Kenya //

Health

Disease is an ever-present threat to most Kenyans, but health should not be a big issue for visitors. Malaria is endemic and HIV infection rates are high, but so long as you take sensible precautions – remember your malaria pills, clean any cuts or scrapes, and avoid food that has been left out after cooking – you should have no problems beyond the chance of minor tummy trouble.

One of the biggest hazards is the fierce UV radiation of the equatorial sun. Brightness rather than heat is the damaging element, so wear a hat and use high-factor sunblock, especially in your first two weeks. If you’re going to be on the road for a long time, it may be worth considering taking some vitamin tablets with you, though they are no substitute for a balanced diet with plenty of fresh fruit and vegetables. If you’re going to Kenya for longer than a short holiday, get a thorough dental checkup before leaving home. A freshly cut “toothbrush twig” (msuake) is a useful supplement, and some varieties contain a plaque-destroying enzyme. You can buy them at markets.

Sexually transmitted diseases, including HIV, are rife. Four out of five deaths among 25- to 35-year-olds are AIDS-related. Using a condom will help to protect you from this and other STDs, including hepatitis B, which is quite widespread and can lead to chronic liver disease.

Medical resources

Your doctor is your best first source of advice and probable supplier of jabs and prescriptions. Depending on your doctor and your health provider, you may get your requirements free of charge, or have to pay.

Inoculations

For arrivals by air direct from Europe and North America, Kenya has no required inoculations. Entering overland from Uganda or Tanzania, though (or flying via another African country), you may well be required to show an International Vaccination Certificate (IVC) for yellow fever. If you intend to enter Kenya by land or to break your journey to Kenya elsewhere in Africa, plan ahead and start organizing your jabs at least six weeks before departure. A yellow fever certificate only becomes valid ten days after you’ve had the jab, but is then valid for ten years. If you are returning home to a country that requires an IVC for yellow fever in the case of travellers who have been in Kenya (Australia is one), then you should get your vaccination before departure.

You should ensure that you are up to date with your childhood tetanus and polio protection: boosters are necessary every ten years and it’s as well to check before travelling.

Although not necessary for an ordinary safari-and-beach holiday, if you’re going to be exposed to unhygienic conditions, doctors recommend jabs for typhoid, hepatitis A and hepatitis B (or a combined vaccination course). Effective protection takes some time to develop after the vaccination, so again, if you’re going to be working locally or travelling extensively, talk to your doctor as far ahead as you can.

Malaria

Malaria is endemic in tropical Africa and has a variable incubation period of a few days to several weeks, meaning you can get it long after being bitten. It’s caused by a parasite called Plasmodium, carried in the saliva of the female Anopheles mosquito. Anopheles prefers to bite in the evening, and can be distinguished by the eager, head-down position as she settles to bite. Anopheles is rarely found above 1500m, which means Nairobi and much of central Kenya is naturally malaria-free, but infected humans are vectors for the disease, meaning that an uninfected Anopheles mosquito that bites an infected person can pass malaria on to someone else, so you should assume the whole country is risky. Recent research has spotlighted a number of areas as having relatively high levels of malaria transmission, including the far south coast, around Shimoni, and the Lake Victoria shoreline and the plains inland from it. It can’t be stressed enough, however, that you can catch malaria virtually anywhere in Kenya.

Though not infectious, the disease can be very dangerous and sometimes fatal if not treated quickly. The destruction of red blood cells by the Plasmodium falciparum parasite can lead to cerebral malaria (blocking of the brain capillaries) and is the cause of a nasty complication called blackwater fever in which the urine is stained by excreted blood cells.

Wherever you travel, mosquito bites are almost a certainty and protection against malaria is essential. The best and most obvious method is to reduce your risk of being bitten. Keep your arms, legs and feet covered as much as possible after dusk (long, light-coloured sleeves and trousers are best), and cover exposed skin with a strong repellent. Deet-based repellents (“deet” is the insecticide diethyltoluamide) are best; citronella oil is considered much less effective, and has the disadvantage that elephants are attracted to the smell, and have been known to break into cars and tents to get at it. Sleep under a mosquito net (if you’re using your own, you might want to impregnate it with Deet) and burn mosquito coils, or mosquito-repellent tablets on a plug-in electric burner, both readily available in Kenya. Electronic buzzers have been shown not to work.

However much you can avoid being bitten, most medical professionals consider it essential to take anti-malaria tablets. The commonly recommended preventatives are the weekly mefloquine (sold as Lariam), which has a poor record for side effects, the antibiotic doxycycline, taken daily, and atovaquone-with-proguanil, taken daily (sold as Malarone), which, while expensive, has few, if any, side effects and can be started just two days before you leave. Your doctor may be able to advise further on which of these pills is the best one for you, and what the various side effects can be. It’s important to maintain a careful routine and cover the period before and after your trip with doses.

If you do get a dose of malaria, you’ll soon know about it: the fever, shivering and headaches are something like severe flu and come in unpleasant waves, making you pour with sweat for half an hour and then shiver uncontrollably. If you suspect anything, go to a hospital or clinic immediately. You will be rapidly tested and sold the appropriate treatment. If you can’t get to a doctor, seeing a pharmacist is a good plan B.

