Make sure your health insurance covers you for medical expenses abroad. If not, supplemental insurance for overseas coverage, including possible evacuation, should be seriously considered. All travelers should visit either their personal physician or a travel health clinic 4-8 weeks before departure.
The following are the recommended vaccinations for Kenya:
> Hepatitis A
> Yellow fever*
> Hepatitis B
* Certificate required for entry into, or travel between, some African countries.
What to Pack
It is advisable to travel with a small medical kit that includes any basic remedies you may need, such as antacids, painkillers, anti-histamines and cold remedies. You will also need anti-diarrhoeal medication such as Imodium (adults only); and oral rehydration sachets such as Electrolade, especially if travelling with children. Also include first aid items such as band aids, antiseptic and dressings. It may be worth asking your doctor to prescribe a broad spectrum antibiotic, suitable for treating dysentery or severe infections. Take along scissors, tweezers, and thermometer, lip salve, sun block, water purification tablets or drops, as well as your preferred brands of toiletries and cosmetics. A sterile needle kit is strongly recommended. Don’t rely on being able to find these items locally. If you wear spectacles or contact lenses, take spares. Also take a torch and a pocket knife.
Malaria is a disease spread by mosquitoes that bite mainly at dusk and at night: every traveller to Africa needs reliable, up to date advice on the risks at his or her own destination. Prevention consists of using effective protection against bites (see below), plus taking anti-malarial medication. The most suitable choice of medication depends on many individual factors, and travellers need careful, professional advice about the advantages and disadvantages of each option.
The most effective preventive drugs for travel to Africa are:
Lariam: widely-used; side-effects have received much media attention (ranging from vivid dreams to more serious neurological reactions); those who should not take this drug include travellers with a previous history of neurological and psychological problems.
Doxycycline: possible side-effects include a skin reaction that can be triggered by bright sunlight, as well as an increased risk in women of vaginal thrush.
Malarone: highly effective, well-tolerated, and with an extremely low rate of side-effects, but more expensive and currently only available on an unlicensed basis from specialist centres.
Chloroquine and Paludrine have little risk of side effects and were previously widely used, but are now only about 50-60 per cent effective in many parts of East, West, and Central Africa, and must be used with caution, if at all. Commercial import to neighbouring Tanzania has even been stopped.
Whatever your choice, you must take an anti malarial drug if you are visiting a malarial region, and you must continue taking the drug for the necessary period after your return; you must also take precautions to reduce the number of insect bites (see below).
Visitors to malarial areas are at much greater risk than local people and long term expatriates – from malaria as from several other diseases: do not change or discontinue your malaria medication other than on skilled professional advice. Travellers to very remote places should also consider taking stand-by malaria treatment, for use in an emergency.
Food & Hygiene
If you eat every meal you are offered, anywhere in the tropics, you will undoubtedly become ill. (This is probably also true in the North!) Be selective. Possible disease hazards range from minor bouts of travellers’ diarrhoea to dysentery and more serious parasitic diseases that may ruin your trip, so precautions are worthwhile. Always choose food that has been freshly and thoroughly cooked, and is served hot. Avoid buffet food, or anything that has been re-heated or left exposed to flies. Avoid seafood. Raw fruit and vegetables tend to be very difficult to sterilise: don’t eat them unless they have been carefully and thoroughly washed in clean water, or are easy to cut open or peel without contaminating the flesh. In the tropics, the easiest and safest fruits are bananas and papayas. Do not be afraid to reject food you consider unsafe, to ask for something to be prepared specially, or to skip a meal.
Only drink water that you know is safe. Don’t drink tap water or brush your teeth with it, stick to bottled or canned drinks – well known brands are safe. Have bottled mineral waters opened in your presence, and regard all ice as unsafe. Alcohol does not sterilise a drink! If in doubt, purify water by boiling or with chlorine or iodine, or using a water purifier. (One of the safest methods is to use 2 percent tincture of iodine: add 1 drop of iodine to each cup of water, and wait 20 minutes before drinking.)
