Top five things to look for in a travel doctor, and why you should have one

travel doctorsDespite writing about food and adventure travel for a living, I used to be somewhat blasé about the concept of travel medicine. Multiple incidents of Giardia/dysentery/traveler’s diarrhea/full-body outbreaks of mosquito and sand fly bites just taught me to carry a serious stash of antibiotics in my first-aid kit. At least I’ve always been conscientious about travel immunizations and educating myself about the primary diseases indigenous to my destination.

When you’re young and healthy, it seems silly to have a travel medicine specialist. Although this article is primarily directed at adventure travelers, odds are, the worst thing you’ll come home with is a backpack full of crappy souvenirs. But no one’s invincible, and should you require a specialist for something not responding to conventional treatment or with progressive symptoms, time is of the essence. Many “exotic” diseases progress rapidly, and can cause irreversible damage or death if not properly diagnosed and treated. Even with incurable diseases, the earlier you catch them, the easier it will be to manage symptoms and prevent them for worsening.

No, I’m not a doctor, although I come from a medical family. But I got seriously schooled after visiting Ecuador two years ago. After a fantastic month of adventure activities in remote parts of the Andes and Amazon Basin, I fell seriously ill the last day my trip. Two years of at-times crippling symptoms, 10 CT scans, five medical facilities, dozens of specialists, four surgical procedures, two surgeries, one cancer diagnosis, and near-medical bankruptcy later, I’ve become an expert at being my own advocate.

My infectious disease doctor believes that I contracted a form of bartonellosis called Oroya Fever after being bitten by sand flies. The good news: My health is currently stable, but we don’t know if the disease is in remission or not. But I have permanent cognitive damage, scarring or tumors on most of my internal organs, and intermittent arthritis. But believe me, I feel lucky.

I don’t want anyone to go through the health and medical nightmare I’ve endured, so I’ve compiled a list of essentials in a travel medicine doctor. Ergo, number one with a bullet:

1. Is he/she a travel or tropical medicine specialist?
Pre-bartonella, I used an internist as my GP/prescriber of antibiotics. If you can find an internist, gastroenterologist, or infectious disease doctor who is also a specialist in travel medicine, that’s a huge plus.travel doctors 2. Does he/she have personal experience traveling or practicing in developing nations?
There are a lot of practicioners who aren’t globally aware, so to speak. You can’t diagnose what you don’t understand, know about, or have first-hand experience with. Period.

3. Is he/she a good listener and empathetic?
It’s difficult to find these qualities in any doctor, especially in today’s medical climate. But it’s imperative to find someone you can communicate with, and who understands what you’re going through if you’re suffering from a mystery travel ailment. Don’t settle, even if you need to travel to another state or country to seek treatment (what stumps doctors here is often commonplace in the country of origin).

4. Does he/she have a good network of colleagues in multiple specialties (including travel/tropical medicine) to consult for additional opinions?
My current mantra is to seek a third opinion, from at least two different medical facilities. That, and to have a travel physician who actively consults colleagues and does additional research to assist with a diagnosis and/or treatment. My infectious disease doctor talked to specialists at a medical school in Peru on my behalf, and even tracked down a relevant medical paper from 1897 as he honed in on a diagnosis. And while I wouldn’t consider it a deal-breaker if the answer is no, see if your doctor is an active and participating member of the International Society of Travel Medicine.
travel doctors
5. Does he/she return your calls/provide you with email, pager, or office number so you can get in touch directly?
I’ve learned that a good doctor who is invested in your recovery will provide an open line of contact to address questions, concerns, and exchange pertinent information. Tip: Please don’t abuse this privilege. Physicians work insanely long hours, under constant stress. And don’t expect to hear back immediately if you leave a non-urgent message; be realistic. A couple of days, fine (many specialists aren’t in clinic every day). A week? Make a polite follow-up.

