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Kenya

Health & safety

Before you go

A little planning before departure, particularly for pre-existing illnesses, will save you a lot of trouble later. Before a long trip, get a check-up from your dentist, and from your doctor if you use regular medication or have any chronic illness, such as high blood pressure. 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 all the preparations 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 (known in some countries 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, which includes Kenya, 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 (Iamat; www.iamat.org). Its website can help travellers find a doctor who has completed 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 or another potentially serious disease is suspected, seek medical help as soon as possible or begin self-medicating if you are off the beaten track.

Insurance

Find out in advance whether your insurance plan will make payments directly to providers or will reimburse you later for overseas health expenditures (many doctors expect payment in cash). It’s vital to ensure that your travel insurance will cover the emergency transport required 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 Kenya, as well as air ambulance transfers between medical facilities. Money paid by members for this service goes into providing grass-roots medical assistance for local people.

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. A great time to ensure that all routine vaccination cover is complete is when you are planning your travel. 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 Kenya: hepatitis A, hepatitis B, meningococcal meningitis, rabies and typhoid, and boosters for tetanus, diphtheria, polio and measles. It is also advisable to be vaccinated against yellow fever.

Medical checklist

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

Following is a list of items you should consider bringing:

Acetaminophen (paracetamol) or aspirin

Acetazolamide (Diamox) for altitude sickness (prescription only)

Adhesive or paper tape

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

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

Antidiarrhoeal drugs (eg loperamide)

Antihistamines (for hay fever and allergic reactions)

Anti-inflammatory drugs (eg ibuprofen)

Antimalaria pills

Bandages, gauze, gauze rolls

Insect repellent containing DEET, 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

Steroid cream or hydrocortisone cream (for allergic rashes)

Sunscreen

Syringes, sterile needles and fluids if travelling to remote areas

Thermometer

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

Internet resources

There is a wealth of travel health advice on the internet. A good place to start is the Lonely Planet website (www.lonelyplanet.com). The World Health Organization publishes a superb book called International Travel and Health , which is revised annually and available free at www.who.int/ith/. Other useful websites include MD Travel Health (www.mdtravelhealth.com), which provides complete travel health recommendations, updated daily, Centers for Disease Control and Prevention (www.cdc.gov) and Fit for Travel (www.fitfortravel.scot.nhs.uk).

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

Australia www.smartraveller.gov.au

Canada www.hc-sc.gc.ca/english/index.html

UK www.nhs.uk/Healthcareabroad

USA www.cdc.gov/travel/

Further reading

Comprehensive Guide to Wilderness and Travel Medicine by Eric A Weiss

Healthy Travel by Jane Wilson-Howarth

Healthy Travel Africa by Isabelle Young

How to Stay Healthy Abroad by Richard Dawood

Travel in Health by Graham Fry

Travel with Children by Cathy Lanigan

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Dangers & annoyances

While Kenya is a comparatively safe African destination, there are still plenty of pitfalls for the unwary or inexperienced traveller, from everyday irritations to more serious threats. A little street sense goes a long way here, and getting the latest local information is essential wherever you intend to travel.

Banditry

Wars in Somalia, Sudan and Ethiopia have all had their effect on the stability and safety of northern and northeastern Kenya. AK-47s have been flowing into the country for many years, and the newspapers are filled with stories of hold-ups, shoot-outs, cattle rustling and general lawlessness. Bandits and poachers infiltrating from Somalia have made the northeast of the country particularly dangerous, and it has gotten worse in recent years due to a number of complicated factors.

In the northwest, the main problem is armed tribal wars and cattle rustling across the Sudanese border. There are Kenyan shiftas (bandits) too, of course, but cross-border problems seem to account for most of the trouble in the north of the country.

Despite all the headlines, tourists are rarely targeted, as much of the violence and robberies take place far from the main tourist routes. Security has also improved considerably in previously high-risk areas such as the Isiolo–Marsabit, Marsabit–Moyale and MalindiLamu routes. However, you should check the situation locally before taking these roads, or travelling between Garsen and Garissa or Thika.

