Health & insurance
As long as you stay up to date with your vaccinations and take basic preventive measures, you’re unlikely to succumb to most health hazards while in Southern Africa. While countries in the region have an impressive selection of tropical diseases on offer, it’s more likely you’ll get a bout of diarrhoea or a cold than a more exotic malady. The main exception to this is malaria, which is a widespread risk in Southern Africa, and precautions should be taken.
Before You Go
A little predeparture planning will save you trouble later. Get a check-up from your dentist and your doctor if you take any regular medication or have a chronic illness, eg high blood pressure or asthma. You should also organise spare contact lenses and glasses (and take your prescription with you); get a first-aid and medical kit together; and arrange necessary vaccinations.
Travellers can register with the International Association for Medical Assistance to Travellers (www.iamat.org), which provides directories of certified doctors. If you’ll be spending much time in remote areas, consider doing a first-aid course (contact the Red Cross or St John’s Ambulance), or attending a remote medicine first-aid course, such as that offered by Wilderness Medical Training (http://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.
Find out in advance whether your insurance plan will make payments directly to providers, or will reimburse you later for overseas health expenditures. In most countries in Southern Africa, doctors expect payment upfront in cash. It’s vital to 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. Not all insurance covers this, so check the contract carefully. If you need medical assistance, 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 (WHO) 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 do occur.
According to the US Centers for Disease Control & Prevention (www.cdc.gov), the following vaccinations may be recommended for travel in Southern African countries: hepatitis A, hepatitis B, rabies and typhoid, and boosters for tetanus, diphtheria and measles. Yellow fever is not usually a risk in the region, but the certificate is an entry requirement if you’re travelling from an infected region. Consult your medical practitioner for the most up-to-date information.
It’s 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 to consider packing.
- antibiotics (prescription only), eg ciprofloxacin (Ciproxin) or norfloxacin (Utinor)
- antidiarrhoeal drugs (eg loperamide)
- acetaminophen (paracetamol) or aspirin
- anti-inflammatory drugs (eg ibuprofen)
- antihistamines (for hay fever and allergic reactions)
- antibacterial ointment (eg Bactroban) for cuts and abrasions (prescription only)
- antimalaria pills, if you’ll be in malarial areas
- bandages, gauze
- scissors, safety pins, tweezers, pocket knife
- DEET-containing insect repellent for the skin
- permethrin-containing insect spray for clothing, tents, and bed nets
- sun block
- oral rehydration salts
- iodine tablets (for water purification)
- sterile needles, syringes and fluids if travelling to remote areas
There is a wealth of travel-health advice on the internet. The Lonely Planet website at www.lonelyplanet.com is a good place to start. The World Health Organization publishes the helpful International Travel and Health, available free at www.who.int/ith/. Other useful websites include MD Travel Health (www.mdtravelhealth.com) and Fit for Travel (www.fitfortravel.scot.nhs.uk).
Official government travel health websites:
- A Comprehensive Guide to Wilderness and Travel Medicine (1998) Eric A Weiss
- The Essential Guide to Travel Health (2009) Jane Wilson-Howarth
- Healthy Travel Africa (2000) Isabelle Young
- How to Stay Healthy Abroad (2002) Richard Dawood
- Travel in Health (1994) Graham Fry
- Travel with Children (2015) Sophie Caupeil et al
Deep Vein Thrombosis
Prolonged immobility during flights can cause deep vein thrombosis (DVT) – the formation of blood clots in the legs. 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 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 may cause chest pain and breathing difficulty. Travellers with any of these symptoms should immediately seek medical attention. To prevent DVT, 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.
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.
In Southern Africa
Availability & Cost of Health Care
Good-quality health care is available in the urban areas of many countries in Southern Africa, and private hospitals are generally of a good standard. Public hospitals by contrast are often underfunded and overcrowded; in off-the-beaten-track areas, reliable medical facilities are rare.
Drugs for chronic diseases should be brought from home. In many countries there is a high risk of contracting HIV from infected blood transfusions. 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.
With a few basic preventive measures, it’s unlikely that you’ll succumb to any of the diseases that are found in Southern Africa.
Cholera is caused by a bacteria, and spread via contaminated drinking water. In South Africa the risk to travellers is very low; you’re likely to encounter it only in eastern rural areas, where you should avoid tap water and unpeeled or uncooked fruits and vegetables. 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 close attention to drinking 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.
Dengue Fever (Break-Bone Fever)
Dengue fever, spread through the bite of mosquitos, causes a feverish illness with headache and muscle pains similar to those experienced with a bad, prolonged attack of influenza. There might be a rash. Mosquito bites should be avoided whenever possible. Self-treatment: paracetamol and rest. In rare cases in Africa this becomes Severe Dengue Fever, with worsening symptoms including vomiting, rapid breathing and abdominal pain. Seek medical help as this can be fatal.
Filariasis is caused by tiny worms migrating in the lymphatic system, and is spread by the bite from an infected mosquito. Symptoms include localised itching and swelling of the legs and/or genitalia. Treatment is available. Self-treatment: none.
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 and delayed recovery. If you’ve had 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, hepatyrix or viatim. Self-treatment: none.
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. It affects the liver, causing 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 routinely give hepatitis B as part of the childhood vaccination program. 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. Self-treatment: none.
HIV, the virus that causes AIDS, is an enormous problem across Southern Africa, with a devastating impact on local health systems and community structures. 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 and 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 used intravenous needles. At present there is no cure; medication that might keep the disease under control is available, but these drugs are too expensive, or unavailable, for the overwhelming majority of those living in Southern Africa.