Whether or not you end up getting a travel doctor, the International Association for Medical Assistance to Travelers (IAMAT) provides loads of useful information, including a directory of global travel medicine clinics with English-speaking staff, and a destination-specific travel health planner. And depending upon what you plan to do on your trip, where you’re traveling, and your financial situation, you may want to invest in travel insurance.

[Photo credits: blood transfusion, Flickr user CarynNL;patient, Flickr user kk+; legs, Laurel Miller]

The Ultimate Travel First Aid Kit

Knocked up abroad: pregnant travel in the first trimester

pregnant travelFor more on pregnant travel, see parts 1 and 2 of Knocked up abroad: pregnancy in a foreign country here and here.

There’s no question that having a baby changes you: your body, your lifestyle, even your shoe size. One thing I hoped not to change altogether was traveling, as long as it was reasonably safe and comfortable for me and the baby. From the beginning of my pregnancy in Istanbul, my doctor has okayed travel, as long as I get up to stretch frequently on flights and try not to overdo it. Most doctors (and mothers) agree that the second trimester is the most comfortable time for pregnant travel but the first trimester can be a good time as well (while you can still squeeze into pre-maternity clothes and walk without waddling) with a little extra precaution and a little more babying (of the mother, of course).


The first trimester of pregnancy is a tricky time for many women: the risk of miscarriage is highest up to 10 weeks, morning sickness is common, and hormones are running wild. It’s too early to tell anyone outside family or close friends and without a visible belly, it’s impossible for strangers to tell as well. At later points in your pregnancy, a baby bump acts as the international symbol for pregnancy and can make it much easier to express your condition when traveling abroad. If you travel in the early months before showing, you may want to learn the local language words for “I’m pregnant” to avoid a Bridget Jones-esque “mit kinder” scene if you need extra help while traveling.


Over this past December, my husband and I were looking for a good trip to take over the holidays, when I was around 10 weeks pregnant. Our location in Istanbul changes the list of short-haul destinations considerably from what we would have considered from New York, and we debated between a warm-weather beach destination (husband) or a snowy and “Christmassy” European city (me). We ruled out Egypt (not warm enough and not Christmassy), New Zealand (even less convenient to get to than from New York), and Sri Lanka (not enough time to plan properly and some risks of disease I couldn’t be vaccinated against). In the end, we chose…Russia.
Going to Russia in winter while pregnant may seem crazy to some, but for me it made sense: Moscow and St. Petersburg are a few hours from Istanbul by direct flight, my husband speaks fluent Russian in case of any problems, and there was no risk of malaria or eating any food that had spoiled in the sun. While it was cold and snowing during our trip and I couldn’t take advantage of some of Russia’s cold-weather remedies like vodka and saunas, a week in Moscow and St. Petersburg was a perfect mix of exotic and comfortable.

Nearly every cafe had a variety of non-alcoholic and caffeine-free beverages for me to choose from, I even had non-alcoholic sangria, mojitos, and mulled wine in addition to fresh juices and herbal teas. Both cities are beautiful to explore in the snow, with plenty of museums and cafes to warm up in, and the New Year holiday displays made it festive.

If you are planning a trip to a foreign country while pregnant, it makes sense to keep in mind the following guidelines. Always discuss plans with your doctor before booking and err on the side of caution when choosing a destination.

Check airline restrictions – Most airlines allow pregnant women to fly internationally up to 28 weeks, after which you must provide a doctor’s note issued within a week or so of departure. 35 weeks (earlier for women carrying multiples) is the cutoff for nearly all airlines to prevent women from giving birth on board. Most US domestic carriers will allow pregnant women to fly up to the final month; hilariously, Continental will not let women board if “physical signs of labor are present” though they don’t specify what.

Consider travel insurance – If your medical insurance doesn’t cover you overseas, you may want to look into supplementary medical travel insurance, but be sure it covers pregnancy as many policies do not. Additionally, if you are traveling to a country where English is not spoken, you may want to research the name of a clinic or doctor in case of emergency as well.