The areas along the Sudanese and Ethiopian borders are very risky, so please inquire about the latest security situations if you’re heading overland.

Crime

Even the staunchest Kenyan patriot will readily admit that the country’s biggest problem is crime. It ranges from petty snatch theft and mugging to violent armed robbery, carjacking and, of course, white-collar crime and corruption. As a visitor you needn’t feel paranoid, but you should always keep your wits about you, particularly at night.

Perhaps the best advice for when you’re walking around cities and towns is not to carry anything valuable with you – that includes jewellery, watches, cameras, bumbags, day-packs and money. Most hotels provide a safe or secure place for valuables, although you should also be cautious of the security at some budget places. Cheap digital watches and plastic sunglasses can be bought in Kenya for a few hundred shilling, and you won’t miss them if they get taken.

While pickpocketing and bag-snatching are the most common crimes, armed muggings do occur in Nairobi and on the coast. However, they usually occur at night or in remote areas, so always take taxis after dark or along lonely dirt roads. Conversely, snatch-and-run crimes happen more in crowds. If you suddenly feel there are too many people around you, or think you are being followed, dive straight into a shop and ask for help.

Luggage is an obvious signal to criminals that you’ve just arrived. When arriving anywhere by bus, it’s sensible to take a ‘ship-to-shore’ approach, getting a taxi directly from the bus station to your hotel. You’ll have plenty of time to explore once you’ve safely stowed your belongings. Also, don’t read this guidebook or look at maps on the street – it attracts unwanted attention.

In the event of a crime, you should report it to the police, but this can be a real procedure. You’ll need to get a police report if you intend to make an insurance claim. In the event of a snatch theft, think twice before yelling ‘Thief!’ It’s not unknown for people to administer summary justice on the spot, often with fatal results for the criminal.

Although crime is a fact of life in Kenya, it needn’t spoil your trip. Above all, don’t make the mistake of distrusting every Kenyan just because of a few bad apples – the honest souls you meet will far outnumber any crooks who cross your path.

Money

With street crime a way of life in Nairobi, you should be doubly careful with your money. The safest policy is to leave all your valuables in the hotel safe and just carry enough cash for that day. If you do need to carry larger sums around, a money belt worn under your clothes is the safest option to guard against snatch thefts. However, be aware that muggers will usually be expecting this.

More ingenious tricks include tucking money into a length of elasticised bandage on your arm or leg, or creating a hidden pocket inside your trousers. If you don’t actually need your credit card, travellers cheques or cash with you, they’ll almost always be safer locked away in your hotel safe. Don’t overlook the obvious and leave money lying around your hotel room in plain view. However well you get on with the staff, there will be some unlikely to resist a free month’s wages if they’ve got a family to feed.

Scams

At some point in Kenya you’ll almost certainly come across people who play on the emotions and gullibility of foreigners. Nairobi is a particular hotspot, with ‘friendly’ approaches a daily, if not hourly, occurrence. People with tales about being refugees or having sick relatives can sound very convincing, but they all end up asking for cash. It’s OK to talk to these people if they’re not actively hassling you, but you should always ignore any requests for money.

Be sceptical of strangers who claim to recognise you in the street, especially if they’re vague about exactly where they know you from – it’s unlikely that any ordinary person is going to be this excited by seeing you twice. Anyone who makes a big show of inviting you into the hospitality of their home also probably has ulterior motives. The usual trick is to bestow some kind of gift upon the delighted traveller, who is then emotionally blackmailed into reciprocating to the order of several hundred shillings.

Tourists with cars also face potential rip-offs. Don’t trust people who gesticulate wildly to indicate that your front wheels are wobbling; if you stop, you’ll probably be relieved of your valuables. Another trick is to splash oil on your wheels, then tell you the wheel bearings, differential or something else has failed, and direct you to a nearby garage where their friends will ‘fix’ the problem – for a substantial fee, of course.

