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Travelers' Diarrhea (or the Montezuma's Revenge)
Travelers' Diarrhea (TD )
TD is a syndrome characterized by a twofold or greater increase in the frequency of unformed bowel movements. Typical associated symptoms include abdominal cramps, nausea, bloating, urgency, fever, and malaise.
An important determinant of risk is the destination of the traveler. High-risk destinations include Mexico. TD is usually acquired through ingestion of fecally contaminated food or water, or both. Both cooked and uncooked foods might be implicated if they have been improperly handled. Tap water, ice, and unpasteurized milk and dairy products can be associated with increased risk of TD.
No data have been presented to support noninfectious causes of TD, such as changes in diet, jet lag, altitude, and fatigue.
Paying meticulous attention to food and beverage consumption can decrease the likelihood of developing TD. Most travelers encounter difficulty in observing the requisite dietary restrictions. Use of antibiotics is not recommend to prevent TD because they can cause additional problems.
For treatment, fruit juices, soft drinks (preferably without caffeine), and salted crackers are advised.
Travelers should be advised to consult a physician for antimicrobial drugs prescription and dose schedules rather than attempt self-medication if the diarrhea is severe or does not resolve within several days; if there is blood or mucus, or both, in the stools; if fever occurs with shaking chills; or if there is dehydration with persistent diarrhea.
Antidiarrheals can decrease the number of diarrheal stools, but can cause complication for persons with serious infections.
KEEP IN MIND
If bloody diarrhea, dehydration, fever in excess of 38°C, or persistent vomiting occurs, seek immediate medical help!
Drugs should be prescribed with caution for children, infants, pregnant women and nursing mothers.
Risks from Drink
Water that has been adequately chlorinated will afford significant protection against viral and bacterial waterborne diseases.
However, chlorine treatment alone, as used in the routine disinfection of water, might not kill some enteric viruses and the parasitic organisms that cause giardiasis, amebiasis, and cryptosporidiosis.
Travelers should be advised that only the following might be safe to drink:
Beverages, such as tea and coffee, made with bottled water or water that has been boiled for 10 minutes.
Canned or bottled carbonated beverages, including carbonated bottled water and soft drinks.
Beer and wine.
If ice has been in contact with containers used for drinking, you should clean the containers, preferably with soap and hot water, after the ice has been discarded.
It is safer to drink a beverage directly from the can or bottle than from a questionable container.
However, water on the outside of beverage cans or bottles might be contaminated also. Therefore, you should be advised to dry wet cans or bottles before they are opened, and to wipe clean surfaces with which the mouth will have direct contact.
TREATMENT OF WATER
Boiling is by far the most reliable method to make water of uncertain purity safe for drinking.
Water should be brought to a vigorous rolling boil for 10 minute and allowed to cool to room temperature; ice should not be added.
Chemical disinfection with iodine is an alternative method of water treatment when it is not feasible to boil water.
Chemically treated water is intended for short-term use only.
If iodine-disinfected water is the only water available, it should be used for only a few weeks.
Portable filters currently on the market will provide various degrees of protection against microbes.
Proper selection, operation, care, and maintenance of water filters is essential to producing safe water.
NOTE: The manufacturers' instructions for any treatment of water should be followed.
Food and Drink
CONTAMINATED FOOD AND DRINK are common sources for the introduction of infection into the body.
Among the more common infections that travelers can acquire from contaminated food and drink are Escherichia Coli infections, shigellosis or bacillary dysentery, giardiasis, cryptosporidiosis, and hepatitis A.
Other less common infectious disease risks for travelers include typhoid fever and other salmonelloses, cholera, infections caused by rotavirus and Norwalk-like viruses, and a variety of protozoan and helminthic parasites (other than those that cause giardiasis and cryptosporidiosis).
Many of the infectious diseases transmitted in food and water can also be acquired directly through the fecal-oral route.
RISKS FROM FOOD
To avoid illness, travelers should select food with care.
All raw food is subject to contamination. Particularly in areas where hygiene and sanitation are inadequate, you should avoid salads, uncooked vegetables, and unpasteurized milk and milk products such as cheese, and to eat only food that has been cooked and is still hot (vegetables and fruits should be peeled or washed in a purifying solution), or fruit that has been peeled by yourself.
Undercooked and raw meat, fish, and shellfish can carry various intestinal pathogens. Cooked food that has been allowed to stand for several hours at ambient temperature can provide a fertile medium for bacterial growth and should be thoroughly reheated before serving.
