This was originally written for another website, TrekWorld, now defunct. The format of 1. experience, 2. "practical lesson" and 3. "insight" was at their request. (not normally a format I'd use)

Suffering through a severe sickness while abroad is one of the most rotten pieces of luck you can have. When you feel like you’re going to die, all you want is to be at home in your own bed, where your friends, family, pets, doctor and pharmacy are a phone call away in your native language. Like many adversities, though, in retrospect such horror stories typically become humorous and good story fodder. Sick-abroad stories among travelers can become a bit like fishing stories… you’ve always got a better one than the other guy. Oh yeah? If you think you were sick, let me tell you what I went through in …  I’ve learned some practical lessons for the traveling life, though, and gained some worthy personal insights through surviving these situations. Here are five of my own ordeals:

(1) The Inca Trail, Peru.

It’s embarrassing to say that I came down with altitude sickness while hiking the Inca Trail, the day before descending into Machu Picchu, because my home in Colorado is at 8,400 feet above sea level. People respond: “But you already live at high altitude.” Well, I don’t live at 14,000 feet. Even worse, when flatlanders come to visit me in my home, I tell them to drink lots of water to avoid altitude sickness. So take a wild guess at what brought on my Peruvian misery ...

Our trail camps were at 8,000 to 10,000 feet above sea level, but within the course of a day we climbed up to 14,000 feet and back down to 8,000 feet … a relatively steep and rapid ascent and descent. Cresting the mountain pass I could barely put one foot in front of the other; I felt 800 years old. By the time I recognized the symptoms, though I was already descending toward camp, it was too late. My stomach would keep nothing down, not even water. Then dry heaves overtook me. Stubbornly, I rebuked my guide’s suggestion that I have the porters help me. But eventually I became so weak I couldn’t walk without help, and in the end, the porters literally carried me into camp.

The practical lesson:  Stay super hydrated at high altitude; drink until you think the rivers will run dry. I was taking some medications that raised one’s susceptibility to dehydration, and I neglected to compensate by drinking even more water. The high altitude exacerbated what otherwise might have been a simple mild case of dehydration.

This was a proverbial trip of a lifetime … my dad, whose health was failing, had been dreaming of a trip to Peru with family for ages. I myself was incredibly excited to see Machu Picchu, but as I stumbled toward it, I wanted nothing more than to curl up on the ground and sleep. I looked at my dad, carrying on with Parkinson’s Disease dragging down his heels, and knew I couldn’t ruin this time for him.

You know that Nat King Cole song, “Pretend you’re happy when you’re blue …?” I descended through the misty Cloud Forest that day determined to follow Mr. Cole’s advice. So… Puke, smile. Puke, stumble, smile. Dry heave, stumble, cry, smile. Dry heave, ask God to kill me now, smile. It took my mind off my misery to pay attention to, and try to appreciate, every detail I could. I asked my husband to take pictures of pretty birds and flowers I saw because I couldn’t hold a camera myself.

Once I was back at about 8,000 feet in that night’s camp, I made a full recovery by the next morning. Though still feeble from the ordeal, I spent the following day wandering around Machu Picchu – continually drinking water, of course. My family thought I should rest, but this was my one opportunity to explore the ancient city; I knew I would have plenty of time to sleep on the train back to Cusco. Many fellow trekkers on the train recognized me as the girl who had been carried into camp the night before. While my husband regaled them with pleasant tales of incessant puking, I curled up contentedly and fell into dreams, happy I had rallied to experience Machu Picchu to the best of my ability.

My insight:  Don’t presume you are immune to any illness. I failed to recognize the early symptoms of altitude sickness because I sincerely imagined that my high-altitude home properly prepared me … I attributed the signs to other causes. Severe altitude sickness can be life-threatening; I was fortunate to have only moderate symptoms.

(2) Beijing, China.

So there I was in a taxi cab in the middle of Beijing. Six lanes of bumper-to-bumper traffic going one way. We were in lane three, the dead middle. Nausea began overtaking me about 20 minutes into the 45-minute cab ride I had secured across town. I began slumping in my seat, my arms wrapped around my stomach. Then my head flopped against the window. I had taken Mandarin lessons to get myself around and fed, but my skills were basic. I tried to get the cab driver to pull over, to no avail. I curled into a fetal position, but he seemed unconcerned, if puzzled. I begged to pull over, but he was focused on the address that I’d originally given him. He said, “We’re not there yet!”

“I know! I want to get out here.”

“But we’re not there yet.”

“Now I want to go right here.”

“But there’s nothing here.”

“But I feel bad, I need for you to let me out.”

“But we’re not there yet.” 

Ironically, during this trip, he was listening to a cassette tape of a basic English language course. I gave up trying to talk in Chinese, afraid the next time I opened my mouth something besides words would come out. I stayed curled in a ball and watched the enormous city creep by.

