• Keep well hydrated, especially in hot climates.
• Always pee after sex. Normal urine is sterile and will wash away bacteria that have managed to work their way up the urethra during sex. This really works.
• If you feel a UTI coming on, start drinking even more water, or cranberry juice if it is to hand. Take a sachet of cystitis relief if you have one.
If you haven’t stocked up on antibiotics in advance but think you need them, it’s best to consult a doctor. If that’s not possible, you might be able to buy them without prescription from street pharmacies. Try to get local advice on which ones are reputable. Antibiotics useful for UTI include:
• Cefalexin – 500 mg twice daily for three days
• Amoxicillin – 500 mg three times a day for three days
• Co-amoxiclav (Augmentin) – 250 mg three times a day for three days
Warning: Do not take these antibiotics if you are allergic to penicillin. Ask a doctor back home what you can and can’t take if you are allergic, and ask him to provide some for you. Always read the label and always take the full course of the drug.
If you develop fever, abdominal pain or back pain, or feel unwell, you should seek medical attention immediately as you may be developing a kidney infection.
/CONTRACEPTION
The contraception you use at home might not be the best for your trip. Asking yourself the following questions before you leave might stave off difficulties or disasters down the line.
Are you planning to have sex on your travels?
If so, take a supply of condoms. This is the only form of contraception that can protect you from sexually transmitted infections.
Are you on the pill?
If so, consider switching to a longer-term form of contraception (see chart opposite).
Do you use contraception for medical reasons (e.g. regulating periods or skin conditions)?
In this case, you probably need to stay with the pill, but check that you have enough to last your trip.
Will your GP prescribe enough pills to last the trip?
If not, you need to find out if you can obtain more pills at your destination. If your brand is not available, find out in advance what the equivalents are in other countries.
/WHICH CONTRACEPTIVE METHOD IS BEST FOR YOU?
If using any method other than condoms, you will need to consult a doctor before you start a new one.
For more detailed advice on contraceptive options, please visit the website www.patient.co.uk
/THE CONTRACEPTIVE PILL
The pill works by preventing ovulation. Taking a pill on seven consecutive days is sufficient to prevent ovulation. In addition, omitting more than seven days of the pill (i.e. lengthening the ‘withdrawal bleed’) allows ovulation to occur.
It is important to note that the ‘withdrawal bleed’ you get with the pill is not a true period. It occurs because of the hormone-free seven days between packets. Some pill brands require the user to stop taking a pill for a week. Other brands include a week of dummy pills so that the routine of pill-taking is not interrupted.
Why have a hormone-free period at all? There are two reasons:
• To reduce a woman’s exposure to the hormones which, over a long period of time, are known to increase the risk of deep-vein thrombosis and certain cancers.
• To mimic the natural menstrual cycle.
It is a common misconception that missed pills towards the end of the packet do not matter as a ‘period’ will soon follow. In fact, the opposite is the case: during the bleed, hormone levels are at their lowest and ovulation is more likely. If unprotected sex has occurred in that time, pregnancy might result.
If you forget to take a pill, what you should do depends on the type of pill you are taking. Ideally, you should find out in advance by reading the leaflet that comes with the pills.
Ovulation and pregnancy may occur if you miss pills, especially if the omission occurs at the beginning or end of the packet. In order to prevent pregnancy, you should use condoms for a week after the missed pill.
If you run out of pills in a foreign country, one option is to switch to condoms. However, you may be able to buy an equivalent to your current pill (i.e. one containing similar hormone levels) but with a different international trade name. A useful website on which to look this up is the IPPF Directory of Hormonal Contraceptives (http://contraceptive.ippf.org).
Kathleen McCaul came out to Iraq with me from Oxford University to work at the Baghdad Bulletin. We were both as wide-eyed and naive as each other. She had an amazing ability to use that innocence to win her one exclusive interview after another. That access to the top corridors of power also made her vulnerable. At meetings that were supposed to be professional interviews sex-starved politicians, lawyers and soldiers, buoyed by the excitement of talking to their first girl in months and armed with an illicit bottle of booze, thought she was ripe for the picking. She had to learn how to bat them off with her eyelids:
‘I guess the first way to prevent yourself getting pregnant is by not having sex. But in stressful situations with not much other than work to do, an affair is a good way of letting off steam and doesn’t give you such a hangover as whisky, although it can have more serious consequences if you aren’t careful.
‘Not getting pregnant is pretty straightforward. Use a condom. Always carry condoms with you. Many of the countries mentioned in this book are rife with HIV. You want to come back with good stories, not a lethal STD.
‘If something does go wrong, the morning-after pill is readily available practically everywhere – even up a mountain. You might get a few odd looks when you ask for it, but don’t let that put you off.
‘I think a greater danger than getting pregnant is getting trapped in a relationship that is furtive and ultimately unsustainable in conservative countries. It hasn’t ever, in my experience, ended happily. How do you avoid it? Don’t stay up late talking when there is a power cut. Don’t go on trips to remote, romantic places in the countryside. Don’t pick apart your personal stories and histories on walks in deserted gardens.
‘Avoid married men, especially if they are married to their cousins. Avoid men with girlfriends. Avoid your translator. Above all, avoid your boss, especially if their father happens to be a head mullah or something like that.’
/EMERGENCY CONTRACEPTION
The morning-after-pill is available in the UK and many other countries as an advance prescription. This means that you can hold up to three packets of the emergency pill in anticipation of a burst condom or accidental lapse in contraception. It is available for purchase from certain pharmacies both in store and online, and in the UK is also available free from family planning clinics and GPs at the doctor’s discretion.
Warning: Do not use the morning-after pill as a regular method of contraception. It is a heavy dose of hormones that can cause side effects in some women.