By Dr. Colin Michie of AUC Medical School
Dr. Colin Michie has worked as a paediatrician in the United Kingdom, Africa, the Caribbean and the Middle East. He specialised in nutrition, haematology and infectious diseases. Now the Associate Academic Dean for the American University of the Caribbean Medical School in Sint Maarten, his enthusiasm is training medical students and health care teams to ensure they deliver better value health care.
At this time of year, many of us take holidays, go on picnics, hold gatherings with family and friends or take culinary adventures. These activities are important and valuable breaks from the busyness of life. Sharing food is a central part of our lives and as you plan these diversions, it is always worth remembering the possibility of food poisoning. Food poisoning is more common in the summer months. Prevention is always better than suffering. There is nothing worse than feeling nauseated and unwell with abdominal pain and diarrhoea, having to stay near a bathroom.
Food poisoning happens most often when bacteria multiply in food that is not stored or prepared well. The bugs involved are most commonly salmonella, campylobacter, listeria or E.coli. Sometimes toxins, viruses (such as norovirus) or parasites (such as Giardia) give similar symptoms. Illness caused by food is one of the most frequent complaints after the “common” cold. Most people do not seek medical help or treatment and tend to treat themselves, so that finding out about this troublesome condition is not easy. Estimates from the USA and the UK are that 1 in 6 of us will suffer with food poisoning each year.
More severe cases – most often in young children or the elderly – can lead to dehydration that needs hospital admission; sometimes this condition is fatal. Some food-poisoning toxins – particularly those from moulds (fungi) – can have long-lasting effects. Surveys in the UK have suggested that most food poisoning develops because of problems with the storing and preparation of foods in the home. Microbiologists find large numbers of bacteria in our homes on door handles, kitchen surfaces and often on our hands! Without exception, these studies conclude that we are good at cutting corners when managing food in the home and could do with education and training.
Many campaigns have passed but illness continues. So here is the challenge to each of us: Do you match up to high standards? Is your kitchen well cleaned? What about your fridge? Are there any mouldy fruit or slightly-smelly bags of cereals, rice, pasta or nuts in the pantry? Do you have any pet paw marks in your kitchen? All of these could represent an increased risk of contamination of your meals.
Those working in catering should be well aware of the rules of great food care. If supplying or making meals for the public, a range of tests and inspections will take place to check that local regulations are being followed. But this does not happen in our homes. When we think of preparing food, we should imagine we are making it in a fancy restaurant for a fragile grandparent or difficult inspector. Would they complain to the management if they could watch us?!
The rules are as follows: Clean yourself, your hands and the surfaces that will contact your food. Hands should always be washed for two minutes (sing the “Happy Birthday” song twice). Check your fingernails which can hide a zoo of bacteria. Wash your food. Separate raw and cooked foods. Cook foods appropriately. Chill ingredients or prepared dishes properly before and after cooking. Do not use anything that is old or out of date on its packaging. Keep flies away from your kitchen and food. The “Foodkeeper” app for mobile phones has been developed in several languages and it is regularly updated. This is a useful resource if you have questions.
Restaurants can be an accidental source of food poisoning among groups of patrons. Last month, a publication summarized food-poisoning cases from 2009 to 2016 in America. Chicken was the most frequent single food reported as a source of illness. This study shows how much care needs to be taken with poultry and eggs. Salmonella and campylobacter bacteria can often be found on the outside of egg shells and can occasionally be found inside if the shell is cracked or damaged, so use only unbroken eggs. Sometimes, outbreaks of food poisoning can be traced to a specific food supplier – there have been scares involving norovirus in salads, Salmonella in ice-cream and E.coli in hamburgers or sausages.
How should you treat food poisoning? Infections typically develop one to two days after we eat contaminated food; most of us will recover in two to three days as our own gut bacteria help us recover. The main risk is dehydration so drink water. If a child or elderly person becomes sleepy and cannot drink, they will require urgent medical attention. However, most of us can look after this illness at home. It would be sensible to identify the source of the illness and dispose of it safely. Take care of yourself as you may be infectious, particularly if an agent such as norovirus or salmonella is involved. Consider carefully how to reduce the spread of any food poisoning agent. If a restaurant or food seller could have been involved, it is worth contacting the relevant authorities on the island in order to prevent an outbreak.
There is a rich and varied list of herbal remedies in every culture for treating food poisoning – sometimes a family or community will have a traditional favourite. Many of these aid recovery and several have been shown in trials to have pharmacological benefit for stomach pain, fluid loss or the speed of recovery. As examples, European herbals recommend lemon, mints and garlic; Asian cultures promote lemongrass and ginger in various forms. In the Caribbean, we have bissy tea made from the kola nut, the bitter cerasee, banana and the roots of sea grapes. Some recommend drinking charcoal or colloidal silver to reduce toxins in the bowel; others use live yoghurt to help the bowel to recover. No specific studies point to any one of these as being more effective.
Safe food and safe meals are important for all of us. We can all play an important part in promoting this in our communities. Have safe meals!
