Travel and Drinking Water – Staying healthy and treating water to make it safe to drink

Today I want to address the topic of travel and drinking water overseas – “What to do if you can’t find bottled water?” and “Should you rely solely on water bottles abroad?”

ANSWER: No, do not rely solely on bottled water overseas.

Always be prepared to filter/clean your own water! It’s not very expensive and it doesn’t take that much time if you think about where you are going before you travel and prepare accordingly. (Article begins below image.)

Clean water and water safety

Clean water is essential to staying healthy overseas. Approximately 70-80% of all travelers will get travelers diarrhea this year while traveling abroad. A significant number will get a much more serious disease due to contaminated food or unclean water.

This article is written to protect your health and help you think about safe drinking/food preparation. We realize that there are big differences between a volunteer trip overseas and actually moving overseas to serve in some capacity (community health work, social work, vision, orphan care, education and more). This article will try to address the basics for both audiences.

Some of this information is also described in a YouTube video we made (https://www.youtube.com/watch?v=yfoFNiFEjvY&t=15s) as well as is a subject in our newly enlarged and updated Travel Medical Guide (offered free by Good Neighbor Insurance.) It was originally written by Dr. John Askew and has been updated and enlarged by Good Neighbor Insurance travel experts.

See the resources and downloadable .pdf at the bottom of this article.

What are the risks?

Bad water can carry germs, bacteria, intestinal worms and more.
It is responsible for dysentery, giardia, hepatitis A, typhoid and cholera to name just a few things you could pick up overseas if you are not careful. And while diarrhea is the most widely known disease linked to contaminated water, almost 240 million people are affected by schistosomiasis every year – an acute and chronic disease caused by parasitic worms contracted through just swimming in infected water.

Some quick pointers on travel and drinking water:

Filter water, and use bottled water as a backup. (Consider ways to filter or clean water below.)
Always make sure bottled water is still factory sealed/unopened. Some places refill water bottles and even though the water may be filtered/clean, they may not have properly sterilized the bottles before re-use. (Such as washing them out using unfiltered water.)
Be careful putting your mouth directly on bottle tops and cans without first cleaning the top.
Do not drink anything out of an open cup, in the marketplace, or out of a tap unless you are sure that you are not in an “at-risk” area. (Cups are usually washed using regular tap water.)
Any hot drinks must be boiled for at least 3 minutes, including tea or coffee (coffee machines are not hot enough long enough to kill all viruses. Water for tea should be allowed to get to a rolling boil.
Avoid ice and drinks prepared with ice and/or dairy as they could make you very ill
Likewise, you can filter water, but if you wash/rinse your hands or food containers and utensils in questionable water, you stand a strong chance of infection regardless.
Make sure you also use safe or bottled water to take pills, and when brushing your teeth.
Water can also put you at risk when you shower or swim.
Make sure food preparation is clean, boiled or cooked well at high temperatures, plates are washed/rinsed under filtered water, and stay away from sauces, etc. that might include water but not cooked again at a high temperature. As you can imagine, it can be very hard to ensure safe food preparation when eating out overseas. This article is not intended to discuss safe eating, but securing and/or preparing a clean water supply.

Methods of ensuring safe water when traveling:

There are three primary ways to clean water overseas (not counting UV light): 1.) Filtration/Purification, 2.) Boiling and 3.) Sanitizing or Disinfecting water.

1.) Filtration/Purification –

There is a difference between water filtration and water purification. Most house-use type water filters just filter for taste. They will not protect you overseas. Camping and hiking water filters (like “straws”) do not filter for viruses which is one of the BIG THREE YOU HAVE TO LOOK OUT FOR WHEN TRAVELING ABROAD.

You want your purifier to protect against:

Protozoa and cysts (Cryptosporidium parvum, Giardia lamblia). Single-cell parasites; tiny (between 1 and 20 microns. A micron is 1-millionth of a meter, or 0.00004 inch.) They are the easiest to filter out, but can be tougher to kill with chemicals.

Bacteria (like E. coli or salmonella,). Very tiny (0.1 to 10 microns). Can make you very sick.

Viruses (Hepatitis A, rotavirus, enterovirus, norovirus). Exceptionally tiny (0.005 to 0.1 micron). Most often caused by human waste or by someone who has the virus contaminating a water source. Most of the filters designed for campers/hikers will not filter for viruses and are less useful overseas.

Understand that these filters do not remove VOC’s, heavy metals, or chemicals in solution such as fluoride and arsenic.

Brands like Brita and PUR should never be used on anything but water from a safe clean water source. They can be used along with boiling to make water taste better.

We like Sawyer water filters/purifiers, which you can get for either personal use or with buckets for teams/households or whole village usage. They are affordable and we regularly encourage teams traveling together to leave them behind with a family or group when they depart. They offer the Point ZeroTWO Purifier (0.02 micron absolute pores). They were the first and only portable purification device to stat removing viruses. And they do it at a >5.5 log (99.9997%) rate, exceeding EPA and NSF recommendations. Their products and filters can also accept muddy water, although it will require more frequent backwashing.

• Here’s a list of just some of the NGOs already using Sawyer filtration: http://international.sawyer.com/ngos/
• We especially like Business Connect World’s business model as it employs local people and gives them the ability to become local suppliers/earn income. (https://businessconnectworld.com/)

Water Filtration/purifiers should be able to be “backwashed” (Clean water only) so they do not require replacing filters which may be hard to locate overseas. Filters and purifiers work by forcing water through media that looks solid to the eye, but contain microscopic pores (typically 0.1 to 0.4 microns) that water can penetrate. Protozoa, cysts and bacteria cannot. Microbiologists call this process “size exclusion.” The filtering media basically acts as a microscopic colander that strains bugs out of the water. You will want to make sure any filter you are using has uniform pore size(s).