Be prepared for jet lag – Before pregnancy, I had little issues with jet lag, trying to get on local time as soon as possible. I discovered when flying back from the US to Turkey that it hits you much harder as a pregnant traveler, especially as you can’t use sleeping pills or alcohol to help you sleep. Factor this into your schedule and give yourself plenty of time to acclimate and adjust to time changes.

Realize your limits have changed – On a usual trip, I’d be up early to walk around a city all day, have a late lunch (or maybe just a big afternoon beer) followed by more museums and exploration, and still be up for checking out the local nightlife. Once pregnant, I required more sleep and three solid meals a day (plus maybe some snacks, I am eating for two!), tired after walking short distances, and was ready to call it a night long before last call. If you have an itinerary, pare it down to the must-sees and double the time to see everything; better to take it easy and enjoy your trip than feel exhausted and sick.

Look for destinations that don’t require vaccinations – One of the first tests your doctor will give you after confirming pregnancy will be for immunizations to hepatitis and rubella. If you haven’t had the vaccines, they will have to wait until after the baby is born as they are not safe for pregnant women. I have not had the hepatitis vaccine yet, and thus have a greater risk of contracting it, which rules out much of Africa and southeast Asia for travel, but also means I must avoid raw vegetables including salad in Istanbul. Most other medications and vaccines commonly given to travelers before going to an area prone to Malaria, Typhoid or Yellow Fever are not advised for pregnant women. But there’s still a big world out there, check the CDC for destination-specific information.

Be extra aware of food and water safety – Pregnant women are more susceptible to food poisoning the average person, as the immune system is suppressed so it doesn’t reject the fetus. This is the reason most pregnant women are told to avoid sushi and food that is not prepared in sanitized conditions. Even adventurous eaters should play it safe while pregnant and drink bottled water when in doubt. I recently had an opportunity to visit Mumbai, India but after consulting with a few friends who had lived there, I worried I’d spend the trip inside my hotel room eating pre-packaged food. Again,

check the CDC and use the same common sense you’d use anytime while traveling: stick with food that is freshly prepared in restaurants full of people.


Stay tuned for more on pregnancy travel, including Turkish superstitions and customs, travelling in the second trimester, where to do pre-baby shopping, and more on having a baby in a foreign country. Check here for further updates.

[Photo courtesy Mike Barish from the Istanbul tram]

Top fifteen items to have in your travel first aid kit

travel first aidEven if the worst travel-related malady you’ve suffered is a touch of turistas, it pays to pack at least a few first aid essentials in your luggage. If you carry nothing more than Band-Aids, moleskin, Neosporin, and Pepto-Bismol tablets, you’re set for minor emergencies that might otherwise derail a day of sightseeing.

If, however, you travel frequently/do adventure travel/spend time in developing nations, it pays to have a fully-loaded first aid kit. It’s no substitute should you get seriously ill or injured, but its contents can likely stabilize you until you’re able to get medical assistance

You don’t need to spend a lot of money on a kit, either. You can pick one up for as little as $12 at REI, and augment it as needed. The most expensive thing is filling prescriptions for antibiotics (just in case) before you leave home. Cipro is really pricey, but broad-spectrum drugs like Doxycycline are very inexpensive.

Below, my picks for travel first aid kit essentials.

1. Band-aids/gauze pads/moleskin (for blisters)

2. Surgical tape
Use it to hold dressings in place, or to strap sprains or strains. A roll of this saved my ankle after a bad fall while backpacking.

[Photo credit: Flickr user ffi]travel first aid3. Sewing needle and safety pins
Sterilize and use to drain blisters, remove splinters, or make a makeshift sling.

4. Small mirror
Useful if you get something in your eye or have a facial injury. If you’re the outdoorsy type, it’s an emergency kit essential for signaling should you get lost.

5. Prescription drugs
All of your regular prescriptions, as well as antibiotics or other meds prescribed by your doctor. Be sure to keep them in their original bottles, and carry copies of your prescriptions with you.

