Health & insurance
Before You Go
Medical insurance is crucial for travel in Rwanda, but policies differ. Check that the policy includes all the activities you want to do. Some specifically exclude ‘dangerous activities’ such as trekking. Also find out whether your insurance will make payments directly to providers or will reimburse you later for overseas health expenditures (in Rwanda 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.
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. Proof of yellow-fever vaccination is mandatory for travel to Rwanda.
Availability & Cost of Health Care
Good, Western-style medical care is available in Kigali, and to a lesser extent in Huye (Butare). Elsewhere, reasonable to good care is available in larger towns. If you fall ill in an unfamiliar area, ask staff at top-end hotels or resident expatriates where the best nearby medical facilities are; in an emergency, contact your embassy.
Well-stocked pharmacies are found in major towns. It’s best to bring whatever you think you may need from home, including malaria pills and a malaria test kit. Always check the expiry date before buying medications, especially in smaller towns.
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.
For Western standards, expect to pay Western prices.
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 during paddling or swimming and then migrate to the bladder or bowel. They’re 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 might be no symptoms; there might be a transient fever and rash; and advanced cases might 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’s not possible for you to infect others.
Malaria is endemic in Rwanda (except at altitudes higher than 2000m, where risk of transmission is low), particularly in eastern Rwanda and during the rainy season.
Yellow fever is spread by infected mosquitoes. Symptoms range from a flu-like illness to severe hepatitis (liver inflammation), jaundice and death. The yellow-fever 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 travellers.
Travellers must carry a certificate as evidence of vaccination and present it at immigration upon arrival in Rwanda.
The lack of oxygen at high altitudes (over 2500m) affects most people to some extent. Symptoms of Acute Mountain Sickness (AMS) usually develop in the first 24 hours at altitude but may be delayed up to three weeks. Mild symptoms are headache, lethargy, dizziness, difficulty sleeping and loss of appetite. Severe symptoms are breathlessness, a dry, irritated cough (followed by the production of pink, frothy sputum), severe headache, lack of coordination, confusion, vomiting, irrational behaviour, drowsiness and unconsciousness. There's no rule as to what is too high: AMS can be fatal at 3000m, but 3500m to 4500m is the usual range when it can cause problems. In Rwanda, this can be a problem when trekking in the Volcanoes National Park, where a few summits are over 3000m. Ascend slowly; drink extra fluids; eat light, high-carbohydrated meals for more energy; and avoid alcohol, sedatives and tobacco.
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’re one of these people, carry an ‘epipen’: an adrenaline (epinephrine) injection, which you can give yourself. This could save your life.
Tsetse flies can also be unwelcome companions in some areas, especially in Akagera National Park, delivering painful, swelling bites. To minimise the nuisance, wear thick, long-sleeved shirts and trousers in khaki or other drab shades, and avoid bright, contrasting and very dark clothing.
Scorpions are frequently found in arid or dry climates. They can cause a painful bite that is sometimes life-threatening. If bitten by a scorpion, take a painkiller. Medical treatment should be sought if collapse occurs.
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 treating to avoid spreading scabies, even if they do not show any symptoms.
Basically, do all you can to avoid getting bitten! Do not walk barefoot, or stick your hand into holes or cracks. However, 50% of people bitten by venomous snakes are not actually injected with poison (envenomed). If you are 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 try to cut or suck the bite. Get medical help as soon as possible so you can get treated with an antivenene if necessary.
Don’t drink tap water in Rwanda unless it has been boiled, filtered or chemically disinfected (such as with iodine tablets). Don’t drink from streams, rivers and lakes. It’s also best to avoid drinking from pumps, boreholes and wells; some bring pure water to the surface, but the presence of animals can contaminate supplies. Bottled water is widely available throughout the country.