Medical Concerns In this age of instant litigation if anything goes wrong, the last thing that we are going to do is to give you detailed advice on medical precautions, immunisations, vaccinations and so on. What you must do is to visit your own doctor in plenty of time before you travel (some vaccinations need to be applied in several doses over an extended period of time), and ask him what medical precautions you need to take, for the countries that you are intending to visit. Your doctor will then look up what is required – usually on a constantly updated website – and arrange the treatment that is required. This said you might find the following observations to be useful. (Photo by NEA Healthy Futures)
• Bilharzia – We don’t want to delve too deeply into the myriad other tropical diseases that you might encounter, but bilharzia (or schistosomiasis) is worth mentioning. Quite nasty, although curable, this disease can be picked up from small infected snails whilst bathing in freshwater lakes and streams. Unfortunately, this includes the otherwise idyllic Lake Malawi – in theory, a strong rival to the Indian Ocean resorts, such as Zanzibar), although it is possible to find resorts here that are claimed to be bilharzia-free.
• Cholera – Cholera is mainly a product of poor sanitation but can be guarded against by prior vaccination if your doctor so recommends. Worth a Note is that this vaccination is not regarded as all that effective by some medical authorities.
• DVT (Deep Vein Thrombosis) – DVT is the formation of potentially dangerous blood clots, usually in the veins of the legs, caused by inactivity. This may be accentuated during a long-haul flight, where the combination of low cabin air pressure, stress, fatty food, caffeine and alcohol can result in a significant increase in blood coagulation, making DVT that more likely. It is claimed that one in ten to one in thirty long-haul passengers may be at risk from this condition – which may not make its effects evident until several days, weeks or even months, following your flight. The advice given for avoiding this condition includes wearing loose-fitting clothes, drinking plenty of fluids, although avoiding alcohol, tea and coffee, which all have a diuretic effect, and – most of all – performing physical stretching exercises, both whilst seated, and on walking around the cabin. For example, whilst seated, you can try repeating the following exercises (5-10 times each):
(a.) hold the arm-rests, whilst slowly lifting your knees simultaneously, holding for a few seconds (b.) hold one knee and bring it up towards your chest, holding it there for 15 seconds, repeating with the other knee (c.) contract your thighs and perform a sitting ‘march on the spot’ (d.) lift foot, point toes outward and rotate foot in a circular motion, repeating with the other foot (e.) with heels on the floor, lift toes upwards as far as possible, holding for 30 seconds (f.) with the balls of your feet on the floor, lift up your heels as high as possible, again holding for 30 seconds.
These giraffes won’t get DVT! (Photo from Reddit)
In the past taking aspirin has been recommended – for its blood-thinning properties – but current medical opinion is that it is of no value in avoiding veinous blood clotting, and it can also cause stomach irritation or even gastric bleeding in susceptible people. A natural alternative that is recommended is garlic (in the form of odour-free tablets!). Other recently introduced ‘natural’ products include Zinopin, which contains pine bark and ginger, and ‘Flite Tabs’, which are somewhat similar. But do research these yourself first, for example on the internet, and, as always, get your doctor’s approval. It is also possible to buy specially designed compression stockings from most pharmacies, which may be particularly recommended for those with varicose veins.
• Hepatitis A – Transmission of Hepatitis A virus can occur through direct person-to-person contact; through exposure to contaminated water, ice, or shellfish harvested in contaminated water; or from fruits, vegetables, or other foods that are eaten uncooked and that were contaminated during harvesting or subsequent handling.
• Hepatitis B – You can become at risk from Hepatitis B if you are exposed to blood or body fluids, for example, if you have sexual contact with the local population, but you can also be at risk as a result of emergency medical or dental treatment if infected blood or instruments are used.
• Jet Lag – Although the flight from Europe to sub-Saharan Africa can be a very long one, the difference in time zones is normally only an hour or two, and therefore jet lag as such is not a problem.
• Malaria – Malaria is not strictly a matter of immunisation or vaccination, but rather of prophylaxis, or preventative measures. Sub-Saharan Africa is a high-risk area for Malaria, spread by bites from infected mosquitoes. All visitors to this region should adopt the following two-stage process. Firstly try to reduce the chances of being bitten, by covering up with clothing such as long sleeves and long trousers especially after sunset, using insect repellents on exposed skin and, when necessary, sleeping under a mosquito net. Mosquito nets and room sprays will be provided, where needed, by your hosts. Insect repellents should ideally contain a minimum of 50% DEET and should be applied to all exposed skin – always on top of sunscreen. Secondly, take the anti-malarial medication prescribed by your doctor, remembering to start the treatment the appropriate number of days before you travel, in addition to continuing it for the correct period of time after you return. Although, as already stated, we cannot recommend any particular treatment, let me just make the following remarks regarding anti-malaria treatments. Many international visitors make use of Malarone – it isn’t cheap (costing about £2.50 per day), is prescription-only, and can have side effects with some people (as can all medications), but it generally shows positive results. The principal alternatives are Mefloquine (Lariam), which, again, is prescription-only, and which, quite frankly I wouldn’t even go near, since it can have appalling psychological side effects, which can sometimes be fatal; Doxycycline, again prescription only, and which can cause adverse reactions in the presence of sunlight (of which there is quite a bit in Africa); Chloroquine and Proguanil (or in combination), which are non-prescription, but which may also be less effective, as resistance to these drugs has built up over several years’ usage. Which is best for you may depend on which countries you are visiting, and other factors, such as pregnancy etc. It’s up to you (or rather your medical practitioner!). Regardless to mention is that none of these treatments can be regarded as 100% effective, which is why the avoidance of bites, as discussed above, is crucial. Incidentally, it is claimed that you are more likely to be a target for mosquitoes if you consume bananas (not sure why this phenomenon)! The initial symptoms of malaria can be quite mild, and easy to confuse with flu. If you are in any doubt, contact your medical professional immediately, and tell them that you have recently returned from a malaria-risk zone.