Terrorism

Kenya has twice been subject to terrorist attacks: in August 1998 the US embassy in Nairobi was bombed, and in November 2002 the Paradise Hotel, north of Mombasa, was car-bombed at the same time as a rocket attack on an Israeli jet. While these events caused a brief panic in the tourist industry, it now seems they were isolated incidents and that Western travellers to Kenya can expect to have a trouble-free time in the country. Visitors to the predominantly Muslim coast region should be aware that anti-American sentiment can run high here, but actual violence against foreigners is highly unlikely.

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While you're there

Availibility & cost of health care

Health care in Kenya is varied: it can be excellent in Nairobi, which generally have well-trained doctors and nurses, but it is often patchy off the beaten track, even in Mombasa. Medicine and even sterile dressings and intravenous fluids might need to be purchased from a local pharmacy. The standard of dental care is equally variable, and there is an increased risk of hepatitis B and HIV transmission from poorly sterilised equipment.

By and large, public hospitals in Kenya offer the cheapest service, but will have the least up-to-date equipment and medications; mission hospitals (where donations are the usual form of payment) often have more reasonable facilities; and private hospitals and clinics are more expensive but tend to have more advanced drugs and equipment and better trained medical staff.

Most drugs can be purchased over the counter in Kenya, without a prescription. Many drugs for sale in Kenya might be ineffective; they might be counterfeit or might not have been stored under the right conditions. The most common examples of counterfeit drugs are malaria tablets and expensive antibiotics, such as ciprofloxacin. Most drugs are available in Nairobi, but remote villages will be lucky to have a couple of paracetamol tablets. It is strongly recommended that you bring all medication from home. Also, the availability and efficacy of condoms cannot be relied upon – bring all the contraception you’ll need. Condoms bought in Kenya might not be of the same quality as in Europe, North America or Australia, and they might have been incorrectly stored.

There is a high risk of contracting HIV from infected blood if you receive a blood transfusion in Kenya. The Blood Care Foundation (www.bloodcare.org.uk) is a useful source of safe, screened blood, which can be transported to any part of the world within 24 hours.

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Infectious diseases

It’s a formidable list but, as we say, a few precautions go a long way…

Bilharzia (Schistosomiasis)

This disease is spread by flukes (minute worms) that are carried by a species of freshwater snail. The flukes are carried inside the snail, which then sheds them into slow-moving or still water. The parasites penetrate human skin as people paddle or swim and then migrate to the bladder or bowel. They are passed out via stool or urine and could contaminate fresh water, where the cycle starts again. Paddling or swimming in suspect freshwater lakes or slow-running rivers should be avoided. There may be no symptoms. However, there may be a transient fever and rash, and advanced cases may have blood in the stool or in the urine. A blood test can detect antibodies if you might have been exposed, and treatment is then possible in specialist travel or infectious disease clinics. If not treated the infection can cause kidney failure or permanent bowel damage. It is not possible for you to infect others directly.

Cholera

Cholera is usually only a problem during natural or other disasters, eg war, floods or earthquakes, although small outbreaks can also occur at other times. Travellers are rarely affected. The disease is caused by a bacteria and spread via contaminated drinking water. The main symptom is profuse watery diarrhoea, which causes debilitation if fluids are not replaced quickly. An oral cholera vaccine is available in the USA, but it is not particularly effective. Most cases of cholera can be avoided by drinking only clean water and by avoiding potentially contaminated food. Treatment is by fluid replacement (orally or via a drip), but sometimes antibiotics are needed. Self-treatment is not advised.

Diphtheria

Found in all of Africa, diphtheria is spread through close respiratory contact. It usually causes a high temperature and a severe sore throat. A membrane can form across the throat, requiring a tracheostomy to prevent suffocation. Vaccination is recommended for those likely to be in close contact with the locals in infected areas. This is more important for long stays than for short-term trips. The vaccine is given as an injection alone or with tetanus, and lasts 10 years.