Make sure any cup or bucket used to collect water is first sterilized and protected against dust and dirt or inadvertent contamination.

Sawyer offer the Point ZeroTWO Purifier and S3, but Grayl, Lifestraw Mission and Lifestraw Family, and MSR Guardian all filter viruses and reduce the waste plastic and need for bottled water overseas. Ignoring warnings and drinking from questionable water sources can cause serious pain and a trip to the local health clinic! Questionable water sources can include drinking fountains, upscale restaurants, hotels, street-side food vendors, airports and more. (article continues after image)

Videos on:

Sawyer’s ZeroTWO: Check out https://www.youtube.com/watch?v=vX4ht…

Sawyer Select S3: https://www.youtube.com/watch?v=7LJ9g…

MSR Guardian: https://www.youtube.com/watch?v=Gkqdw…

Grayl: https://www.youtube.com/watch?v=VK88X…

Lifestraw Family: https://www.youtube.com/watch?v=84rUA…

Lifestraw Mission: https://www.youtube.com/watch?v=ZYeb3…

Links to company websites:

Sawyer’s ZeroTWO: https://sawyer.com/products/sawyer-point-zerotwo-bucket-purifier-assembly-kit/

Sawyer Select S3: https://sawyer.com/products/select-filter-and-purifier/

MSR Guardian: http://guardianpurifier.com/

Grayl: https://www.thegrayl.com/why-grayl/

Lifestraw Family: http://lifestraw.com/products/lifestraw-family/

Lifestraw Mission: http://lifestraw.com/products/lifestraw-mission/

Always follow all manufacturers’ directions: Filters that are not well maintained can do more harm than good, so it is crucial to follow all manufacturers’ instructions for proper maintenance. Usually water will begin to slow down as filters become less effective.

2.) Boiling –

Known as “heat disinfection,” is a foolproof treatment method, however the water may still taste bad or be cloudy. This is where a filter may help, after boiling, for taste.

Start by bringing water to a rolling boil for at least one minute. Doing so will kill most types of disease-causing organisms that may be present. If the water is cloudy, you may want to filter it through a clean cloth, or allow it to settle first, and draw off the clear water for boiling. Boil the water for one minute, let it cool, and store it in clean containers with covers. At an altitude greater than 6,562 feet (greater than 2000 meters), boil the water for 3 minutes.

The most heat-resistant bug out there is the virus hepatitis A. Even it is believed to die in less than 1 minute in water heated to 98°C/208°F.

3.) Sterilization, aka Disinfection –

In an emergency you can add 8 drops of 6% bleach, or 6 drops of 8.25% bleach, to each gallon of water to disinfect it. Double the amount of bleach if the water is cloudy, colored, or very cold. Stir and let stand for 30 minutes. Dirty water is less of a concern when disinfecting water than cold water. If possible always try to disinfect water close to room temperature.

Household bleach is a solution of sodium hypochlorite and generally contains 5%-6% chlorine. Different bleach products may contain different concentrations of available chlorine and the concentration should be checked before use. Also, bleach loses its strength over time so be aware of the age of the bleach or use a higher concentration if in doubt.

Chlorine effectively kills a large variety of microbial waterborne pathogens, including those that can cause typhoid fever, dysentery, cholera and Legionnaires’ disease. Chlorine is widely credited with virtually eliminating outbreaks of waterborne disease in the United States and other developed countries. However, this method kills some, but not all, types of disease-causing organisms that may be in the water (Chlorine may not be as effective in controlling more resistant organisms like Cryptosporidium and should be left 3-4 hours, if suspected, before drinking). And it has a low to moderate effectiveness in killing Giardia.

Useless fact(?): Chlorine is currently used by over 98 percent of all U.S. water utilities to disinfect drinking water.

Iodine solution or tablets also work but some people complain about the taste. After water has sat out long enough to kill any viruses/bacteria, it can still be filtered for taste. In general, iodine is most effective against bacteria, followed by viruses. Iodine is least effective against cysts. Iodine is not an effective disinfectant against Cryptosporidium parvum.

Iodine is not recommended as a long-term water disinfectant if you are an expat living overseas.

Treating water if traveling can be part of a morning “getting ready for the day” ritual or a bedtime ritual, before going to sleep, so that you always have access to “microbiologically safe water” the next day.

If you are living overseas, adding two drops of household chlorine bleach per gallon of water can also help maintain water quality while in storage.

NOT RECOMMENDED:

Another possible method you can use in an emergency but I haven’t discussed is using UV light to kill bacteria, etc. Start with a clean plastic bottle filled with questionable water. Leave the clear bottle of water on a reflective surface in bright sunlight for three hours so the UV light can disinfect the water. This doesn’t work for glass bottles or if the water is cloudy. The only way to know if it worked is to have the water tested or try it and see if you get sick. That’s why I do not recommend this method.

Don’t forget travel insurance (or international health insurance if you are moving overseas)!

Travel medical insurance will protect you in an emergency if you get ill overseas and need to see a doctor, or need serious care/treatment. Most U.S. domestic health plans will not pay medical bills incurred overseas, outside their network, unless it is a life and death situation. They will not pay for emergency evacuation. For about $1-2 a day you can have top-of-the-line protection 24/7 wherever you go. This site has plans specially designed for volunteers and charitable travel featuring additional discounts. All other travelers can check out www.gninsurance.com for general travel insurance (also at great rates and great service!).