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John Macdonald thinks it was chicken that poisoned him last month, causing four painful hours split between bed and bathroom in Awassa, Ethiopia. The Illinois-based sales manager for a radio equipment manufacturer has become ill on various business trips abroad, and he's not alone.
Half of U.S. travelers heading to other countries will experience a health problem, says Phyllis Kozarsky, chief of travelers' health for the Centers for Disease Control and Prevention (CDC).
With foreign travel surging, more Americans face the prospect of travel-related illness while abroad. For business travelers, staying home is usually not an option. But doctors and veteran foreign travelers alike say much can be done to avoid, or at least minimize, discomfort.
The most common problem: traveler's diarrhea. In addition to the normal symptoms, it might lead to nausea, vomiting, stomach cramps and fever, the CDC says. About 10 million people develop diarrhea each year while traveling abroad. Other common health problems: colds, respiratory-tract infections, influenza, fevers and skin rashes.
The likelihood of illness is greater for travelers going to developing countries. A study of Swiss travelers shows about three-fourths suffer a health problem when visiting a developing country.
Foods and beverages contaminated by feces are the usual cause, says Robert Steffen, the expert on travelers' diseases at the University of Zurich who conducted the study. The contamination primarily comes from sewage that touches food and water supplies, he says. It can also come from food or beverage preparers, or from shaking hands with people who don't properly wash after using the bathroom.
Patricia Pulver, a faculty member at Albany Medical College in Albany, N.Y., says it's easy to slip up, even when you know what to do to prevent illness. Despite repeated reminders not to drink the tap water on a medical mission in Honduras about five years ago, she rinsed with tap water after brushing her teeth with bottled water.
By quickly starting antibiotics, she tamed what she calls a bad case of traveler's diarrhea. But, says Pulver, ''We held hands during prayer time, and I think that I inadvertently spread some of my illness.''
Precautions only go so far
Travelers can take steps to minimize the risk of traveler's diarrhea, but they're often not in control of food supplies or preparation, says Bradley Connor, president of the International Society of Travel Medicine. Connor advises travelers to eat fully cooked hot foods, avoid freshly washed salads, and peel raw vegetables and fruits yourself.
The CDC says travelers should avoid eating foods or drinking beverages from street vendors or ''other establishments where unhygienic conditions are present.'' Tap water, ice, milk that's not pasteurized and dairy products increase the risk of traveler's diarrhea. Safe beverages, the CDC says, include bottled carbonated beverages, hot tea or coffee, beer, wine and water boiled or treated with iodine or chlorine.
The CDC doesn't recommend that most travelers take antibiotics to prevent traveler's diarrhea. Studies show use of a non-prescription drug, bismuth subsalicylate, commonly sold as Pepto-Bismol or Kaopectate, decreases the incidence of traveler's diarrhea.
It shouldn't be taken by people allergic to aspirin, who are pregnant or taking certain other medications. Bismuth subsalicylate or antibiotics can be used to treat traveler's diarrhea, but the illness often resolves itself without treatment, the CDC says.
Diana Smith, an IRS employee in Pittsburgh who often vacations in Third World countries, says she became ''deathly ill,'' stricken by diarrhea and vomiting, during a cruise on China's Yangtze River in 1997. Since then, she says, she has carried a medical kit with pills, medicine and antibiotics when traveling overseas.
High-risk destinations for traveler's diarrhea include developing countries in Latin America, Asia, Africa and the Middle East, according to the CDC. The highest risk is just before monsoon season, which can be April to July in such countries as India and Nepal, Connor says. Abundant heat, humidity and flies then promote contamination.
British travelers are particularly prone to traveler's diarrhea, but no one knows why, Steffen says.
Also at high risk: people lacking an effective immune system, diabetics, people who have inflammatory-bowel disease and those taking antacids or an H2-blocker, including such brand-name drugs as Tagamet and Zantac.
Other ailments can strike
Traveler's diarrhea is not the only health risk. Business traveler Samuel Fenimore says he developed ''a sinus condition'' while traveling in Scotland two years ago. He didn't see a doctor immediately because he thought his stuffed nose and head pressure were minor problems caused by the cool, wet weather. After he arrived home, his doctor said he had a serious viral infection.
''Unfortunately, I waited until I got home to see about it,'' says the Nashville-based technology consultant, ''and it resulted in a 40% hearing loss in my right ear.''
Macdonald, the traveler from Illinois, estimates he's become seriously ill no more than 10 times on 225 business trips abroad during the past 15 years.
He recalls a staph infection on his leg while in Guatemala and warns travelers to steer clear of folk remedies.
''It turned ugly, and I received all sorts of advice from well-meaning people,'' says Macdonald, 47. ''They said, 'Soak it in sea water, let it breathe, and put on some of this black tar to suck out the infection.' I was debilitated for several months until I ran into a nurse who advised me to take antibiotics and properly dress the wound. It cleared up in a matter of days.''
Doctors specializing in travel medicine urge travelers heading to many countries to consult a travel health clinic. The clinics provide medical news about specific destinations, including recent disease outbreaks and the need for immunizations.
''Your own doctor is not likely to know the latest travel medicine problems,'' Connor says.
Maria Flannery, manager of the travel health office at Paoli Hospital in Paoli, Pa., says her staff has the most recent information available from the CDC and the World Health Organization. Doctors unaffiliated with a travel clinic might not know that a certain shot is needed for a traveler entering a particular country, she says.
Concerns about getting sick shouldn't deter people from traveling to a foreign country, medical experts say.
Says Connor: ''You can get on a phone and talk to your doctor. The world is safer than it was years ago.''
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