East Africa is a fairly healthy area to visit. Malaria is endemic and you need to take precautions against chloroquine-resistant strains. Chloroquine-based malaria tablets are available over the country even in tiny stores out in the town.
Locally manufactured medicine is also available, in Arusha or Dar es Salaam at least, and at a fraction of the cost, you’ll pay at home. In Tanzania, tap water is not safe to drink and water obtained from other sources, especially wells and bores, should be treated with suspicion.
Travel health depends on your pre-departure preparations, your day-to-day health care while travelling and how you handle any medical problem or emergency that does develop. While the list of potential dangers can seem quite frightening, with a little luck, some basic precautions and adequate information, few travellers experience more than mild upset stomachs.
Pre-departure Preparations
Prescriptions & Medications
Make sure you are healthy before you start travelling. If you’re embarking on a long trip make sure your teeth are OK; dentists are few and far between in Africa and treatment is expensive. If you wear glasses take a spare pair and your prescription.
Losing your glasses can be a real problem, although in Arusha and Dar -es Salaam you can get new spectacles made up quickly, cheaply and competently. In East Africa, medicines which you would normally need a prescription for in your own country are available over the country (if they have them) at either a chemist (pharmacist) or a dispensary and the price will be much cheaper than what you would pay in the West. You need, however, to check the expiry date as it may have passed.
It’s also possible that drugs which are no longer recommended in the West (or have even been banned) are still being dispensed in East Africa, so make sure you know what medicine you require.
General Health
The main things which are likely to affect your general health while you’re abroad are diet and climate. Stomach upsets are the most likely problem but the majority of these upsets will be relatively minor. Don’t become paranoid — trying the local food is part of the experience of travel after all.
Water
Avoid drinking unboiled water anywhere it’s not chlorinated unless you’re taking it from a mountain spring. Unboiled water is a major source of diarrhoea and hepatitis, as are salads that have been washed in contaminated water and unpeeled fruit that has been handled by someone with one of these infections.
You will be provided with water throughout your tour time and they are safe and clean, for safari we provide mineral water while for Kilimanjaro we use water from underground springs which they are safe to drink.
In hot climates, you sweat a great deal and lose a lot of water and salt. Make sure you drink sufficient liquid and have enough salt in your food to make good the losses (a teaspoon of salt per day is generally sufficient). If you don’t make good the losses, you run the risk of suffering from heat exhaustion and cramps.
Rest
Adjustment to the outlook, habits and social customs of different people can take a lot out of you. Many travellers suffer from some degree of culture shock.
This is particularly true if you fly directly from your own country to an African city. Under these conditions, heat can aggravate petty irritations which would pass unnoticed in a more temperate climate. Exhausting all-night, all-day bus journeys over bad roads don’t help if you’re feeling this way. Try to take things at a slower pace, and make sure you get enough sleep.
Hygiene
Many health problems can be avoided by taking care of yourself. Wash your hands frequently – it’s quite easy to contaminate your own food. Clean your teeth with purified water rather than straight from the tap. Avoid climatic extremes: keep out of the sun when it’s hot, dress warmly when it’s cold. Hot, dry air will make your hair brittle, so oil it often with, say, refined coconut oil. Take great care of cuts, grazes and skin infections otherwise, they tend to persist and get worse.
Clean them well with antiseptic or mercurochrome. If they’re weeping, bandage them up since open sores attract flies. Change bandages daily and use an antibiotic powder if necessary. Avoid potential diseases by dressing sensibly. You can get worm infections through walking barefoot, or severe cuts from coral or sea urchin spines by walking over coral without foot protection. You can avoid insect bites by covering bare skin when insects are around, by screening windows or beds or by using insect repellents.
Seek local advice: if you’re told the water is unsafe due to jellyfish, crocodiles or bilharzia, don’t go in it. In situations where there is no information, discretion is the better pan of valour.
Medical Problems & Treatment
While the list of medical problems might seem long and off-putting, it isn’t meant to be. Most travellers arrive healthily and leave even healthier. If you do pick up something, however, it’s useful to know what to do. Self-diagnosis and treatment can be risky, so wherever possible seek qualified help.
Although we do give treatment dosages in this section, they are for emergency use only. Medical advice should be sought before administering any drugs. An embassy or consulate can usually recommend a good place to go for such advice.
So can five-star hotels, although they often recommend doctors with five-star prices. (This is when that medical insurance really comes in useful!) In some areas of Tanzania, standards of medical attention are so low that for some ailments the best advice is to get on a plane to Nairobi.