Consumption of food and beverages obtained from street food vendors has been associated with an increased risk of illness.
With improper refrigeration or preservation, histidine contained in some fishes is converted to histamine, which can cause flushing, headache, nausea, vomiting, diarrhea, and urticaria.
Cholera cases have occurred among people who ate crab brought back from Mexico by travelers.
Travelers should be advised not to bring perishable seafood with them when they return to their home-land from high-risk areas.
Gasoline and Diesel
Unleaded GASOLINE (Premium, 93 octanos and Magna sin, 87 octanos) and DIESEL are generally available throughout Mexico.
Check the fuel prices, pay ONLY in mexican pesos, and be sure that the station attendant clears the gas pump before fueling your vehicle at any PEMEX service station.
Military and law enforcement checkpoints aimed at detecting narcotics, alien smuggling, and firearms traffic are located at various places throughout Mexico.
Areas known to possess more checkpoints include the Yucatan peninsula, Chiapas, Oaxaca, Guerrero, Michoacán, Sinaloa, Baja California and areas next to the borders.
Many checkpoints will have a red flag marker and are operated by uniformed officials; however, others will not be marked and are manned by police/military officers not in uniform!
These checkpoints have 'spiked devices' and are sometimes used to deflate tires of vehicles attempting to evade these checkpoints.
Also, in some places at the borders, there are HEALTH INSPECTION STATIONS to eradicate swine fever and control inspectors may confiscate products that arrive at these inspection stations.
NOTE: Militar personnel and health inspectors may hold travelers for possible arrest by Federal authorities if travelers appear in violation of ANY Mexican laws, such as immigration, fire-arms, narcotics, etc...
Mexican Driving Conditions
For your safety, you must drive more slowly than you do at home, I mean avoid excessive speed and, if at all possible, do not drive at night.
Be prepared for a sudden stop at any time.
In many places frequented by tourists aroud the world, victimization of motorists has been refined to an art.
Criminals may offering help for tires that they claim are flat or that they have made flat.
Or they may flag down a motorist, ask for assistance, and then steal the rescuer's luggage or car.
Usually they work in groups.
Other criminals get your attention with abuse, either trying to drive you off the road, or causing an 'accident' by rear-ending you or creating a 'fender bender'.
Any case you must contact the 'Angeles Verdes' for mechanical assistence and the hihway patrol for protection.
Don't get out of the car if there are suspicious looking individuals nearby.
Carjackers and thieves operate at gas stations, parking lots, in city traffic and along the highway.
Thieves can and do snatch purses through open windows of moving cars.
Keep car doors locked at all times.
Wear seat belts.
Don't leave valuables in the car.
If you must carry things with you, keep them out of sight locked in the trunk.
When you RENT a car, don't go for the exotic; choose a type commonly available locally.
If available, choose a car with universal door locks and power windows, features that give the driver better control of access to the car.
An air conditioner, when available, is also a safety feature, allowing you to drive with windows closed.
Do not, under any circumstances, pick up hitchhikers who not only pose a threat to your physical safety, but also put you in danger of being arrested for unwittingly transporting narcotics (or narcotics traffickers) illegal immigrants in your vehicle!
Your vehicle can be confiscated if you are transporting any amount of mariguana or other narcotics.
There are military checkpoints and temporary roadblocks where vehicles are checked...
If you plan to drive, learn about your route from an auto club, guide book, atlas, the Internet or a Mexican government tourist office.
Some routes have heavy truck and bus traffic, others have poor or nonexistent shoulders and many have animals on the loose.
Also, some of the newer roads have very few restaurants, motels, gas stations or auto repair shops.
You may not be able to avoid all problems, but at least you will know what to expect if you have done some research.
For your safety, have your vehicle serviced and in optimum condition before you leave for Mexico.
If you have an emergency while driving, call from emergency phones on highways to obtain help from the Federal Highway Police and the 'Angeles Verdes' (Green Angels), a fleet of radio dispatched trucks with bilingual crews that patrol daily, from dawn until sunset. Angeles Verdes services include protection, medical first aid, mechanical aid for your car, and basic supplies.
You will NOT be charged for services, only for parts, gas, and oil.
If you are unable to call them, pull off the road and lift the hood of your car; chances are good they will find you.
