A common sight all over Yangon!

Tummy Bugs

Whether a short-term visitor or long-term resident, you won’t get away without a few bouts of upset tummy whilst in Yangon.  Some are more sensitive than others but it will take time for your gut to become accustomed to its new surroundings and bacteria, and your physical health will be compromised by the climate, jetlag, stress, change of diet and/or lack of exercise.  Suffice to say, that whilst some months you may seem to just go from upset to upset, you will soon find yourself going for much longer periods without so much as indigestion.  Just give it time!

One of the main factors in your health will be hydration – you really need to step up your fluid intake in a hot country and being dehydrated can make you very ill, never mind exhausted.

What you need to know

Dehydration: Occurs when the fluid loss is greater than the input of fluid.  This means that dehydration occurs not only when someone does not drink enough but when there is excessive fluid loss commonly through sweating and bouts of diarrhoea and or vomiting.  This is always a bigger consideration when the climate is hot and humid and when there is an increased chance of transmission of disease through food and water. Prevention and treatment: Steps to avoid dehydration are simple.  It is recommended that you drink a minimum of one litre of clean water for every 10 degrees Celsius per day, so if it is 40 degrees that will be 4 litres and 35 degrees 3.5 litres, plus whatever other oral fluids of choice over the day.  Avoid long periods in the sun.  If these preventative steps are not effective and treatment is required, ORS (Oral Rehydration Salts) can be given to replace both the fluid and minerals that are depleted. You continue to lose water even when asleep so while you may feel OK when going to bed but you can develop the symptoms of dehydration while actually in bed.

Symptoms of dehydration include thirst, decreased urine volume, urine that is darker than usual, unexplained tiredness, lack of tears when crying, headache, dry mouth, and dizziness when standing.

Diarrhoea

For most people, the term diarrhoea needs no explanation!  But diarrhoea is defined as watery or liquid stools, usually with an increase in stool weight above 200 g per day and an increase in daily stool frequency.  If prolonged (and depending upon the offending bug) dehydration may occur.  Try to estimate the amount of diarrhoea and replenish one litre of ORS for every litre of diarrhoea (or a medium glass for every movement). You must also try to include in your daily intake the same 1 litre for every 10 degrees as noted above. Diarrhoea can have many differing causes; some are serious and need treatment some are not so serious and are self limiting. For this reason if you get diarrhoea, no matter how mild you think it is talk to a health professional.  All cases of diarrhoea will mean that you are suffering from an excess loss of water and salts. But it can be treated at home long before it becomes serious in the most simple of ways;

• More fluids should be taken, such as bottled, boiled or treated water, or weak tea.
• For children, very diluted juice is easier to drink than plain water
• If diarrhoea continues for more than one day, oral rehydration salt (ORS) solution should be taken
• Normal food consumption should continue.

ORS Solution (Oral Rehydration Salts); is available commercially in sachets that are mixed with clean (bottled, boiled or sterilised) water. If ORS solution is not available, a substitute containing 6 level teaspoons of sugar plus 1/2 level teaspoon of salt in 1 litre of safe drinking-water can be used, in the same amounts as for ORS. (A level teaspoon contains a volume of 5 ml.) Medical help should be sought if diarrhoea lasts for more than 3 days and/or there are very frequent watery bowel movements, blood in the stools, repeated vomiting or fever.

Antibiotics: When no medical help is available and there is no blood in the stools, a course of ciprofloxacin may be taken by adults (1g a day for 3 days) or doxycycline 100 mg or trimethoprim 100mg (twice a day for 3 days). For children and pregnant women, azithromycin is recommended (1 tablet 500mg once). Prophylactic use of antimicrobials is not recommended. Antidiarrhoeal medicines, e.g. loperamide, are not recommended for general use but may be used exceptionally (such as when embarking on a long journey), in addition to fluids and by adults only, for symptomatic relief. Antidiarrhoeal medicines should never be used to treat children.

This of course only covers some of the antibiotics you may need and therefore try to get medical advice as soon as possible. If there are any other symptoms, medical advice should be sought as soon as possible.

Vomiting: If you are vomiting when you have diarrhoea then the causative agent in all likelihood needs to be treated. Treatment in these cases should be on a case by basis due because of the causative agent and therefore medical advice should be sought. Your doctor can prescribe, if necessary, a drug that can be used to stop the vomiting and the nausea that often comes with it.

Vomiting can be due to other issues like reactions to something we ingest such as a form of toxin that the body is trying to get rid of. Vomiting is also a sign of a blockage in the Gastro Intestinal tract (the tube that goes from the mouth to the anus via the stomach and the gut). In this instance medical attention should be sought as soon as possible.

When we vomit we lose a large volume of water but also salts from the stomach contents and from the resulting green/brown stuff that comes later (bile fluid). It is very important, especially if you have diarrhoea as well to replenish the lost fluid and prevent dehydration. Even if you vomit after drinking you vomit less volume back that you drink in, so despite how bad you feel keep going with small, frequent sips of ORS. You will feel much, much worse if you are dehydrated as well.

Prevention and treatment: Most pathogens are introduced via the faecal-oral route and therefore hand washing is an absolute must.  The rule of thumb with food in most countries is peel it, cook it, wash it or DON’T eat it.

 What to avoid

• Water should only be drunk when you are sure of its purity. Don’t drink it without boiling, chemical disinfection or using a reliable filter. NOTE:  Water needs to be boiled for 20 MINUTES to be safe. This also applies to water used for making ice cubes and cleaning teeth. Bottled or canned drinks (including water) are usually safe, as are hot tea and coffee. Remember that while the actual water may be clean; is/are the water containers used from the source to your mouth dirty or contaminated including the water dispenser in the office/house?
• Milk should be boiled (twice) unless you are sure it has been pasteurised.
• Cheeses and ice-cream are often made from unpasteurised milk. So take care and only buy from a reputable source when quality can usually be assured.
• Meat should be thoroughly cooked and eaten hot whenever possible. Avoid leftovers.
• Fish and shellfish can be hazardous at certain times of year, even if well cooked. Take local advice about seafood, but when in doubt it is best to avoid them.
• Vegetables should only be eaten when thoroughly cooked.
• Green salads should be avoided.
• Fruit should be peeled, including tomatoes.
• Wash hands thoroughly before eating or handling food, and always after using the toilet.

Remember be prepared with some ORS in your first aid kit AND ask someone for some help. If you are ill like this at least a fit pair of helping hands to make up a new batch of ORS or help clean up any mess or vomit is very useful!

With thanks to Peter Wilson and the Red Cross.