Prickly Heat
A temporary but troublesome skin condition which affects many people from temperate climates is prickly heat. Many tiny blisters form on one or more parts of your body — usually where the skin is thickest, such as your hands.
They are sweat droplets which are trapped under your skin because your pores aren’t large enough or haven’t opened up sufficiently to cope with the greater volume of sweat. Anything which promotes sweating — exercise, tea, coffee, alcohol — makes it worse. Keep your skin aired and dry, reduce clothing to a loose-fitting minimum and keep out of direct sunlight.
Calamine lotion or zinc oxide-based talcum powder helps to soothe the skin. Apart from that, there isn’t much else you can do. The problem is one of acclimatisation and shouldn’t persist for more than a few days.
Heat Stroke
This serious, sometimes fatal, the condition can occur if the body’s heat-regulating mechanism breaks down and the body temperature rises to dangerous levels. Long, continuous periods of exposure to high temperature can leave you vulnerable to heat stroke. You should avoid excessive alcohol or strenuous activity when you first arrive in a hot climate.
The symptoms of heat stroke are feeling unwell, not sweating very much or at all and high body temperature (from 39 to 410 C). Where sweating has ceased the skin becomes flushed and red. Severe, throbbing headaches and lack of coordination will also occur, and the sufferer may be confused or aggressive.
Eventually, the victim will become delirious or convulse. Hospitalisation is essential, but meanwhile, get patients out of the sun, remove their clothing, cover them with a wet sheet or towel and then fan continually. Be careful not to cool them down too rapidly; if they start to shiver, their core temperature will rise still further rather than decrease.
Fungal Infections
Hot weather fungal infections are most likely to occur on the scalp, between the toes or fingers (athlete’s foot), in the groin (jock itch or crotch rot) and on the body (ringworm). You get ringworm (which is a fungal infection, not a worm) from infected animals or by walking on damp areas, like shower floors.
To prevent fungal infections wear loose, comfortable clothes, avoid artificial fibres, wash frequently and dry yourself carefully. If you do get an infection, wash the infected area daily with a disinfectant or medicated soap and water, and rinse and dry well.
Apply an anti-fungal powder like the widely available Tinaderm. Try to expose the infected area to air or sunlight as much as possible and wash all towels and underwear in hot water as well as changing them often.
Tropical Ulcers
These are sores which often stand from some insignificant scratch or blister which doesn’t seem to heal up. They often get worse and spread to other areas of the body and they can be quite painful. If you keep clean and look after any sores which you get on your arms and legs (from ill-fitting shoes, accidents to your feet, or from excessive scratching of insect bites) then it’s unlikely you will be troubled by them. If you do develop sores which won’t clear up then you need to hit the antibiotics quickly. Don’t let them spread.
Giardia
Giardia is prevalent in tropical climates and is characterised by swelling of the stomach, pale-coloured faeces, diarrhoea and, after a while, depression and sometimes nausea. Many doctors recommend Flagyl (metronidazole) — seven 250 mg doses over a three-day period should clear up the symptoms, repeated a week later if not.
Flagyl, however, has many side effects and some doctors prefer to treat giardia with Tinaba (tinadozole). Two grams are taken all at once normally knocks it right out but if not you can repeat the dosage for up to three days.
Dysentery
Dysentery is, unfortunately, quite prevalent in some places. It’s characterised by diarrhoea containing blood and lots of mucus, and painful gut cramps. There are two types. Bacillary dysentery is short, sharp and nasty but rarely persistent — it’s the most common variety. Amoebic dysentery is, as its name caused by amoebic parasites.
This variety is much more difficult to treat and often persistent. Bacillary dysentery comes on suddenly and lays you out with fever, nausea, painful cramps and diarrhoea but, because it’s caused by bacteria, it responds well to antibiotics. Amoebic dysentery builds up more slowly and is more dangerous. You cannot starve it out and if it’s untreated it will get worse and permanently damage your intestines. If you see blood in your faeces persistently over two or three days, seek medical attention as soon as possible. Flagyl is the most commonly prescribed drug for amoebic dysentery. The dosage is six tablets per day for five to seven days.
Flagyl is both an antibiotic and an antiparasitic. It is also used for the treatment of giardia and trichomoniasis. Flagyl should not be taken by pregnant women. If you get bacillic dysentery, the best thing for slowing down intestinal movements is codeine phosphate (30 mg tablets take two once every four hours). It’s much more effective than Lomotil or Imodium and cheaper. Treatment for bacillary dysentery consists of a course of tetracycline or bactrim (antibiotics).
