When you arrive in a city you’d expect that three days later you will have seen some of said city. Unfortunately, this hasn’t been the case with Bangkok and I as, due to the ever present tummy bugs, Kane and I have been hold up in our room for the past few days, surviving on a strange mix of almonds from the 7/11, rice from the Hainanese chicken rice food stalls, and the free breakfast toast from the hostel. Almost every backpacker will be here at one point, curled up in bed, moaning at the world for making them be sick inside instead of enjoying the Chinese New Year festivities. The setting might be different, it could be watching Netflix on your iPad from the toilet in your one bedroom apartment in Guatemala because you’ve decided that leaving the toilet for any period of time is futile, but the story is the same, you are sick abroad.

Being sick abroad sucks, it cuts into exploration time, you don’t have anyway to order delivery food when you feel too weak to leave the house (if you’re lucky enough to still have an appetite), and unless you’re traveling with a partner, you generally suffer alone. However, there are ways to make it slightly more bearable and in the end the sickness will pass, leaving you with stories your friends would rather you not tell at dinner. So without further ado, here’s how to be sick abroad.

Water and food
When you start feeling those angry stomach rumblings, make a quick stop at your local convenience store and stock up on water and easy to digest snacks. Most of the countries that you are prone to food/water borne illnesses in will not have potable piped water, thus the bottled water stock pile for when you can’t leave the house. (This lack of potable water is also likely the reason why you got sick in the first place, but I digress). This is more important if you are traveling alone and cannot beg a partner and/or travel buddy to run out to the store for more water when you’ve just pissed the last couple liters out your ass. Sorry for the graphic detail guys, but this is a post about being sick.

For food, if you have a proper tummy bug you likely won’t have an appetite(i.e. parasite, bacterial infection, amoebas, etc.) and if this is the case do not try to force yourself to eat, especially if it is paired with vomiting or diarrhea. Your body is trying to clear itself out from whatever bad thing you ingested so let it do that with the least addition of ammunition possible. The exception to this is water, you want to keep trying to drink a little at a time so you have something in you to avoid dry heaving. Keep up your fluids and ride it out.

Once you can hold down food start with small, easy to digest meals, this is where the snacks come in handy. You likely won’t be feeling like leaving the room just yet, but the sooner you can keep food down the sooner your body can begin regaining its strength so you’ll want to have snacks on hand. Personally, I love salted and roasted almonds, but some people find these too heavy right after being sick. In that case sticking to as plain of foods as possible will be kindest to your ravaged stomach, for example rice, bread, crackers, and bananas. Bananas, bread, and crackers store well without a fridge and are often a good choice in a hostel situation.

Medications
Most tummy bugs will pass within one to two days without any medications, however, there are rougher bugs out there, like giardiasis, that will require some assistance. In general, I like to give it about three days before I consider medication, because I want to be sure it’s not something my body could easily resolve on its own. Once, I’ve decided it’s not budging, I make the choice to go to the doctor or not. This is highly dependent on what country I’m in, if I’m near good medical facilities, how bad the sickness is, and what the treatment for the sickness would be if I went to the doctor. Travel medical insurance is important if you want to be able to utilize the doctor option, which is always prudent to have anyway in case of other emergencies, but I have been fine with self medication 9 times out of 10. Also, most medications can be purchased over the counter in developing countries, just be sure you are taking the full course of antibiotics (Metronidazole, Tinidazole, etc) so that you do not add to antibiotic resistance. This is important to note as midway through an antibiotic course you begin to feel much better, but your body is still killing off the last of the bug. If you do not finish the full course you risk letting some of the bug survive, which builds that bug’s immunity to the medication you used thus causing a nightmare for you and the rest of the medical community when the usual antibiotics stop working (this is a very short hand explanation of antibiotic resistance, if you want to read more click here).

The medications I have used/like to keep on hand are as follows:

Imodium
This is a lifesaver for if you are unlucky enough to have to travel during a diarrhea bout or if it has been more than three days and you really just need to absorb some nutrients. Imodium will stop you up for a while, but use it sparingly as it is important that your body be able to clear the bug from its system.

