Monthly Archives: July 2011

X is for Ex-Lax

My apologies for the significant gap between posts. I’m still in India but I started a new job that is a wee bit time-consuming. And then I have more socializing responsibilities here in Kolkata. And below you can read about the final chink in the well-intentioned plan:

All right. I’m cheating. It’s not that I couldn’t find an X-related (or X-rated) subject in Kolkata to discuss, but at this point at least, I prefer not to write a post about Kolkata’s red-light district (save that for Nicholas Kristof) or about the two X-named restaurants I found in the Times of India Food Guide. If you are going to name your venue X-Spicy and Xrong Place, you at least have to deliver on the food. Instead, they advertise “multicuisine”(always a word to steer clear of anywhere in the world) and – sigh – Brittany Spears videos. So, I wasn’t about to take the hour and a half hike to Salt Lake – even for you, dear reader. Thus, the compromise.

Besides, an overview of the dangers that await your stomach in India is paramount for travelers, especially for those virgins out there. I love Indian food, and I love coming to Kolkata, the capital of Indian foodies. And I’m not one for being overly concerned about germs or dangers to my health. But I am humbled by the stomach issues that India has learned to coin with a cute phrase, “Delhi Belly.”

It’s unclear which country has the highest rates of food poisoning, but a FDA report on a year’s worth of food import violations listed India as having had the most food imports rejected (after the Dominican Republic). A year’s worth of data on imports cannot paint a clear picture of the overall quality of Indian food, but it does show that food can be significantly compromised in the country.

Food poisoning in India results from the same circumstances in any other country – improper agricultural practices, poor hygiene, misuse of chemicals, among others. But one issue that makes India’s food system difficult to manage is a lack of a clear, regulating body. India has had laws on the books for years. But only in 2006 was the Food Safety and Standards Act passed (itself a Herculean effort because it required the consolidation of all previous laws). The Act established the Food Safety and Standards Authority of India, now a center of the regulation process that heretofore didn’t exist.

For the past few years I had been lucky to avoid any food poisoning. Contrary to what most guidebooks say, food poisoning is not inevitable. But if you are buying a ticket to India, you should accept that it very well might happen. If it does, you’ll be more prepared to take it in stride. My issues largely involved the opposite problem. Most Indians cook their food to death, so that the level of vitamins and other nutrients that end up on your plate are negligible, including fiber.  Last summer I realized that diuretics are not a pleasant exercise in health maintenance. I came much better armed this time around. My Metamucil didn’t make too much weight in my suitcase either.

But different issues arose. Earlier this week I woke up with that inexplicable, pre-illness sixth sense. The air smelled different. Food didn’t smell much at all, and my fiance Surya smelled way too much. Later in the day, whatever had compromised my sense of smell, pushed southward. By the time we arrived home in the middle of a Kolkata downpour, I lay prostrate on my back. My abdomen churned from cramps.  Only occasionally did I turn my head sideways. These were the worst pre-menstrual cramps I’d ever had.

Later that night, I spent a number of hours in the bathroom, standing, sitting, crouching on the floor, afraid to leave but equally afraid that the three-inch spider we’d killed in there two days before had a vengeful brother. I had  scoured the Internet comparing pictures of poisonous arachnids to the shriveled ball that now sat in a tissue in the dustbin. It was the brown recluse; I was certain.

“Those are found in the United States,” Surya said and then pointed to the description on the open Web page.

“You shouldn’t trust everything you read on the Internet,” I’d retorted.

And the next day, when I was sure I didn’t suffer from PMS, I thought that perhaps Surya had been right about the spider. That was my final thought. I spent the rest of the day shivering under a blanket.

Of course, you probably want to know how to avoid this problem altogether. There are a few food-related precautions that every traveler to India should follow:

  • Drink only bottled water. Most restaurants and hotels do not use any filter systems for their water, as some middle and upper class homes have. It’s best not to wonder whether or not your water is clean. Shell out the 50 rupees for a liter of bottled water.
  • Do not consume ice from street stalls. As per the reasoning above, you should avoid potentially untreated water in all its forms, even when it is 100 degrees out with 85% humidity.
  • Avoid yogurt and milk-based products from street stalls. **sigh** This rule of thumb is the hardest to stomach (pun intended). Milk products like yogurt contain a high concentration of bacteria and can easily go off. Although there are some street vendors in Kolkata where it is safe to try foods like lassis and doi phuchka, it’s best to get advice from a trusted local or guide.
  • Fruits sold on the street are best avoided. Because the fruits on the street are uncooked and exposed to the germs surrounding them, most people, including Indians themselves, choose to buy fruit at a local market and prepare it at home instead.