The practical lesson:  Have in your arsenal of communication skills a sure-fire way of convincing someone you’re sick, short of having to collapse on their feet. Perhaps this is the best argument for carrying a small phrase book with you.

Finally, sweet mercy pulled us into a parking lot and I got out, shoved some money in the cabby’s hand, ran to the nearest manicured topiary bush and barfed. This was Beijing, there were people everywhere, but no one seemed to notice, and I was relieved to feel incognito despite exhibiting such poor manners. After a few more barf-oriented mishaps, I finally made it back to my hostel.  Fortunately, I’d ordered a single room with en suite bathroom. For the next eight hours I huddled over my toilet inside the bathroom where the sign on the door read, “Please do not drink the water in the toilet.”

My insight:  Remain calm. As soon as I stopped panicking over the things I seemed unable to control, I was much better able to handle the situation. That was my first solo trip in a completely foreign location, and subsequent solo trips benefited from this reminder to myself to remain calm.

(3) KwaZulu Natal Province, South Africa.

It’s my genuine belief that the best skill a traveler can have is the ability to stay up late and kick back a few drinks with the locals. You can come at me with protestations – nighttime is unnecessary, alcohol is unnecessary – but my experience has shown that’s simply the way it is. You’ll never know people and culture like you will if you can do this.

That said, I can, admittedly, get a little carried away. While I was volunteering in a Big 5 game park in South Africa to do an herbivore census … which required walking transects across the park with an armed ranger and recording data on the herbivores we encountered … I struck up a good friendship with one of the camp managers. I never expected alcohol even to be an option in a bush camp, but we drove to a tourist hotel in the park and stocked up. One night for reasons unknown … let’s just assume they were not at all reasonable … we began pouring cane alcohol directly into our beer cans. This was at about midnight, and reveille for us was 4:30 a.m. to be on the road toward our transect drop-offs by 5:00 a.m. You can see where this is going.

The first practical lesson:  Do not pour cane alcohol into your beer. The second:  Bring vitamin and electrolyte packets. Hangovers aside, your body can get unbalanced with poor eating or drinking habits on the road.

I have seldom cursed myself so vehemently as I did that day, as we tromped up and down hills blackened by prescribed burns in the glaring African sun. I felt miserable. Each day had its own heart-thumping animal encounters with elephants or lions, hyenas or buffalo, or in particular, rhinos. Thank goodness that day, all confrontations required slow, subtle movements to diffuse. If my ranger had told me to run or climb a tree, in my compromised state, I think I would have been a casualty. I had no energy for such an endeavor.

My insight:  Prioritize. I like getting to know people over a drink, but I was there in that park to know and experience the wildlife in a rare opportunity of walking alone through Big 5 territory with only a ranger. Whether in reference to drinking, or any other activity, make sure you don’t sabotage your own ability to experience whatever it is you traveled around the globe to do. (You can read all about my amazing experience walking through this park HERE.)

(4) Bratislava, Slovakia.

Here, in a run-down old Communist hotel, I had the pleasure of being the sickest I’ve ever been in my life. A strange harbinger of things to come, it’s the only hotel I’ve stayed in during a fairly broad travel “career” where we were handed a list upon check-in of financial penalties that would be assessed for various infractions against hotel property. Of all things, listed in the number one infraction slot was, “Vomit disinfection.”

I’ll sum up by saying that my body had decided it needed to evacuate every single molecule from the entire tract of my digestive system. It decided the most expedient way to do this was to expel from both ends simultaneously, and some unfortunate decisions had to be made between courting the toilet or the sink. Despite the coordinated effort of my top and bottom ends, it took nearly 10 solid hours to accomplish the task.

This hotel was essentially formed concrete. Even the beds were poured from the same concrete as the walls and topped with a thin mattress. I’m not sure exactly what the maids did, but cleaning didn’t appear to be a very high priority. As I lay on my bed between the countless rounds of expulsion, while my husband read a book out loud to me, I would look up and stare at the dead bugs that had been smashed on the concrete wall and left hanging, literally like trophy heads above a mantelpiece. It was so hot in the room, we had to open the door to get a cross-breeze with the window, so everyone on that floor got to share the soundtrack of my ordeal.

The practical lesson:  I don’t know ... perhaps be wary of the food in a place clearly prepared for you to start vomiting.

My insight:  I think what I can say of this experience is that it, like no other, helps me remember that present hell makes future humor. If you’ve tried to appreciate your surroundings and tried to be happy when you’re blue, if you have remained calm, and you are still in absolute hell … just remember that light at the end of the tunnel: someday you will laugh about it. Or at least write about it! 

(5) Fort Portal, Uganda.

The morning I left Entebbe for Fort Portal by public bus, I felt awful. I continued to feel worse as the day went on. Marooned and nauseated on the bus in the Kampala bus park until it was full enough to leave for Fort Portal, I was convinced I was going to be sick. Hot and stuffy, no AC, I hung my head out the window like a dog, panting. I asked my local friend who was escorting me if he would be embarrassed if I barfed out the window.

