Diarrhea is one of the most common health problems that you have to deal with on a vacation in Morocco. How to protect yourself from it and what to do when you are haunted by “Montezuma’s revenge”, is revealed in this article.
How do you get infected with diarrhea and what can be done to prevent it? About 40% of all travelers are affected by the unpleasant disturbances of the digestive tract between the third and the ninth day of travel. They spend more time on the toilet than outside their hotels. The infections of the stomach and intestines are usually caused by contaminated water, unpeeled fruit or uncooked food.
Food Hygiene and Diarrhea: cook it, boil it or forget it!
The best precaution therefore is to use a particularly hygienic handling of food in keeping with the motto: cook it, boil it, peel it or forget it!; which, however, cannot always be applied. Meat and fish should always be thoroughly cooked or baked. So the couscous and tagine dishes, which are offered everywhere, are on the safe side.
Uncooked salads should be avoided and fruit should only be consumed after peeling it thoroughly. Against all expectations, street food is usually also safe and you can observe the preparation of the food and the hygienic conditions. The foreign food is not easy on the stomach anyway, but alcohol as well as greasy and spicy food make it even more difficult for the stomach to adjust.
Caution is also required with water. In order to avoid diarrhea, you should only drink water that has been boiled or that comes in sealed bottles such as the Moroccan mineral water Oulmes, Sidi Harazem or Sidi Ali. It is, of course, important to ensure that fruit juices are freshly pressed and no water has been added to them. Ice cream and ice cubes should also be avoided, but you can have plenty of thé à la menthe or ginger tea. If you want to be safe, use the bottled water instead of water from the pipeline for brushing your teeth, even if the water in cities such as Marrakech is strongly chlorinated.
General hygiene: one hand washes the other
Consistent hand hygiene can also reduce the risk of catching any intestinal infections considerably. Since the germs are spread easily through direct interpersonal contacts and people shake hands rather frequently or exchange money the greatest infection risk comes from the hands. With a strict hygienic discipline, however, you can prevent infection.
Our hygienic routine should, for example, include frequent and regular washing of hands, especially when you eat with your fingers and if you’re a street food fan. Since a washbasin with hot water and soap is not available on every corner, I have been using the hand disinfecting gel from Sagrotan for a couple of years now. It comes in practical, small packs, smells quite well and is absorbed quickly, so that I don’t have sticky hands and I can use it regularly. For me this means hourly. I also keep a few disinfecting towels in the laundry bag, you never know what to expect in some hotel rooms. I have never regretted having them.
If it has caught you: effective remedies for diarrhea
From a medical point of view, you have diarrhea if you have unformed — i.e. pulpy to watery — bowel movements more than three times a day. The change in the rhythm of the day, the warm climate in Morocco and the unfamiliar food can irritate your digestion, while the germs take care of the rest. The body reacts immediately, because the diarrhea fulfills an important function: it literally rinses viruses, bacteria and toxins from our bodies. This causes high fluid loss — especially children, pregnant women and the elderly are prone to this dehydration.
How to compensate fluid and electrolyte loss
As an affected person, you should rest and drink as much as possible — at least 3 liters a day, as an adult — in order to compensate for the loss of fluid caused by diarrhea and to rehydrate the body. Almost all herb souqs sell “Louisa” (lemon verbena), which relieves digestion problems when used as boiled tea. Coffee and alcohol should be avoided, as well as dairy products and greasy food, because they ask too much of the stomach. The famous coke & pretzel sticks therapy is unfortunately not as good as its reputation, because the sugary diet can even intensify the electrolyte loss. A much better option are electrolyte solutions like Elotrans, which should be kept as a portioned powder in the first-aid kit and can be dissolved in a bottle of water. In Morocco, there is a similar powder, which you can get at the pharmacy asking for “Sels de rehydration”. In most cases, an electrolyte mixture can also be produced on site:
On 1 liter drinking water:
- 8 teaspoons sugar (dextrose)
- 1 teaspoons cooking salt
- 3/4 teaspoons baking soda
- Juice from 4 oranges
In addition, you should eat 1-2 bananas a day, then gradually let the stomach get used to the food intake again with dry bread, zwieback, a few apples or boiled carrots. For diarrhea, I have had very good experience with medical activated charcoal, which I keep in the form of charcoal tablets in my travel pharmacy, and of which I take two pieces three times a day in case of a problem. They act in the medium term and help the body get rid of the toxins.
