Jane Wilson-Howarth

The original idea for the book came from Laura Fleminger who was then a literary agent with Peters Fraser & Dunlop in London. Way back in 1993, she heard me talk at a symposium on expedition health at the Royal Geographical Society in Kensington. Laura convinced me that I should write an antidote to the professorial style of the only other guide at the time, Travellers Health. So, with some trepidation at setting up in competition with a host of academics, professors and consultants, I began work on my first comprehensive health guide for use in remote regions. I had by then acted as medical officer on expeditions to the Himalayan region, Madagascar (twice) and Peru and had lived in several remote corners of rural Asia (Ladakh, Sri Lanka, Sindh, Baluchistan, Indonesia), so I had some experience and knowledge of coping with exotic health problems and limited facilities. And I was used to improvising.

Soon after meeting Laura, and while our sons were still small, we went to live on an island in the Karnali River, Nepal where there was no electricity. It was perfect place to hone my expertise in improvisation. Here too I had the luxury of uninterrupted writing time. I also saw a great deal that convinced me of the power of health information; my interest in health education grew. I recognised the dearth of readable information to help people avoid ill-health in remote places and settled down to enjoy the challenge of writing on the subject. It took me about 18 months to complete the book.

My Essential Guide was first published simultaneously by Cadogan in the UK and Globe Pequot in the US in 1995 as Bugs Bites & Bowels. It has to date sold over 40,000 copies. The fifth edition had the slightly cumbersome title The Essential Guide to Travel Health: don't let Bugs Bites & Bowels spoil your trip.

The publisher of this guide was originally London-based but has been bought and sold several times. For a while they had a head office in Australia, and they've and moved back and forth and back and forth again across the Atlantic. Now, with yet another new publisher (Pennsylvania-based Fox Chapel) this guide should finally be launched as an e-book, in 2023.

Travel is risky. Even venturing out for a meal in your home town carries a risk of road accident, suffering food poisoning or encountering a mad gunman. As more and more of us are travelling to exotic places – for both business and pleasure – we naturally wonder how much greater the risks become when we are away from home.

What is the commonest plague to hit travellers? Do you know how to treat it? What is the most common cause of death in travellers abroad? This book answers these and other questions you may have, and many more you will not have contemplated. Like how you avoid flesh maggots, how to remove a tick from your scrotum, what to do in a squat toilet and why women should travel with a femidom. Equally, it details ways of dealing with all the little biters that join you on that balmy Mediterranean evening or even by a Scottish lough.

Milk 
(from page 109; 6th edition)
When in resource-poor regions it makes good sense to boil milk before drinking it, even if it is supposedly pasteurized. I’ve found wood shavings and buffalo hair in “hygienic” milk. Throughout the Indian subcontinent, milk is usually safe because it has been boiled, but do check. Unboiled milk (and/or the water used to adulterate it) can give you TB, TBE, brucellosis, listeria, Q-fever, salmonella, typhoid, paratyphoid, and polio, as well as other forms of dysentery and diarrhea. Horse and donkey milks are probably less risky than raw cow’s milk and travelers may wish to try reindeer, moose, llama or alpaca milk but boiling is still recommended before consuming any of these. Camel milk has been implicated in cases of Middle East Respiratory Syndrome (which has a 36% mortality rate) but again boiling will render it safe.

Dangerous Sea Fish
(from page 175; 5th edition)
About 100 species of fish can administer dangerous stings, and a selection (barracuda, moray and conger eels, garfish, groupers and sharks) can inflict severe bites. Fish stings are common, and there are around 1500 stingray stings and about 300 scorpionfish stings a year in the USA alone. However, fatalities from fish stings are rare, and so are deaths from shark attacks.

Giardia
(from page 130; 4th edition)
Giardia are elegant heart-shaped microbes that swim around the small intestine propelled by two splendid whiskers. Infection upsets the stomach and causes sulphurous, foul-smelling belches and farts, abdominal distension and often diarrhoea.

Giardia infection is probably the most over-diagnosed, inappropriately treated travellers’ ailment; if you think you have it get a stool check before rushing to take a course of antibiotics, and/or try 24 hours on clear fluids and a bland, fat-free diet. Other microbes cause similar symptoms, and untreated giardiasis does little harm except make you an unwelcome guest. One fairly specific symptom is passing stools that stink, float and are difficult to flush away (there are other causes of this, so if the treatment appears to fail, find a doctor). The parasite causing giardiasis is Giardia lamblia.

Ease and Relief
(from page 83; 5th edition)
Lavatories can be a challenge for less nimble travellers. In many public facilities with pedestal lavatories, there may be no seat. Consequently, one needs to be able to hover over the pan, a trick that may be difficult for older travellers or those with hip disease or knee pain. Some remote places or budget destinations may only offer squat toilets. If you can’t squat to relieve yourself, limber up or re-book; alternatively, women might invest in a Whizzy, an ingenious foldable, disposable, gutter-like device that allows you to pee standing. The British alternative is the Shewee. These are also good for the squeamish who want to keep clear of less-than-salubrious lavatories. Another solution is the disposable Mini Potti urinal. Never restrict the amount of fluid you take in to reduce the amount you need to pee and do not miss out on taking prescribed ‘water tablets’ when travelling. Both strategies can be harmful.
 
Case history: Cave Rescues
(from page 286; 5th edition)
When I lived in the south-west of England I spent a lot of time underground. I enjoyed caving and also researched the ecology of blind, cave-adapted animals in the limestones of Devon and Somerset. I served as a cave rescue warden too.
The call-outs were mostly to inexperienced people who had ventured into a cave or abandoned tin mine with ordinary battery-operated torches / flashlights. They didn’t realise that these lights fail after only an hour or so. These rescues got me thinking about how truly difficult it would be to navigate through a cave I knew well without a light.
My zoological investigations meant that I visited my underground research site at least twice a week. The cave I was studying had one entrance with a loop of low passage and boulder-strewn corridor comprising just 320 feet (less than 100m) in absolute darkness. I experimented with trying to move, lightless, through my familiar cave and time after time managed to progress only a metre or two before ending up in a blind alley.
Even knowing this small cave well, I realised that if my light failed, I’d be incapable of finding my way out. In absolute darkness, however, the tiniest light can save you. One chap found his way out of a small cave in Somerset - by the light of a cigarette. Even better would be to carry emergency lighting; the glow stick variety are convenient.

The fifth edition is still available from online bookshops including

Amazon UK | Amazon US | Blackwells bookshop

Also in the UK through Grantham Book Services phone 01476 541080 quoting the ISBN number