In many people's minds India epitomizes all the terrifying diseases that have plagued mankind throughout history. The outbreak of bubonic plague in Surat, North India, a few years back helped cement the medieval image of the Indian disease scene.
While it's true that diseases long vanquished in the West still take a toll here, most visitors can travel in reasonable safely by practicing some basic preventative steps. The truly gruesome diseases like leprosy are basically impossible to catch through casual contact, and most of the deformities you see among the halt and lame at the roadside are the results of birth defects, accidents, or neglect of minor injuries turned infectious. If India had even a minimal public health system, working sewers, and a clean water supply that reached the bulk of the people, there would be a huge improvement in the general health of the population.
Travelers coming from countries where basic health facilities and public sanitation are taken for granted need to condition themselves to a new reality while traveling in India. You must become very pro-active about your health. Be aware of common diseases you can encounter here, how you get them, and some of the symptoms. Get the advice of a doctor about inoculations required and other medical precautions you should take. Carry a simple first aid kit, and make sure it is with you all the time. Keep it simple. Band-Aids, antiseptic, and mosquito repellant are the minimum. Some travelers bring large amounts of antibiotics and other medicines from their home country "just in case". This is wasteful and unnecessary (unless you have a specific drug you need to take regularly) as India has a well developed pharmaceutical industry and most any drug is available here. Often, Indian doctors will be able to advise more recent and effective treatments for tropical diseases than Western doctors with little tropical background. Should you get sick, you can get excellent medical attention in India. (This doesn't mean you will get it. You must be pro-active about your medical treatment, as you must be about so many other things.)
It is certainly possible to travel in India without getting sick. But it is also possible, even being terribly careful, to get sick here. Usually it is that kind of minor bug that provides a bit of conversation at backpacker gatherings, but sometimes it is more annoying. Besides personal hygiene (wash hands often, keep finger nails short, treat minor cuts and scrapes immediately) travelers should be concerned with three key areas - clean water, cooked food, and avoiding mosquitos. The most common and incapacitating diseases are gastro-intestinal upset, hepatitis and mosquito borne diseases like dengue fever, Japanese encephalitis, filaria and malaria.
Water - Clean drinking water, these days, is not too difficult since bottled water is sold in most places. A recent survey of some popular brands conducted by the magazine INDIA TODAY indicated that the brands they tested all fell short of ideal purity but none seemed to harbor serious disease causing organisms. Not the best news, but definitely safer than relying on tap water. In the past, rumors of bottled water refilled from local taps and resold were common enough but these days bottled water is a fairly mature industry and supplies seem reliable. Check the seal, and see if things are floating in it before buying. A certain amount of suspicion can be healthy.
You may sometimes encounter backpackers who drink the local water everywhere and claim no ill effects. Whether this is because they have an unusually robust intestinal tract or because they have not yet encountered anything serious, it's hard to say. Some travelers swear by papaya or yogurt (recommended - eating both regularly helps your digestive system) and others rely on the powers of gurus, gods, or fate. One young woman was going high tech, with a battery device that sent current through her body to purify her gut.
Considering the antiquated state of most Indian cities' water systems, where ancient sewage pipes leak into rusting water mains, it is probably just a matter of time before they encounter something their system can't deal with. Also, the treatment of drinking water in local restaurants is terrifyingly casual - often one large storage bin that every waiter dips poorly-washed glasses into. The vectors for rapid transmission of diseases are in place. As a result, it is not surprising to encounter travelers suffering from mild to major problems with their intestines. In fact, a common topic of discussion at backpacker gatherings is the condition and nature of one's shit. Mild stomach upset and diarrhea caused by unfamiliar or overly spicy food affect many travelers from time to time. Most people consider it an initiation into India and a minor irritant. For minor intestinal problems, try increasing your intake of both papaya and yogurt, and make sure you drink a lot of (non-alcoholic) liquids. Rehydration salts, available at medical shops, may be useful. "Intestinal brakes" like Lomotil and Kaopectate aren't generally recommended. Major problems, with symptoms which include blood or pus in stools, and/or fever merit consulting a doctor. So might persistent, recurring problems that you can't seem to shake.
Food - Water isn't your only concern. What food you eat, how it's cooked, stored and served is important too. As a rule, stick to freshly cooked food, made in a reasonably clean restaurant. (This doesn't mean the high priced food in major 5-star hotels.) As it is the world over, you can sometimes get excellent, safe food in a grotty tea shop, and stomach churning food in a high priced fancy place. Here are some things to consider:
Freshly cooked food is safest. Food left sitting can attract flies, which may have winged over from a nearby latrine.
Be wary of salads and fresh vegetable garnishes. There isn't much awareness of washing vegetables before serving. I don't even trust the fanciest of restaurants enough to eat raw vegetables there.
Fresh fruit juices can be a problem, since many tropical fruits blend into a pulp that you have to dilute with water. It's unlikely that the vendor is adding expensive bottled water.
Ice can be suspect, especially if it has arrived in a block carried on a bicycle and dropped off on the street in front of the restaurant.
Quite a few travelers avoid meat in India, reasoning that meat is more likely to be off, or make you sick. India has probably the best vegetarian cuisine in the world, so this is no hardship. However, if your diet does include meat you may not want to miss some of the excellent meat dishes you can get here. As a rule, though, don't do your meat ordering in the lower end restaurants or station platforms.
