Why Some Tourists Get Sick with Intestinal Issues When Traveling Abroad

Eating bad food or water is a serious problem with travelers to other countries, especially in countries where there are no restaurant health inspections to speak of.   Every time we eat out we are putting our trust in cooks, cleaners and servers that work in restaurants and that’s putting our trust in a lot of people, don’t you think?

NOTE: before you begin reading this article, we want to let our readers know that we have never gotten sick from eating out in Quito, Panama, or Cuenca. However, I did fall ill several years ago with intestinal issues when we traveled to Salinas from a cream filled pastry from one of the Panaderias.   
UPDATE 2015: I've been sick with food poisoning twice and Frank once, in Cuenca Ecuador. We do not touch our food with our hands at all, so it is either from unsanitary restaurant food preparation, spoiled food (unlikely) or dirty hands from the prep/cook. Take your pick. I do not want to name the popular restaurant because we did not go to the doctor, or have tests done or any other facts to back up these unfortunate events, although it was food poisoning, a person just knows that kind of thing...especially when you have all the symptoms. 

Restaurant we ate at in Quito, Ecuador

Being a tourist we are more apt to eat out for every meal because we don’t have a choice, at least not usually; and because we’re traveling and can’t cook our own meals that ups our chances of getting sick. However, we have to remember that there are many factors to look at when traveling abroad that would make a traveler sick, not just food borne bacterium.
 
Usually what happens when we become ill with intestinal issues while traveling abroad is, we think we ate something spoiled in the last restaurant we ate in, but is it really from food poisoning or could it be attributed to something else?
 
Four Main Types of Food Poisoning
 
There are many different types of food borne illnesses but some of them are rare to travelers, so we’re going to only talk about the four main ones that people seem to get most often when eating out or sometimes, just being in the wrong place at the wrong time.
 
Norovirus – Norovirus is highly contagious bacteria and the most prevalent of the four types and is usually spread from not washing hands and then handling food. Noroviruses are the ones the cruise ships seem to always have which sends multitudes of people on board rushing to the toilet with vomiting and diarrhea.  Ugh! Onset of symptoms after ingested is 12 to 48 hours. Talk about being in the wrong place at the wrong time.
 
E-Coli –  E-Coli is a prevalent food borne bacteria found in some US meat factories; E-coli is found most often in processed ground beef?  It can also be found on raw vegetables where the ground water is contaminated with feces. E-coli bacterium, like the norovirus is not always from food but can be spread from an infected person’s hands to food preparation and other objects. Onset after ingesting is 1 to 3 days.
 
Salmonella - Salmonella is caused usually from undercooked beef, poultry and eggs. It is also possible to get salmonella from an infected food handler that did not wash their hands. Cooking the food very done or at the very least, all the way through, kills the bacteria.  Onset after ingesting is 6 to 36 hours.

Staphylococcus – Staph food poisoning is the bacteria most often found in foods that have been sitting for hours unrefrigerated; it can be found in street carts and buffet type cafeterias and restaurants where food sits on warmers or hot plates. Once the bacterium hatch they continue to grow and multiply. Staph poisoning comes on quickly so you’ll definitely know if it was the meal you just ate a few hours earlier. Onset after ingesting is 1 to 6 hours.
 
Source: http://www.fda.gov/food/resourcesforyou/consumers/ucm103263.htm
 
As you can clearly see getting intestinal illness abroad is not always from bacteria in the food. It’s gross to think about, but often times the prep person who prepared your food was infected and didn’t wash his or her hands. If bathrooms do not have soap, it’s best to turn around and walk out. 

Sometimes the restaurant kitchen counters and cutting boards are contaminated with a myriad of bacteria and that's where they prep the food. This kind of thing happens where the cooks and servers are ignorant about food and kitchen sanitation, and usually where health inspection is nonexistent.

Fast food in Quito, Ecuador

And heck, it’s scary to think about but perhaps a fly or two or three landed on your food while it sits around in the kitchen. Flies are dirty, hairy little creatures that can and do transfer E-coli, Salmonella and Norovirus onto your food from their hairy little legs. All it takes is a fly to land on your food for a few seconds to contaminate your food and you will get sick. And many times we think the food was spoiled but it wasn’t; the dirty fly that landed on your food while the food sat around in the kitchen contaminated it. 
  