Filariasis

Tiny worms migrating in the lymphatic system cause filariasis. The bite from an infected mosquito spreads the infection. Symptoms include localised itching and swelling of the legs and/or genitalia. Treatment is available.

Hepatitis A

Hepatitis A is spread through contaminated food (particularly shellfish) and water. It causes jaundice and, although it is rarely fatal, it can cause prolonged lethargy. If you’re recovering from hepatitis A, you shouldn’t drink alcohol for up to six months afterwards, but once you’ve recovered, there won’t be any long-term problems. The first symptoms include dark urine and a yellow colour to the whites of the eyes. Sometimes a fever and abdominal pain might be present. Hepatitis A vaccine (Avaxim, Vaqta, Havrix) is given as an injection: a single dose will give protection for up to a year, and a booster after a year gives 10-year protection. Hepatitis A and typhoid vaccines can also be given as a single-dose vaccine, with hepatyrix or viatim.

Hepatitis B

Hepatitis B is spread through infected blood, contaminated needles and sexual intercourse. It can also be spread from an infected mother to the baby during childbirth. Hepatitis B affects the liver, which causes jaundice and occasionally liver failure. Most people recover completely, but some people might be chronic carriers of the virus, which could lead eventually to cirrhosis or liver cancer. Those visiting high-risk areas for long periods or those with increased social or occupational risk should be immunised. Many countries now give hepatitis B as part of routine childhood vaccinations. It is given singly or can be given at the same time as hepatitis A (hepatyrix).

A course will give protection for at least five years. It can be given over four weeks or six months.

HIV

Human immunodeficiency virus (HIV), the virus that causes acquired immune deficiency syndrome (AIDS), is an enormous problem in Kenya, where the infection rate is around 6.7% of the adult population. The virus is spread through infected blood and blood products, by sexual intercourse with an infected partner, and from an infected mother to her baby during childbirth or breastfeeding. It can be spread through ‘blood to blood’ contacts, such as with contaminated instruments during medical, dental, acupuncture and other body-piercing procedures, and through sharing intravenous needles. At present there is no cure; medication that might keep the disease under control is available, but these drugs are too expensive for the overwhelming majority of Africans, and are not readily available for travellers either. If you think you might have been exposed to HIV, a blood test is necessary; a three-month gap after exposure and before testing is required to allow antibodies to appear in the blood.

Malaria

Malaria is a major health scourge in Kenya. Infection rates vary with season (higher in the rainy season) and climate, so check out the situation before departure. The incidence of malarial transmission at altitudes higher than 2000m is rare.

Malaria is caused by a parasite in the bloodstream spread via the bite of the female anopheles mosquito. There are several types, falciparum malaria being the most dangerous and the predominant form in Kenya. Unlike most other diseases regularly encountered by travellers, there is no vaccination against malaria (yet). However, several different drugs are used to prevent malaria and new ones are in the pipeline. Up-to-date advice from a travel-health clinic is essential, as some medication is more suitable for some travellers than others. The pattern of drug-resistant malaria is changing rapidly, so what was advised several years ago might no longer be the case.

SYMPTOMS

Malaria can affect people in several ways. The early stages include headaches, fevers, generalised aches and pains, and malaise, often mistaken for flu. Other symptoms can include abdominal pain, diarrhoea and a cough. Anyone who develops a fever while in a malarial area should assume malarial infection until a blood test proves negative, even if you’ve been taking antimalarial medication. If not treated, the next stage can develop within 24 hours, particularly if falciparum malaria is the parasite: jaundice, reduced consciousness and coma (known as cerebral malaria), followed by death. Treatment in hospital is essential, and if patients enter this late stage of the disease the death rate may still be as high as 10%, even in the best intensive-care facilities.

