Development: Diarrhea

I know a little bit about diarrhea – experientially that is. I have had it quite often while working overseas. As I look at my bouts of diarrhea I realize that many of them are a result of identifying with and eating with the people with whom I have been working. I have often been working to improve the water and sanitation systems overseas, but in the meantime I had to live in less than ideal situations.

In 2001 I was doing an evaluation of the water/sanitation systems in six small Peruvian towns. Nueva Cajamarca had the most appalling sanitation of all of the towns that I investigated. While I was there, the local people invited me to have a drink of ‘lemonade’ in a nearby shop. I dutifully had drinks with them and then struggled with diarrhea for 4-5 days. I finally go some relief at a local clinic where I was given Chinese made antibiotics.

In 1998 I was in Guinea Conakry evaluating a water project there. My fellow Guineans invited me to eat with them in a local restaurant upcountry. The restaurant was located in a dark little shed. After eating with them I was smitten with a serious bout of diarrhea. I suspected that it might be cholera. It wasn’t, and the diarrhea finally subsided.

I also remember having a serious case of diarrhea in Rwanda (cause unknown) when I was working there in 1985 with USAID.

You will note that all of my experiences occurred in poor developing countries. Picking up diarrhea is definitely a sign of poor sanitation, as is found in many developing countries. You may ask, why I insisted on eating local food, given the risks that were involved. More on that later!

To understand my views of diarrheal ailments one needs to go back to the beginning. The first time that Fran and I ventured into the “third world” was during a visit to Mexico in 1963. We travelled to Mexico City and back by local busses from Nogales, Arizona in the USA. We were warned about ‘Montezuma’s revenge’ so we bought a whole box of cans of a liquid diet food. It was claimed that this liquid diet would satisfy all of our nutritional needs. All was OK during our two day trip to Mexico City. On our return trip we met an American adventurer who had just visited Cuba and was passing thorough Mexico. At every bus stop he freely went into local food places to eat. We were aghast. How could he do it? Didn’t he ever get sick? “”Yes” he replied, “I did get sick at the beginning but not anymore”. To top it all off, with my sanitized liquid diet, I got a case of the runs as we approached the US border.

The next incident occurred soon after we arrived in Tanzania for the first time in 1966. With our friends the Millers (who were experienced travelers, having lived in Africa for many years) we travelled from Dar es Salaam to Nairobi. As we approached Nairobi we stopped at a small shop to eat some local ‘samosas’ (small triangular buns filled with meat). The shop only had six left. I ate three. Fran had two and Annetta Miller only had one. Poor Harold who had gone off to park the car had none. We all got sick in proportion to the number of samosas eaten. I had raging diarrhea and vomiting for most of a week.

After that bout of diarrhea I vowed never to eat local roadside food again. However after a few months I realized that this was not a very practical way to live if I was to work in the countryside. So I began to cautiously eat local food – and miraculously I did not get sick again!

Now, to come back to the question as to why I continued to take these risks of catching diarrhea. From what I have seen, if your intestinal tract is healthy and you have access to sufficient potable water ( it is better if it is supplemented with the correct balance of sugars and salts), you will not die from diarrhea. It is true that you may contract some virulent forms of intestinal diseases (i.e. amaebic dysentery caused by protozoan parasite, or cholera caused by the bacteria vibrio cholerae) but eventually with medicinal assistance you can flush this out of your system. So in other words when I have taken risks in eating local foods I have definitely risked getting sick, but not really risked dying.

But what about my bout of diarrhea in Mexico, which I contracted without having eaten any local food, which might possibly contain pathogens? The human intestine is a remarkable organism. It contains trillions of bacteria – whose job it is to break down food so that nutrients can be extracted through the intestinal wall. When young babies are born this ‘microscopic flora and fauna’ is not yet developed. It takes a few days before the system is up and ready to go. After this, babies are drinking their mothers’ milk and merrily pooping away.

These trillions of microorganisms adjust over time to adapt to the food regime that is being sent down to them. Their numbers and variety adjust to most efficiently deal with the food regimes they are treating. When this food regime is suddenly changed, the microorganisms are confused and cannot cope for a while. The result is that the food passing through is poorly or inefficiently digested. We experience this as a mild diarrhea, but it is not caused by pathogenic organisms, This is called “travelers diarrhea”.

So there you have it – my experience with diarrhea in a nutshell. The bad news is that most travelers will experience some diarrhea (unless they confine themselves to tourist hotels that serve essentially the same kind of food that they would eat back home). The good news is that these diarrheas will probably not kill you.

Ottawa

January, 2010