If you think you might have been infected with 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. Self-treatment: none.
Malaria is a widespread risk in Southern Africa and the risk of catching it should be taken seriously. The disease is caused by a parasite in the bloodstream spread via the bite of the female anopheles mosquito. There are several types of malaria; falciparum malaria is the most dangerous type and the predominant form in South Africa. Infection rates vary with season and climate, so check out the situation before departure. 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 (eg people with epilepsy should avoid mefloquine, and doxycycline should not be taken by pregnant women or children aged under 12).
The early stages of malaria include headaches, fevers, generalised aches and pains, and malaise, which could be mistaken for flu. Other symptoms can include abdominal pain, diarrhoea and a cough. Anyone who develops a fever in a malarial area should assume malarial infection until a blood test proves negative, even if you have been taking antimalarial medication. If not treated, the next stage could 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. Treatment in hospital is essential, and the death rate might still be as high as 10% even in the best intensive-care facilities.
Many travellers think that malaria is a mild illness, and that taking antimalarial drugs causes more illness through side effects than actually getting malaria. This is unfortunately not true. If you decide against antimalarial drugs, you must understand the risks, and be obsessive about avoiding mosquito bites. Use nets and insect repellent, and report any fever or flulike 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.
Malaria in pregnancy frequently results in miscarriage or premature labour, and the risks to both mother and foetus during pregnancy are considerable. Travel throughout the region when pregnant should be carefully considered. Adults who have survived childhood malaria have developed immunity and usually only develop mild cases of malaria; most Western travellers have no immunity at all. Immunity wanes after 18 months of nonexposure, so even if you have had malaria in the past and used to live in a malaria-prone area, you might no longer be immune.
Rabies is spread by receiving bites or licks from an infected animal on broken skin. Few human cases are reported in Southern Africa, with the risks highest in rural areas. 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 given 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 postbite vaccine is not available within 24 hours. Three preventive injections are needed over a month. If you have not been vaccinated you’ll need a course of five injections starting 24 hours or as soon as possible after the injury. If you have been vaccinated, you’ll need fewer postbite injections, and have more time to seek medical help. Self-treatment: none.
This disease is a risk when swimming in freshwater lakes and slow-running rivers – always seek local advice before venturing in. It’s spread by flukes (minute worms) that are carried by a species of freshwater snail, which then sheds them into slow-moving or still water. The parasites penetrate human skin during swimming and then migrate to the bladder or bowel. They are excreted via stool or urine and could contaminate fresh water, where the cycle starts again. Swimming in suspect freshwater lakes or slow-running rivers should be avoided. Symptoms range from none to 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 readily available. If not treated, the infection can cause kidney failure or permanent bowel damage. It’s not possible for you to infect others. Self-treatment: none.
Tuberculosis (TB) is spread through close respiratory contact and occasionally through infected milk or milk products. BCG vaccination is recommended if you’ll be mixing closely with the local population, especially on long-term stays, although it gives only moderate protection against the disease. TB can be asymptomatic, being picked up only on a routine chest X-ray. Alternatively, it can cause a cough, weight loss or fever, sometimes occurring months or even years after exposure. Self-treatment: none.
This is spread through food or water contaminated by infected human faeces. The first symptom is usually a fever or a pink rash on the abdomen. Sometimes septicaemia (blood poisoning) can 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. Self-treatment: none.
Although not a problem within Southern Africa, you’ll need to carry a certificate of vaccination if you’ll be arriving from an infected country. For a list of countries with a high rate of infection, see the websites of the World Health Organization (www.who.int/en/) or the Centers for Disease Control & Prevention (wwwnc.cdc.gov/travel).
In most areas of Southern Africa you should stick to bottled water rather than drinking water from the tap, and purify stream water before drinking it.
This is a common travel-related illness, sometimes simply due to dietary changes. It’s possible that you’ll succumb, especially if you’re spending a lot of time in rural areas or eating at inexpensive local food stalls. To avoid diarrhoea, eat only fresh fruits or vegetables that have been cooked or peeled, and be wary of dairy products that might contain unpasteurised milk. Although freshly cooked food can often be a safe option, plates or serving utensils might be dirty, so be selective when eating food from street vendors (make sure that cooked food is piping hot all the way through). If you develop diarrhoea, be sure to drink plenty of fluids, preferably an oral rehydration solution containing lots of water 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 (such as loperamide) if you’re 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 severe abdominal pain, you should seek medical attention.
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).
This, like amoebic dysentery, is also caused by ingesting contaminated food or water. The illness usually appears a week or more after you have been exposed to the offending parasite. Giardiasis might cause only a short-lived bout of typical travellers’ diarrhoea, but it can also 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.
This condition occurs following heavy sweating and excessive fluid loss with inadequate replacement of fluids and salt, and is primarily a risk 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 as in 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.
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. Bee and wasp stings cause real problems only to those who have a severe allergy to the stings (anaphylaxis), in which case, carry an adrenaline (epinephrine) injection.
Scorpions are found in arid areas. 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.
Ticks are always a risk away from urban areas. If you get bitten, press down around the tick’s 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 the attached mouth parts into the skin, increasing the risk of infection and disease. Smearing chemicals on the tick will not make it let go and is not recommended.
Basically, avoid getting bitten! Don’t walk barefoot, or 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.