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Managing IBS (irritable bowel) in Ghana or on the road there.
When I got diarrhea for the first time in months last week, I realised that finding a public toilet in
Bolgatanga-central is like getting into the UN: you almost need connections. So, I decided to share how I survived living in developing countries, mostly Ghana, with
IBS over the past four years.
Bit of history: I discovered my bowels had a mind of their own when I was about 22. I begrudgingly accepted it after the fifth doctor I visited confirmed the same as the previous four. I went into a depression after that. I vowed I’d never have kids as I did not want to pass this on to anyone—it’s hereditary. My Dad has it. I used to think of all the disabilities I’d rather have than this: the prospect of losing an arm seemed more attractive than not being able to control my bowel movements. That was “then”, though, not now.
I was scared of any situation in which I could not control the environment, especially if I did not know where the toilets were. I used to plan business flights and meetings to suit my bowel’s patterns, which took me about eight years to figure out. If I don’t get enough sleep (7 hours) or I’m too stressed, I’m in trouble. If anything bad is going to happen it usually happens in the morning.
And then, naturally, I came to Ghana, toilet capital of the world.*
I can’t tell you how
few toilets there are here and how
many ten hour-plus
trotro journeys I’ve taken not knowing when the next toilet stop will be, and even if we did stop, if there would be a toilet, and even if there was a toilet, was it filthy dirty, and even if it was filthy dirty, could I stand it, and even if I could stand it, would there be a door, and even if there was a door, would there be loo paper, and even if there was, would it have a seat, and even if it didn’t, could I squat and go, and even if I could, would I need to go 5 minutes after getting back on the bus…and so went my insane thoughts.
But, four years after first arriving, there are many plus sides to this story.
First, I could do you a map of the best toilets all over Ghana. I was famous for this as a volunteer. I’m serious. Second, contrary to expectations, Ghana provided the answer to my anxiety.
How?
1. Relinquishing control
Turns out that traveling where nothing departs or arrives “on time”, where no one knows if you’ll stop once or twenty times, where events often start four hours late, where there are virtually no public toilets and the ones that do exist are often putrid (although improving), and where you have a very real chance of being involved in a serious traffic accident—in short, a place where you can’t control anything—is a rather effective solution to
IBS-related anxiety. I call it the “What’s the worse that could happen? Oh, f*@k it…” approach to coping. Hey, it works.
2. Appreciating what you
do have
I began to get perspective a couple of months after first arriving. You’d have to be blind to miss the hunger on every corner. While starvation and extreme hunger are rare, serious hunger (where even university students survive on filling their stomachs with tea, bread and bananas for four years) is common. The fact that many around me don’t eat enough each day has made me appreciate that I have access to enough food to have
IBS in the first place. I wish it weren’t so. Twisted rationalization. I find myself thinking, So you have to run to the toilet. So what? At least you can eat. Get over it.
3. It’s relative
After severe malaria and typhoid,
IBS seems the least of my worries. Although, when I get malaria I become constipated, which I’d never had before. I used to wish I was constipated when I had diarrhea. But constipation nearly killed me. It was like giving birth to a clay watermelon through your butt. I’d rather have diarrhea in the middle of a long journey stuck between farting fishermen with chickens around my feet (and I have a serious bird phobia)—that’s how bad constipation was.
4. The bigger picture
Ultimately, being involved in something bigger than myself helped put
IBS in perspective. There’s nothing like being of service to others in need to make you see that one person’s bowels don’t amount to a hill of beans in this world—especially where most people struggle to live on about $2 a day, which doesn’t buy enough food for even one person a day.
What happened when I first arrived?
I got sick during my first week in Ghana—“the welcome bug”—and I stayed by the toilet for a few days. And then I felt better than I had for years for the next couple of months. Everyone else got sick during that time except for me. I was amazed.
Why?
There is very little junk food. I think a simple diet of rice, beans, eggs and stews, as well as endless fresh fruit, made my bowels cooperate for once. I have, overall, had much less trouble with my bowels here than I ever did in Australia, illnesses and all.
What do I think really worked?
Diet: Firstly, I went on a special
IBS diet for months before leaving Australia. It was basically vegetarian (which I’m not) with oodles of protein: mostly tofu and fish. I cut out a lot of oil, fried foods, sugar, caffeine (but I did sneak a coffee once a week and was OK), bread and processed foods.
Supplements: I took acidophilus powder which made an instant difference. It is brilliant. And I added protein powder to fruit shakes, too. These were good quality brands.
Exercise: I also belly danced almost every day. The hip twisting of dancing completely healed my bowel pain. Even if I felt pain before I went to class and anxiety about having noisy bowels (they squeak a lot), it disappeared when I started dancing. I always felt uplifted afterwards. I sometimes do it now and I always feel better. It’s worth trying. I met some wonderful people dancing—young or old, fat or thin, everyone was accepted. There was an amazing respect for our middle-aged teachers among the younger girls. It was an empowering and very positive environment for women. And it’s not at all sleazy like the mainstream makes it out to be. In fact, it evolved from a birthing ritual, which is no wonder that it’s good for your bowels.
