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Africa

Health & safety

Before you go

Insurance

Travel insurance to cover theft and illness is highly recommended. Although having your camera stolen by monkeys or your music player eaten by a goat can be a problem, the medical cover is by far the most important aspect because hospitals in Africa are not free, and the good ones are not cheap. Simply getting to a hospital can be expensive, so ensure you’re covered for ambulances (land and air) and emergency flights home.

There are many policies available, including several pitched at travellers on long trips. Some forbid unscheduled boat or plane rides, or exclude dangerous activities such as white-water rafting, canoeing, or even hiking. Others are more sensible and understand the realities of travel in Africa. Shop around and read the small print to make sure you’re fully covered.

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Insurance

Legislation covering third-party insurance varies considerably from one country to another – in some places it isn’t even compulsory. Where it is, you generally have to buy insurance at the border (a process that is fraught with corruption), but the liability limits on these policies are often absurdly low by Western standards; this means if you have any bad accidents you’ll be in deep shit, so it’s a smart plan to insure yourself before heading out. If you’re starting from the UK, one company highly recommended for insurance policies and for detailed information on carnets is Campbell Irvine (020-7937 6981; www.campbellirvine.com).

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A little planning before departure, particularly for pre-existing illnesses, will save you a lot of trouble later on. Before a long trip get a check-up from your dentist and from your doctor if you have any regular medication or chronic illness, eg high blood pressure and asthma. You should also organise spare contact lenses and glasses (and take your optical prescription with you); get a first-aid and medical kit together; and arrange necessary vaccinations.

It’s tempting to leave it all to the last minute – don’t! Many vaccines don’t take effect until two weeks after you’ve been immunised, so visit a doctor four to eight weeks before departure. Ask your doctor for an International Certificate of Vaccination (otherwise known as the yellow booklet), which will list all the vaccinations you’ve received. This is mandatory for the African countries that require proof of yellow fever vaccination upon entry, but it’s a good idea to carry it anyway wherever you travel.

Travellers can register with the International Association for Medical Advice to Travellers (IMAT; www.iamat.org). Its website can help travellers to find a doctor who has recognised training. Those heading off to very remote areas might like to do a first-aid course (contact the Red Cross or St John’s Ambulance) or attend a remote medicine first-aid course, such as that offered by the Royal Geographical Society (www.wildernessmedicaltraining.co.uk).

If you are bringing medications with you, carry them in their original containers, clearly labelled. A signed and dated letter from your physician describing all medical conditions and medications, including generic names, is also a good idea. If carrying syringes or needles be sure to have a physician’s letter documenting their medical necessity.

How do you go about getting the best possible medical help? It’s difficult to say – it really depends on the severity of your illness or injury and the availability of local help. If malaria is suspected, seek medical help as soon as possible or begin self-medicating if you are off the beaten track.

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Insurance

Find out in advance whether your insurance plan will make payments directly to providers or will reimburse you later for overseas health expenditures (in many countries doctors expect payment in cash). It’s vital to ensure that your travel insurance will cover the emergency transport to get you to a hospital in a major city, to better medical facilities elsewhere in Africa, or all the way home, by air and with a medical attendant if necessary. Not all insurance covers this, so check the contract carefully. If you need medical help, your insurance company might be able to help locate the nearest hospital or clinic, or you can ask at your hotel. In an emergency, contact your embassy or consulate.

Membership of the African Medical and Research Foundation (Amref; www.amref.org) provides an air evacuation service in medical emergencies in some African countries, as well as air ambulance transfers between medical facilities. Money paid by members for this service provides grass-roots medical assistance for local people.

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Recommended vaccinations

The World Health Organization (www.who.int/en/) recommends that all travellers be covered for diphtheria, tetanus, measles, mumps, rubella and polio, as well as for hepatitis B, regardless of their destination. Planning to travel is a great time to ensure that all routine vaccination cover is complete. The consequences of these diseases can be severe, and outbreaks of them do occur.

