Posted by: facetothewind | July 6, 2015

The Price of “Adventurous Eating” in the Developing World

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This time I’ve really done it. Look at my belly! I look like a pregnant hairy woman and yet I weigh in at about 137 pounds. So that’s not fat. It’s gas and I’m about to lift off from my apartment and float out over Kuala Lumpur like a balloon and zoom past the Petronas Towers giving a friendly wave and a little toot. Some tourists will take a selfie with me photo-bombing by in the background. Their videos will go viral…or bacterial.

For a month I’ve been sick with diarrhea, nausea, extreme bloating, some fatigue, but curiously no fever. So I figured it was traveler’s diarrhea which is all too common in my life since I left the United States. I know TMI. Well, I finally went to the hospital and got a battery of tests done last Friday. Today when I turned my phone ringer on, I noticed several missed calls from the doctor at the local Indian hospital here. He asked me to come in (uh oh) and here’s what he showed me…

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There it is (underlined). I have tested positive for typhoid fever. Apparently I managed to nip it in the bud with antibiotics before it could have been fatal.

Typhoid is spread by food or water contaminated with human feces. I could have avoided this with a simple vaccination but I somehow never managed to get it thinking I was going to a developed nation. Hah! Malaysia has a veneer of being more developed than it really is. It is a very, very multicultural society with a huge influx of unskilled foreign workers staffing the bars and restaurants. We don’t know what the hygienic practices are in their homeland but whatever it is, it has translated to my contracting food poisoning 4 times in a year, one of which could have taken my life.

typhoid-map

IN ALL THE YEARS of traveling in Thailand, I’ve never been sick and I was doing lots of adventurous eating at street stalls there…something that is unadvisable in Malaysia. So one has to conclude that since they really don’t have much foreign labor in Thailand and it’s the Thai mama in the kitchen or at the street side wok, that over a lifetime she has figured out how to cook and not kill the tourists. But here in Malaysia, typhoid is considered “strongly endemic” (red) according the Wikipedia map above. The food and beverage workers in Malaysia are mostly Bangladeshi, Pakistani, Indonesian, Filipino and Indian immigrants. And those countries don’t have a great reputation when it comes to food cleanliness.

Boil it, cook it, peel it, or FORGET IT!

Click here for a quick overview of typhoid fever, how not get it, and how to treat it if you do. First, get vaccinated! But since that’s only partially effective, I also recommend always carrying with you a supply of Ciprofloxacin which you can buy cheap over the counter in Southeast Asia. Because I treated my diarrhea early with Cipro, I managed to avoid the worst of typhoid, not even knowing that’s what I had. Now I just have the decimation of my intestinal flora to deal with, which explains the bloating.

My other advice: avoid eating out in Malaysia. Just cook for yourself here as you cannot count on even an expensive restaurant to practice proper hygiene. If you do eat out, beware of restaurants (no matter where they are or how fancy they are) whose staff speaks no English or don’t seem to know what they’re doing. Lots of staff mingling around with nothing to do translates into a lot of hands touching your food and you are increasing your odds of something going wrong. If a server can’t answer a simple question about the menu, leave!

Malaysians speak English and are more likely to know about good hygiene than the wild card of foreigner workers who might have just arrived and received no training at all. An established Chinese restaurant staffed by a Chinese family is likely a safe bet. A big name Indian restaurant with staff who speak English is probably a safe bet also. A restaurant with all foreign staff is a gamble. Street food is risky and avoid the mixed rice (buffet) restaurants with trays of food sitting out. It may look tempting, but flies can and do walk on feces and then on that food…and in tropical heat, bacteria grows fast. So eat in established places, eat indoors, eat freshly cooked food. It’s the same advice I’d give about anywhere in the developing world, but seeing the numbers of Lamborghinis and Bentleys on the streets here in KL, I guess I forgot that it’s still a developing nation…and those people have domestic servants who cook for them.

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Chuan wrote to me that he was angry about this — not at me — but at what’s happened to his country that this should happen and he could have lost his boyfriend over someone’s carelessness in the kitchen. He isn’t the only one to express this to me. A number of Malaysians have said to me that they feel the country’s huge influx of foreign workers has deteriorated the quality of life and standard of living. This is not the Malaysia they grew up with.

I’m reluctant to blame the workers themselves, they are poor immigrants taking advantage of a financial opportunity that has been made available to them. But they have no investment in Malaysia — they are here for a brief period to make as much money as possible and then go back home. That circumstance doesn’t breed excellence or pride in one’s work and as I’ve found out, it does breed germs — the unintended consequences of being a mercenary in a place that wants a cheap labour source. As one Malaysian-Indian friend said, “Our hardware may appear developed but the software is still behind.”

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Responses

  1. Oh David, I had no idea you were so ill…I am sorry! Sending you healing thoughts, and gratitude for the sharing of wisdom…

    Big love, january

  2. “In the United States, an estimated 5,700 cases of typhoid fever occur annually, mostly among travelers. An estimated 21 million cases of typhoid fever and 200,000 deaths occur worldwide.”

    http://www.cdc.gov/nczved/divisions/dfbmd/diseases/typhoid_fever/technical.html

    We have a friend a few blocks away who contracted Giardia here in the U.S. She doesn’t know how. She’s an avid cyclist, including a racer, so the docs speculate that maybe some dirt/mud flew up and hit her in the face at some point.

    I don’t think being “invested” in a country has anything to do with anything. Hundreds of thousands of people in this country contract food poisoning every year. Granted, it’s more benign than typhoid fever, but it still makes one sick. And obviously many of the people handling that food are born-and-bred Americans. Proper hygiene is proper hygiene, whether practiced by native-born citizens or by immigrants. Illness can happen anywhere.

  3. Augh! Sorry, David. Ugh. I read the piece you linked to about recognizing Typhoid, but didn’t see much there about how it’s treated. I take it you’re on a heavy dose of antibiotics? Is it working? So far in my life I’ve been consistently lucky with eating unknown stuff in unclean areas (Egypt, Chinese engineering vessels, Mexico, my own house) and I had a gf who declared that I could eat botulism and survive. I rarely even get stomach pain.

    Maybe once this is all over with you too will have developed Stomach of Steel. In any event, I’m hoping that for you, this illness too, shall, uh, pass.

  4. So sorry David but glad you were able to avoid the worst of it. Hope your tummy flora is blooming beautifully again soon. I agree with Lisa that these things can happen anywhere – especially if it can be spread by something as simple as a fly from shit. Isn’t the US or UK also a very very multicultural society with a huge influx of unskilled foreign workers staffing the bars and restaurants? There will always be some unscrupulous or ignorant food producers out there whatever their origin, but maybe you were just unlucky….Take care and get well soon 🙂

  5. This is bad news,! I’m so sorry to hear it. I clicked on the link and am having second thoughts about not being vaccinated against anything, and about eating raw veggies. There is an ad therin by iHerb.com. coincidentally I just ordered some supplements from them. They feature many well known brands from the US and delivery charge is small.

    Hope you soon recover!

    Dianna

  6. Yuckaroo. Surely you are on the mend by now…and your tummy calmer and happier. Between this and the ‘mystery nuts’ – who knows what else lies ahead in the gastronomical sphere for you. love you!


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