That time I thought I would die of diarrhea in Kathmandu, and other tales from the toilet

Our digestive health is one of the indicators of our overall health — so I think it’s worth talking about. Also…I’m just a girl who likes talking about poop (I’m not a girl who talks shit though — there is a difference). Anyways, with erratic schedules, new time zones, potentially poor or inadequate sleep, changes in diet, and different standards of water quality, sanitation and hygiene, travelling to new places can lead to some unpleasant digestive experiences. And if you’re travelling to a place like Nepal, you’re probably gonna get a case of traveller’s diarrhea, no matter how hard to try to avoid it. NEPAL GONNA GET YA!

A squatting toilet in Bhaktapur, Nepal

A squatting toilet I used in Bhaktapur, Nepal. This was in someone’s home. Do not take your porcelain throne for granted.

I had the unfortunate luck to get sick three times during my stay in Nepal. The first time, within a few days of arriving in Kathmandu, could have truthfully been stress-related, and the same goes for the second time — a very brief case of diarrhea on the second day of my  Everest Base Camp (EBC) trek (thankfully at night, when I had the comfort of a relatively clean Western toilet in my lodge at Namche Bazaar). But the third time — OH! I felt like I was going to DIE of diarrhea. The pain! The dashes to the toilet! The simultaneous hunger and fear of eating! MISERABLE. For three full days I could not keep a thing in my system — not even water. I was lucky to have two friends from my EBC trek, a nurse and paramedic (I LOVE YOU ECKA AND TSAD), living down the hall from me at the time, who were kind enough to check in on me with crackers, oral rehydration salts and water, and hotel staff who offered to bring me soup and anything I needed (which was mainly toilet paper, because I had not yet mastered the art of the “bum gun“). Travelling alone can be tough, but travelling alone and being sick is REALLY rough. I remember telling my family about the terrible state I was in and my father told me to “just buy a plane ticket and head home” — I laughed…given the nature of my illness, I couldn’t be more than a two-metre radius from a toilet!

I write this post because a number of travellers I’ve met throughout my time in Nepal and Southeast Asia have also come down with stomach ailments, all despite attempts to eat at “clean” places and practice good hygiene. And while some people were reticent to talk about the topic of digestive health at first, one poop story tended to lead to another, and it seems that most long-term travellers have a shit story, or at least a tale of crazy vomiting. I just don’t think we should feel embarrassed talking about this stuff — it happens to us all! I’m pretty careful, but I still managed to pick up some food poisoning (at a fancy cafe, no less) in Pai, Thailand and likely ingested some contaminated water while tubing in Vang Vieng, Laos. Both of these experiences lead to some pretty epic episodes of projectile vomiting!

The bottom line (catch the pun?) is that you can’t always control what you’re exposed to, so know that you’re not simply weak and you’re certainly not alone if you get a bad case of diarrhea and/or throw your guts up while you’re on the road.

Below are some of my tips, and additional tips crowdsourced from fellow travellers, that may help you prevent or manage a case of “the shits”/a waterfall of vomit:

  1. Be wary of the tap water. Of course in more developed places you’re probably ok, but some are definitely not (NEPAL). Do some research on your destinations and when in doubt, be super bougie and posh, and brush your teeth with bottled water.
  2. When you’re sick, STAY HYDRATED. Find clean, safe water and sip slowly if you must, but keep drinking your water.
  3. Bring oral rehydration salts and other supplements that include potassium and electrolytes to help avoid dehydration and keep water in your body. You can actually pick up World Health Organization approved rehydration salts quite easily in Nepal, Thailand and Laos for less than $1/package at local pharmacies and grocers.
  4. Pack some anti-diarrheal meds — especially if you’re going on a trek. Generally I think it’s best to let your body flush out whatever has caused the problem. However, this might not be convenient/an option if you’re spending a great portion of your day without access to a toilet/hiking cliffside.  (If your diarrhea persists for more than three days though, you should get some medical help).
  5. Pack probiotics. They can help you restore good gut bacteria after gastrointestinal ailments, and have helped me feel better and get regular after my bad episodes.
  6. Stock up on tissues, toilet paper and baby wipes and keep them on you (again, especially if you’re on a trek or in a rural place, as many places don’t have toilet paper and you can’t always control when you gotta go.)
  7. Bring mini liquid hand soap/hand sanitizer.
  8. Maybe think twice about petting dirty street animals? Perhaps I’m a Grinch/germophobe but I’ve seen so many travellers petting stray animals and then going to eat a sandwich or touching all of their stuff…I just don’t get it…
  9. Bring broad-spectrum antibiotics and discuss what symptoms necessitate taking different drugs with your doctor, just in case you don’t have access to a doctor. It might also be worthwhile to look up clinics in the places you’re visiting. For example, if you’re in Kathmandu there’s a great travel clinic called the CIWEC clinic that can help if you get traveller’s diarrhea, or if you get sick in general. I also got my shots for rabies and Japanese encephalitis here for a fraction of the cost I would have paid at home.
  10. If you do get sick, pay attention to your poop — if you end up seeing a doctor, this can help them diagnose the problem (e.g. parasites or bacteria) or help you make an assessment, if you don’t have access to a doctor.
  11. Let people know you’re not well — hotel staff, other travellers you’ve met — just so that people can check up on you if you’re not able to venture out or become severely dehydrated (which could necessitate a hospital visit).
  12. Consider upgrading your accommodations. I was SO happy to be staying in a nice hotel with a hot shower and clean, Western toilet when I got sick in Kathmandu…I think I would have struggled with a squatter in my state back then. I was also fortunate to be in decent places in Pai and Vang Vieng when I had food/water poisoning (hostels, but lots of toilets at both). I think comfort and rest make all the difference when you’re trying to recover. I’m all for budget travel, but sometimes…you just gotta treat yo’self!
  13. Ask about your ice in cold drinks — was it made with filtered water or tap water?
  14. Don’t take a long bus ride while you’re sick…just rest. Stay in one place until you recover, if possible.
  15. Eat where you see a lot of people eating, because the high turnover means the food is likely fresh. Be careful with open buffets or anything that looks like it’s been sitting out exposed or is cold. A lot of people will tell you to avoid the street food, but I say EAT THE STREET FOOD! First of all, it’s delicious, and second, it’s often a great way to interact with local people and learn something about a new culture and cuisine; just choose your vendors wisely. I’ve eaten a lot of street food and have never been sick from it…it’s the nice restaurants that have gotten me!
  16. Have a sense of humour. This is a key piece of advice for travel (LIFE?!) in general. Getting sick on the road sucks…but it will pass (another double entendre!). Best to have a laugh about it, take some downtime, and catch up on your reading.

If you think I’ve missed any helpful tips, please do let me know. Stay healthy!

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