SIDE EFFECTS & RISKS

Many travellers are under the impression that malaria is a mild illness, that treatment is always easy and successful, and that taking antimalarial drugs causes more illness through side effects than actually getting malaria. Unfortunately this is not true. Side effects of the medication depend on the drug being taken. Doxycycline can cause heartburn and indigestion; mefloquine (Larium) can cause anxiety attacks, insomnia and nightmares, and (rarely) severe psychiatric disorders; chloroquine can cause nausea and hair loss; and proguanil can cause mouth ulcers. These side effects are not universal, and can be minimised by taking medication correctly, such as with food. Also, some people should not take a particular antimalarial drug, eg people with epilepsy should avoid mefloquine, and doxycycline should not be taken by pregnant women or children younger than 12.

If you decide that you really do not wish to take antimalarial drugs, you must understand the risks, and be obsessive about avoiding mosquito bites. Use nets and insect repellent, and report any fever or flu-like symptoms to a doctor as soon as possible. Some people advocate homeopathic preparations against malaria, such as Demal200, but as yet there is no conclusive evidence that this is effective, and many homeopaths do not recommend their use. Some people should not take a particular antimalarial drug, eg people with epilepsy should avoid mefloquine, and doxycycline should not be taken by pregnant women or children younger than 12. Malaria in pregnancy frequently results in miscarriage or premature labour and the risks to both mother and foetus during pregnancy are considerable. Travel in Kenya when pregnant should be carefully considered.

Adults who have survived childhood malaria develop a resistance and usually only develop mild cases of malaria if it recurs; most Western travellers have no resistance at all. Resistance wanes after 18 months of nonexposure, so even if you have had malaria in the past, you might no longer be resistant.

STAND-BY TREATMENT

If you are going to be in remote areas or far from major towns, consider taking a stand-by treatment. Emergency stand-by treatments should be seen as emergency treatment aimed at saving the patient’s life and not as routine way of self-medicating. It should be used only if you will be far from medical facilities and have been advised about the symptoms of malaria and how to use the medication. Medical advice should be sought as soon as possible to confirm whether the treatment has been successful. The type of stand-by treatment used will depend on local conditions, such as drug resistance, and on what antimalarial drugs were being used before stand-by treatment. This is worthwhile because you want to avoid contracting a particularly serious form such as cerebral malaria, which can be fatal within 24 hours. Self-diagnostic kits, which can identify malaria in the blood from a finger prick, are also available in the West.

Meningococcal Meningitis

Meningococcal infection is spread through close respiratory contact and is more likely to be contracted in crowded situations, such as dormitories, buses and clubs. Infection is uncommon in travellers. Vaccination is recommended for long stays and is especially important towards the end of the dry season. Symptoms include a fever, severe headache, neck stiffness and a red rash. Immediate medical treatment is necessary.

The ACWY vaccine is recommended for all travellers in sub-Saharan Africa. This vaccine is different from the meningococcal meningitis C vaccine given to children and adolescents in some countries; it is safe to be given both types of vaccine.

Poliomyelitis

Polio is generally spread through contaminated food and water. It is one of the vaccines given in childhood in the West and should be boosted every 10 years, either orally (a drop on the tongue) or as an injection. Polio can be carried asymptomatically (ie showing no symptoms) and could cause a transient fever. In rare cases it causes weakness or paralysis of one or more muscles, which might be permanent.

Rabies

Rabies is spread by the bites or licks of an infected animal on broken skin. It is always fatal once the clinical symptoms start (which might be up to several months after an infected bite), so postbite vaccination should be taken as soon as possible. Postbite vaccination (whether or not you’ve been vaccinated before the bite) prevents the virus from spreading to the central nervous system. Animal handlers should be vaccinated, as should those travelling to remote areas where a reliable source of post-bite vaccine is not available within 24 hours. To prevent the disease, three injections are needed over a month. If you have not been vaccinated and receive a bite, you will need a course of five injections starting 24 hours or as soon as possible after the injury. If you have been vaccinated, you will need fewer postbite injections, and have more time to seek medical help.

Rift Valley Fever

This fever is spread occasionally via mosquito bites and is rarely fatal. The symptoms are of a fever and flu-like illness.

River Blindness (Onchocerciasis)

This is caused by the larvae of a tiny worm, which is spread by the bite of a small fly. The earliest sign of infection is intensely itchy, red, sore eyes. Travellers are rarely severely affected. Treatment should be sought in a specialised clinic.