Hepatitis
Hepatitis is a liver disease caused by a virus. There are basically two types — infectious hepatitis (known as type A) and serum hepatitis (known as type B). The one you’re most likely to contract is type A. It’s very contagious and you pick it up by drinking water, eating food or using cutlery or crockery that’s been contaminated by an infected person.
Foods to avoid are salads (unless you know they have been washed thoroughly in purified water) and unpeeled fruit that may have been handled by someone with dirty hands. It’s also possible to pick it up by sharing a towel or toothbrush with an infected person. An estimated 10% of the population of the Third World are healthy carriers of type B but the only ways you can contract this form are by having unprotected sex with an infected person or by being injected with a needle which has previously been used on an infected person.
Symptoms of type A appear 15 to 50 days after infection (generally around 25 days) and consist of fever, loss of appetite, nausea, depression, complete lack of energy and pains around the base of your rib cage. Your skin will turn progressively yellow and the whites of your eyes yellow to orange.
The easiest way to monitor the situation is to watch the colour of your eyes and urine. If you have hepatitis, the colour of your urine will be deep orange no matter how liquid you have drunk. If you have not drunk much liquid and/or you’re sweating a lot, don’t jump to conclusions. Check it out by drinking a lot of liquid all at once. If the urine is still orange then you’d better start making plans to go somewhere you won’t mind convalescing for a few weeks. Sometimes the disease lasts only a few weeks and you only get a few really bad days, but it can last for months.
If it does get really bad, cash in that medical insurance you took out and fly back home. There is no cure as such for hepatitis except rest and good food. Diets high in B vitamins are said to help. Fat-free diets have gone out of medical fashion, but you may find that grease and oil make you feel nauseous. Seeking medical attention is probably a waste of time and money, though you are going to need a medical certificate for your insurance company if you decide to fly home.
There’s nothing doctors can do for you that you can’t do for yourself other than run tests that will tell you how bad it is. Most people don’t need telling; they can feel it! Wipe alcohol and cigarettes right off the slate. They’ll not only make you feel much worse, but alcohol and nicotine can do permanent damage to a sick liver. To avoid these problems, think seriously about getting that gamma globulin vaccination.
There is also a vaccine available for hepatitis A (brand name Harvix) which provides protection for 12 months, or for 10 years if you choose to have a booster injection as well. There is also a very effective vaccine against hepatitis B, given as a course of three injections over a six-month period, which is an option for those who know their travel plans well in advance of their trip. The course offers protection for about five years.
Typhoid
Typhoid fever is another ‘gut infection that travels the faecal-oral route ie contaminated water and food are responsible. Typhoid is very infectious and vaccination available against it is not totally effective. It is one of the most dangerous infections so medical help must be sought. In its early stages, typhoid resembles many other illnesses: sufferers may feel like they have a bad cold or flu on the way, as early symptoms are a headache, a sore throat, and a fever which rises a little each day until it is around 40C or more.
The victim’s pulse is often slow relative to the degree of fever present and gets slower as the fever rises — unlike a normal fever where the pulse increases. There may also be vomiting, diarrhoea or constipation. In the second week, the high fever and slow pulse continue and a few pink spots may appear on the body; trembling, delirium, weakness, weight loss and dehydration are other symptoms. If there are no further complications, the fever and other symptoms will slowly go during the third week.
However, you must get medical help before this because pneumonia (acute infection of the lungs) or peritonitis (burst appendix) are common complications. The fever should be treated by keeping the victim cool and dehydration should also be watched for. Chloramphenicol is the recommended antibiotic but there are fewer side effects with ampicillin. The adult dosage is two 250 mg capsules, four times a day. Children aged between eight and 12 years should have half the adult dose; younger children should have one-third the adult dose. Patients who are allergic to penicillin should not be given ampicillin.
Worms
These parasites are most common in rural, tropical areas and a stool test when you return home is not a bad idea. Worms can be present on unwashed vegetables or in undercooked meat and you can pick them up through your skin by walking barefoot. Infestations may not show up for some time, and although they are generally not serious, if left untreated they can cause severe health problems. A stool test is necessary to pinpoint the problem and medication is often available over the city.
Tetanus
This potentially fatal disease is found in undeveloped tropical areas. It is difficult to treat but is preventable with immunisation. Tetanus occurs when a wound becomes infected by a germ which lives in the faeces of animals or people, so clean all cuts, punctures or animal bites. Tetanus is known as lockjaw, and the first symptom may be discomfort in swallowing or stiffening of the jaw and neck; this is followed by painful convulsions of the jaw and body.