6. OTC drugs
Imodium, Pepto-Bismol tablets, antihistimines, Pepcid, ibuprofen, eye drops. For women: Uristat and an OTC or prescription for yeast infections. Comprehensivey, these meds cover a wide range of ailments, from food-borne illness to allergies, but reserve the Imodium only for emergency situations where you must travel (it’s a potent anti-diarrheal).

7. EpiPen
This isn’t just for those with known anaphylactic allergies. When you’re traveling abroad, you never know what might trigger a reaction; it’s also possible to develop a sensitivity to things you haven’t previously had a problem with.
travel first aid
8. Alcohol wipes and hand sanitizer
Sterilize your hands, implements like tweezers, even wounds, if necessary. Sanitizer is something you should be in the habit of carrying when you travel, regardless.

9. Tweezers and non-safety nail scissors
Remove splinters and insect stingers, cut surgical tape or bandages; there are endless uses for these two.

10. Thermometer
If you develop a sustained fever of 100.4 or higher, it’s time to seek medical attention.

11. Electrolyte powder packets and Emergen-C
If you’re suffering severe diarrhea or vomiting, it’s absolutely essential you rehydrate and replenish electrolytes. If you have access to Gatorade, you can down that, along with bottled (if necessary) water. I use Airborne and Emergen-C after long flights and at other times I need to keep my resistance up, or if my immune system is taxed.

12. Antibiotic ointment and hydrocortisone cream
Don’t underestimate the importance of these two, especially if you’re traveling in the tropics, where things tend to fester, or you have a coral cut, serious blister, sting, bite, or rash.
travel first aid
13. Matches
Sterilize needles or safety pins; matches are also an essential for wilderness emergency kits. Store in old film canister or Rx bottle to keep dry. You can additionally waterproof by painting the tips with nail polish.

14. Ziploc bags
You never know when these will come in handy. You can make an impromptu ice pack, store creams and ointment in them to prevent spillage, use them as an extra layer to keep meds dry, etc..

15. Mini first aid or wilderness safety manual
If you’re traveling long-term or spending lots of time outdoors, you’ll find this useful at some point. Many first aid kits come with one.

[Photo credits: knee, Flickr user Sukianto; Pepto-Bismol, Flickr user chris.corwin;dressing, Flickr user tiny_packages]

Ask Gadling: You develop a serious illness while traveling

serious illness while travelingThe very thought of acquiring a serious illness or injury while traveling strikes fear into the hearts of even the most stalwart adventurers. Speaking from personal experience, it’s terrifying to find yourself alone (or not) in dodgy accomodations, in a remote area of a developing country, with a raging fever and/or an uncontrollable case of the runs or other unsavory symptoms. Which isn’t to say the same ailments suffered in the comfort of a five-star hotel in Paris are a picnic, either. Any way you slice it, getting sick in a foreign country sucks.

And sometimes, despite taking precautions, you fall ill anyway, as I can attest. It can be a matter of circumstance (That water my guide “boiled” in a bamboo culm on a Thai Hilltribe trek? Yeah, I pretty much saw the resulting case of dysentery coming), or just bad luck. I’ve been on my own during most of my unfortunate on-the-road maladies. Between my experiences and those of fellow travelers, I’ve accumulated some wisdom over the years for dealing with sudden-onset illness in less-than-ideal circumstances.

For the purposes of this article, I’m not going to include injuries, pre-existing conditions, or focus on food poisoning, which was well-covered in a previous Ask Gadling post by Melanie. I also want to stress that we’re not medical professionals here at Gadling, myself included. For the technical stuff, I turned to Dr. John Szumowski, Clinical Fellow of University of Washington Medical Center’s Division of Allergy and Infectious Disease.

After the jump, tips on prevention, what to do when illness strikes, and how to get yourself home in the event of a full-blown medical emergency.

[Photo credit: Flickr user MoHotta18]

serious illness while traveling

Before you leave home

Hit the internet
Do a bit of research on emergency medical options for a worst-case scenario. The U.S. Department of State produces a list of American doctors and hospitals in foreign countries.

