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Health

As long as you stay up to date with vaccinations and take basic preventative measures, you’re unlikely to succumb to any hazards.

While South Africa has an impressive selection of tropical diseases, suffering from diarrhoea or a cold is more likely than contracting an exotic malady.

The main exception to this is malaria, which is a real risk in northeastern South Africa and lower-lying areas of Swaziland.

In South Africa

Availability & Cost of Health Care

  • Good-quality health care is available in all of South Africa’s major urban areas.
  • Private hospitals are generally of an excellent standard.
  • Public hospitals are often underfunded and overcrowded.
  • In off-the-beaten-track areas, reliable medical facilities are rare.
  • Your accommodation should be able to recommend the nearest source of medical help.
  • Western-embassy websites often list doctors and clinics, and your travel insurer might also be able to help.
  • In an emergency, contact your embassy or consulate.
  • Most doctors expect payment immediately after the consultation.
  • Patients may also have to pay on admission to a hospital.
  • Bring drugs for chronic diseases from home.
  • Blood-transfusion services test donated blood for hepatitis B and C, syphilis and HIV, but there is nonetheless a tiny risk of contracting HIV from infected transfusions.
  • 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; join before you need its services.

Tap Water

High-quality water is widely available in South Africa and drinking from taps is fine, except in rural and drought-struck areas.

Traditional Medicine

If you are ill, some locals may recommend you see a sangoma (traditional healer, usually a woman) or inyanga (traditional healer and herbalist, usually a man). These practitioners hold revered positions in many communities and are often interesting characters to meet on a tour. However, if you are ill, recourse to tried-and-tested Western medicine is a wiser option. Likewise, treat the traditional medicinal products found in local markets with circumspection.

Infectious Diseases

Cholera

Spread through Contaminated drinking water. The risk is low, and mostly confined to occasional outbreaks in rural parts of Limpopo, Mpumalanga, KwaZulu-Natal, the Eastern Cape and Swaziland.

Symptoms and effects Profuse watery diarrhoea, which causes debilitation if fluids are not replaced quickly.

Prevention and treatment In rural parts of eastern South Africa and Swaziland, pay close attention to drinking water, don’t drink tap water, and avoid potentially contaminated food such as unpeeled or uncooked fruits and vegetables. Treatment is by fluid replacement (orally or via a drip); sometimes antibiotics are needed. Self-treatment is not advised.

Typhoid

Spread through Food or water that has been contaminated by infected human faeces.

Symptoms and effects Initially fever, a pink rash on the abdomen, appetite loss and listlessness. Septicaemia (blood poisoning) may also occur.

Prevention and treatment Vaccination given by injection. In some countries, an oral vaccine is available. Antibiotics are usually given as treatment.

Tuberculosis

Spread through Close respiratory contact and, occasionally, infected unpasteurised milk or milk products. Tuberculosis is highly endemic in South Africa, Lesotho and Swaziland. People mixing closely with the local population, for example working as a teacher or health-care worker, or planning a long stay, are most at risk.

Symptoms and effects Can be asymptomatic, although symptoms can include a cough, loss of appetite or weight, fatigue, fever or night sweats months or even years after exposure. An X-ray is the best way to confirm if you have TB.

Prevention and treatment Avoid overcrowded and unventilated environments where TB carriers might be found, such as hospitals and homeless shelters. BCG vaccine is recommended for those likely to be mixing closely with the local population; as it's a live vaccine, it should not be given to pregnant women or immunocompromised individuals. Travellers at risk should have a predeparture skin test and be re-tested after leaving the country. Treatment is a multiple-drug regimen for six to nine months.

Rabies

Spread through Bites or licks on broken skin from an infected animal. Few human cases are reported in South Africa, with the risks highest in rural areas.

Symptoms and effects Initial symptoms are pain or tingling at the site of the bite with fever, loss of appetite and headache. With 'furious' rabies, there is a growing sense of anxiety, jumpiness, disorientation, neck stiffness, sometimes seizures or convulsions, and hydrophobia (fear of water). 'Dumb' rabies (less common) affects the spinal cord, causing muscle paralysis, then heart and lung failure. If untreated, both forms are fatal.

Prevention and treatment People travelling to remote areas, where a reliable source of post-bite vaccine is not available within 24 hours, should be vaccinated. Any bite, scratch or lick from a warm-blooded, furry animal should immediately be thoroughly cleaned. If you have not been vaccinated and you get bitten, you will need a course of injections starting as soon as possible after the injury. Vaccination does not provide immunity, it merely buys you more time to seek medical help.