Keep your finger nails short and clean. Wash your hands frequently, and especially before you eat. Even the dirtiest dive will have a place to wash hands, though they may not have soap. Carry some with you, though you can usually get someone to deliver a tiny sliver of soap, or a bit of liquid or powdered dish soap if you protest long enough. I see this as a service to other patrons, and have noticed that more and more restaurants, even on the low end, are trying to supply soap.
Avoiding Mosquitos - There are several nasty diseases you can get this way, and India has an overabundance of mosquitoes. Don't panic. Many types of them don't carry serious diseases, and those types that do are not necessarily infected unless they have bitten a carrier recently. Still, mosquito-borne diseases can be very serious, even fatal and you should develop some habits that will minimize the amount of exposure you have to mosquitos.
Use a good repellent. You can bring one from the home country, but there are quite adequate repellants here. "Odomos" is one brand that is freely available, seems to work pretty well, and is inexpensive. Dusk seems to be the "Mosquito Hour" and it's a good idea to oil up before that - say 5:30 or 6:00 and perhaps change into a long-sleeved shirt and pants. If you make a routine of it you're less likely to suddenly realize that the sun's gone down and you've got welts all over your exposed skin. Malaria-carrying mosquitoes, in particular, bite in the early evening and early morning. Dengue mosquitos apparently like dark, shady areas around a house and bite in the daytime so, if you hear of dengue around, you may want to apply repellant in the day too. I don't know when Japanese encephalitis carrying mossies do their dirty work, but if you're in an area with an outbreak you will want to be careful. When you see reports in the papers of cases of "brain fever" assume it is encephalitis.
Other mossie defenses include a mosquito net - easy enough to buy or bring, but sometimes awkward to put up. * You can also buy mosquito coils that burn about 8 hours or so and keep mosquitoes away. The problem is that the coils break easily, and there is a risk of fire. They are very inexpensive.
You can also buy a little electric heater pad that heats a chemically impregnated mat releasing mossie-killing vapours. These heaters and mats are readily available and are fairly easy to carry. However you do need electricity - something to remember if you are going either REALLY low budget or somewhere rugged. They are supposed to be used in a well ventilated room.
Reduce the number of mosquitos around you, if possible. One trick is to try and get a room as high above the ground as possible. Third and fourth floor rooms seem to have fewer mossies than those below. Maybe the commute is too much for them. And a good strong fan running all night helps keep them away while you sleep, but beware of power outages. Don't forget to use repellent when travelling on trains overnight, unless perhaps in Air Con class. Trains can stop, sometimes for long periods in the night, and you may be exposed to all kinds of new mosquito types as you sleep. Malaria drugs are often recommended as preventative, but there seem to be various views on the use of such drugs. In some cases they can mask symptoms if you do get infected. Also, the local mosquitos may be resistant to that drug and sometimes the side effects of these drugs can be annoying, even dangerous. Also, you can't use them for very long. (If you're resident out here you'll have to put up major mosquito defenses, like window screens or sleeping nets.) Check with a doctor who is knowledgeable in the latest practices. And be aware that in some Western countries the public health services require their citizens to use such a prophylactic when they travel in malaria countries or they cannot claim treatment at home if they contract the disease.
Bed Bugs - Not related to mosquitoes, but extremely annoying is the problem of bed bugs. This is not a widespread a problem as one would suspect, considering the look of many low-end hotel rooms, perhaps because many such hotels anticipate the problem and spray rooms and beds regularly. Most hotels will let you have a look at the room before you check in. Look for tiny blood smears or stains on the sheets or even the walls. Or look in the cracks on the bed or under the mattress for dead bugs. If you find your room does have bed bugs, move immediately to another hotel.
Other Medical Concerns
AIDS - AIDS has been spreading in India, as in many other countries, at an alarming rate. If you do not already have a good idea of the seriousness of this disease, know how it is transmitted, and what precautions you must take, OR if you do not think AIDS can or will infect you if you are careless, then you should stop reading this web site, and head to one on AIDS. Apply the same caution in India that you should apply anywhere else. And make sure that others you deal with are also cautious. This is particularly true with medical personnel. Every good doctor or hospital in India will be acutely aware of the seriousness of the AIDS epidemic. However, as with many other areas of your experience in India, it is important to be pro-active. Make sure any syringes used are disposable and properly sealed. Better yet, carry your own syringes. And watch how they are handled by the medical people. There are excellent, aware doctors and medical staff in India, but, unfortunately, there are also incompetent ones. Even in good hospitals carelessness can happen. Be pro-active.
Hepatitis - There are several strains of the Hepatitis virus. Hepatitis-A is fecal borne and good hygiene and care about drinking water should protect you. Hepatitis-B and some other strains are transmitted in a similar manner to AIDS. Protect your self the same way. There is a vaccination available for Hepatitis-B and you may consider asking a doctor's advice about taking it, especially if you frequently travel in India and other parts of Asia.
Dehydration and Sun/Heat Stroke - The sun and the heat it generates can be a powerful force in India,even in the cooler winter months. You may not notice the process of dehydration until weakness and dizziness set in. Make it a point to drink a lot of liquids, especially water. Rehydration salts from a medical shop may help. You can eat them as powder or mix them in water.
Be wary of sunburn. Use a sunscreen. Wear a hat. Good sunglasses will protect your eyes. Avoid too much activity in the hotter parts of the day. Go native. Take a siesta if you can.