If you have specific questions (about, say, where to find the best dentists in Europe), Lonely Planet’s Thorn Tree travel forum can be a useful place to get ideas (please do additional research before following any advice). Take the diagnostic-related questions directed to forum members with a heaping grain of salt, and save them for your doctor.

Get vaccinated
Check the CDC’s (Centers for Disease Control and Prevention) website to see what, if any, vaccinations you need before your trip. You can also get updates on things like outbreaks of cholera or bird flu. Be sure you allow ample time before your trip for the protective effects of vaccines to establish themselves. Dr. Szumowski also recommends the CDC’s “Survival Guide to Safe and Healthy Travel” webpage.

View more Ask Gadling: Travel Advice from an Expert or send your question to ask [at] gadling [dot] com.

Keep an immunization card on you (some countries require proof of certain vaccinations) as well as an online record, like Google Health.

All travelers should get flu and tetanus shots. If you’re a frequent world traveler, get vaccinated for hepatitis A, typhoid, and polio. Depending upon where you’re traveling, you may require a Yellow Fever or Japanese Encephalitis vaccine, or malaria prophylaxis.

I used to think a rabies vaccination was overkill until I saw a fellow traveler get seriously nipped by a puppy we were playing with in a remote village near the Myanmar border. The deathly silence that followed was sufficient motivation. Adds Dr. Szumowski, “It’s still important to remember that excellent wound-care and post-bite medical evaluation are necessary, even if a person has had prior rabies pre-exposure vaccination.” The International Society of Travel Medicine has a list of global travel medicine clinics.

I also carry an EpiPen, because you never know what could trigger anaphylaxis while you’re abroad. It also bears mentioning that you can develop a life-threatening allergy to something previously benign. A chef I know went into anaphylactic shock after tasting one of his dishes containing taro root, even though he’d been cooking with it for over 20 years.

If you get sick

Stay calm, and assess your symtoms
It’s easy to get carried away and assume the worst, but odds are your sudden fever isn’t malaria.
serious illness while traveling
Try to identify the source of infection or illness

Know when to seek professional medical assistance
In general, says Dr. Szumowski, some symptoms or exposures that should prompt “expeditious” medical evaluation include:

  • high fevers (over 101ºF, especially if sustained or accompanied by shaking or drenching sweats)
  • bloody diarrhea
  • inability to keep food or liquids down in situation of significant vomiting or diarrhea
  • confusion or severe headache
  • severe cough, especially if accompanied by shortness of breath
  • animal bite or other animal-related attack

Tips for self-care

Stay hydrated
If you’re vomiting or have diarrhea, stay hydrated with (purified/bottled water), and Gatorade or other electrolyte beverages. If you absolutely have to travel, take Imodium as an anti-diarrheal.

Eat bland foods
Remember the BRAT diet for gastrointestinal upset: rice, bananas, applesauce, and toast.
serious illness while traveling
Control your fever
To lower a high fever, take the recommended dosages of acetaminophen (Tylenol) or ibuprofen (Advil).

Wear ID
Wear a medical alert bracelet for serious conditions, allergies, etc., Write down your condition in your destination country’s language in both your phrasebook, and place a card in your passport.

Emergency Measures

Know when to self-diagnose
Sometimes, you find yourself in a position where you have no other option. That said, this is something you want to avoid for obvious reasons. Says Dr. Szumowski, “Self-diagnosis and treatment can be appropriate for less serious conditions such as traveler’s diarrhea, but it is important not to delay evaluation by a medical professional for more serious illness [see warning signs above]. If someone chooses to self-treat, it’s important to be aware of potential for counterfeit medications locally.”

What if the only available hospital/clinic/doctor’s office is seriously sketchy?
If you’re in a situation where the medical facility is primitive/lacking in sanitation, you’ve got a tough call on your hands.
serious illness while traveling
I posed this question to Dr. Szumowski. He says, “It depends on the acuity and seriousness of the condition. In general, evaluation and treatment in a facility with adequately-trained staff and more comprehensive resources is preferable whenever possible–this may mean seeking evaluation in the capital, at a private hospital, or even returning home. Aside from limited diagnostics and medications, smaller/less-resourced facilities may have inadequate sanitary practices (e.g. reuse of equipment) and screening of blood products, raising the risk of contracting pathogens such as hepatitis C or HIV. Therefore, having evacuation insurance is advisable, especially for extended travels in the developing world.”

