Travel is becoming easier and cheaper than ever before. But a lack of health advice and misinformation is leading to fear and complacency - with many people not taking even the most basic precautions. And it may be putting their lives at risk, reports Louise Brownlee

The consistency and frequency of everyone's faeces may seem an odd choice of after-dinner conversation. But when backpacking in less developed countries, such chats are not only frequent and surprisingly entertaining, but are also a common way of exchanging information on symptoms, diagnosis and treatment. In fact there is nothing like sitting in a rickety wood and corrugated iron café, listening to fellow travellers describe how they completed a 12-hour bouncy bus ride while barely assisted by Immodium. Because on a beach or in a hill station, sickness tales around the chai pot are the traveller's equivalent of horror stories around the campfire, with the element of relief that it hasn't happened to you - yet.

But while some holiday illnesses such as the various forms of "Delhi belly" can be diagnosed and treated quickly, others may be more insidious. Sufferers may be unaware that they need medical attention and what might be thought of as a touch of 'flu could later transpire to be a life-threatening disease such as malaria.

According to Dr Nick Beeching, senior lecturer at Liverpool School of Tropical Medicine, there are 10 to 15 deaths a year in the UK from malaria. "In most of those cases the patients have not taken any anti-malarials," he says. Many tourists simply do not realise that travelling beyond the usual European destinations brings greater risks. "I don't think they appreciate that a package holiday in coastal Kenya, which is rife with malaria and other things, isn't the same as going to Magaluf."

Yet there should be little excuse for ignorance. When an agent sells a holiday, if they belong to ABTA, they are obliged to advise clients to seek medical advice where necessary. "We don't want agents to go into too much detail because they are not doctors," says a spokesman for ABTA. "But outside Western Europe, America and Australasia there are generally issues for various countries. It's part of our code of conduct that members are supposed to bring these issues to people's attention. If they don't and a member of the public informs us about it, we would fine them."

But there are other reasons for not taking preventative medicine. "I think the British public is not used to paying for anything to do with their health," says Dr Beeching. "By the time they've paid for their tickets, hotels and airport taxes they do not wish to pay what may be up to £100 per person extra for the necessary protection."

Indeed when going abroad, every penny can count - especially for the poor student on a gap year. But whether the NHS should absorb the cost of preventative healthcare, says Dr Beeching, is a political decision. "Is it actually cheaper for the British government say 'alright we'll pay for all pre-travel medicine for you to go off on a jolly to Kenya for two weeks' than admit somebody for a week with life-threatening malaria?"

Yet there is still no guarantee that tourists would take preventative medicines. Some people simply do not like having vaccinations or taking medicines. On the website for the Lonely Planet guide books, visitors often ask for opinions on whether they should take preventative medicine. Some of the more negative replies, perhaps echoing the horror stories around the chai pot, talk of hair loss, possible strain on the kidneys and psychological problems. So while some tourists may be genuinely naive or careless, others who try to make informed choices can become confused because of the gap between expert advice, personal experience and hearsay.

When Veronica Gustavsson, 30, sought advice on travel healthcare she left her doctor's surgery none the wiser. "My doctor was absolutely useless," she says. "He didn't give me any advice on what anti-malarials I should take." Frustrated, she carried out what research she could on the internet before choosing Lariam. "It covered everywhere I was going to, and because I burn easily I didn't want to take Doxycycline because it can make you photosensitive." But she still thinks the information should have been clearer - for when things went wrong. Despite taking the drug for three weeks to test it for side effects, a week into her trip Veronica began to feel weak and dizzy. Soon she was having hallucinations. "I was lying on the bed when I started floating towards the ceiling fan," she recalls. "Then I became the fan and was spinning around. Then the fan became a sort of witch and started coming at me." She chuckles about it now but at the time, she says, the experience left her feeling vulnerable and helpless.

The information accompanying the drug states that "Lariam should not be prescribed for prophylaxis in patients with active depression or with a history of psychosis or convulsions". While this did not apply to Veronica, she had, however, not been given any satisfactory advice before travelling as to which anti-malarials she could switch to. Finally, a travel companion who was a nurse e-mailed a doctor in London for advice.

The Centres for Disease Control (CDC) in America describes this kind of reaction as rare, but because of the growth of internet chat rooms, one such incident can take on legendary proportions. Travel forums referring to these episodes as "Lariam freakouts" can cause panic in itself. But other drugs can have equally worrying side effects and it is fear of these which cause many travellers to take their chances. Many tourists are now spending months or years abroad. And because of this, there is a fear that taking preventative medicine for a long time could be damaging. Ashley Childs, 31, contracted malaria in Central America after stopping his course of Paludrine and Chloraquine because the Chloraquine seemed to be giving him headaches. ôI thought I'm going to be doing this for five months and I'm not sure I want my brain to be fried once a week on a regular basis," he says. "Id also heard stories about people's hair falling out on Paludrine and had spoken to people who had actually had it happen. So I thought that as I was away for five months it was fair enough to take the risk."

Ashley's case is not unusual. Some tourists prefer to take their chances because of the fear that "bombarding" the body with vaccinations or taking anti-malarials for a long period can cause damage to the kidneys and liver. Dr Beeching, however, says that a course of anti-malarials over a period such as six months should not have any such effects. He believes that lack of knowledge in both patient and healthcare worker is a prime stumbling block. "The quality of [advice] is highly variable," he says.