Preparation: I came to Ghana armed with acidophilus powder, protein powder, and a few other “food” supplement powders (and was rather concerned about being checked at customs with all that white powder—I needn’t have worried). I also brought about twenty packets of sealed tuna with me for emergencies, but you can buy canned tuna everywhere. I am sure the powders helped me survive in the beginning. I can’t find them anywhere now (although there is a new chemist in the Accra Mall that looks fancy enough to stock specialist health food products).
Courage: At the end of my second week in Ghana a mad Italian, bonkers Brit and loopy American invited me to travel north to Mole—the wildlife sanctuary. I said a firm no—the thought of traveling for 18 hours on buses was too scary. I had no intention of traveling at all while I was here. (Hahaha!) However, they persuaded me and so I downed a couple of Immodiums and set off. Nothing bad happened. I ate simply—mostly plain rice. The loopy and most wonderful Brit also had bowel issues and we both had to limit how much water we drank to stop us from peeing all the time. I still ration water on long journeys, but I have mastered the urge to pee: mind over matter. I still rely on Immodium, though, and it never let me down (except once) and I’ve probably taken more than 100 long-distance bus journeys, not to mention erratic taxis every day to and from work where breaking down was par for the course.
Empathising: I met many volunteers and learnt that nearly half of them had bowel issues, anyway, and more so when they traveled. It just wasn’t a big deal. When they exited the bathroom and threw their arms into the air shouting “Yes!” I knew they’d finally managed “to go”. I knew when others were about to pass out that they were probably “going too much” and needed re-hydration salts—always have loads of these on hand.
Talk: At dinner we’d be eating fufu and ground nut soup (brown, runny peanut soup) and people would be describing the state of their bowels. I’d never experienced anything like this openness before. It was bizarrely liberating.
Acceptance: Nowadays I don’t care what anyone thinks. I don’t even care if everyone watches (if I have to stop a car and jump out, which I did only once in four years). Ghanaians themselves will openly declare, “I am running” which means they have diarrhea. Sometimes I’d be hit with diarrhea, especially when stressed, but I just told the whole office “I’m running” as I flew out the door. When I returned to the office my colleagues would just say “Sorry oh” and that would be that.
Laugh about it: One of the funniest moments came from a very unBritish British volunteer. I’d been here a year and heard and told my fair share of bowel stories, but her directness still managed to shock me. About a dozen of us were sitting around the table eating dinner and one of the newer vols complained about stomach problems.
The British girl asked, “So what would you say it is on the P-scale?”
“P-scale?” the newbie replied. This was a first for me too. Everyone stopped talking to listen.
“Pooh scale,” she answered, without blinking. “On a scale of 1-10, 1 being completely watery and 10 being super hard, what would you say it was?” (or the other way round—I can’t remember.)
I think even my jaw dropped, despite the previous 12 months exposure. Spontaneous giggles erupted around the table. I can’t remember the answer, and it doesn’t really matter. The point is that there are places in this world where no one gives a shit (sorry!) and you are not at all alone.
These are my 10 tips for managing
IBS on the road anywhere, especially in developing countries:
1. Always have a spare pack of your own “T-roll” (loo paper) in your bag, just in case. On one trip there was no loo paper in the toilets and I forgot to bring any. I ended up tearing a few pages from my guide book of an area I thought I’d probably never visit (I now live here). I know someone who had to use currency (yes, paper notes).
2. If you are diarrhea prone, always have a strip of Immodium in your purse. They are sold everywhere here, for much less cost than abroad. Two pills were enough to get me through my long journeys. The downside is you can end up constipated but I know that a cup of coffee gets things moving for me. Whatever works.
3. If you are “C” prone, then have laxatives on hand. I’d never taken laxatives in my life until my clay watermelon episode and I think I would have died without them.
4. Be open. Tell everyone you have bowels with a mind of their own. Trust me, they’ll understand. There’s a 40% chance they’ll have them too, so you can angst for the better part of your eighteen hour journey together. You can even rate toilets together. I did.
5. Have rehydration salts handy. You can buy them for about 20 pesewas in pharmacies all over Ghana. They work wonders for energy lost during diarrhea. Also good during malaria or other illnesses.
6. Carry more knickers than you need. It’s worth having a change, just in case.
7. Don’t eat anything dodgy, ever. I have a rule: no salad on the street. I do eat it in decent restaurants and at home. Don’t eat the fried fish or prawns that have been sitting in the sun all day. Be smart.
8. Eat simply when you travel. If worse comes to worse, I’ll eat plain rice and a boiled egg for every meal. I don’t eat my trigger foods while traveling, no matter how tempting. That means no coffee, no pineapple, not too much bread, not too much alcohol, etc.
9. Don’t push yourself. Get enough sleep.
10. Step outside your comfort zones if you want to get over your bowel anxiety (or any anxiety for that matter). What’s the worse that could happen?
11. A freebie tip: Count your blessings.
*Kidding. If you want toilets, Japan's the ticket. You may also wish to read this post at
Skool of Life about IBS and ADHD.
