Moctezuma's Revenge in Bolivia
Montezuma's Revenge is the colloquial term for any episodes of travelers' diarrhea or other sicknesses contracted by tourists visiting developing countries, being Bolivia the poorest country in South America, Moctezuma is all around. The name humorously refers to Emperor Moctezuma II (1466-1520), the Tlatoani ruler of the Aztec civilization who was defeated by Hernán Cortés the Spanish conquistador.
While many gastrointestinal illnesses fall under the umbrella term "Montezuma's Revenge", approximately 80% of cases are caused by bacterial infection. The most common organisms are enterotoxigenic Escherichia coli, Shigella and Campylobacter jejuni. It is likely that residents have developed a tolerance to these organisms, but they cause sickness in visitors who consume the same food or liquids. In my case, my twins and I developed Moctezuma when we went back to Bolivia in 1999 after living in Sweden not even home made food was safe for us and trust me, mom can be a freak about cleaning; it took a while for my twins to get immune and for me to re-build immunity.
A very high percent of foreign traveler visiting Bolivia are disrupted by the infection. Most cases are mild and resolve in a few days with some treatment. Severe or extended cases, however, may result in extensive fluid loss and/or dangerous electrolytic imbalance which pose a severe medical risk and may prove fatal if mismanaged. The oversight of a medical professional is always advised.
Mild cases are best treated by drinking liquids to replace fluid loss, combined with a light diet, Bolivian food is spicy and we use spices, all kind, like there’s no tomorrow. It is important to include sources of electrolytes in the diet as drinking water alone in large amounts incurs the risk of hyponatremia which can be quite dangerous. Treatment of traveler's diarrhea includes antibiotics and antidiarrheal medications. A typical regimen would include a loading dose of loperamide or Imodium (unfortunately the Bolivian Bacterias do not speak English and they are immune to Imodium, several friends that visited Bolivia got sicker with this medication) and a fluoroquinolone antibiotic such as ciprofloxacin or levofloxacin. Over the counter anti-diarrheal medications DO NOT cure the underlying illness but may provide temporary relief allowing the traveler to enjoy brief sight-seeing episodes or endure a plane trip home.
Coca tea is a good alternative to relief stomachache and discomforts same as Trimate but this will not kill any bacteria, these teas will surely help with the altitude sickness. The most common form of the disorder may include headaches, nausea, vomiting, dizziness, malaise, insomnia, and loss of appetite. Severe cases may be complicated by breathlessness and chest tightness, which are signs of pulmonary edema (fluid in the lungs), or by confusion, lethargy, and unsteady gait, which indicate cerebral edema (brain swelling). Just drink your tea regularly while in Bolivia to prevent any symptom that can be confused with Moctezuma but be sure to use boiled water only for the infusion. Coca tea candy are not as effective as the tea, the sugar in the candy neutralize or diminishes some of the coca benefits that's why I always suggest not to use any sugar with coca tea, use Stevia, Splenda, lime or lemon or a little bit of honey.
There is a product in all the Bolivian drugstores called DG-6 (etiletanoil) , this is powerful and effective to rinse fruits and vegetables, you just need to add a few drops in to the water and submerge the fruits and vegetables for 10 to 15 minutes, to my knowledge this product kills E-coli and any other possible bacteria. Most of Bolivian fruits and products are organic, delicious and full of flavor, there is no reason for you not to enjoy the best of nature, just get a DG-6 as soon as you arrive and keep it with you at all time. DG-6 is good for rinse greens, fruits and to disinfect surfaces only. Do not add to your drinking water!
To avoid Montezuma's revenge travelers are recommended to avoid food and drink that can harbor bacteria cultures. Dry, processed, or cooked foods are safe; as long as they have not been handled or rinsed with local water, just remember: ''If you can't boil it, cook it or peel it, forget it.''
Bottled beverages are safe if they come from a major manufacturer, although ice cubes added to the drink may make it unsafe, this depends on the source of the water in the ice; we are talking about Bolivia, just stay away from the ice, I have never seen no one boiling water to make ice cubes and that includes my whole family.
Fruit drinks pose a risk if they are prepared with unfiltered water or by fresh squeezing. The traveler should also refrain from ingesting any water while showering or brushing their teeth. If the traveler has a significant underlying disease, antibiotic prophylaxis may be in order while in country. Antibiotics such as ciprofloxacin and trimethoprim-sulfamethoxazole are effective.
(Dedicated to D. Stuefloten future Bolivian visitor)