According to the Centers for Disease Control and Prevention (www.cdc.gov), the following vaccinations are recommended for all parts of Africa: hepatitis A, hepatitis B, meningococcal meningitis, rabies and typhoid, and boosters for tetanus, diphtheria and measles. Yellow fever is not necessarily recommended for all parts of Africa, although the certificate is an entry requirement for many countries.

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Medical checklist

It is a very good idea to carry a medical and first-aid kit around with you, to help yourself in the case of minor illness or injury. Following is a list of items you should consider packing.

Acetaminophen (paracetamol) or aspirin

Acetazolamide (Diamox) for altitude sickness (prescription only)

Adhesive or paper tape

Anti-inflammatory drugs (eg ibuprofen)

Antibacterial ointment (eg Bactroban) for cuts and abrasions (prescription only)

Antibiotics (prescription only), eg ciprofloxacin (Ciproxin) or norfloxacin (Utinor)

Antidiarrheal drugs (eg loperamide)

Antihistamines (for hay fever and allergic reactions)

Antimalaria pills

Bandages, gauze, gauze rolls

DEET-containing insect repellent for the skin

Iodine tablets (for water purification)

Oral rehydration salts

Permethrin-containing insect spray for clothing, tents and bed nets

Pocket knife

Scissors, safety pins, tweezers

Sterile needles, syringes and fluids if travelling to remote areas

Steroid cream or hydrocortisone cream (for allergic rashes)

Sunblock

Syringes and sterile needles

Thermometer

If you are travelling through a malarial area – particularly an area where falciparum malaria predominates – consider taking a self-diagnostic kit that can identify malaria in the blood from a finger prick.

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Online resources

There is a wealth of travel health advice on the internet. For further information, the Lonely Planet website at www.lonelyplanet.com is a good place to start. The World Health Organization publishes a superb book called International Travel and Health, which is revised annually and is available online at no cost at www.who.int/ith/. Other websites of general interest are MD Travel Health at www.mdtravelhealth.com, which provides complete travel health recommendations for every country, updated daily, also at no cost; the Centers for Disease Control and Prevention at www.cdc.gov; and Fit for Travel at www.fitfortravel.scot.nhs.uk, which has up-to-date information about outbreaks and is very user-friendly.

It’s also a good idea to consult your government’s travel health website before departure, if one is available:

Australia (www.dfat.gov.au/travel/)

Canada (www.hc-sc.gc.ca/pphb-dgspsp/tmp-pmv/pub_e.html)

UK (www.doh.gov.uk/traveladvice/index.htm)

USA (www.cdc.gov/travel/)

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Further reading

A Comprehensive Guide to Wilderness and Travel Medicine by Eric A Weiss (1998)

Healthy Travel by Jane Wilson-Howarth (1999)

Healthy Travel Africa by Isabelle Young (2000)

How to Stay Healthy Abroad by Richard Dawood (2002)

Travel in Health by Graham Fry (1994)

Travel with Children by Cathy Lanigan & Maureen Wheeler (2004)

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Dangers & annoyances

Crime

Travel in Africa is remarkably safe most of the time, but you need to be alert on the streets of some cities. Dakar (Senegal) can be a bit edgy, and Nairobi (Kenya) is often called ‘Nairobbery’, while Lagos (Nigeria) and Johannesburg (South Africa) are no joke at all. Snatch-theft and pick-pocketing are the most common crimes, but violent muggings can occur, so it pays to heed the dos and don’ts below, and the warnings in country chapters.

Don’t make yourself a target on the streets. Carry as little as possible.

Don’t wear jewellery or watches, however cheap. Strolling with a camera or iPod is asking for trouble.

Don’t walk the backstreets, or even some main streets, at night. Take a taxi – a few bucks for the fare might be a sound investment.

Do use a separate wallet for day-to-day purchases. Keep the bulk of your cash hidden under loose-fitting clothing.

Do walk purposefully and confidently. Never look like you are lost (even if you are!).

Do be discreet with your possessions, especially in dorms. Keep your gear in your bag. Out of sight, out of mind.