Sleeping Sickness (Trypanosomiasis)

Sleeping sickness is spread via the bite of the tsetse fly and causes a headache, fever and eventually coma. There is an effective treatment.

Tuberculosis (TB)

TB is spread through close respiratory contact and occasionally through infected milk or milk products. BCG vaccination is recommended for anyone who is likely to be mixing closely with the local population, although the vaccination gives only moderate protection against TB. It is more important to be vaccinated for long-term stays than for short stays. The BCG vaccine is not available in all countries, but is given routinely to many children in developing countries. The vaccination is usually given in a specialised chest clinic and causes a small permanent scar at the site of injection. It is a live vaccine and should not be given to pregnant women or immunocompromised individuals.

TB can be asymptomatic, only being picked up by a routine chest X-ray. Alternatively, it can cause a cough, weight loss or fever, sometimes months or even years after exposure.

Typhoid

This illness is spread through handling food or drinking water that has been contaminated by infected human faeces. The first symptom of infection is usually a fever or a pink rash on the abdomen. Sometimes septicaemia (blood poisoning) can also occur. A typhoid vaccine (typhim Vi, typherix) will give protection for three years. In some countries, the oral vaccine Vivotif is also available. Antibiotics are usually given as treatment, and death is rare unless septicaemia occurs.

Yellow Fever

You should carry a certificate as evidence of vaccination against yellow fever if you’ve recently been in an infected country, to avoid immigration problems. For a full list of countries where yellow fever is endemic visit the websites of the World Health Organization (www.who.int/wer/) or the Centers for Disease Control and Prevention (www.cdc.gov/travel/blusheet.htm). A traveller without a legally required up-to-date certificate could possibly be vaccinated and detained in isolation at the port of arrival for up to 10 days, or even repatriated.

Yellow fever is spread by infected mosquitoes. Symptoms range from a flu-like illness to severe hepatitis (liver inflammation), jaundice and death. Vaccination must be given at a designated clinic and is valid for 10 years. It’s a live vaccine and must not be given to immunocompromised or pregnant women. For visitors to Kenya, vaccination is not mandatory but is recommended.

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Traveller’s Diarrhoea

Although it’s not inevitable that you will get diarrhoea while travelling in Kenya, it’s certainly likely. Diarrhoea is the most common travel-related illness, and sometimes simply dietary changes, such as increased spices or oils, are the cause. To help prevent diarrhoea, avoid tap water. You should also only eat fresh fruits or vegetables if cooked or peeled, and be wary of dairy products that might contain unpasteurised milk. Although freshly cooked food can often be safe, plates or serving utensils might be dirty, so be highly selective when eating food from street vendors (ensure that cooked food is piping hot right through).

If you develop diarrhoea, drink plenty of fluids, preferably an oral rehydration solution containing water (lots), and some salt and sugar. A few loose stools don’t require treatment but, if you start having more than four or five stools a day, you should start taking an antibiotic (usually a quinoline drug, such as ciprofloxacin or norfloxacin) and an antidiarrhoeal agent (eg loperamide) if you are not within easy reach of a toilet. If diarrhoea is bloody, persists for more than 72 hours or is accompanied by fever, shaking chills or abdominal pain, seek medical attention.

Amoebic Dysentery

Contracted by eating contaminated food and water, amoebic dysentery causes blood and mucus in the faeces. It can be relatively mild and tends to come on gradually, but seek medical advice if you think you have the illness as it won’t clear up without treatment (which is with specific antibiotics).

Giardiasis

This, like amoebic dysentery, is caused by contaminated food or water. The illness usually appears a week or more after exposure to the parasite. Giardiasis might cause only a short-lived bout of typical traveller’s diarrhoea, but may cause persistent diarrhoea. Ideally, seek medical advice if you suspect you have giardiasis, but if you are in a remote area you could start a course of antibiotics.

