Health & insurance
Before You Go
Medical insurance is crucial, but policies differ. Check that the policy includes all the activities you want to do. Some specifically exclude ‘dangerous activities’ such as diving or trekking. Also find out whether your insurance will make payments directly to providers or will reimburse you later for overseas health expenditures (in Djibouti many doctors expect payment in cash).
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. 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 & Research Foundation (www.amref.org) provides an air-evacuation service in medical emergencies in many African countries, including Djibouti. It also provides air-ambulance transfers between medical facilities. Money paid by members for this service goes into providing grassroots medical assistance for local people.
The World Health Organization (www.who.int) recommends that all travellers be covered for diphtheria, tetanus, measles, mumps, rubella and polio, as well as for hepatitis B, regardless of their destination. The consequences of these diseases can be severe, and outbreaks of them do occur.
According to the Centers for Disease Control & 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. Depending on where you’ve travelled from, a cholera vaccination may also be required.
Availability & Cost of Healthcare
Health care in Djibouti is varied: Djibouti City has good facilities with well-trained doctors and nurses, but outside the capital health care is patchy at best. Medicine and even sterile dressings and intravenous fluids might need to be purchased from a local pharmacy by patients or their relatives. The standard of dental care is equally variable, and there’s an increased risk of hepatitis B and HIV transmission via poorly sterilised equipment. By and large, public hospitals in the region 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.
Djibouti City is well endowed with excellent French-supplied pharmacies, and most drugs can be purchased over the counter, with or without a prescription. It’s strongly recommended that all drugs for chronic diseases be brought from home.
Although condoms are readily available (sometimes boxes – yes boxes! – are in hotel rooms), their efficacy cannot be relied upon, so bring all the contraception you’ll need. Condoms bought in Africa might not be of the same quality as in Europe or Australia, and they might have been incorrectly stored.
There’s a high risk of contracting HIV from infected blood if you receive a blood transfusion in the region. The BloodCare 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.
One of the biggest hazards in Djibouti, and the one taken least seriously by travellers, is the sun. Heat exhaustion 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 is by 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 table salt to foods than usual.
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.
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.
Bottled water is available everywhere, though it’s better for the environment if you treat/filter local water.