“Yes,” he replied. 

He was nice enough, however, to negotiate a plastic bag from a vendor that I could puke in if necessary. It was a miserable ride and though I never needed the plastic bag, my stomach was steadily invaded by what felt like a set of freshly-sharpened knives, and they stayed there for the following two days, piercing my stomach with pain.

Two practical lessons:  One: carry an antibiotic like Ciproflaxin in your traveling first-aid kit. It may or may not cure an illness, but you’ll be super psyched if it does. Second, though I tried to remain calm, I became quite stressed over the possibility of needing to get sick on the crowded bus and not having a barf bag. It’s not a bad idea to have a disposable bag accessible if you’ll be traveling by public transport, particularly in less-developed countries … who knows what could overtake you in the course of an 8-hour trip.

I decided to try my best to experience what I could rather than remain locked in my hotel room in Fort Portal. So I booked a daytrip through the Crater Lakes area. I paid extra and had a private guide. If I did become too ill to travel, I could just ask my guide to take me back to the hotel, and I would not put out any other tourists who might have booked the same tour with me. It was a beautiful and interesting experience, and though I was in quite severe pain all day, I couldn’t be more thankful for the decision I made.

Since that was a success, I booked a hiking trip through the lower Rwenzori mountains for the following day. I slept poorly and began the trek with knives still twisting around in my gut. I guess I hadn’t paid much attention to the itinerary that had been given me when I booked. When my guide, Rose, led me inside a hut on the hillside, I thought maybe she was visiting a friend or something. We sat on a low bench against the mud wall.

“Have you formulated your questions for the witch doctor yet?” she asked me.

“What?”

I was very surprised by this situation. No, I hadn’t formulated any questions for him to divine the answers to because I didn’t know we’d be visiting him. It took him quite a while to prepare, though, donning a series of animal skins on his head and chest, and laying another down on the floor, leveling and preparing his wooden bowl of water and sticks.  So I used the time to think up some, and his responses were certainly interesting.

My guide had a burning question also, and it was a very complicated issue, for it took a long time for him to settle it. While I was sitting there, as the witch doctor and Rose carried on, I realized that I had no pain in my stomach. None at all. I had not mentioned my illness either to the doctor or to Rose. The very first thing the doctor had said to me, though, before he told me to proceed with questions, was that someone was bothering me, causing me grief. I presumed he meant a person, and this happened to be somewhat true. But as I sat there suddenly pain-free (and remaining so after I left), I wondered if he had alluded to something different. Could he have influenced an evil spirit of illness to leave me alone? (You can read a more detailed account of my visit with the witch doctor HERE. It was far more involved and bizarre than briefly summarized here.)

My insight:  This was a nice lesson that the world works in mysterious ways. It could have been simply coincidence that I abruptly recovered inside a witch doctor’s hut, but it could have been the result of a power beyond my knowledge. Because I got outdoors and didn’t abandon the experiences I had traveled to the Rwenzoris to have, despite my pain, I had a unique opportunity to contemplate the existence of the mystic in my own life.

In sum:  You can never be too prepared. Research where you’re going, check the CDC website for recommended shots and inoculations, carry a first-aid kit equipped with recommended medications and medical supplies for all situations (especially nausea and traveler’s diarrhea), get travel insurance that includes emergency evacuation, etc. Anything can happen.

When I mentioned to friends I felt very ill in Fort Portal, they gave me a good ribbing. They aren’t mean people, it was just a bit ironic that I had had a total of eight inoculation shots before leaving for Uganda. They laughed, "All those shots, and you still got sick!"

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ENDNOTE:  I wrote an entire essay, published in Cutbank, centered around the Slovakia incident; you can read it here: Aluminum Dreams. I wrote a long Tuesday Tale about a painful accident I suffered in Hawaii; you can read it here: Dreams and the Olive Death Pools. What I did not mention in either piece was the connection. My Slovakia ordeal ended when I finally vomited out two little black strings, probably half a centimeter long each. They slid down the sink drain, it was pretty weird. The very next morning, a piece of black volcanic rock that had been lodged inside my shin since the Olivine Death Pool incident in Hawaii had finally worked its way to the surface of my skin, precisely one year from the day of the accident. I grabbed the tip that was now poking out of my skin with tweezers, and pulled the rock bit out of my leg. I can't help but wonder if those two black strings that finally came out of the depths of my stomach were also bits of rock I ingested that day. To me, it seems pretty coincidental. After a year, my body just said, "OK, everything must go!" But who knows, the meat I had for lunch could have been undercooked. Perhaps it was a conspiracy with the hotel for them to be able to collect vomit disinfection money. haha.

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Learn some practical local remedies I've learned on the road