Rabies
Rabies is found in many countries and is caused by a bite or scratch by an infected animal. Dogs are a noted carrier. Any bite, scratch or even lick from a mammal should be cleaned immediately and thoroughly. Scrub with soap and running water, and then clean with an alcohol solution. If there is any possibility that the animal is infected medical help should be sought immediately. Even if the animal is not rabid, all bites should be treated seriously as they can become infected or can result in tetanus. A rabies vaccination is now available and should be considered if you are in a high-risk category — eg if you intend to explore caves (bat bites could be dangerous) or work with animals.
Meningococcal Meningitis
Sub-Saharan Africa is considered the ‘meningitis belt’ and the meningitis season falls at the time most people would be attempting the overland trip across the Sahara the northern winter before the rains come. This very serious disease attacks the brain and can be fatal. A scattered, blotchy rash, fever, severe headache, sensitivity to light and neck stiffness which prevents forward bending of the head are the first symptoms. Death can occur within a few hours, so immediate treatment is important. Treatment is large doses of penicillin given intravenously. or, if that is not possible intramuscularly (ie in the buttocks). Vaccination offers good protection for over a year, but you should also check for reports of current epidemics.
Tuberculosis
Although this disease is widespread in many developing countries, it is not a serious risk to travellers. Young children are more susceptible than adults and vaccination is a sensible precaution for children aged under 12 travelling in endemic areas. TB is usually spread by coughing or by unpasteurised dairy products from infected cow’s milk. Milk that has been boiled is safe to drink; the souring of milk to make yoghurt or cheese also kills the bacilli.
Bilharzia
This is caused by blood flukes (minute worms) which live in the veins of the bladder or the large intestine. The eggs which the adult worms produce are discharged in urine or faeces. If they reach water, they hatch out and enter the bodies of a certain species of freshwater snail where they multiply for four or more weeks and are then discharged into the surrounding water. If they are to live, they must find and invade the body of a human being where they develop, mate and then make their way to the veins of their choice. Here they start to lay eggs and the cycle repeats itself. The snail favours shallow water near the shores of lakes and streams and they are more abundant in water which is polluted by human excrement. They particularly like reedy areas. Generally speaking, moving water contains less risk than stagnant water but you can never tell.
Bilharzia is quite a common disease in Africa so stay out of rivers and lakes. If you drink water from any of these places, boil it or sterilise it with chlorine tablets. The disease is painful and causes persistent and cumulative damage by repeated deposits of eggs. If you suspect you have it, seek medical advice as soon as possible — look for blood in your urine or faeces that isn’t associated with diarrhoea. The only body of water in Africa which is largely free of bilharzia is Lake Nyasa. As the intermediate hosts (snails) live only in freshwater, there is no risk of catching bilharzia in the sea.
Sexually Transmitted Diseases
Sexual contact with an infected sexual partner spreads these diseases. While abstinence is the only 100% preventative, using condoms is also effective. Gonorrhoea and syphilis are the most common of these diseases; sores, blisters or rashes around the genitals, discharges or pain when urinating are common symptoms. Symptoms may be less marked or not observed at all in women. Syphilis symptoms eventually disappear completely but the disease continues and can cause severe problems in later years. The treatment of gonorrhoea and syphilis is by antibiotics. There are numerous other sexually transmitted diseases, for most of which effective treatment is available.
However, there is no cure for herpes and there is also currently no cure for HIV/AIDS. HIV/AIDS is rampant in Uganda, less so in Kenya and Tanzania but still a serious problem and on the increase. The latest figures put the number of carriers of the HIV virus (the virus that causes HIV/AIDS) at one in 12. Most of those who have it are not aware of the fact, and hospitals (if they ever get to them) are likely to diagnose their symptoms as something more mundane. The obvious way to pick up the HIV virus is to have sex with someone who has the disease. The obvious way to avoid it is to be celibate. Not everyone can do this so if you do have sex make sure you cut the risk as far as you can by using condoms. You are still a long way from 100% safe if you do this but the message has definitely got through and most sexually active Africans living in urban areas carry condoms.
There are two other ways you can pick up the HIV virus. The first is if you need a blood transfusion. Blood donors in Tanzania are rarely screened for HIV/AIDS and if you received blood from an infected donor you will be exposed to the virus. Your options are probably limited if you get into the sort of strife which requires a transfusion. It is also possible to pick up the virus if you are injected with an unsterilised needle. If you do have an injection in Tanzania try to ensure that the needle is either new or properly sterilised.