In other words, you may be shit out of luck. But this is why you’re reading this article–so you can be prepared for all kinds of situations! Read on.

OTC antibiotics
In many countries, you can buy OTC antibiotics, and indeed, this may be your only option, but heed Dr. Szumowski’s warning, above. Caveat emptor.

If you need to be evacuated, the U.S. government offers financial assistance and/or repatriation loans. The American Citizens Service and Crisis Management (ACS) is linked to U.S. embassies and consulates all over the globe. It’s a good idea to enroll in the U.S. Department of State’s “Smart Traveler Enrollment Program (formerly known as “Traveler Registration)” if you’re traveling for a long period of time, to a high-risk region, or doing any extreme adventure activities.

Travel prepared

Get antibiotic prescriptions (and carry copies with you) from your primary care doctor or internist, or visit a travel medicine clinic, and pack them in you travel first-aid kit (You don’t have one? REI has some great options). Some people also carry sterile latex gloves and hypodermic needles with them. If you’re diabetic or have another condition that requires injections, this makes sense, provided you have a note from your medical provider. For everyone else, this is a personal choice that comes down to, “How comfortable are you with the knowledge that you’re carrying drug paraphernalia?” If you backpack, travel in places with notoriously corrupt law enforcement, or countries like, say, Malaysia, you may want to hedge your bets.
serious illness while traveling
Email yourself and family or a trusted friend copies of medical insurance, itinerary, and a list of medications, and doctors.

Consider traveler’s insurance.

If the worst happens

In the highly unlikely event you do come home with a mystery disease that isn’t responding to medical treatment, get to a specialist, asap. Depending upon where you’ve been, this may be an infectious disease or tropical medicine doctor, a dermatologist or rheumatologist who specializes in tropical medicine, etc.. You may need to travel–out of state–to find the right specialist. Find someone who has first-hand experience traveling/training or practicing in developing countries, and in diagnosing diseases not found in the U.S.. It may even be best to try and seek medical treatment in the country where you became ill (even if that means a return trip).

Unfortunately, I can speak with authority this subject, because I’m in my 22nd month of diagnostics following a trip to South America. If you do find yourself harboring a travel-related (or not) disease that defies diagnosis, you must be your own advocate. No one is more invested in your health than you are, and doctors are human. They may make mistakes, despite their best intentions. Seek not just a second, but a third opinion, from at least two different medical facilities.

And finally, don’t let anything in this article scare you and put you off travel. Odds are, you’ll come home with nothing more than great memories, and the eagerness to plan your next trip. I know I can’t wait.

[Photo credits: vaccination, Flickr user alvi2047; mosquito, Flickr user tonrulkens; toast, Flickr user snowriderguy; farmacia, Flickr user ibirque; drugs, Flickr user cavale]

Five tips to reduce your health risk while eating street food

It was the 18th century food writer and gastronome Jean Anthelme Brillat-Savarin who famously said, “Tell me what you eat, and I’ll tell you what you are.” For certain cultures, street food is more than just a cheap, tasty, easy way to fuel the body. It’s part of a daily ritual, a way to catch up on neighborhood or community gossip, a means of eking out a living to provide for one’s family. By eating foreign street food, you get a sense of the social fabric and gender roles of a community or culture, but what about the health risks?

Some travelers equate a love of street food with a latent wish to sightsee whilst wearing an adult diaper. They steer clear of anything sold from a vendor, or resembling fruit, vegetable, or beverage not from a bottle (although when it comes to drinking water, you should always err on the side of caution, and there is something to be said about peeling or washing produce to avoid pesticide residue, since many developing nations use chemicals banned in the U.S.). What these folks may not realize is that foodborne illnesses such as E.coli, salmonella, and listeria don’t discriminate. FDA statistics show you’re more likely to get sick from preparing food at home than from dining in a domestic restaurant.