Malaria

Spread through A parasite in the bloodstream, spread via the bite of the female Anopheles mosquito. Malaria is mainly confined to northeastern South Africa (parts of Kruger National Park, Limpopo, Mpumalanga and northern KwaZulu-Natal) and Swaziland (although Swaziland is taking steps to be the first country in sub-Saharan Africa to move to malaria-free status).

Symtoms and effects Falciparum malaria, the most dangerous type of malaria, is the predominant form in South Africa. The early, flu-like symptoms of malaria include headaches, fevers, aches and pains and malaise. Abdominal pain, diarrhoea and a cough can also occur. If not treated, the next stage can develop within 24 hours, particularly if falciparum malaria is the parasite: jaundice, then reduced consciousness and coma (also known as cerebral malaria), followed by death. Malaria in pregnancy frequently results in miscarriage or premature labour; the risks to both mother and foetus are considerable.

Prevention Infection rates vary with the season and climate, so check the situation before departure. During summer, prophylaxis is generally necessary. Several drugs are available and up-to-date advice from a travel clinic or similar is essential; some medication is more suitable than others (eg people with epilepsy should avoid mefloquine, and doxycycline should not be taken by pregnant women or children aged under 12). There is no conclusive evidence that antimalarial homeopathic preparations are effective, and many homeopaths do not recommend their use. It’s a dangerous misconception that malaria is a mild illness and that taking antimalarial drugs causes more illness through side effects than actually getting malaria. Immunity, developed by surviving a bout of malaria, wanes after 18 months of nonexposure, so even if you have had malaria or lived in a malaria-prone area, you might no longer be immune. If you decide against taking antimalarial prophylaxis, you must understand the risks and be thorough about avoiding mosquito bites.

Treatment If you develop a fever in a malarial area, or shortly after leaving one, assume malarial infection until a blood test proves negative, even if you are or have been taking antimalarial medication. Report any fever or flu-like symptoms to a doctor as soon as possible. Treatment in hospital may be required; even in the best intensive-care facilities there is still a chance of fatality in the worst cases.

Antimalarial A To D

A Awareness of the risk. No medication is totally effective, but protection of over 90% is achievable with most drugs, as long as other measures are taken.

B Bites, to be avoided at all costs. Sleep in a screened room, use a mosquito spray or coils, and sleep under a permethrin-impregnated net. Cover up at night with light-coloured long trousers and long sleeves – preferably permethrin-treated clothing. Apply repellent (preferably DEET-based) to all areas of exposed skin in the evenings.

C Chemical prevention (ie antimalarial drugs) is usually needed in malarial areas. Get medical advice, as resistance patterns can change, and new drugs are in development. Not all antimalarial drugs are suitable for everyone. Most antimalarial drugs need to be started at least a week beforehand and continued for four weeks after the last possible exposure to malaria.

D Diagnosis. If you have a fever or flu-like illness within a year of travel to a malarial area, malaria is a possibility, and immediate medical attention is necessary.

Lymphatic Filariasis (Elephantiasis)

Spread through The bite of an infected mosquito. Larvae are deposited on the skin and migrate to the lymphatic vessels, where they turn into worms.

Symptoms and effects Localised itching and abnormal enlargement of body parts, commonly the legs and/or genitalia, causing pain and disability. In severe cases, the kidneys and lymphatic and immune systems are damaged.

Prevention and treatment Avoid mosquito bites. If infected, seek treatment, preferably by a specialist in infectious diseases or tropical medicine. Diethylcarbamazine (DEC) is commonly used to treat travellers.

Schistosomiasis (Bilharzia)

Spread through Flukes (minute worms) are carried by a species of freshwater snail, which sheds them into slow-moving or still water. The parasites penetrate human skin during swimming and migrate to the bladder or bowel. They are excreted via stool or urine and could contaminate fresh water, beginning the cycle again. Bilharzia is found in northeastern South Africa and Swaziland, reaching as far south as the Wild Coast and (very occasionally) as far west as the Northern Cape section of the Orange (Senqu) River.

Symptoms and effects Early symptoms may include fever, loss of appetite, weight loss, abdominal pain, weakness, headaches, joint and muscle pains, diarrhoea, nausea and cough, but most infections are asymptomatic at first. Untreated, bilharzia can cause problems such as kidney failure and permanent bowel damage.