Be wary of persons representing themselves as Mexican police or other local officials.
It is not uncommon for tourists to become victims of harassment, mistreatment and extortion by officials.
Travelers to Mexico should take precautions when traveling on all highways in Mexico.
Of specific concern are Highway 190 (Tuxtla to Tapachula,), Highway 195 (Tuxtla to Villahermosa,), Highway 186 (Chetumal to Villahermosa,), Highway 15 (Sinaloa), Express Highway 1 (Sinaloa) and the highway from Altamirano to Ixtapa/Zihuatanejo.
These highways have recently seen particularly high levels of criminal assaults and robberies...
Crossing the border
People are often surprised when inconveniences occur because they were unaware of the laws regarding crossing the border.
The government of Mexico strictly regulates the entry of vehicles into Mexico.
If you wish to travel to Mexico City, you will need to adhere to certain procedures.
If these steps are carefully followed, there should be no problem taking your car to Mexico City.
ATTENTION: If your car is found in Mexico beyond the authorized time or without the proper documents, it is subject to seizure by Mexican authorities.
If confiscated, they are not returned!
Also, the sale, abandonment, or use of the vehicle for financial gain will result in its confiscation.
If you bring spare auto parts to Mexico, declare them when you enter the country. When you leave, be prepared to show that you are taking the unused parts with you or that you have had them installed in Mexico. Save your repair receipts for this purpose.
Many car rental companies in the USA have clauses in their contracts prohibiting drivers from traveling out of the country.
The Mexican police are aware of these regulations and will sometimes impound rental vehicles driven from the United States.
When renting a vehicle there, check with the company to see if your contract allows you to drive it into Mexico.
The standard insurance included with many car rental contracts in MEXICO provides only nominal liability coverage.
Read your contract carefully and purchase additional liability and comprehensive insurance if necessary.
ATTENTION: Mexican law permits the jailing of drivers after an accident until they have met their obligations to third parties and to the rental company.
Finally, all travelers are advised to consult with the nearest Mexican Consulate in the USA, Belize and Guatemala for additional detailed information prior to departing.
Keeping in Touch
Consider getting a TELEPHONE CALLING CARD.
Know how to use a PAY TELEPHONE and have the proper change or card on hand.
It is a convenient way of keeping in touch.
Make a note of emergency telephone numbers you may need: police, fire, your hotel, and the nearest embassy or consulate.
ATM Machines & Private Info means Money
Tourists should be very cautious in using ATM MACHINES ('cajero automatico') IN MEXICO CITY.
If an ATM machine must be used, it should be only during the business day at large protected facilities (preferably inside commercial establishments, rather than at a glass-enclosed, highly visible ATM machine on streets where criminals can observe financial transactions).
Travelers are advised to be careful when ordering beverages in local NIGHTCLUBS AND BARS, especially at night.
Some establishments may contaminate or drug the drinks to gain control over the patron.
Victims, who are almost always unaccompanied, have been robbed of personal property and abducted and held while their credit cards were used at various businesses and ATM locations around the city.
Avoid providing PERSONAL IDENTIFYING INFORMATION to individuals. Information obtained from unaware travelers has been used by individuals in Mexico to extort money from families by contacting them and fraudulently informing them that a family member has been arrested in Mexico or requires urgent medical care.
The caller gains their confidence by providing this personal information and requests that funds be sent to assist their family member.
Obtain an International Driving Permit (IDP). Carry both your IDP and your state driver's license with you at all times.
If possible, obtain a copy of the rules before you begin driving in the city.
Minimum driving age in Mexico is 16 years old.
If you rent a car, make sure you have liability insurance. If you do not, this could lead to financial disaster.
Always know the route you will be traveling. Have a copy of a good road map, and chart your course before beginning.
Do not pick up hitchhikers or strangers.
When entering your vehicle, be aware of your surroundings, keep an eye out for potentially criminal pedestrians, motorists and cyclists.
ALL VEHICULAR TRAFFIC IS RESTRICTED in Mexico City in order to reduce air pollution.
The restriction is based on the last digit of the vehicle license plate.
NOTE: This applies equally to permanent and temporary plates.
There is no specific provision regarding plates with letters only.
Car rental agencies in the capital city usually provide auto insurance.
NEVER try to travel alone by night.
ALL BUS TRAVEL should be done during daylight.
Tourists should not hitchhike or accept rides from strangers anywhere in Mexico.