Metronidazole
This drug is an anti-parasitic and anti-bacterial which means it’s a go to for clearing up a stomach bug that hasn’t gone away on it’s own. I used it after being sick for a week in Guatemala and it worked wonders, but beware it makes you EXTREMELY sensitive to alcohol and really anything fermented. I had a balsamic vinaigrette on a salad a couple days into the treatment and the vinegar in the dressing made me vomit. They are not kidding when they say don’t drink on this treatment.

Tinidazole
Tinidazole is very similar to metronidazole, however with tinidazole you take it for a short time, but in higher doses so while you don’t have to deal with the not drinking for 7-10 days like on metronidazole you can deal with some nasty side effects. Kane and I just took this for giardiasis (1 dose of 2 g and then you’re done) and while I only experienced stomach cramping Kane dealt with fever, headache, skin rash/acne, and body aches. (Let the record note that at this point I was saying he should probably go to the hospital due to the high fever, but he soldiered on, intelligently or not, and was fine after a couple days.)

Paracetamol or acetaminophen
These are your classic pain relieving workhorses, they bring down fevers, deal with headaches, and are generally used all the time. The reason that I choose to bring Tylenol (the US brand of acetaminophen) on my travels as my pain killer is that the other common option, ibuprofen, is a blood thinner, which if you might have dengue is a really bad idea due to the dangers of hemorrhagic fever. A very helpful doctor from Australia who happened to be on our plane to Tikal told me this one, at the time I was moaning on the floor of the airport contemplating death. I can be a little overly dramatic sometimes as it turns out I did not have dengue, just a nasty virus of some sort.

NyQuil and DayQuil
Classic cold medication that will deal with stuffy noses, coughs, congestion, and the inability to sleep due to said stuffy nose. These are always a good idea to pack as traveling exposes you to all sorts of bugs and with all the airplanes, hostels, and new places you’ll get a cold if you are on the road long enough.

Benadryl
Always bring an anti-histamine with you when you’re traveling. I repeat always bring an anti-histamine with you when you’re traveling. Not only because it acts as a great way to combat excessive bug bite reactions (I swell up like a balloon from sand fly bites and this brings them right down), but because you never know when you might find out you’re allergic to something and you’ll never know how far away from a hospital you might be. With all the new food you’ll be eating, it’s better safe than sorry.

Oral Rehydration Salts
Whenever you’ve had a fight with traveler’s diarrhea it is a good idea to add ORS to your water to make sure you aren’t getting dehydrated. Dehydration is the biggest worry with traveler’s diarrhea and these handy packets will make sure you are well prepared.

Avoidance
Some people may tell you that if you follow all the right rules, you can avoid getting sick. I don’t agree with this statement. There are ways to give yourself the best shot at avoiding a stomach bug, such as only drinking bottled water, not eating anything uncooked, only eating fruit you peeled yourself with a clean knife, avoiding all street food, but honestly, most of these aren’t worth missing out on the food culture you are in and to top it off, you are just as likely to get sick from the fancy restaurant as the food stall due to poor sanitation practices that are common everywhere, such as not washing hands after using the bathroom. The rule I follow is do as the locals do (within reason). If the locals drink the water, you will probably be okay, if the locals don’t drink the water please for the love of all that is holy do not drink the water. If the food stall looks popular, lots of locals are there, food is turning over quickly and/or cooked in front of you, sit down and enjoy. If the food stall is empty and meat looks like it’s been sitting there since the morning, moving on is your best bet.

So there you have it, my best advice for dealing with the inevitable sickness that accompanies long term travel. I wish you luck in the stomach department and if a sickness should befall you, you may rest well knowing that it is practically a right of passage in the backpacker world to be curled up on the floor of the bathroom cursing the universe.

Disclaimer: I am not a doctor, these are just tips about what I have done to stay well and get well abroad. Talk to your doctor about the best treatment for you.