Due to the prevalence of Zika in Honduras, we strongly recommend that women who are pregnant, or may be pregnant at the time of the mission trip, to not attend. If you are planning on joining the mission trip and are a woman of child bearing potential, you should use appropriate precautions to prevent pregnancy during the time of the trip, and several weeks after. Use this link to the CDC Zika Virus page if you have other concerns!
Below is more information regarding other diseases or illnesses you maybe exposed to and suggestions on how best to protect yourself.
Food prepared warm and then allowed to sit before consumption is the classic producer of “Ptomaine Poisoning”. Actually, the term is no longer accurate; at one time it was thought Ptomaine was a type of bacteria or a substance. We now call this “Food poisoning”. Usually, Staphylococcus is the culprit. Introduced by the food preparer’s hands, then it is incubated in the warm food. Then it grows in quantity until ingested. (Potato salad is often the culprit.) Once ingested the person’s stomach acid kills the bacteria releasing toxins from their little bodies. The toxins induce rapid onset nausea, vomiting, and diarrhea. This is usually 2-4 hours after ingestion.
Norovirus is the most frequent cause of vomiting in the U.S. as well as many other parts of the world. It is often the cause of epidemics on cruise ships that sicken so many, so quickly. Recent studies show it is spread more by hand to hand contact than being food borne by 5-1 ratio. But, it can be food borne and can also be transmitted as an aerosol from vomiting. It can even be spread via aerosol by flushing a commode with vomitus or contaminated feces in it. This stuff is contagious! The stories that the virus can jump 35 feet are simply not true.
Malaria is endemic to this area. It isn’t rampant, but is prevalent enough that, over the 15 years of our groups going to this area, there have been one or two cases among mission workers but never in one of our team members we know. The mosquitoes that carry malaria are only active from dusk to dawn. They also only inhabit the lower geographic areas and do not go above 3500 ft. elevation. This results in less exposure for our group since we are in the higher altitudes much of the time and are back in urban areas by dusk. Thus for us the risk for malaria is small, but no one can say it is zero. For those who decide that they want protection from malaria, we recommend prophylaxis with Aralen (chloroquine) tablets. This medication is used for prophylaxis at 500 mg (300 mg base) once a week, starting two weeks before departure and continuing for four weeks after return. You must take the full course, even the part after returning, to get adequate prevention. This medicine can be expensive. Talk it over with your physician if you have any questions. If you want to take it and cannot afford it let us know. We MIGHT be able to help.
How to spend less time in the bathroom while in Honduras
Traveler’s diarrhea, or TD, is a worldwide phenomenon. As the name implies it affects people who are some distance from home. It has various names depending on the locale: Montezuma’s Revenge, Karachi Trots, and Delhi Belly are just a few of the names. The culprit is the ubiquitous bacteria, Escherechia Coli, which resides in everyone’s colon. Normally there is a symbiotic relationship between a person and “Their” E.Coli. It is colonized in everyone’s GI tract worldwide, does not make you sick, and it helps in GI functions. The trouble begins when you encounter a variant of E. Coli that your body does not recognize. Thus, when traveling a good distance away from home the local E. Coli is immunologically different from the one in your intestines and your body doesn’t recognize it. After ingesting it in large enough quantities you develop an infection that starts as growling, grumbling, and cramping in the intestines usually on the third day or fourth day of your visit. Antibiotics and double dose Pepto Bismol will stop it at this stage if used promptly. If you ignore those symptoms you will often proceed to the vomiting and diarrhea stage. Some individuals will proceed on to the stage where they develop a closer relationship with God, pleading Divine Intervention for relief of symptoms. (My wife, Bobbi, has been there several times. Ask her.)
These organisms collectively are called “Coliforms”. This sounds so much better than saying “Bacteria that came from someone’s colon into my food”. So, you ask, how does the E. Coli get from someone else’s colon into my GI tract? A close study of this process is not for the weak of heart. The awful fact is that coliforms are everywhere. Yes, Virginia, even on your toothbrush. This is by a process I call “The Tooth Fairy Phenomenon™”. Coliforms, like the Tooth Fairy, are everywhere yet you never see them. There is more TD in third world countries because their sanitary standards are different than ours and you simply get a heavier load, or “Bacterial Burden”, of coliforms when traveling there.
Other Illnesses / Infections
There are other illnesses, caused by bacteria such as Salmonella, Shigella, and Campylobacter. Usually the person who spreads this is sick, or has recently been sick, and is still putting out the pathogenic bacteria. We have a controlled population on our team and our lunch food preparers are known to us. Thus these are not likely to affect us. We are at the mercy of Zamorano or Montaña Santa Clara retreat for the other meals but we have an excellent record of our team not getting sick from their food.
