predominat enema (Snehavasti) and nasal medication (Nasya). They do oil massages and prescribe internal medicines. The oil treatments help with migraines, rheumatoid, arthritis, lower back pain, paralysis and spondilitis.

There are 7, 14 and 21-day programs. There are also extended 28 and 35-day programs. There is a strict vegetarian diet served. The programs are for detoxifying the system and improving the general health. Different yoga asana are taught, which are very helpful in maintaining good health. Also pranayama, or breathing exercises, and meditation are taught.

Some treatments are snana, or bath with herbal powders, abhyanga, or oil massages, nasya, when two drops of oil are put in the nose before inhalation, karnapurana, or pouring on medicated oil in the ears, gandoosha, or gargling for five minutes with different liquids (according to each person’s needs) and several other treatments. Dhara is a treatment in which different medicated items are poured onto the patient’s head by the therapists. The day begins with an hour of yoga and mediations, and then breakfasts. Then treatments are then performed all day, with just a break for lunch.

Rajah Healthy Acres Health Farms & Resort, Perumanoor, Chalissery, Kootanad, Palakkad District, Kerala 679-536. The administration office (0487 556-425; fax 0487 556-822; email: rha@rajahkajah.com; web site: www.rajahkajah.com). The lowest end packages begin at Rs 5,000 for a three-day package to Rs 45,000 for a 28-day package. They also offer higher-end facilities in cottages ranging from Rs 1500 to Rs 2000 per day. Typical high-end packages range from Rs 9000 for a three-day package to Rs 91,000 for a 28-day package.

Sreedhari Ayurvedic Resorts (0488 853-380), Koottala P.O., Pattikad 680 652, Thrissur, Kerala. It is surrounded by beautiful countryside with coconut palms and nutmeg trees, and is located on a riverside. They use a rejuvenation therapy by strengthening the degenerated muscles. They use a system of Panchakarma Chikitsa to rid the body of impurities and waste materials. They offer a 9-day rejuvenation package, which comprises of seven day of oil massage and one day each of vasthy and steam bath. Treatment is done under the consultation of the Chief Physician, Ashta Vaidyan Pulamanthol Shankaran Mososs, an authority on Ayurveda. Hatha-yoga classes can also be taken. They serve vegetarian fare in the traditional Kerala style.

Ayurprastha (04266 71144), Kothagiri Nilgiris, Tamil Nadu. For details contact Ayurvedic Trust Hospital (0422 313-194, 314-132; fax: 314-953; web site: www.avpayurveda.org), Ramananthapuram, Coimbatore. Facilities range from US$55 for a single to US$90 for a double and up to US$100 for a single and US$150 for a double. They offer a strict vegetarian diet, and no alcohol is allowed. It is located in a beautiful hilly area 6,000 feet above sea level, overlooking a valley. There is oil therapy massages for an hour daily, yoga classes and meditation sessions. They serve three wholesome vegetarian meals daily with herbal tea.

Beach Resort (0496 683-760; fax 0496 683-706; email: moosa@kappadbeachresort.com; web site:
www.kappadbeachresort.com), Kappad, Kozhikode 673 304, is spread across three acres of beautifully landscaped gardens right next to the sea. All the A/C and non-A/C cottages have views of the sea. The resort is managed by the Kerala Ayurveda Pharmacy, which has its own herbal gardens where herbs are grown. Various rejuvenation packages are offered and there is a special herbal diet. There is the Bliss Program (Completeness-Poorna), which is two hours a day for 7, 14 or 21 day. Various treatments are massage, herbal steam bath, panchakarma, pizhichil, sirodhara and njavarakizhi. The Blossom Program (Rejuvenation-Kalika) is 1½ hours daily for 7, 14 or 21 day, with the above therapies. There is Blessing Program (Individual therapies), which includes all of the above therapies, but is specially geared for the individual needs of each patient. The resort has a modern Health Club and indoor and outdoor sports facilities. Residents can also take a boat cruise and visit the nearby tourist destinations.

Copyright ©2001 John Howley and Spiritual Guides