Careful precautions reduce the risk of insect-borne disease by a factor of ten. These diseases include: Yellow fever, dengue fever, other viral diseases, sleeping sickness, filariasis and of course, malaria. At dusk, and at other times when insects are biting, cover up: wear long-sleeved shirts and trousers, socks, and pyjamas at night. Use an insect repellent containing DEET on exposed skin and on your clothing. Use both a permethrin-impregnated mosquito net and some form of insecticide during the night – pyrethrum coils or an electric mosquito killer. Spray your hotel room each evening.
OTHER TROPICAL DISEASES AND HEALTH HAZARDS
Tropical diseases are relatively uncommon in travellers. Most of them tend to be food-borne or insect-borne, so the precautions listed above will prevent the majority of cases. Schistosomiasis, also known as Bilharzia, is a parasitic disease spread by contact with water from lakes, rivers and streams. Regardless of any advice you may receive to the contrary by local people, and even tour guides, no lake, river, or stream in Africa is free of risk. Contact should be avoided or kept to a minimum. Chlorinated swimming pools are safe.
In Africa, dogs are not pets: avoid handling any animal. Rabies is transmitted by bites, but also by licks and scratches: wounds need thorough scrubbing and cleansing with antiseptic, followed by prompt, skilled medical attention including immunisation. Seek advice about pre-travel rabies immunisation, especially if your trip will be a long one.
Heat & Sun
Do not expect that you will be able to acclimatise instantly to the heat – it takes most people up to 3 weeks. During this period, avoid physical exertion, keep cool and stay in the shade – especially during the hottest parts of the day. Increase your salt intake by adding extra to your food, and perhaps a small quantity to your drinking water. Thirst is a poor guide to how much fluid you need: it is essential to drink plenty of fluids (not alcohol, coffee, or strong tea, which are diuretics and cause increased water loss). The best guide is that your body should always produce plenty of pale urine. Use plenty of high factor sunscreen, wear a hat and shady clothing, and avoid exposure to direct sunlight – especially during the hottest part of the day.
Preventing HIV & Sexually Transmitted Diseases
There is a very high risk of HIV and other sexually transmitted diseases. Condoms are widely available, but some travelers have found packs for sell beyond the sell-by date. Take the necessary precautions! Also take a good sterile needle kit.
Accidents and Injuries
Accidents and injuries kill many more travellers than exotic infectious diseases: be constantly alert! Risks arise not just from the accidents themselves but also from the scarcity of skilled medical care. Don’t drive on unfamiliar, unlit roads at night. Don’t ride a moped, motorcycle or bicycle. Don’t drink and drive, and don’t drive too fast. Insist that taxi-drivers drive carefully when you are a passenger. Use seat belts, and for children, take your own child seats. Take special care at swimming pools: never drink and swim, and always check the depth. Carry a small first aid / medical kit. Minor wounds may easily become infected: look after them carefully and seek prompt attention if necessary.
Most cases of traveller malaria occur when travellers stop taking antimalaria drugs as soon as they get home. This is dangerous – tablets should be continued as instructed (at least 4 weeks after leaving a malarial area, except for Malarone, which can be stopped after 1 week).
Symptoms of malaria – and other tropical diseases – may not appear until long after your return home – you may not necessarily associate them with your trip. Always report any symptoms to your doctor, and make sure that he or she knows that you have been to Africa, even up to 12 months after your visit. DEMAND a blood test for malaria. If you have been exposed to schistosomiasis, a blood test at least six weeks after returning home should be considered.
The Flying Doctor Service
In many parts of Africa access to adequate health care can mean long, tortuous journeys by road. The Flying Doctor Service operated by AMREF not only provides outreach and emergency care to local communities in remote regions, it also provides a medical air evacuation service to tourists. By joining the Flying Doctors’ Society you can help the service reach the people who need it most and also ensure a free emergency evacuation flight for yourself should the worst happen on your travels. Visit the Flying Doctors page to find out more, and to become a member of the society, click here
No responsibility can be accepted by AMREF, contributors or visitkenya.com for actions taken as a result of information contained here. Everyone is advised to seek proper medical advice where necessary before, during and after travel. © Amref – Flying Doctors