Trypanosomiasis (Sleeping Sickness)
This is another disease transmitted by biting insects, in this case by the tsetse fly. Like malaria, it’s caused by minute parasites which live in the blood. The risk of infection is very small and confined to areas which are only a fraction of the total area inhabited by the tsetse fly.
The flies are only found south of the Sahara but the disease is responsible for the absence of horses and cattle from large tracts of central Africa, particularly central and eastern Tanzania. The fly is about twice the size of a common housefly and recognisable from the scissor-like way it folds its wings while at rest. The disease is characterised by irregular fevers, abscesses, local oedema (puffy swellings caused by excess water retained in body tissues), inflammation of the glands and physical and mental lethargy. It responds well to treatment.
Cut and Scratches
Skin punctures can easily become infected in hot climates and may be difficult to heal. Treat any cut with an antiseptic solution and mercurochrome. Where possible avoid bandages and Band-aids, which can keep wounds wet. Coral cuts are notoriously slow to heal, as the coral injects a weak venom into the wound. Avoid coral cuts by wearing shoes when walking on reefs, and clean any cut thoroughly.
Bites & Stings
Bee and wasp stings are usually painful rather than dangerous. Calamine lotion will give relief, or ice packs will reduce the pain and swelling. There are some spiders with dangerous bites but antivenenes are usually available. Scorpion stings are notoriously painful and in Mexico can actually be fatal. Scorpions often shelter in shoes or clothing. There are various fish and other sea creatures which can sting or bite dangerously (eg jellyfish, stonefish on coral reefs) or which are dangerous to eat.
Snakes
To minimise your chances of being bitten always wear boots, socks and long trousers when walking through undergrowth where snakes may be present. Don’t put your hands into holes and crevices, and be careful when collecting firewood. Snake bites do not cause instantaneous death and antivenoms are usually available.
Keep the victim calm and still, wrap the bitten limb tightly, as you would for a sprained ankle, attach a splint to immobilise the limb and then seek medical help, if possible with the dead snake for identification. Do not attempt to catch the snake if there is even the remotest possibility of being bitten again. Tourniquets and sucking out the poison are now completely discredited
Fleas, Lice & Bedbugs
Unwanted passengers you’re likely to come across are fleas, lice and bedbugs. There isn’t ‘t a lot you can do about fleas. They vary considerably in numbers from one season to another; some places have a lot, others none at all. The less money you pay for a bed or a meal, the more likely you are to encounter fleas.
You can generally avoid lice by washing yourself and your clothes frequently. You’re most likely to pick them up in crowded places like buses and trains, but you might also get them by staying in very cheap hotels. You ‘Il occasionally meet tribespeople whose hair is so matted and so unwashed that it’s literally crawling with lice. However, it takes a while for lice to get stuck into you so you should get a companion to have a look through your hair about once a week to see if you ‘ve acquired any eggs. They are always laid near the base of the hairs.
If you find any, you can either pick them out one by one (very laborious) or blitz them with insecticide shampoos. With luck, you won’t come across bedbugs too often. These evil little bastards live in the crevices of walls and the framework of beds where they hide during the day.
They look like lice but they move like greased lightning once you become aware of their presence and switch on the light to see what’s happening. Look for telltale bloodstains on the walls near beds in budget hotels. If you see them, find another hotel. Jiggers are nasty small fleas (Tunga penetrans) which burrow under the skin of the feet (usually under the toenails) to lay their eggs! After incubation, the eggs hatch out and you will have enough fleas to start a circus! The best preventative is to avoid walking around barefoot.
Women’s Health
Gynaecological Problems Poor diet, lowered resistance due to the use of antibiotics for stomach upsets and even contraceptive pills can lead to vaginal infections when travelling in hot climates. Keeping the genital area clean, and wearing skirts or loose-fitting trousers and cotton underwear will help to prevent infections.
Yeast infections, characterised by a rash, itch and discharge, can be treated with vinegar or even lemon-juice döuche or with yoghurt. Nystatin suppositories are the usual medical prescription to thrush. Trichomoniasis is a more serious infection; symptoms are discharge and a burning sensation when urinating. Male sexual partners must also be treated, and if a vinegar-water douche is not effective, medical attention should be sought. Flagyl is the prescribed drug.
Pregnancy
Most miscarriages occur during the first three months of pregnancy, so this is the riskiest time to travel. The last three months should also be spent within a reasonable distance of good medical care, as quite serious problems can develop at this time. Pregnant women should avoid all unnecessary medication, but vaccinations and malarial prophylactics should still be taken where possible. Additional care should be taken to prevent illness and particular attention should be paid to diet and nutrition.