In fact as Polly Cozens found, receiving medical attention can be an up-hill struggle. Six years ago Polly, 27, won a trip to the Nile in a student bar draw. "The literature from the tour did say not to swim in the Nile because it's infected with Bilharzia," she says. "But I went on a camping tour and ended up swimming in the Nile, partly because it was so bloody hot and partly because our tour guide, who was a kind of up-for-it Australian guy, said he'd done it loads of times and never caught anything.ö Back in the UK, however, Polly worried that she may have been infected. "When I told my GP she just said ôHow do you know about Bilharzia?" When I explained why she just said 'If you knew it was infected why did you go swimming in the Nile? That was as far as I got." Over the next few years Polly occasionally mentioned it to other doctors. "They've either not known what I'm talking about and have had to look it up in a book, or just said not to worry." But this year, after reading an article on travel health she pursued the matter again. When tests at the Hospital for Tropical Diseases in London proved positive she received treatment and reassurance. ôBut until then I'd been made to feel like I was just a hypochondriac for nearly six years."

Suffering with malaria, Jacqueline Smith, 28, also had difficulty being taken seriously. Despite taking anti-malarials, she contracted the disease in Uganda and was treated quickly. But within days of returning home she began to feel ill. Malaria was easy to recognise, she says. "Hot and cold sweats worse than 'flu, stomach cramps a 100 times worse than period pains. You feel like death is trying to creep up on you." Jacqueline went straight to Torbay hospital, Torquay. "The nurse who dealt with me basically said I shouldn't be wasting her time, should go to a GP, and shouldn't be making judgements about my condition as I was not qualified to do so.

"Despite me saying that a few days ago I was in an African country rife with malaria, and that I had already had malaria there, I apparently didn't know what I was talking about. After much stress on my behalf, and tears and gradual deterioration in my condition - she left me for four or five hours - she took my blood sample." After being diagnosed Jacqueline says she received very good treatment and was clearly a novelty for the hospital. "Soon after I had an intrigued doctor come in with a handful of medical students, proudly saying they'd never had a case of malaria before."

But not all patients are left feeling frustrated. Barry Dicks, 33, spent six months in India and had suffered with stomach problems for much of his trip. Back home his doctor gave him a thorough examination. "I was lucky to find that my doctor had travelled in Asia and had also been afflicted with Giardia. "Barry is happy with the wayhe was treated but adds: "I guess some GPs are not so experienced in treating Asian problems so the advice and diagnosis varies from practice to practice."

Dr Beeching says it is unreasonable to expect GPs to have detailed knowledge of several exotic diseases, but he believes healthworkers need to be made more aware. "I think the time has come to look at whether minimum operating standards are necessary for producing quality standards for ordinary practice," he says.

Yet even with minimum standards the medical profession is likely to continue facing those other obstacles: the tourist's poor planning, money and fear of side effects. Also, as it becomes easier to book last minute trips to exotic locations, tourists may not even have time to consider healthcare. This is a concern, says ABTA. "But you can't refuse to sell someone a ticket if they want to go in a week. If they go to their doctor they may have to reconsider whether they should go. That's up to the client."

But once abroad, there is nothing like meeting other travellers to put one off one's drugs. Myself? As a reasonably seasoned traveller who has survived a fall to the waist in an Indian sewer and the severe diarrhoea that followed, several brushes with third-world electrical wiring, and a motorbike crash with a rickshaw, I tend to take all the precautions I can. But after meeting a woman who claimed she had once gone completely bald after taking anti-malarials I became seriously worried when - although it may have been my imagine working overtime - I saw far too many hairs on my pillow. After three months I stopped taking my pills. Was I worried about what the pills were doing to my body long-term? Very much so. And was I motivated by vanity? Definitely. And while vanity might not seem the most rational reason to make such a decision, it is a very human one - and one that I have often seen get the vote whilst whiling away the hours around the chai pot.

Bilharzia (or schistosomiasis) is caused by the parasitic fluke Schistosoma. It lives in lakes and rivers, and penetrates the skin of humans in the water. It matures to its adult form in the body, settling in veins in the bladder and intestines. The females lay eggs (which pass out of the body in urine and faeces) the release of which may cause anaemia and inflammation. Bilharzia is endemic in tropical countries, and can cause kidney and liver damage, the symptoms including diarrhoea: dysentery, enlargement of the spleen and liver, and cirrhosis of the liver. It is treatable with drugs.

Malaria is spread by the mosquito Anopheles sp., which deposits Plasmodium sporozoites whilst feeding off its host's blood. The parasite enters the liver where it reproduces and releases merozoites that enter the red blood cells where they multiply - bursting out when mature to reinfect other blood cells. Affected red blood cells are destroyed and the host animal becomes anaemic, suffering from recurrent fevers that can be fatal.

A human parasite of the gastrointestinal tract, it causes the disease giardiasis (or lambliasis), an infection of the small intestine most common in tropical areas. Abdominal cramps, swelling, diarrhoea and nausea may occur. The organism is spread by direct contact or through contaminated food and water. Severe cases are treated with antibiotics.

The bacterium Salmonella typhi is the causative agent of typhoid fever in humans. It is transmitted through food or drinking water contaminated by the faeces or urine of patients with typhoid, or through other carriers. Typhoid fever is an infection of the digestive system, causing high fever, rash, chills and sweating. A severe attack includes inflammation of the spleen and bones, delirium and erosion of the intestinal wall leading to haemorrhage.

Other common ailments for which travellers should consider taking precautions for are: polio, meningitis, hepatitis A and B, Yellow Fever, TB and HIV.

Websites for further information:

Should you be concerned that you may have contracted a tropical disease, the Hospital for Tropical Diseases (www.uclh.org/services/htd/index.shtm) has a emergency clinic for people who have a "fever or bloody diarrhoea" from 9am-4pm Monday to Friday. The hospital recommends you seek a referral from your GP if it is not an emergency. It runs a travel medical advice clinic, ring 020 7388 9600 for an appointment. It also has a recorded information line on: 09050 567733.