Prevention and treatment Avoid swimming in stagnant or slow-running water, for example in a dam, lake or river. Heat baths and showers and vigorously towel yourself after swimming. A blood test can detect the parasite, and treatment is available – usually taking the drug praziquantel (Biltricide).

HIV

Spread through Infected blood and blood products; sexual intercourse with an infected partner; ‘blood to blood’ contacts, such as through contaminated instruments during medical, dental, acupuncture and other body-piercing procedures, or sharing intravenous needles. HIV and AIDS are widespread in South Africa, Lesotho and Swaziland.

Symptoms and effects Progressive failure of the immune system, leading to death.

Prevention and treatment Be cautious about sexual relationships with locals, regardless of their background, and don’t have one-night stands. Travellers and aid workers have been infected by locals. If you think you might have been infected, a blood test is necessary; a three-month gap after exposure is required to allow antibodies to appear in the blood. There is no cure, but medication to keep the disease under control is available.

Dengue Fever

Spread through Mosquito bites; in the north of KwaZulu-Natal’s Elephant Coast and eastern Swaziland, and from there up South Africa’s northeastern border to the top of Kruger National Park.

Symptoms and effects Feverish illness with headache and muscle pains, similar to those experienced during severe, prolonged influenza attacks. There might be a rash.

Prevention and treatment Avoid mosquito bites. Self-treatment: paracetamol (not asprin or non-steroidal anti-inflammatory drugs such as ibuprofen), hydration and rest. Dengue hemorrhagic fever, which mostly affects children, is more serious and requires medical attention.

Hepatitis A

Spread through Contaminated food (particularly shellfish) and water. Very occasionally, close physical contact with an infected person.

Symptoms and effects Jaundice, dark urine, a yellow colour to the whites of the eyes, fever and abdominal pain. Although rarely fatal, it can cause prolonged lethargy – recovery can be slow.

Prevention and treatment Vaccine (eg Avaxim, Vaqta, Havrix or Epaxal) is given as an injection, with a booster extending the protection offered. Can also be given as a combined single-dose vaccine with hepatitis B (Twinrix) or typhoid (Hepatyrix or Viatim). If you’ve had hepatitis A, you shouldn’t drink alcohol for up to six months afterwards.

Hepatitis B

Spread through Infected blood, contaminated needles and sexual intercourse.

Symptoms and effects Jaundice and liver problems (occasionally failure).

Prevention and treatment Those visiting high-risk areas for long periods or those with increased social or occupational risk should be immunised. Regular travellers in sub-Saharan Africa should consider having hepatitis B as a routine vaccination. Treatments include an injection of immunoglobulin within 12 hours of exposure, rest, a nutritious diet and lots of fluids, possibly accompanied by antiviral drugs or hospital admission. Chronic cases may require ongoing antiviral medication and a liver transplant.

Environmental Hazards

Insect Bites & Stings

Causes Mosquitoes, scorpions (found in arid areas), ticks (a risk outside urban areas), bees and wasps.

Symptoms and effects Stings can cause irritation and get infected. The scorpion’s painful sting can be life-threatening. If you’re stung, take a painkiller and seek medical treatment if your condition worsens. Tick-bite fever (rickettsia), a bacterial infection transmitted by ticks that can cause malaria-like symptoms, is a risk in the lowveld, including Swaziland.

Prevention and treatment Take the same precautions as for avoiding malaria, including protective clothing and repellent. If you pick up a tick, press down around its head with tweezers, grab the head and gently pull upwards. Avoid pulling the rear of the body, as this may squeeze the tick’s gut contents through its mouth into your body, or leave its head inside you; both outcomes increase the risk of infection and disease. Smearing chemicals on the tick will not make it let go and is not recommended. If you suspect tick-bite fever, visit a doctor; treatment is a strong dose of antibiotics.

Snake Bites

Causes Venomous snakes found in South Africa include the black mamba, puff adder and Cape cobra. Snakes like to bask on rocks and sand, retreating during the heat of the day.

Prevention Do not walk barefoot or stick your hands into holes or cracks.

Treatment If bitten, do not panic. Half of the people bitten by venomous snakes are not actually injected with poison (envenomed). Immobilise the bitten limb with a splint (eg 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. Note the snake's appearance for identification purposes, and get medical help as soon as possible so that antivenin can be given.