Historical Poster regarding Malaria and Quinine (by Pinterest)
There is an ancient rumour that apparently a drink of Gin and Tonic could also act as a measure against Malaria. Hence this is a debated statement, here is what The Travel Doctor has to say:
“Travellers often joke about drinking gin and tonic to prevent malaria, and here is an interesting answer to the question of how many G &Ts would need to be consumed to deliver a preventative dose of quinine?
Short Answer: 67litres per day!!
The Long Answer, for those interested, is according to Meshnick’s chapter in “Malaria: Parasite Biology, Pathogenesis and Protection (1998, ed Sherman) that modern tonic water contains 15mg/L quinine, and so has a little antimalarial effect. However, Meshnick also mentions that drinking a glass of a decoction of Cinchona bark (made by soaking the bark in brandy or gin for 5 or 6 days) two or three times a day would have provided at least 1-2g quinine per day. Meshnick says that this would have protected against malaria.
Therefore, consuming 67 litres of tonic water would provide 1g quinine. That means a lot of G&T’s, and there are definitely easier ways to prevent malaria.” (taken from the link)
• Meningitis – Meningitis is inflammation of the protective membranes covering the brain and spinal cord and can have either viral or bacteriological origins. Epidemics do periodically occur in sub-Saharan Africa, and hence protection is advised.
• Medication & First Aid Kits – If you are taking medication of your own, then, given the possibility of luggage going astray, it may be a good idea to carry it in your hand luggage (provided it meets current anti-terrorist regulations!) or split it between hand and hold luggage, if its use is important to you. You might also like to take a small first-aid kit with you as well – obtainable from large pharmacies. Useful contents include plasters, bandages, tweezers, possibly a sterile needle kit.
A complete Safari First Aid kit available at Survivaloutdoor.com. Prices range from N$549.- up to N$1,099.- (prices may change without prior Notice)
• Pre-existing Medical Conditions – If you have any pre-existing medical conditions, you should certainly seek advice from your GP to discuss the suitability of your proposed trip. You must also tell your Travel Insurer about your condition: if you don’t and you become ill while you are away (even from something quite different), you run the risk of losing your cover. If necessary carry a copy of a letter from your doctor with you, together with details of any prescriptions. Finally, to ensure that you carry sufficient medication to cover any delays.
• Rabies – Since rabies is a potentially deadly disease, found throughout most of the world, you are well advised to be vaccinated against this – especially if you are prone to making friends with every stray pussy who crosses your path. Rabies is a virus that is usually spread by the bite or scratch of an animal. By the time the symptoms appear, it is generally too late to save the patient. However, a person who may have been exposed to rabies can usually be treated effectively if they seek help at once. Symptoms include neurological problems and a fear of light and water.
• Tetanus – Tetanus is found all over the world, so it’s a good idea to make sure that your tetanus jabs are kept up to date. Polio A one-time booster used to be recommended for any adult travellers who completed the childhood series but never had polio vaccine as an adult, although you are more likely now to be offered a combined tetanus, polio and diphtheria vaccine.
• Tsetse Fly Bites – A relation to the horse-fly, but ten times more vicious, the tsetse fly is both a nuisance and a benefit to safari travellers. The bite itself can be extremely painful, and can sometimes result in huge swollen red areas on the legs and arms (the reaction found varies greatly between individuals, and even from occasion to occasion). However, the tsetse fly also gives rise to sleeping sickness in cattle (although not usually in human beings, at least not the variety found in Zambia) and hence keeps the best game viewing areas free from human encroachment.
The revered Tsetse Fly (Photo by DSW)
Nevertheless, in some areas, there may be areas of intense tsetse fly activity to be traversed into and out of camp. These little nasties can inflict highly painful bites even through clothing, socks or head-gear. Some camps proudly exhibit ‘tsetse fly traps’ around their boundaries. These consist of a jar containing something sickly sweet that is irresistible to tsetse flies, contained within a blue canvas structure (for some reason, the colour blue attracts tsetses). This is designed to trap all such visitors. If you are someone being of an enquiring mind then go to examine one of these traps more closely. Guess how many tsetse flies you will see trapped in it? Thousands? Hundreds? The answer is ‘not one’! If you are bitten there are a number of possible treatments. Applying, for example, a hot mug of tea, to the bite can give immediate relief hence the increased blood flow will wash the poison away from the site more quickly, in addition to breaking down the anti-clotting agent that such bites often contain. Another treatment is to apply a ‘zapper’ – a piezoelectric device that, when triggered against the skin, produces a short electrical shock to the site, which can also give rapid relief. We were told recently that a mixture of 50% Dettol/50% water is an excellent repellent – although only if you want to smell like a hospital ward! However, none of these treatments work all the time, or with all people. A small tip: Should you catch one of these nasty’s it is generally recommended to decapitate this insect hence they are such tough beings. Many times by simple squashing this insect won’t do the job. These little creatures are indeed very robust.
• Typhoid fever – Typhoid fever can be caught through contaminated drinking water or food, or by eating food or drinking beverages that have been handled by a person who is infected. Large outbreaks are most often related to faecal contamination of water supplies or foods sold by street vendors.
• Yellow Fever – Yellow Fever is spread by mosquito bites. It is uncommon in tourist areas but can cause serious, often fatal, an illness so most people visiting risk areas should be immunised. Indeed, as we saw above, some countries make it an entry requirement to have a valid immunisation certificate, and since this requirement may suddenly be introduced if there is an outbreak elsewhere, it is probably a good idea to have this anyway.