Kidnapping, including the kidnapping of non-Mexicans, is increasing.
Robbery assaults on passengers in taxis have become more frequent and violent, with passengers subjected to beatings, sexual assault or murder.
Travelers should absolutely avoid taking any taxi not summoned by telephone or on their behalf by a responsible individual or contracted in advance at the airport.
Passengers arriving at Mexico City airport should take only airport taxis (yellow with an airport symbol on the door) after pre-paying the fare at one of the special booths inside the airport.
When in need of a taxi, telephone a radio taxi or 'sitio'. Ask the dispatcher for the driver's name and the cab's license plate number.
If you walk to a 'sitio' taxi stand, use only a driver known to you.
Radio taxis may be called at telephone numbers.
Tourists should avoid taking taxis parked outside the Bellas Artes theater, in front of nightclubs, restaurants or cruising throughout the city
Subway robberies are also becoming more frequent in Mexico City. If riding the Metro, you should hold valuables and belongings tightly.
Avoid using Metro during busy commuting hours in the morning or afternoon
BE VIGILANT in the aiport, bus stations, bus stops and subway stations. Watch for pickpockets in these areas.
hey often have an accomplice who will jostle you, ask you for directions or the time, point to something spilled on your clothing, or distract you by creating a disturbance.
Beware of groups of vagrant children who create a distraction while picking your pocket.
IF YOU ARE CONFRONTED, don't fight back (don't be stupid). Give up your valuables.
Your money and passport can be replaced, but your life cannot...
Safety on Streets
The most frequently reported crimes involve taxi robberies, armed robbery, pickpocketing and purse snatching.
In several cases, tourists report that uniformed police are the crime perpetrators, stopping vehicles and seeking money or assaulting and robbing tourists walking late at night.
Be wary of persons representing themselves as Mexican police or other local officials.
It is not uncommon for travelers to become victims of harassment, mistreatment and extortion by Mexican law enforcement and other officials.
Mexican authorities are concerned about these incidents and have cooperated in investigating such cases.
You must, however, have the officer's name, badge number, and patrol car number to pursue a complaint.
Make a note of this information if you are ever involved with police or other officials.
Be especially cautious in or avoid areas in the city where you are likely to be victimized.
These include some crowded subways, train stations, tourist sites, some market places, festivals and all the marginal areas of Mexico City.
Avoid public demonstrations and other civil disturbances and scam artists.
Try to seem purposeful when you move about. Even if you are lost, act as if you know where you are going. When possible, ask directions only from individuals in authority.
A flashy wardrobe or one that is too casual can mark you as a tourist. To avoid being a target, dress conservatively.
As much as possible, avoid the appearance of affluence. Don't wear expensive looking jewelry.
Keep a low profile and avoid loud conversations or arguments if you don't know or understand the Mexican culture and way of life.
Do not discuss travel plans or other personal matters with strangers.
Learn a few phrases in the local language so you can signal your need for help, the police, or a doctor.
Mexicans are friendly with tourists and are good hosts, but better beware of strangers who approach you, offering bargains or to be your guide. Who knows?...
Safety at the Hotel
Mexico City in not too dangerous as it seems, but as much as possible, plan to stay in larger hotels that have more elaborate security.
Safety experts recommend booking a room from the second to seventh floors above ground level to deter easy entrance from outside, but low enough for fire equipment to reach.
Travelers to Mexico should leave valuables and irreplaceable items (passport, cash, credit cards, jewelry) in a safe place.
All visitors are encouraged to make use of hotel safes when available.
Do not leave your belongings on the pool area while you are swimming.
Crime and the City
CRIME IN MEXICO CITY has reached critical levels.
Low apprehension and conviction rates of criminals contribute to the high rate of crime.
Metropolitan areas other than the capital are considered to have lower but still serious levels of crime activity.
During 1998, criminal activity in Mexico City continued at a high rate, with a marked increase in violent crime, including sexual assaults committed against women.
Travelers are discouraged from bringing very large amounts of cash into Mexico, as officials may suspect money laundering or other criminal activity.
As a visitor to Mexico, be alert to your new surroundings. Problem situations in Mexico may be different from those you are used to, and safety regulations and their enforcement are generally not too good.
If you have been the victim of a crime, immediately contact the corresponding embassy or consulate.
You should also report the crime to the local police immediately.
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Mexico City Travel Guide
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