Heatstroke

Causes Extreme heat, high humidity, physical exertion or use of drugs or alcohol in the sun, and dehydration. Occurs when the body’s heat-regulating mechanism breaks down.

Symptoms and effects An excessive rise in body temperature, accompanied by the ceasing of sweating, irrational and hyperactive behaviour and eventually loss of consciousness and death.

Treatment Rapid cooling by spraying the body with water and fanning. Emergency fluid and electrolyte replacement by intravenous drip is usually also required.

Heat Exhaustion

Causes Occurs following heavy sweating and excessive fluid loss with inadequate replacement of fluids and salt. This is common in hot climates when taking unaccustomed exercise before full acclimatisation.

Symptoms and effects Headache, dizziness and tiredness.

Prevention Dehydration is already happening by the time you feel thirsty – drink sufficient water such that you produce pale, diluted urine. The African sun can be fierce, so bring a hat.

Treatment Fluid replacement with water and/or fruit juice, and cooling by cold water and fans. Treat the salt loss by consuming salty fluids such as soup or broth and adding a little more table salt to foods than usual.

Before You Go

Courses

If you’ll be spending much time in remote rural areas, consider doing a first-aid course, for example one offered by the American Red Cross (www.redcross.org) or St John Ambulance (www.sja.org.uk).

Particularly if you’re going trekking, you could take a wilderness medical training course, such as those offered in the UK by Wilderness Medical Training (http://wildernessmedicaltraining.co.uk) and the Royal Geographical Society (www.rgs.org).

Also consider becoming a member of the International Association for Medical Assistance to Travellers (www.iamat.org), which lists trusted English-speaking doctors.

Medical Checklist

Get a check-up from your doctor if you have any regular medication or chronic illness. Bring medications in their original, clearly labelled containers. A signed and dated letter from your physician describing your medical conditions and medications, including generic names, is helpful. If carrying syringes or needles, ensure you have a physician’s letter documenting their medical necessity. See your dentist before a long trip.

Assemble a medical and first-aid kit, especially if you will be hiking or staying in parks and reserves, and consider packing the following:

  • antibacterial ointment (eg Bactroban) for cuts and abrasions
  • antibiotics (if travelling off the beaten track)
  • antidiarrhoeal drugs (eg loperamide)
  • antihistamines (for hay fever and allergic reactions)
  • anti-inflammatory drugs (eg ibuprofen)
  • antimalaria pills (if you’ll be in malarial areas)
  • bandages, gauze
  • DEET-containing insect repellent
  • insect spray for clothing, tents and bed nets
  • oral rehydration salts (eg Dioralyte)
  • paracetamol or aspirin
  • scissors, safety pins, tweezers, pocket knife
  • sterile needles and syringes (if travelling to remote areas)
  • sun block
  • thermometer
  • water-purification tablets

Websites

In addition to the information on their websites, the Centers for Disease Control and Prevention and World Health Organization publish handbooks and apps.

Recommended Vaccinations

Visit a doctor or travel clinic at least four weeks before departure for vaccinations; some don’t ensure immunity for two weeks. America’s Centers for Disease Control and Prevention (CDC; www.cdc.gov/travel) suggests immunisations, including the following, as routine for adults, in addition to routine childhood vaccines.

  • Diphtheria
  • Human Papillomavirus
  • Influenza
  • Meningococcal
  • Pertussis (whooping cough)
  • Pneumococcal
  • Shingles
  • Tetanus

The CDC also suggests the following immunisations:

  • Hepatitis A
  • Typhoid

The CDC suggests the following for some travellers to the region, depending on the areas to be visited:

  • Hepatitis B
  • Malaria
  • Rabies

Ask your doctor for an International Certificate of Vaccination or Prophylaxis (ICVP or 'yellow card'), listing all the vaccinations you’ve received.

Further Reading

  • The Essential Guide to Travel Health by Jane Wilson-Howarth

  • Travel Health Guide by Mark Wise

  • Travels with Baby by Shelly Rivoli

  • Traveller’s Good Health Guide by Ted Lankester

  • Travellers' Health by Dr Richard Dawood

  • Wilderness and Travel Medicine by Eric Weiss

Health Insurance

  • Find out in advance whether your insurer will make payments directly to providers or reimburse you later for overseas health expenditures.
  • If your policy requires you to pay first and claim later for medical treatment, be sure to keep all documentation.
  • Ensure that your travel insurance will cover any emergency transport required to get you to a hospital in a major city, or all the way home, by air and with a medical attendant if necessary.