Ron McGregor's web site - Welcome to South Africa -healthg.htm
Southern Africa is a mix of First and Third World situations, and visitors tend to be exposed mostly to the First World side of things. There is thus little risk to health.
In most places, you can drink the tap water, although mineral water is increasingly available, because if you are prepared to pay for it, we are prepared to profit from the sale of it. We're not short on simple business sense, you know!
Smallpox has long been absent, cholera is rare, typhoid and para-typhoid even rarer. Most of us don't actually know what para-typhoid is. We just know it is something that Americans are always getting innoculated against.
Proof of innoculation against Yellow Fever is not required UNLESS you are coming via an area where yellow fever is endemic.
An anti-tetanus shot is recommended, though not compulsory.
Hepatitis shows up now and then, so perhaps a shot for that wouldn't be a bad precaution, though none of us locals worry about it.
If you are American, and discuss the matter with your own authorities, they will insist that you spend a fortune and get yourself shot full of holes with jabs for all kinds of things. I am not sure if the American authorities know where South Africa is, let alone what goes on here.
The most common health problem encountered by our visitors is diarrhoea - it's probably the most common traveller's problem encountered anywhere. There are various remedies available, of which Immodium seems to be the tried and trusted favourite. I wish I had shares in the corporation that makes it!
People are inclined to blame standards of cleanliness if they suffer from stomach upsets. However, the standards of hygiene in Southern Africa are good (that is, in the establishments that you are likely to patronise). Don't be scared to tuck into our ice cream or enjoy our salads.
If you come down with an upset stomach, the chances are it has everything to do with a change of diet rather than any lack of hygiene in the preparation of what you ate. So, although it is tempting to go somewhat overboard because you are on holiday, try to stick roughly to the quantity and type of food you eat at home.
Another ailment is the common cold. I'm no doctor, but my advice is to use the air conditioner sparingly, so that you are not forever moving from an ice cold room into the tropical heat, and also so that you are not forever breathing recycled air!
The only thing you can do about a common cold is to carry plenty of tissues, a decongestant syrup or lozenges, and ensure you get plenty of vitamin C. We have a useful preparation called Berocca C which is good for building up your resistance. Another useful over-the-counter medication is Vicks Medi Nite, which is so good at giving you a good night's sleep that the warning on the pack tells you not to use it by day!
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Now we come to the real nasties. There are four of these:
The Nasty Diseases Menu
For the average visitor, the risk of contracting bilharzia is very small indeed.
Bilharzia is a debilitating disease found in all rivers that flow into the Indian Ocean north of Port Elizabeth. It is carried by a snail, that lives on a certain type of reed, which grows in these rivers. Ordinary tourists don't mess about in the rivers, so they are not exposed. Adventurous tourists - canoeists, rafters, water-skiers - are advised to enquire about the risk from the adventure tourist companies that handle these activities.
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Sleeping sickness is a disease carried by the tsetse-fly, an unpleasant little creature that spends its time passing the disease from one animal to another. And as we are also animals, every so often it passes it on to one of us. It is debilitating, but prompt care ensures that nowadays it is very seldom fatal.
Most of the sub-continent is free of tsetse. The WHOLE of South Africa, Swaziland and Lesotho are completely safe. Only the northern parts of Namibia, Botswana and Zimbabwe are affected. Victoria Falls seems to be pretty well clean. However, the fly is present in the Zambezi Valley from below the Falls to Kariba and beyond.
Hotels and lodges are sprayed regularly, and air conditioning keeps the temperature below the norm for these tropical insects, so the risk is minimal to visitors who stay in First World accommodations. Folks who camp out run a higher risk, but even so, few cases are reported in these modern times.
The Tsetse fly is also not active during the dry winter months (approx May - August). The best - indeed, only - precaution is to wear protective clotthing, use insect repellent, and make sure you are ready to swat the blighters promptly if they land on you!
Fortunately, only infected flies carry the disease, and there seem to be a great many that are quite harmless, for I have been bitten many times with no ill effects.
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AIDS is rampant in Africa, and alarming tales appear regularly in the news. It is a problem in Southern Africa too, mainly amongst the poorer classes, where ignorance and poor social conditions have effectively ensured that very few people understand either the disease or what should be done to avoid getting it. The risk to our visitors, however, is almost negligible. (That is, except for a certain type of visitor who hasn't really come to see the sights. Those who look for trouble, get trouble!!)