What to do?
There is a great deal of individual variation. I very rarely get food borne illness and pretty much eat what I want any where we go. Living 16 years in Venezuela and Colombia probably had a lot to do with producing this state. Bobbi is the very opposite. We can fly over Mexico and she gets sick. If you have a sensitive GI tract or have experienced food borne illness on prior trips you need to be very, very selective about what you eat. Food selection plays a very important role in preventing illness. Selecting cooked food that is still hot and eating from freshly opened cans is an effective preventative. Not eating any raw vegetables is one of the Golden Rules of Those Who Do Not Want To Be Sick. Eating fresh fruit that you peel is acceptable. The old rule is “If you can’t peel it to eat it, forget it.”
Using disposable knives, forks, plates and glasses is important in preventing illness. Part of the problem we have is that through interchange with other countries many different food items from around the world are now available not only here in the U.S. but also in Honduras. We can now get such wonderful food items at PriceMart in Tegucigalpa that it is very tempting. Adequate washing with soap and water will generally remove most of the bacterial burden of food items. Some items, such as grapes and similar items are just hard to wash. You can soak foods for 30 minutes, including grapes and hard to wash items, in water with added Chlorox to help sanitize them. Problem is that Norovirus is harder to kill than the other agents and the 3 drops per quart ratio of chlorox to water usually recommended may not do the job for Norovirus. You add from 5-25 teaspoons of Chlorox to a gallon of water to sanitize countertops and other surfaces of Norovirus so possibly you could use that. (In case you are wondering you can drink a quart of pure Chlorox and it will not hurt you, unpleasant though it be.)
Role of Gloves
Gloves work best to protect the person wearing them. At the cafeteria in the Agricultural College in Zamorano the food service personnel wear gloves. This provides us Gringos with protection from their local form of coliforms plus the occasional person with Giardia. That eliminates the great bulk of our risk. Since they teach food preparation there they practice state of the art procedures to our benefit. I don’t know of anyone on any of our teams who got sick from Zamorano food. Gloves can be deceiving and make you think you are safer than you really are. A person with gloves can very quickly become a vector for the transmission of whatever agent is on one item of food to all the food. Even our nurses and others who often use “sterile technique” if watched closely will be seen to break technique by rubbing their forehead or nose with their gloves on without even realizing it. Unless you are using multiple pairs of gloves, changing them each time you switch from one food product to another, and working from a sanitized countertop you run the risk of the gloves themselves becoming contaminated from one food item or the countertop and then this is spread to all the food items. Use properly washed bare hands, it is much easier to wash hands between items and thus maintain cleanliness. Nobody washes the gloves and I haven’t seen any changing of the gloves. In our case members of our team do not have “foreign” coliforms and we know if they have recently been sick or not, so there is no compelling reason for gloves in my opinion. Do you use gloves to prepare food for your guests when you have someone over for dinner?
Hand Washing Versus Alcohol Gels
Alcohol gels are effective against many, if not most, bacteria and viruses. To be effective the gels have to be at least 62% alcohol and they have to be vigorously rubbed into the hands. 98% of the use of alcohol gels that I have watched in Hospital ER’s and nursing homes is simply not adequate. You have to do more than rub the gel around for 2-3 seconds then clap your hands together twice before you are sanitized. Be sure and rub around the fingernails, under the ends of the nails, and then rub vigorously until all the gel has been used up or dries up. The gel really doesn’t do much to prevent Norovirus. This has something to do with the virus not having a lipid coat they tell me. Handwashing does better for Norovirus.
Those who are particularly susceptible to food borne illness may consider taking antibiotics the whole time we are in Honduras. That will prevent TD, most of the bacterial illness, but will not prevent viral illness such as Norovirus. See your Dr. if you are considering that. Many different antibiotics are used and the recommendations change periodically.
On our second Mission Honduras (year 2000) we had a physician who was determined not to get any food borne illness. He brought all of his own food. He did not eat once what we ate, instead eating from his own cache of Stateside food he brought in his luggage. He got sick on the fourth day and could not go to clinics. He had typical TD symptoms. You see, you can get coliforms from simply touching the Hondurans, shaking hands with them and other forms of contact (Tooth Fairy™). So, even the best food selection and preparation is not a guarantee that you will not get sick. Wash with soap and water or sanitize your hands frequently with alcohol gel! This is especially true before eating.