If you’re going to get sick in India, Kolkata is a great place to do it. Bengalis love taking medicine and giving medical advice. No. They’re not quacks (well, some of them are). I think it derives from their affinity for turning life into art. Giving non-professional, medical advice is an art form in Kolkata. The medicines on offer for treating any one symptom are astounding. In India, small pharmaceutical companies proliferated after the government passed the no patent law for pharmaceuticals forty years ago. Since the law was reversed in 2005, that’s beginning to change. But in Kolkata the culture of giving medicinal advice is still strong. At least fifteen medicine shops line the main road of our Behala neighborhood alone (and that’s not counting the homeopathic ‘doctors’ who sell mood rings as cures for ailments like kidney stones and cancer). Everyone has her favorite brand, and everyone is more than willing to give you the name.

Over the next two days, I was given all kinds of pills to choose from – pain medications, digestive enzymes, electrolyte concoctions.  On clockwork, every few hours Kakima appeared in the doorway to our bedroom.

“It’s time for her to take her pill,” she’d whisper.

I also received advice about what and what not to eat. Kakima, Kaku, our cook Raju, and our driver Shonjit debated amongst themselves about whose idea had the best healing potential. The food you eat here when you are sick is delicious, by the way.  A vegetable soup called macher jhol, chicken stew with ginger, and a béchamel-like vegetable curry called shukto. Shukto is a bitter dish with a number of ingredients (bitter gourd, bottle gourd, raw banana). These are difficult to find in North America. But it is these vegetables that are famous for their aid in digestion. Bengalis often prepare shukto as form of cleansing the digestive tract.

Raju brought me lots of tea; Shonjit ran to get the electrolytes, then popped his head in to say ‘hello.’  Sickness in India is a time for visiting, oddly enough, and, even more odd, another opportunity to bring sweets. I had a pantua, my favorite. Even Surya’s friend, Rana, called on his way to work one morning, assuring me that he had a medicine that worked wonders. For what, I didn’t know. From what I knew of food poisoning, you just had to let it pass.

In all seriousness, it’s always good to take essential medications with you when you travel. I use an old cosmetic bag and fill it with items I found to be indispensable when I travel:

  • Ibuprofen: Both a low-grade muscle relaxer and a pain reliever!
  • Bismuth caplets: the most common brand is Pepto-Bismol. Although bismuth relieves heartburn, gas, diarrhea only for short periods of time it’s worth taking with you for when food just isn’t sitting right.
  • Prescription azithromycin: azithromycin is used to control diarrhea. Unlike the similar-acting luoroquinolones (e.g., Noroxin or Cipro), it can be used for children with severe diarrhea (though it is best to avoid giving these medications to children altogether).
  • Enzyme dietary supplements: I take Beano with me wherever I go. You take a few pills just before you eat a “problem” meal (e.g. beans or, in my case at present, everything, and life becomes just a little bit smoother.
  • Acid reducer: This is a separate or additional option to taking bismuth or enzymes. I had a helpful bottle of Zantac in my bag, until I realized it was about three years past the expiration date.  Note to everyone: medications really do go bad.
  • Oral Rehydration Therapy: If food poisoning does hit you, it’s important to stay hydrated and put back the salts and other nutrients that you are losing. In the U.S. this is sold as CeraLyte and Kaolectrolyte.

Although the above may seem like a lot to take, if you pick up small bottles it really isn’t. I still have plenty of room for my antibiotic ointment, bandages, calamine lotion, and hand sanitizer.

It’s also good to keep in mind that forms of each of these medications can be found in India. In case you are wondering (which you probably are), most medicines in India are safe, and you don’t need to be seen by a doctor to procure the ones I mentioned. If you are unsure what manufacturer is best, it’s helpful to stick to the biggest pharmaceutical brands, which include Aurobindo, Dr. Reddy’s, Glenmark, Lupin, Torrent and Wockhardt. These six have recently been approved for the U.S. drug market.

In India being well prepared is essential. Of course, India will always kick that preparedness right to the curb. But you’ll be out of the bed or hotel room in no time and, like me, dishing into a succulent, Kashmiri chicken drumstick off the street.

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