Interviews with fishermen and traditional healers indicate that villagers on the Zanzibar Islands (Unguja and Pemba) regularly avoid consuming particular types of fish, or parts of those fishes that can sicken and sometimes kill. The western-trained medical community appears largely unaware of these avoidance patterns and the potential exposure of tourists, who may be more at risk than locals. This presentation will describe results from the interviews indicating the types of poisonous fish and the symptoms that result from their consumption. The dangers appear largely to be those expected from ciguatera toxins. The suite of phytoplankton responsible are poorly known, with the exception of Prorocentrum lima, Gambierdiscus sp., and Pseudo-nitzschia sp. Although local fishers and villagers are hesitant to acknowledge problems with seafoods, none-the-less consumption patterns appear largely to protect local populations from illnesses stemming from harmful algae. These avoidance patterns and the existence of more common and life-threatening medical problems have reduced the visibility of dangers from toxins in seafoods. In Zanzibar, and possibly in other coastal communities in the developing world, these cultural practices and other health issues likely account for serious under-reporting of harmful algal events, a topic that will be briefly discussed in this presentation.