AT THE CLINIC

When Delhi belly could kill

I am in my sixties and for 30 years have had to take cortisone replacement tablets to compensate for the fact that I have no adrenal glands. A doctor once told me that if I (or anyone on a course of life- supporting medication) should ever suffer from a severe attack of diarrhoea or vomiting I would need emergency treatment. My husband now wants to take me on a trip of a lifetime to India and I am afraid that a tummy- bug will finish me off. What should I do?

Juliana Roper

Oxford

Dr Gill Lea replies: Obviously you must discuss your individual case with the doctor looking after your adrenal condition, but here are some suggestions which may help.

For any overseas travel it would be wise to carry extra supplies of your tablets (in your hand luggage of course). This is sensible for any prescription medication but especially so as your requirements might increase with travelling.

As you realise, severe vomiting or diarrhoea might prevent sufficient absorption of the cortisone. You could discuss with your doctor whether you should carry injectable hydrocortisone and a pack containing sterile needles and syringes. You would also need a letter explaining your medical history and the necessity for the medicines, needles and syringes.

It would be sensible to choose a trip which does not venture far from main centres. If concerns arose you should be able to get to medical help, taking your own supplies in case they were not easily available.

On a trip of a lifetime it may be worth staying in hotels with an international reputation to maintain. The aim is to reduce the chance of diarrhoea and vomiting to a minimum.

Eating in the dining-room of such a hotel may be safer than in small restaurants, and it is easy to wash your hands first. Most people know they should avoid tap water and ice in drinks unless certain it is from a satisfactorily chlorinated supply. Choice of food is important and freshly cooked, piping-hot meals are safest. Indian dishes such as curries where meat and vegetables are in pieces, which have been thoroughly heated, are likely to be safer than splendid-looking cold buffets. Cold meats, salads, shellfish and creamy desserts are often displayed for hours without adequate refrigeration and sometimes open to flies. Peel all fruit and avoid salads and shellfish. Carry treatment for diarrhoea including rehydration salts and request medical help earlier rather than later.

Remember to take out good travel medical insurance, having informed your insurer of your condition in advance.

l Dr Gill Lea is chief medical adviser at Trailfinders' immunisation clinic, 194 Kensington High Street, London W8 7RG (0171 938 3999)

To swap or not to swap?

As a family we are keen to do a home-exchange holiday with a family from abroad, probably the US. What are the snags, how do we start and can you give us details of firms that can arrange this?

Rupert Littlecote

London W12

Jill Crawshaw replies: Low cost - you only have to pay your fares and living expenses - and a family home, car, sometimes even a second holiday home are yours for the vacation, plus the appeal of living in a real community, mixing with locals rather than other tourists in a hotel ... these are the obvious advantages and the chief motivators of home-swap holidays. The main snag is the time it takes to plan the holiday, and the number of letters you have to write to your opposite number before you can even book your flight.

The usual procedure is to have your own home listed for a fee of between pounds 50-pounds 80 in a directory, and then you contact any exchange partners whose offer interests you. Several companies now also have pages on the Internet which can shortcircuit procedures considerably.

Green Theme International (01208 873123) is a founder member of the International Home Exchange Association, with a wide choice of homes, from city flats to large country houses. It publishes three directories each year in five languages, and it covers 30 countries. It is particularly strong in the US, Australia, New Zealand, Europe and increasingly the former Eastern bloc countries. It admits that it is difficult to arrange home swaps in Third World countries.

One of the reasons that it gives for being involved in this type of holiday is that "our clients are not contributing to the march of mass tourism and the many problems generated by the short-term profit motive". It costs pounds 38 to be listed in Green Theme directories, and the closing date for the next edition is 15 February.

The benefits and pitfalls of home exchange are also described in some detail in Home Exchange Vacationing (Rutledge Hill Press), pounds 9.95 from bookshops or pounds 9 from Homelink International (01344 842642), Linfield House, Gorse Hill, Virginia Water, Surrey GU25 4AS. An annual subscription for five directories each year is pounds 65. Among American criticisms: the vagaries of British plumbing and domestic appliances - and the neighbours!

2 Jill Crawshaw is a travel expert, writer and broadcaster

How a woman can travel alone in Islamic countries without being harassed

I am planning to travel alone through the Middle East, as a means of sampling some Islamic culture. I am, however, slightly concerned, as a woman, about the possibility of sexual harassment. I would like to do a fairly extensive tour of, say, six weeks, taking in as many places as possible, but I want to feel comfortable. Are there any particular places to recommend or to avoid?

A Drinkwater

Redruth, Cornwall

The Travel Editor replies: As a single woman travelling in the Middle East, you are presumably a hardy person, and apart from Algeria and Afghanistan, both of which are off-limits to foreigners, there is nowhere you must avoid. As a bare minimum, there are certain courtesies you can follow that should minimise the risk of serious harassment. The main point, quite simply, is to dress and behave more modestly than you would at home. Keep your eyes down, look serious, and do not expose more of your flesh than the local women do. In certain resorts in Tunisia, Turkey and Lebanon this can mean virtually anything. In Syria, Jordan and most parts of Egypt it can mean bare knees and forearms. In Iran and eastern Turkey you should cover up as much as possible, including your hair. If you follow these guidelines the chances are that the Islamic propriety that keeps a clear distance between men and women will apply to you too. If you don't follow them, there is a greater chance that it will be waived.

Legal queries

Our legal expert can reply to queries regarding any holiday rip- off you may have suffered on condition that you have already complained to the airline or tour operator and received an unsatisfactory response. All correspondence and relevant documentation should be supplied. Unfortunately we can only reply to letters we print.