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Drugs

It’s very straightforward: the buying, selling, possession and use of all recreational drugs is illegal in every country in Africa. Having said that, cannabis (grass or resin) and other drugs are easily found if you want them. If this is your scene, take care. In 1999, two Kiwi travellers in Zambia got busted with a relatively small amount of grass, and did six months in jail with hard labour.

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Scams & con tricks

The main annoyance you’ll come across in Africa are the various hustlers, touts, con men and scam merchants who always see tourists as easy prey. Although these guys are not necessarily dangerous, some awareness and suitable precautions are advisable, and should help you deal with them without getting stung (or punched).

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Surviving scams

dud sounds

You buy some CDs from the market, but back at the hotel you open the box and it’s got a blank CD inside, or music by a different artist. The solution: always try to listen to the CDs first.

phone home

You give your address to a local kid who says he wants to write. He asks for your phone number too, and you think ‘no harm in that’. Until the folks back home start getting collect calls in the middle of the night. And when it’s the kid’s big brother making false ransom demands to your worried ma and pa, then things can get serious. The solution: stick to addresses, and even then be circumspect.

police & thieves

Local drug salesmen are often in cahoots with the police, who then apprehend you and conveniently find you ‘in possession’, or just tell you they’ve seen you talking to a known dealer. Large bribes will be required to avoid arrest or imprisonment. To complicate things further, many con artists pose as policemen to extort money. Insist on being taken to the police station, and get written receipts for any fines you pay.

take a tour

A tout offers to sell you a tour such as a safari or a visit to a local attraction, and says he can do it cheaper if you buy onward travel with him too. You cough up for bus/ferry/plane tickets, plus another tour in your next destination, only to find yourself several days later with your cash gone and your reservations non-existent. Best to pay only small amounts in advance, and deal with recommended companies or touts only.

welcome, friend

You’re invited to stay for free in someone’s house, if you buy meals and drinks for a few days. Sounds good, but your new friend’s appetite for food and beer makes the deal more expensive than staying at a hotel. More seriously, while you’re out entertaining, someone else will be back at the house of your ‘friend’ going through your bag. This scam is only likely in tourist zones –in remote or rural areas you’ll often come across genuine hospitality.

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In transit

Deep vein thrombosis (DVT)

Blood clots can form in the legs during flights, chiefly because of prolonged immobility. This formation of clots is known as deep vein thrombosis (DVT), and the longer the flight, the greater the risk. Although most blood clots are reabsorbed uneventfully, some might break off and travel through the blood vessels to the lungs, where they could cause life-threatening complications.

The chief symptom of DVT is swelling or pain of the foot, ankle or calf, usually but not always on just one side. When a blood clot travels to the lungs, it could cause chest pain and breathing difficulty. Travellers with any of these symptoms should immediately seek medical attention.

To prevent the development of DVT on long flights you should walk about the cabin, perform isometric compressions of the leg muscles (ie contract the leg muscles while sitting), drink plenty of fluids, and avoid alcohol.

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Jet lag & motion sickness

If you’re crossing more than five time zones you could suffer jet lag, resulting in insomnia, fatigue, malaise or nausea. To avoid jet lag try drinking plenty of fluids (nonalcoholic) and eating light meals. Upon arrival, get exposure to natural sunlight and readjust your schedule (for meals, sleep etc) as soon as possible. Antihistamines such as dimenhydrinate (Dramamine) and meclizine (Antivert, Bonine) are usually the first choice for treating motion sickness. Their main side effect is drowsiness. A herbal alternative is ginger (in the form of ginger tea, biscuits or crystallised ginger), which works like a charm for some people.

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While you're there

Women in Africa

Women form the backbone of African families, institutions that provide an excellent support network. However, these institutions are being sorely tested by the AIDS epidemic and are often upset if the men are forced to leave their homes and move to the cities as migrant industrial workers.

Women usually tackle the lion’s share of agricultural work in traditional village societies, and in some nations sexual equality is enshrined in law. Sadly, on the ground, equal rights are some way off and women are often treated as second-class citizens. Families sometimes deny girls schooling, although education is valued highly by most Africans. More serious still are reports of female infanticide, forced marriages, female genital mutilation and honour killings.