Is street food inherently more risky than eating in a restaurant when you travel? Sometimes, and it depends. Children, the elderly, and those with compromised immune systems are certainly more at risk of getting ill, and may be best off avoiding street eats. But there are certain precautionary measures healthy travelers can take before scarfing their tacos or mystery-meat kebabs that will minimize the chances of bringing home more than just a suitcase full of sweatshop-made tchotchkes as souvenirs. Read on.

1. Is there a crowd? Just like at home, go where the locals go, as they obviously know where to find the good stuff. But high volume also means that food is being prepared fresh, rather than sitting around attracting flies and turning into something useful for waging biological warfare.

2. Are basic hygiene practices being implemented by the vendor(s)? In Mexico, I’ve frequently observed street vendors slipping clean plastic bags over plates. With every order, a new bag is used, then discarded at the end of the meal. It’s an eco-nightmare, but it’s a lot more sanitary than dunking a plate in a bucket of dingy water doubling as a petri dish. Also bear in mind that in many parts of the world, the left hand performs double-duty as toilet paper. I can’t say it enough: Look at the sanitation practices before ordering.

You’ll often find co-workers whose sole responsibility is to handle money, to avoid cross-contaminating food (this isn’t always the case, however, so sometimes you’ll just have to–literally–suck it up). Once, when I accidentally handed my money to the wrong guy, he turned his hand upside-down to avoid contact with my filthy coins.

3. Is the stand or cart clean and well-maintained? Is hot food kept hot or cooked to order, and is cold food cold? Is purified water or ice used for beverages and frozen treats?

4. Are the ingredients fresh? If you’ve got eyes, a nose, and some tastebuds, you can figure this out for yourself. I look at the condiments and garnishes to determine if I want to eat at a given stand or cart. If I see crusty bowls of salsa, dessicated limes, slimy herbs, or flies congregated on any raw foods I might potentially eat, I’m out of there.

Stick to local specialties. One of the greatest joys of travel is eating regional ingredients or dishes. It also stands to reason that ordering seafood in an inland desert is a calculated risk. Raw protein products (egg, meat, poultry, fish, fresh cheeses) in general are to be avoided in the Third World. What about dishes like ceviche, where the acid in the citrus juice denatures (breaks down proteins, killing some potential pathogens in the process) the fish? It’s still risky, because technically it’s an uncooked food, and only application of heat over 145 degrees can totally annihilate anything potentially deadly lurking in fish. Again, use good judgment based on freshness of ingredients and basic sanitation, but remember that you can’t eliminate all risk.

If you’re in a coastal region, it pays to do a bit of homework on the cleanliness of the local fresh and ocean water supplies; algae blooms or cholera outbreaks will be widely reported. Try to avoid eating raw river fish or seafood, or river fish/seafood from just offshore; remember that many developing island nations and coastal regions use high tide as their toilet. If you’re eating pork in the Third World, always make sure it’s well-cooked. While trichinosis has effectively been eradicated from our domestic industrial pork supply, the disease is prevalent in other parts of the world. And not to get too graphic, but you’ll often find pigs in rural parts of the developing world lurking around latrines, searching for a snack.

Fresh ingredients don’t necessarily mean great food, but it helps. Delicious street food is ulimately a reflection of the loving care that goes into its preparation. Are the carnitas slightly crispy on the outside, with an interior succulent with greasy goodness? Is the masa in the tamales moist, with a sweet, earthy corn flavor? Are the noodles slightly toothsome, the herbs fresh and bright-tasting, the broth fragrant and piping hot? These things matter.

5. Use hand sanitizer before eating, take probiotics with live active cultures prophylactically, and pack a broad-spectrum gastrointestinal antibiotic and Imodium, just in case. I’m just sayin’.

For more information on food safety, go to this page on the USDA website.