How to stay healthy without offending local customs

Don’t be a wallflower on your travels: get stuck into the local culture and traditions without risking your health – Dr Jane Wilson-Howarth explains how

I always feel a touch insecure when meeting people from other cultural backgrounds – I worry about unintentionally giving offence. But while I want to remain respectful, I don’t want to risk falling ill – and sometimes the two seem not to mix. Here are a few tips on embracing cultural traditions without endangering your health.

1. In the kitchen

Most of us think that if we’re offered a drink or snack while travelling, we’re obliged to accept for fear of offending the host. But what if the drink is loaded with ice cubes or the vessel is obviously dirty? What are the risks?

Fortunately, slightly stained vessels are unlikely to be contaminated with the kinds of microbes that will make you ill. Sharing cups is riskier: a few pathogens can be passed around this way such as typhoid or the (uncommon) virus causing Bornholm disease, which causes chest pain – the unpleasant but not dangerous ‘devil’s grip’. Surprisingly little else is transmitted by cup-sharing.

In many cultures, such as India and Nepal, cup or plate sharing is a cultural no-no; in others (such as neighbouring Pakistan) you may be invited to join a meal when everyone dips into a central dish. Research your destination before your trip, to see if there are any specific ‘rules’; if in doubt, hold back and watch what others do to avoid making a faux pas.

If in doubt, hold back and watch what others do to avoid making a faux pas

Foreign water frightens some travellers. If your drink looks reasonably clear, it isn’t likely to be nearly as risky as many assume; it is unhygienically prepared food that most often makes people ill. Even so, if you’re new to tropical travel, have a very sensitive stomach or are a worrier, slip in a couple of drops of iodine, or sip a little and leave most of it. Bugs generally need to enter you in their thousands or millions to cause a health problem so if you’re concerned, keep your doses as small as possible.

If faced with food that looks suspect, I sometimes claim that my religion precludes me from partaking. This certainly works well in Asia where there are so many religious sensibilities, people tend not to mind.

High risk: Salad & ice cubes
Low risk: Tap water
Almost no risk: Piping-hot food

2. At the homestay

Many travellers worry when they find themselves in a homestay or hotel where cleanliness standards aren’t perhaps as high as they’re used to, or they’re served traditional – but dodgy-looking – foods.

The good news is that there are no huge health risks in sleeping under less-thanpristine bedding. In very down-market accommodation, you might risk a few flea bites. These are itchy and annoying and can move into your clothes to join you on your travels. Spreading your clothes and sleeping bag out in the sun will make fleas flee.

Bedbugs skulk in small cracks in the wall plaster during the day; moving the bed away from the wall will reduce bites. Keeping the light on will also discourage them. You’re unlikely to pick up crab lice unless the bed is still warm from the last occupant!

Ideally you will be provided with a mosquito net. If it’s full of holes, spray it with insecticide – otherwise it can form a feeding cage for the resident mosquitoes. In regions where mosquitoes are rife, few hosts will be offended if you request a squirt of bug killer, but do ask well before you retire to your room.

High risk: Mosquito bites
Low risk: Odd-looking foods (as long as they’re hot)

Almost no risk: Stained bedding

3. In the bathroom

Bathrooms and toilets offer plenty of scope for causing offence, and can harbour germs. Gen up on loo etiquette. If using a squat loo without a flush, wet the pan before performing, and flush afterwards. Sometimes soiled paper is supposed to be put in a little basket rather than being flushed, to avoid blocking the plumbing – obey this rule.

Although squat toilets can feel a bit alien, they hold no intrinsic risk to your health (though you may want to strengthen your thigh muscles before travelling).

If relieving yourselves outdoors, do dig a hole and then cover what you produce; there’s nothing quite as offensive as a carelessly deposited turd. Ladies, remember that sanitary products will be sniffed out and dug up by dogs so burn them, pack them out or use a Mooncup.

High risk: Not hand-washing after using the toilet
Low risk: Wild bathing (unless in a schistosomiasis area)
No risk: Squat toilets (as long as you wash your hands afterwards)

4. At festivals

Joining in with a local festival or celebration is a joy but big gatherings carry quite a high risk of gastroenteritis. If you can, take only piping-hot food and shun ice in drinks, even if that means taking your bottled drinks luke-warm.

Some traditional ceremonies involve swallowing intoxicating substances such as homemade spirits, magic mushrooms or Amazonian ayahuasca. Think hard before participating. Consider what might happen if you’re rendered unconscious. Will you be raped or robbed? Will someone see you safe? Could the substance itself be dangerous – especially to the uninitiated?

Home-distilled alcohol can be hazardous. Alcohol can be produced by fermenting most things, but some components contain solvents and other poisons. If the distillation process is flawed, the resulting brew can be deadly.

High risk: Moonshine
Low risk: Large gatherings (though be alert)
Almost no risk: Bottled drinks

5. At the mosque/church/temple

Visitors to religious sites may be required to dress modestly. For example, churches in southern Europe often expect women to wear a scarf; some Hindu temples require heads to be covered. Not abiding by such rules could attract unwanted, or potentially dangerous, attention.

In some countries, rhesus monkeys hang around temples and may bite to persuade visitors to part with food. Bites come with a risk of rabies and wound infection. Harming an animal that locals consider sacred could put you at the centre of a very angry mob, so treat them with respect.

Touching icons that many others have touched isn’t great if you plan to eat soon after. Washing your hands with soap (carry a little box with you) is protective. Cup-sharing carries little risk: Holy Communion shouldn’t threaten your health.

Some people also worry about the dangers of touching ‘dirty’ locals. Beggars may hang around religious places; those with leprosy may even try to scare you into paying them off. As long as you wash your hands before eating or putting them to your mouth, such contact is low-risk.

High risk: Animals bites
Low risk: Sharing a communion cup with others
Almost no risk: Being touched by a beggar