African women made history in 2005 when a legal protocol came into force that specifically protects women’s human rights in the 17 countries that ratified it. These countries have pledged to amend their laws to uphold a raft of women’s rights, including the right to property after divorce, the right to abortions after rape or abuse, and the right to equal pay in the workplace, among many others.

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Children

Travelling with kids in Africa might sound like a nightmare but in fact many families find an African holiday is a rewarding and thrilling experience. While some posh hotels and camps ban kids under a certain age, some of the higher-end safari lodges run special wildlife-watching programmes for kids, and baby-sitting services are pretty widely available in midrange and top-end hotels. Africans adore children, and wherever they go your kids will be assured of a warm reception and a host of instant new friends. Outside the main cities, you can pretty safely assume that disposable nappies won’t be available, so bring everything you need with you.

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Women travellers

It’s no use pretending otherwise – women travelling in Africa (alone or with other women) will occasionally encounter specific problems, most often harassment from men. North Africa can be particularly tiresome from this perspective. And in places where an attack or mugging is a real possibility, women are seen as easy targets, so it pays to keep away from these areas (you should investigate the individual country you're considering, but you can also talk to people on the ground to get the latest situation).

But don’t panic! On a day-to-day basis, compared to many places, travel in Africa is relatively safe and unthreatening, and you’ll meet friendliness and generosity – not to mention pure old-fashioned gallantry – far more often than hostility or predatory behaviour. Many men are simply genuinely curious as to why on earth a woman is out travelling the world rather than staying at home with the babies, so keep an open mind and try not to be too hostile yourself.

Having said that, when it comes to evening entertainment, Africa is a conservative society and in many countries ‘respectable’ women don’t go to bars, clubs or restaurants without a male companion. However distasteful this may be to post-feminist Westerners, trying too aggressively to buck the system could lead to trouble.

Because of these attitudes, it can be hard to meet and talk with local women. It may require being invited into a home, although since many women have received little education, unless you have learnt some of the local language, communication between you could be tricky. However, this is changing to some extent because a surprising number of girls go to school while boys are sent away to work. This means that many of the staff in tourist offices, hotels or government departments are educated women, and this can be as good a place as any to try striking up a conversation. In rural areas, a good starting point might be teachers at local schools, or staff at health centres.

Some expatriates you meet may be appalled at the idea of a female travelling alone and will do their best to discourage you with horror stories, often of dubious accuracy. Others will have a far more realistic attitude. When you are on the road, the best advice on what can and can’t be undertaken safely will come from local women. Use your common sense and things should go well. It’s also worth remembering that, as a solo female traveller, you might be best to pay a little extra for midrange hotels where the surroundings may make you feel more comfortable – many of the cheapest hotels in African towns rent rooms by the hour.

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Sexual harassment

Unwanted interest from male ‘admirers’ is an inevitable aspect of travel in Africa, especially for lone women. This is always unpleasant, but it’s worth remembering that although you may encounter a lewd border official, or a persistent suitor who won’t go away, real harm or rape is very unlikely. If you’re alone in an uneasy situation, act cold or uninterested, rather than threatened. Stick your nose in a book. Or invent an imaginary husband who will be arriving shortly.

Part of the reason for the interest is that local women rarely travel long distances alone, and a single foreign female is an unusual sight. And, thanks to imported TV and Hollywood films (not to mention the behaviour of some tourists), Western women are frequently viewed as ‘easy’.

What you wear may greatly influence how you’re treated. African women dress conservatively, in traditional or Western clothes, so when a visitor wears something different from the norm, she will draw attention. In the minds of some men this is provocative. In general, look at what other women are wearing and follow suit. Keep your upper arms and legs covered.

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Sanitary protection

You can buy tampons and pads in most cities and major towns from pharmacies or supermarkets. Prices are about the same as in Europe (from where they’re imported) but you seldom have choice of type or brand. They’re rarely found in shops away from the main towns, so you might want to bring supplies if you’re spending a lot of time in remote areas.

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