If our tourists are in need of medical attention, qualified doctors and top class private hospitals are available. Not everywhere, of course, but we have helicopters if you are unfortunate enough to have an accident a long way from the nearest First World medical care. So as long as you have your traveller's insurance, you can expect the same level of medical care that you would enjoy at home.
You do NOT have to worry about being injected with infected needles, or given a transfusion of contaminated blood. We know about such things, and we are more than qualified to ensure that they do not happen.
Most tourists do not come to South Africa in search of sexual adventures (and if they do, they do not come on my tours). However, for those who might be tempted to risk it, I have one word of advice. DON'T. AIDS in Africa is not confined to homosexuals, as some people would like to believe, and although it occurs far more amongst blacks than whites, it observes no boundaries.
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Africa has nastier diseases than malaria, but they tend to hide in more primitive places. Malaria has no such reservations, and makes itself at home in some of the most popular tourist destinations. Which means that the malarial risk is one that you have to take seriously.
Fortunately, progress has made it possible to visit malarial areas with minimal risk. Which is just as well, because some of the world's greatest attractions, including the Kruger National Park and Victoria Falls, are in malarial areas.
Malaria is carried by the female anopheles mosquito, who needs blood - your blood - when she is breeding. Ms Anopheles is active mostly at night, and mostly in the warmer wetter months, when pools of calm water are available for her larvae to hatch.
If you contract malaria, you will suffer from headaches, hot and cold shivers, you will sweat uncontrollably, and your doctor may quite possibly treat you for influenza or tick-bite fever! Mine did! Indeed, one of the reasons that people die of malaria is that doctors often fail to identify it, and treat the you for something else, while you get on with the business of dying.
Quite often it IS some other kind of fever. However, one useful indicator to separate malaria from the rest is that your spleen becomes swollen and painful. Make sure that you describe every last pain in your body to the doctor, and make sure that you tell him that you have been in a malarial area.
Ask him if he has any experience of malaria. Doctors don't get much experience of it in places like upstate New York, downtown Sidney Australia, or anywhere at all in Yorkshire or Kent.
This, of course, presumes that you got it. But you probably won't, because you are going to be careful, aren't you?
Take your medication as prescribed. The famous Larium seems to be a good one. It is a dual purpose prophylactic, designed to protect against both of the strains of malaria that are currrently experienced. I can recommend it - with one small reservation: in a very small number of people, Larium has had some side effects, and they are extremely unpleasant. If you are one of these, try the alternative.
The alternative is a combination of chloraquin and Paludrin. Chloraquin guards against the "older" strain of the disease, and has been used for many years. The newer strain that emerged around in the eighties is chloraquin resistant, and Paludrin has been developed for this. Paludrin is a brand name, and the drug doubtless exists in other forms, but around Southern Africa we say Paludrin and everyone knows what we mean.
If you are taking the chloraquin/Paludrin combination, life gets just a little complicated. Chloraquin is taken weekly, but you must start a couple of weeks before you enter the risk area, and continue for a couple of weeks after you leave it. Paludrin, on the other hand, is taken daily, but only while you are actually in the risk area.
You thus need to pay close attention to the instructions on the pack.
A useful double pack containing a course of both drugs is available from pharmacists in South Africa.
Much of the sub-continent is entirely free of malaria, and we find many people popping Paludrins long after they could have stopped. If you are following the regular "tourist beat", then you should treat Victoria Falls as malarial, followed by the Kruger National Park, Swaziland and Zululand. When you leave Zululand and head south for Durban, you are out of the malarial belt.
Apart from medication, it is simply smart, and not at all difficult, to avoid getting bitten. Wear protective clothing - slacks and long sleeves - in the evening. Use insect repellent. If the bugs are biting, go indoors - modern resorts are sprayed regularly, as air conditioners create an artificial climate quite unsuitable for tropical insects.
But don't be paranoid about the whole thing. There is nothing as glorious as the African night, and we have lived here for years without dying of malaria. Well, most of us, anyway.
By the way, that old tale about gin and tonic - forget it! The quinine is probably synthesised these days, and even if it wasn't, you'd have to drink so many gin and tonics to get enough quinine, that you would end up dying of alcohol poisoning.
It is rumoured that eating lots of garlic encourages the mosquitoes to choose some other victim. I am sceptical about this. But there is no doubt that they find some folk tastier than others.
Once, when assailed by a whole swarm of the blighters in a non-air conditioned room, I had no insect repellent, and resorted in desperation to bathing my hands and face in after shave lotion. It worked like a dream.
It was Yardley's "English Blazer" but I dare say that anything from Brut Splash-on to Chanel No 5 would probably do just as well.
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