Avoiding Sickness in Africa

There are many people who avoid travel to Africa because they are concerned about their personal health. It’s hard to blame them when we are regularly bombarded by sobering HIV/AIDS and malaria statistics. However, a trip to Africa is not a guarantee of illness. Most travelers will encounter a short lived stomach bug or two, and not much else.

That said, I have had malaria twice, as well as amoebic dysentery and a leg infection, while traveling in Africa. This is largely because of mistakes I made along the way. Consider this post a guide to avoiding sickness in Africa, but also a guide to recognizing and treating sickness if it occurs.

As always, if you are traveling to the developing world, and especially the tropics, you should visit a travel health clinic and have a consultation. You may need immunizations and your doctor can give you information that is specific to your destination.

Vaccination shots

Get your immunizations

Many African countries require a yellow fever vaccination for entry, but there are a number of other immunizations you should get: typhoid (critical), hepatitis A and B, polio (if you have not had a booster as an adult), tetanus, meningococcal meningitis and measles, mumps, and rubella (MMR). Again, this is why it is imperative that you visit a travel health clinic before departing.

Take a malaria prophylactic

Malaria prophylactics are not foolproof, but they are your best defense against one of the most debilitating (and sometimes fatal) illnesses in the world. Malarone is widely considered the best prophylactic option given its few side effects. It is also the most expensive. There are alternatives, doxycycline and mefloquine (lariam), that have their pros and cons. Some factors to consider would be the length of your trip, other prescription medications you may be taking, and any history (personally or within your family) of mental illness – lariam has been shown to have psychological side effects in some cases.

Once you are on the ground, buy a box of coartem from a local pharmacy. Coartem is a powerful malaria treatment option. A combination of artemether and lumefantrine, coartem is widely considered to be the best emergency stand-by treatment available. I have taken it twice and each time it has resolved my malaria.

Bottled water

Watch what you eat and drink

This does not mean avoid all street food and only eat at western themed restaurants. Eat at popular restaurants and from popular street vendors. They didn’t build up a steady customer base by offering food that will make people sick. Most likely, the food will also be delicious. If you are eating fruits or vegetables, make sure you can peel them, boil them, or wash them in potable water. When it comes to potable water, buy bottled water or treat your own. In most places, tap water is untreated and you certainly don’t want to drink well water. One last piece of advice: sometimes you have to say “no, thank you.” I got amoebic dysentery when I drank water that had not been properly heated/boiled. I should have said “no, thank you,” but I was afraid I would upset my hosts. In case you were wondering, it wasn’t worth it. If you feel like something is going to make you sick, politely refuse.

Travel with ciprofloxacin

Cipro is one of the more devastating antibiotics. It will destroy all the malicious bacteria in your body, but it will kill the beneficial flora in your gut as well. If you are suffering from a severe intestinal bacterial infection, cipro may be your savior. While you should not use it as a first response – it is taxing on your body and overuse of antibiotics promotes bacterial resistance – it should be your go to back up plan when things aren’t improving. Cipro can be purchased at pharmacies in most parts of the world without a prescription. If you are trying to purchase it in a western country, get a prescription from a travel health clinic.

Signs of sickness and how to respond

Traveler’s diarrhea is the most common ailment faced by the traveler to Africa and it usually resolves itself in a couple of days. If diarrhea is your only symptom, rehydrate with water and oral rehydration salts (you can buy these at pharmacies and recreational stores), rest and let the infection run its course. Do not take Imodium unless absolutely necessary. Imodium slows down your gut, meaning you will go to the bathroom less. Sounds nice in theory, but it’s actually just holding the offending bacteria in the your intestines for a longer period of time. You might want to use it if there is a long bus trip you have to take, but otherwise steer clear.

If the traveler’s diarrhea worsens or does not get better after two days, begin taking cipro. One 500mg dose in the morning and one in the evening for five days. You will hear people say that you can take it for 2-3 days and be fine, but every doctor I have talked to has said to take it for at least 5 to make sure the bacteria is completely extinguished.

Ciprofloxacin tablets by Wikimedia Commons

If the traveler’s diarrhea does not improve within 24 hours after starting cipro, you need to visit a clinic. You should also visit a clinic if you are having other symptoms with your diarrhea. If there is blood in your stool, you are having burps that smell like sulphur or if you are experiencing nausea and loss of appetite, you may have something more than a bacterial infection.

If you have a fever with your diarrhea, or if you have a fever by itself for that matter, your course of action should be entirely different. A fever in your home country might indicate you are getting the flu or a sinus infection. The same could be true while you are traveling. However, you need to err on the side of caution. If you have a fever, especially one that is coming in waves, get to a clinic. If you are having a fever that is coming in waves and you feel like you are alternately freezing and burning alive while experiencing severe body aches, you almost certainly have malaria and a clinic should be your first priority.

If you are in a rural area or cannot get to a clinic and you have a persisting fever, start taking coartem immediately. I have used this medication to resolve malaria on two separate occasions and it is widely considered to be the best stand-by treatment.

Many travelers I have encountered have expressed fear about visiting clinics in Africa, especially outside of big cities. While it’s true that many clinics might not have the same equipment that you would find in a large western hospital, every clinic I’ve been to in Africa has been clean and I have consistently received good care. Every clinic I have been to has some kind of lab for analyzing blood, urine and stool samples and every doctor and nurse is aware of all the possible illnesses you may run into.

Finally, use your best judgment. If you feel like you need to go to a clinic, go to a clinic. Most often, travel in Africa is disrupted by a minor bacterial infection. There are a few things on the continent, however, that can amount to more than a minor disruption. Be careful, not paranoid, and travel smart.