Source: http://www.food-safety-and-you.com/flies.html
 
So whether you are eating out in a restaurant in Cuenca, Salinas, Quito, Panama City, Lake Chapala or San Jose, there is always a chance for intestinal illness, either directly from the food or contaminated kitchen surfaces, or from dirty unsanitary handlers and environments. 
 
Other Reasons Vacationers Might
Get Intestinal Illnesses

Intestinal illness can also be caused from having dirty hands. Many times it is difficult to find a public restroom to wash your hands in; and in some developing countries when you do find a restroom there’s no soap! Yikes.
 
Think about this scenario for a moment. You just got off the bus or out of a taxi where hundreds of people ride in every single day. Some of the people are sick and coughing and sneezing.  Our resistance is compromised because of traveling and being out of our normal environment and then we become exposed to all of these viruses and contaminates on the bus or in the taxi, and later, without thinking, we touch our mouth area with our hands and this will make us sick.
 
All it takes is a little bit of a bad germ to give us Montezuma’s revenge and one reason why many vacationers become ill; carelessness trumps when we are in a new city or town abroad because we simply do not take the same hygienic measures like we would if we were back home.  For instance, people use alcohol-based wipes before they touch a grocery cart in the US, they use alcohol sanitizer gels at the checkout counters in the US and before they leave public department stores, etc, etc, etc...and then they come to a developing country where none of these things are present, not even soap in some of the restrooms and, BOOM, they get sick!   

Our best tip for eating out: Ask the local office workers where a good tasty and inexpensive restaurant is and they will gladly send you to their favorite.  They eat out almost every day in their city and so they know where to go; that’s what we did in Panama and we were not disappointed. See the video here where one Panamanian office worker eats at and recommended to us. 

Boca Deli - Panama City, Panama

Our second best tip for eating out: Once you find a place that you know is sanitary with clean restrooms, clean kitchen, and you see the wait staff eat the food, keep it in your favorite restaurant list. It's not 100% percent full-proof but is an added measure against falling ill. 

Have You Gotten Sick Abroad? Here’s How to Replenish Your System BACK TO HEALTH in a Jiffy!

Once you can keep a little something down, start sipping on a little water. When you know for sure you can eat something, try these things. When our children were little and on the rare occasion they got sick with diarrhea, we would always put them on the BRAT Diet (bananas, rice, apple sauce, toast) for one full day before eating rich foods.
 
Soda crackers
Plain toast
Plain rice (preferably whole brown rice, if possible)
Bananas (ripe)
Water
Coconut (water) milk (fresh from the coconut)
 
Coconut water, by the way is excellent for bringing back nourishment to the body after intestinal illness. Later in the evening, if you get hungry enough, vegetable or chicken broth with a little rice will sit well in the stomach. 

After one full day on the BRAT diet, it’s time to graduate to foods that will bring back good bugs to your tummy and stabilize your intestinal tract.
 
Kefir
Yogurt
Sauerkraut
And any other fermented foods to your liking.
 
PS…when Frank and I travel we have a set up where we either cook in the hostel kitchen we are staying at, or we use our handy, dandy rice cooker and cook (most) of our own meals right in the hotel room. Sure, we eat out occasionally but we always eat where the locals love to go and have recommended to us and that seems to work well for us. To find out more about this, click here. 
 
If you liked this article we think you will like these too. Enjoy your day!

• What about Food Poisoning in Cuenca Ecuador? Is It Safe Eating Out?

• How We Stay Healthy Eating from Street Vendors and Restaurants in Cuenca

• FREE Restaurant Guide - 16 Good, Inexpensive Restaurants in Cuenca Ecuador

We're an Expat Family of Five, Living Frugal, Healthy and Happy Abroad. We live in Cuenca, Ecuador and travel the Ecuador coast whenever we get a chance. We just adventured throughout the country of Panama for five weeks! Come along and enjoy some of our experiences with us!