Environmental hazards

Heat exhaustion

This condition occurs following heavy sweating and excessive fluid loss with inadequate replacement of fluids and salt, and is particularly common in hot climates when taking unaccustomed exercise before full acclimatisation. Symptoms include headache, dizziness and tiredness. Dehydration is already happening by the time you feel thirsty – aim to drink sufficient water to produce pale, diluted urine. Self-treatment: fluid replacement with water and/or fruit juice, and cooling by cold water and fans. The treatment of the salt-loss component consists of consuming salty fluids such as soup, and adding a little more salt to foods than usual.

Heatstroke

Heat exhaustion is a precursor to the much more serious condition of heatstroke. In this case there is damage to the sweating mechanism, with an excessive rise in body temperature; irrational and hyperactive behaviour; and eventually loss of consciousness and death. Rapid cooling by spraying the body with water and fanning is ideal. Emergency fluid and electrolyte replacement is usually also required by intravenous drip.

Insect bites & stings

Mosquitoes might not always carry malaria or dengue fever, but they (and other insects) can cause irritation and infected bites. To avoid these, take the same precautions as you would for avoiding malaria. Use DEET-based insect repellents. Excellent clothing treatments are also available; mosquitoes that land on treated clothing will die.

Bee and wasp stings cause real problems only to those who have a severe allergy to the stings (anaphylaxis.) If you are one of these people, carry an EpiPen – an adrenaline (epinephrine) injection, which you can give yourself. This could save your life.

Sandflies are found near many African beaches. They usually only cause a nasty itchy bite but can carry a rare skin disorder, cutaneous leishmaniasis. Prevention of bites with DEET-based repellents is sensible.

Scorpions are frequently found in arid or dry climates. They can cause a painful bite that is sometimes life-threatening. If you are bitten by a scorpion, seek immediate medical assistance.

Bed bugs are often found in hostels and cheap hotels. Bites lead to very itchy, lumpy skin. Spraying the mattress with crawling-insect killer then changing the bedding will get rid of them.

Scabies is also frequently found in cheap accommodation. These tiny mites live in the skin, particularly between the fingers. They cause an intensely itchy rash. The itch is easily treated with malathion and permethrin lotion from a pharmacy; other members of the household also need treatment to avoid spreading scabies, even if they do not show any symptoms.

Snake bites

Basically, avoid getting bitten! Do not walk barefoot, and don’t stick your hand into holes or cracks. However, 50% of those bitten by venomous snakes are not actually injected with poison (envenomed). If bitten by a snake, do not panic. Immobilise the bitten limb with a splint (such as a stick) and apply a bandage over the site, with firm pressure – similar to bandaging a sprain. Do not apply a tourniquet, or cut or suck the bite. Get medical help as soon as possible so antivenom can be given if needed.

Water

Never drink tap water unless it has been boiled, filtered or chemically disinfected (such as with iodine tablets). Never drink from streams, rivers and lakes. It’s also best to avoid drinking from pumps and wells – some do bring pure water to the surface, but the presence of animals can still contaminate supplies.

Traditional medicine

At least 80% of the African population relies on traditional medicine, often either because conventional Western-style medicine is too expensive, because of prevailing cultural attitudes and beliefs, or simply because in some cases it works. It might also be because there’s often no other choice – a World Health Organization survey found that there is one medical doctor for every 70,000 people in Kenya, but a traditional healer for every 250 people.

Although some traditional African remedies seem to work on illnesses such as malaria, sickle cell anaemia, high blood pressure and some AIDS symptoms, most African healers tend to learn their art by apprenticeship, so education (and consequently the application of knowledge) is inconsistent and unregulated.

Rather than attempting to stamp out traditional practices, or simply pretend they aren’t happening, a positive step taken by Kenya is the regulation of traditional medicine by creating healers’ associations and offering courses on such topics as sanitary practices. It remains unlikely in the short term that even a basic level of conventional Western-style medicine will be made available to all the people of Africa. Traditional medicine, on the other hand, will almost certainly continue to be practised widely.

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