Using medicine to stay fit to travel with diarrhea
Anyone suffering from stomach discomfort and diarrhea is well advised to cure in a place with secure access to a clean toilet and to find some rest. If, on the other hand, you are on the road for a long time, for example on a bus journey, and cannot be sure that defecation will only happen when a toilet is within reach, you can consider the use of effective diarrhea stoppers such as the famous Imodium acute.
These so-called antidiarrhoeal agents lame the peristalsis of the intestine and only 1-2 hours after the intake the diarrhea stops and you are able to travel. You should not use these tablets for more than 48 hours and only when you have to be on the road, because the diarrhea actually ensures the excretion of the toxins, and this is disabled by these blockers. Nevertheless, these tablets have already saved many bus travels and flights and therefore also have a permanent place in the travel pharmacy.
Diarrhea medication and prevention at a glance:
- Disinfecting gel, e.g. Sagrotan
- Disinfection tissues
- Electrolyte solutions, e.g. Elotrans
- charcoal tablets
- Imodium Acute
These tips are my own experience, which cannot, of course, replace the qualified diagnosis of a doctor. In general, you should consult a physician if the diarrhea persists for more than two days, or there are secondary symptoms such as fever or blood in bowel movements, among others.
(Photos: unless otherwise marked all of Travelguide Marrakech)
Great advice on tummy trouble in Morocco, wish I had read this before my trip. Both of us were ill for 3 days even though we avoided salads and fruit. Think ice may have been the demon.
Im currently in morocco and also currently sick..I have a fairly good reason to believe that all thoses damned unsolicited handshakes at every corner is the cause of tourists getting diarreha here, not ice, not lettuce and not anything else. Think about it: walk on a street of a big city anywhere in the world and shakes 10-20 hands of “homeless” person that wants to chat about your money for 10 minutes before actually asking for it..knowing the toilet those person use before shaking YOUR hand is a hole without any toilet paper or cleaning facilities, anybody would be sick after such sanitary issue. Dont search more where you got turista. You better wonder about how to avoid thoses damned unsolicited handshakes. Personnaly its an absolute NO for any unsolicited hobo that approch me now in this country (anyway they just care about your wallet, if you say NO, or leave me alone, they insult you right after..believe me!).
Huh, I hope that you get healthy soon and that you are not sick of Morocco now. If someone is not willing to understand “No”, don’t hesitate to be a bit more strict and say “La Shukran!”.
When they offer their hand to shake I always say: sorry I have a skin infection. I cannot touch people.
In addition to the good advice above, my friend recommends eating the regional yoghurt, as it provides the gastro-intestinal tract with beneficial bacteria for digestion of the local food.
Thanks for your addition. An I really hope that you are healthy in this moment.
Hi, Thanks for your top-notch article. Actually, In most cases, diarrhea can be treated at home and it will resolve itself in a few days. Drink plenty of fluids, and follow the “BRAT” diet (bananas, rice, applesauce, and toast) to help ease symptoms. Take care to ensure infants and children stay hydrated. Electrolyte solutions such as Pedialyte can be helpful.
Aussie Medico who has lived in many parts of the world
* If it is hot it will “usually” be safe. Exception is rice and grains. e.g. couscous. If cooked and allowed to cool down at room temperature and recooked a nasty bacterium , native in grains and rice, bacillis cereus, can generate a nasty toxin around 37 celcius as the food cools down at room temperatures, AND THIS IS NOT DESTROYED BY HEAT. Unless you are a young child or very old, you will not die from this but it is very unpleasant.
* Staph aureus also generates a heat stable toxin in food that is not cooked at a high enough temperature. Rare but hard to avoid if the chef has S.aureus in the nose (quite common).
* Local Bottled Water. Beware. How was it prepared ? Chlorinated or ozonated or not at all. The safest (not 100%) is soda water as the CO2 makes the drink slightly acid such that gut bacteria not well supported.
Cans of water are the safest as they cannot be refilled with tapwater by the retailer.
Thanks for your comment, Dr. Hughes!