In short. Loose stools three or more times a day count as diarrhoea, and on a trip it is most often caused by bacteria from food and water. The main danger is dehydration, so the first remedy is oral rehydration salts (oralit): dissolve a sachet in clean water and drink it after every loose stool. Medicines that "stop" the stool must not be used if there is blood in the stool or a fever, and antibiotics only on a doctor's prescription. See a doctor the same day if there is blood, a high fever, severe vomiting, you cannot drink or you have signs of dehydration, and in any case if it is no better after two days. Children, pregnant women and older people should go to a doctor sooner.
What it is and where it comes from. WHO defines diarrhoea as three or more loose or watery stools a day. CDC, in its chapter on travellers' diarrhoea, writes that in most cases, 75 to 90%, bacteria are to blame, above all E. coli, Campylobacter, Shigella and Salmonella; viruses, including norovirus with vomiting, account for 10–25%, and protozoa such as Giardia for about 10%, and they more often cause prolonged cases on long trips. The main risk factor, according to CDC, is hygiene in food outlets and poor sanitation, no single "dangerous" food is to blame. The rule "boil it, cook it, peel it or leave it" lowers the risk but does not give full protection.
The first hours: replace fluids. The Indonesian Ministry of Health, WHO and CDC all start with the same thing: replace fluids and salts. Oralit is sold in any pharmacy (apotek) and in many minimarkets. According to the Ministry of Health article, dissolve a sachet in a clean glass with 200 ml of water, stir until clear, and do not mix it with milk or sweet tea. CDC describes ORS packs made up in a litre of boiled or purified water, so check the volume on your own packet. Drink in small sips after every loose stool, and if you are vomiting, a spoonful every few minutes. If there is no oralit, the Ministry gives a substitute: two teaspoons of sugar and half a teaspoon of salt in a glass of boiled water. Plain water and isotonic drinks are also fine for a mild upset, but sweet fizzy drinks in large amounts, according to CDC, make diarrhoea worse. Do not stop eating: WHO advises continuing to eat, and the Ministry recommends soft food and asks you to avoid spicy and fatty food and alcohol. Breastfed babies are fed as usual.
Signs of dehydration. According to WHO, moderate dehydration is two or more signs from this list: restlessness or irritability, sunken eyes, drinking eagerly and thirst. Severe dehydration is two or more from another list: lethargy or loss of consciousness, sunken eyes, the person cannot drink or drinks poorly, a skin pinch goes back slower than two seconds. The Indonesian Ministry of Health adds everyday signs: dizziness, a dry mouth, little urine, weakness. Severe dehydration is treated with a drip in hospital, it cannot be treated at home.
What not to do. Medicines that slow the gut and stop the stool are allowed by CDC for moderate and severe diarrhoea, for example on the road, but not as the only treatment if there is blood in the stool or a fever: with an infection they keep the pathogen inside. According to the Indonesian Ministry of Health, antibiotics are prescribed by a doctor when there are signs of infectious diarrhoea, such as a fever, blood in the stool or changes in a stool test; CDC does not recommend them for mild diarrhoea and warns separately that antibiotics of the fluoroquinolone group work worse in Southeast Asia because of bacterial resistance. CDC does not advise taking antibiotics "just in case" as prevention for almost anyone. We deliberately do not give drug names or doses: a doctor chooses them for your age, weight and other medicines.
When to see a doctor. The thresholds of the three sources put together:
- blood or mucus in the stool, a high fever, severe vomiting, being unable to drink: the same day;
- signs of severe dehydration from the WHO list: right away, and if the person is lethargic or loses consciousness, call 112;
- no better after two days or more than six stools a day, as the Indonesian Ministry of Health explains, as retold by medical portals;
- diarrhoea longer than two weeks: according to CDC you need testing for protozoa, and the treatment will be different;
- children, pregnant women, older people and people with chronic illnesses: see a doctor sooner, because dehydration comes on faster in them, and for small children WHO advises starting oralit at the first signs.
Where to go. Hospitals with 24-hour reception and clinics by area are collected in the guide to hospitals, and an ambulance is called on 112 or through private vehicles from the guide to emergency numbers. Insurance usually covers such a visit, and the procedure is in the guide to health insurance. Buy medicines in a pharmacy with a sign and a licence: prescription drugs are sold there only on the prescription of an Indonesian doctor.
How it differs from other illnesses. A fever with aching and a rash in the rainy season is a reason to test for dengue before blaming the food. Nausea, impaired vision and confusion after alcohol of doubtful origin are signs of methanol poisoning, see the separate guide, and go straight to hospital. A fever and calf pain one to two weeks after contact with flood water: leptospirosis.
How to lower the risk. According to CDC and WHO: wash your hands with soap before eating, and without soap use a hand sanitiser with at least 60% alcohol; drink water from sealed bottles, and take ice only where you are sure of the water; choose fruit that you can peel, and peel it yourself; take food that is fully cooked and served hot, as sliced food and street food are an extra risk. Keep a sachet of oralit in your first-aid kit from the first day: at night, when you feel ill, there is no time to look for a pharmacy.
What this means for you. Buy two or three sachets of oralit in advance and put them in your first-aid kit. If you are hit by it, for the first day drink oralit after every time and eat soft food, do not stop the stool with pills and do not start antibiotics yourself. Blood, a fever, vomiting, weakness and a dry mouth mean it is a day to see a doctor, you cannot wait. If it has not passed in two days, also see a doctor: save the addresses of hospitals and the number 112 in your phone before you need them.