 
INTRODUCTION:
Don't let 'Banjul
Belly', otherwise known as travellers' diarrhea (TD), ruin your
holiday in The Gambia. Mild, moderate or severe diarrhoea affects
about 40% of European travellers who spend a fortnight or more
in The Gambia, but by adopting a number of food and water precautions
you can minimise the chances of being one of them.
FOOD:
To avoid travellers' diarrhoea in Gambia do not eat food that
is either not piping hot or below 5C in the case of chilled foods.
Cooked meals that have been kept at room temperature are particularly
prone to high bacteria levels. Don't eat vegetables or fruits
unless they have been cooked properly, peeled or shelled as in
the case of groundnuts. Don't eat fruits that have damaged skin
as they could contain toxins or bacteria that can lead to food
poisoning. Mouldy fruits could contain Botrytis, and should also
be rejected.
Eating from mobile street vendors is risky as they often do not
keep their raw meats and fish refrigerated or on ice, and are
prone to being landed on by flies. Furthermore they maybe tempted
to carry over their meat from yesterday. Undamaged fruits and
nuts that can be peeled or shelled are a safer option to buy from
street vendors.
When eating in a restaurant avoid raw or undercooked fish or meat.
Certainly do not order rare steak. Certain kinds of fish may contain
bio-toxins even after cooking. Avoid eating certain reef and predator
species such barracuda, grouper, seabass, red snapper, jack,
as it could lead to ciguatera fish poisoning (CFP). Ciguatoxin
is very heat-resistant, so ciguatoxin-tainted fish can't be detoxified
by conventional cooking.
So the simple rule is this: boil it, cook it, peel it, or forget
it!
DRINKS & ICE CREAM:
Tap water, unpasteurised milk, dairy products such as locally
made ice cream and ice cubes are linked with increased risk of
getting TD in Gambia. If you want to have ice cubes you have to
be sure that it is made from purified water otherwise it's just
like drinking the tap water. As for ice-cream you need to make
sure it has been imported and made from pasteurised milk.
Only drink purified or mineral bottled water or water that has
been boiled, micro-filtered or purified with tablets such as iodine.
Bottled and packaged soft drinks, hot tea or coffee, beer, and
wine, are usually safe to drink.
BRUSHING TEETH:
Travellers often ask "Is it safe to brush my teeth with tap
water" in their hotel. The fact is that tap water in the
resorts and residential areas along the coast is chlorinated and
shouldn't really cause any problems, but if you are really concerned
you might want to use a mouthwash afterwards. If you really aren't
confident about the water then use bottled water which is readily
available in most small stores and supermarkets.
DIARRHOEA TREATMENTS:
• Pharmaceutical Remedies
There are a number of over-the-counter antidiarrhoeal medicines
available to treat the unpleasant intestinal disorder such as
bismuth subsalicylate and loperamide.
Bismuth subsalicylate is quite effective for temporary cases of
diarrhoea, if you have a chronic attack, then you'll likely need
something more powerful. The remedy works by balancing the way
liquid moves through your intestines. It also lessens inflammation
and inhibits the growth of certain viruses and bacteria that cause
diarrhoea from growing in the intestines and stomach.
Loperamide works
by decreasing the speed with which food moves through your bowels.
This gives your intestines more time to absorb fluid so that you
have more solid stools and fewer bowel movements a day. It is
normally taken after a diarrhoeal episode.
In addition to the above antidiarrhoeal drugs travellers to The
Gambia should consider packing antibiotics which have been demonstrated
to be effective. Among these are azithromycin, levofloxacin and
rifaximin and if available prulifloxacin. These antibiotics might
be taken as a prophylaxis in situations where a traveller has
a history of digestive disorders, such as irritable bowel syndrome,
or whose immune system is weakened.
• Prevent Dehydration
A bout of diarrhoea usually lasts only a few days and is often
mild to moderate. The problem usually goes away on its own, without
using any remedies. If you get a prolonged bout of diarrhoea or
vomiting it can cause your body to excrete more fluid than is
taken in. This leads to dehydration which can be particularly
dangerous in the aged and children. It is important to increase
your fluid intake when you get an attack.
Adults can increase their intake of water by taking in little
regular sips throughout the day. The other method to combat diarrhoea
in adults is to consume select sports drinks. Their salt and sugar
contents taken together allows water to be absorbed by the body.
Avoid drinks that can exacerbate the symptoms such as alcoholic,
sugary or caffeinated drinks. For some individuals dairy products
such as milk can worsen the symptoms.
The best way to combat dehydration, particularly for children,
is Oral Rehydration Therapy. This is a type of fluid replacement
which is drunk as a treatment for dehydration. It replaces the
lost fluids and essential salts thus preventing or treating dehydration
and lowering the danger. It is basically salt and sugar dissolved
in water in precise proportions, though there are commercially
available rehydration salts which contain glucose and other ingredients.
The solution is also drunk throughout the day in little sips and
is available in most of Gambia's Greater Banjul area pharmacies.
• Plain & Simple Diet Treatment
One way to reduce the severity and length of a diarrhoeal episode
is by going on a bland diet, particularly in the first 24 hours
of an attack, as certain foods can worsen symptoms. Among a few
recommended foods are plain rice, porridge, bananas, toast, mashed
or boiled potatoes, plain crackers, probiotic yogurt, white bread,
plain pasta, canned fruit, applesauce, squash, carrots, low fat
smooth peanut butter, skinless baked chicken, Tapioca pudding,
boiled eggs.
Avoid eating fatty foods, dairy products such as milk and ice
cream, alcohol, sorbitol, and tainted foods.
Note carefully: Disclaimer
Always seek the advice of your medical doctor before deciding
to take or not to take any medications or health precautions.
The above information does not and is not intended to replace
or substitute the advice and / or recommendation from your doctor
or other authorised medical practitioner.
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Travel Advice
Food & Drink Safety
