India presents an interesting problem for travelers. Few who go to Delhi leave without contracting some version of Delhi Belly. Diarrhea, vomiting, and general malaise happens, even to the most seasoned travelers. On our first trip to India, I was seated next to a young woman on the plane who’d never been outside of the U.S. Her company was sending her to India for a short educational trip. She worried about stomach problems.
“Did you bring antibiotics?” I asked her, expecting that surely she had.
“No.” She replied and shrugged. I wondered if she’d gotten a Typhus and the Hepatitis A vaccine. I decided not to ask.
Being fully vaccinated before a trip to India and/or central Africa was a requirement before I felt comfortable taking our daughter there. Some people live more dangerously (for fear of vaccines, I suppose), but our family had the full gamut of vaccines that were available in the U.S. before traveling to India. We even spent a month in Nepal getting our rabies vaccines (available for only $40 each at the clean and amazing CIWEC clinic in Kathmandu–as opposed to spending $3000 on the same thing in the U.S.) before visiting India for a week in 2014. The rabies vaccine may seem like overkill until you get nicked by a seemingly harmless puppy playing with your pant legs at the train station. According to the WHO, 36% of all human deaths worldwide from rabies happen in India. If you feel like waiting to see if you develop symptoms of rabies before checking into a hospital, don’t. After a certain point, rabies is 100% fatal. As of this writing, a small bite could prove deadly if the puppy happens to be infected with rabies (it’s unlikely, yes, but anxiety-provoking nonetheless). Many hospitals in India do not stock the human anti-rabies immunoglobulin necessary to save you if you haven’t already had the vaccine. So, in the event of a small scratch, just to play it safe, you’d have to be evacuated to a country that does have the necessary immunoglobulin at a cost of $50,000 to $100,000 paid up front in cash by you (or by your travel insurance company).
So we spent $120 to just get the rabies vaccine so that a small bite or a scratch from an animal in India or elsewhere wouldn’t be a life or death emergency that could cost upwards of $100,000. I would recommend a full course of the traditional vaccines for things like measles and tetanus for people traveling to India with some extras as well including Japanese Encephalitis.
A visit to a travel medicine clinic (we use Passport Health in Boulder, CO) is always a good idea before traveling to India. A good travel medicine clinic can prescribe some important antibiotics like Zithromycin or Ciprofloxacin to treat diarrhea and other health issues while you’re abroad. These are broad-spectrum antibiotics and they can treat a lot of issues. One thing they can’t treat though is Cyclosporiasis, which can be a devastating disease to contract abroad. Bactrim is the drug of choice for Cyclosporiasis. I buy Bactrim (Trimethoprim/sulfamethoxazole – TMP/SMX) in other countries outside of the United States, like Mexico, Peru, or Egypt and I keep it on hand for emergencies, carrying it along to places like India.
Bactrim, Cipro, and Zithromax are my top three broad-spectrum antibiotics that I always try to keep on hand when we travel to foreign countries. These are essential almost everywhere in the world where you may be unable to find a doctor easily as a traveler.
Where malaria is endemic, I also carry Doxycycline, a drug that’s relatively affordable to purchase in countries outside of the United States, but quite expensive in the U.S. Doxycycline is only a prophylactic though. It will NOT treat malaria if you catch it. If there are a lot of mosquitos or a malaria outbreak, we take the Doxycycline daily and for a period of time after leaving the malarial zone too (look up the specific requirements at the CDC web site). Doxycycline is also a good thing to have on hand should you be bitten by a tick. Take it immediately after being bitten to help prevent Lyme Disease and other rickettsial infections.
In places where malaria is common, I bring along three full courses of Atovaquone-Proguanil. It’s more expensive than Doxycycline, but it will cure most malaria infections anywhere in the world. Atovaquone-Proguanil also prevents malaria and it isn’t as likely to cause yeast infections in women as Doxycycline.
If you decide to carry Doxycycline with you to prevent malaria or treat other infections, be sure to also bring along a viable treatment for yeast infections as these medications are not as available throughout the world as they are in the United States. Diflucan is a prescription drug taken as a pill that can be used to treat yeast infections with only one dose. It’s compact and easy to use. If you can’t find Diflucan though, and you failed to buy the ubiquitous Miconazole or Triconazole cream over-the-counter back in the states (which will take up decidedly more space in your backpack, but it’s better than nothing), seek out some cacao butter and tea tree oil and fashion the two into little vaginal suppositories. Or buy some fresh garlic and unpeel a clove and cut it in half. Put it inside the vagina overnight (it works WONDERS). In a pinch while traveling abroad, these natural remedies can be a life-saver.
In addition to prescription drugs, you should also carry over-the-counter medications like ibuprophen, acetaminophen, diphenhydramine, pseudoephedrine, pepto bismol, and loratadine.
As a final wrinkle, if you have space in your bags to carry along some herbal medications (as herbs do take up more space than synthetic meds), it might be worth your while to take along some American Wormwood (Artemisia absinthium) to help prevent malaria and parasite infections. If I was traveling to central Africa, I would spend the extra money to take Atovaquone-Proguanil (prescribed by a travel medicine doctor and purchased in the United States) as a prophylactic because certain strains of malaria are more deadly there. In other countries, as of this writing, we generally take American Wormwood to both help prevent malaria (Artemisia absinthium has been synthetically reproduced by pharmaceutical companies to produce Artemisin, a synthetic drug effective at treating most strains of malarial) and to prevent an infestation of digestive parasites. Be aware though, that if you happen to have parasites already (most people do have parasites, but in limited numbers that aren’t harmful, but actually may be beneficial to health), the wormwood may cause a die-off reaction that makes you feel like you have the flu. But herbal wormwood could actually be more effective than it’s synthetic counterpart. Be aware, though, that taking too much of it can kill you. Read some literature and decide for yourself how much to take daily.
If you’re staying abroad in India or another third world country for longer than a few weeks, consider bringing along a vermifuge like Albendazole. I’ve yet to find a doctor in the U.S. that knows anything about parasites or who can or will prescribe Albendazole, but you can buy this drug online (known as Valbazen) from Amazon as a veterinary medicine. (Check with your doctor first though. I’m not a doctor after all, so you should talk to the professionals before doing anything that I do.)
A travel medicine bag may seem like a silly thing to worry about or bother carrying until that moment in the middle-of-nowhere when you wish you had something that would keep you from throwing up or having explosive diarrhea (or dying). I once read about a woman who was sleeping on top of a van in central Africa because of the heat. She got a fever (malaria) in the middle of the night and became seriously ill. She laid there, on top of the van suffering with high fevers, muddied, delusional thinking, vomiting, etc.Then she rolled off the van roof and promptly shit herself. You only need ONE of those moments abroad to realize the importance of carrying along a few pounds of antibiotics and herbs. If you don’t plan to have access to the Internet, be sure to carry copies of drug information with dosages and treatment guidelines for everything you carry too. You’ll thank yourself for thinking ahead later, especially in India.