If you’re visiting Kenya for an extended period, it makes sense to buy anti-malarial tablets in Kenya. You can buy all of them over the counter and they can be much cheaper than at home – a box of one hundred doxycycline, for example, costs less than Ksh1000. You may be offered loose tablets in ordinary pharmacies, but the risk of being sold counterfeit drugs means you should stick to properly packed tablets or capsules. In the case of doxycycline, the value should be too low to be worth the effort of counterfeiting the pills.

Waterborne diseases

Serious stomach upsets don’t afflict a large proportion of travellers. That said, Kenya’s once fairly safe tap water is increasingly unfit to drink and the supply can be particularly suspect during periods of drought or heavy flooding. Where there is no mains supply, be very cautious of rain- or well-water. To purify water intended for drinking, use purifying tablets or, better, iodine (six drops per litre of water, then wait for half an hour), or boil it (if at high altitude, for thirty minutes).

If your stay in Kenya is short, you might as well stick to bottled water, which is widely available. For longer stays, think of re-educating your stomach; it’s virtually impossible to travel around the country without exposing yourself to strange bugs from time to time. Take it easy at first, don’t overdo the fruit (and wash it in clean water), don’t keep food too long, and be wary of salads. It is also wise to eat food that is freshly cooked and piping hot.

Should you go down with diarrhoea, it will probably sort itself out without treatment within 48 hours. In the meantime, and especially with children, for whom it may be more serious, it’s essential to replace the fluids and salts lost, so drink lots of water with oral rehydration salts (if you can’t get them from pharmacies, use half a teaspoon of salt and eight teaspoons of sugar in a litre of water). It’s a good idea to avoid greasy food, heavy spices, caffeine and most fruit and dairy products. Plain rice or ugali with boiled vegetables is the best diet. Drugs like Lomotil and Imodium simply plug you up, undermining the body’s efforts to rid itself of infection, though they can be useful if you have to travel.

Avoid jumping for antibiotics at the first sign of trouble: they annihilate what’s nicely known as your “gut flora” and will not work on viruses. But if your diarrhoea continues for more than five days, seek medical help. You should be aware of the fact that diarrhoea reduces the efficacy of malaria and contraceptive pills as they may pass straight through your system without being absorbed.

Bilharzia (medical name schistosomiasis) is a dangerous disease. It comes from tiny worm-like flukes, the schistosomes, that live in freshwater snails and which burrow into animal or human skin to multiply in the bloodstream. The snails only favour stagnant water and the chances of picking up bilharzia are small. The usual recommendation is never to swim in, wash with, or even touch, lake water that can’t be vouched for as schistosome-free. The stagnant and weed-infested parts of Kenyan lakes and rivers often harbour bilharzia, but the danger of crocodile attack means you’re unlikely to want any close contact with most inland waters in any case. If you suffer serious fatigue and pass blood, which are the first symptoms of bilharzia, see a doctor: it’s curable.

Heat and altitude

It’s important not to underestimate the power of the equatorial sun: a hat and sunglasses are strongly recommended to protect you from the bright light. The sun can quickly burn, or even cause sunstroke, so a high-factor sunblock is vital on exposed skin, especially when you first arrive (and it’s expensive in Kenya, particularly in hotel shops, so take it with you). Be aware that overheating can cause heatstroke, which is potentially fatal. Signs are a very high body temperature, without a feeling of fever but accompanied by headaches and disorientation. Lowering the body temperature (by taking a tepid shower, for example), and resting in a cool place, are the first steps in treatment.

The sun’s radiation is stronger at higher altitudes, but the biggest risk if you climb to over 2500m above sea level is altitude sickness, which may affect climbers on Mount Kenya, and even walkers in the Cherangani Hills.

On the coast, many people get occasional heat rashes, especially at first. A warm shower to open the pores, and loose cotton clothes, can help, as can zinc oxide powder. Dehydration is another possible problem, so make sure you’re drinking enough fluids, especially when you’re hot or tired, but don’t overdo alcoholic or caffeinated drinks. The main danger sign of dehydration is irregular urination, and dark urine definitely means you’re not drinking enough water.

Cuts and bites

The most likely way to hurt yourself on a trip to Kenya is while swimming or snorkelling, as old coral rock can be very sharp. Wear fins or swimming shoes. You should also take more care than usual over minor cuts and scrapes. In the tropics, the most trivial scratch can quickly become a throbbing infection if you ignore it. Take a small tube of antiseptic cream with you.

As for animal bites, dogs are usually sad and skulking, and pose little threat, but rabies does exist in Kenya, and can be transmitted by a bite or even a lick, so it’s best to avoid playing with pets or strays unless you know the owner and are sure they are safe. On the smaller scale, scorpions and spiders abound, but are hardly ever seen unless you deliberately turn over rocks or logs. Scorpion stings are painful but rarely dangerous, while spiders – even the big ones – are mostly harmless. Snakes are common but, again, the vast majority are harmless. To see one at all, you need to search stealthily. If you walk heavily they obligingly disappear. Larger animals, especially elephants, pose a potential risk to safari-goers, but not one that you need to worry about if you follow the rules.

Medical treatment

For serious treatment Kenya has too few well-equipped hospitals, and in most you’re expected to pay for all treatment and drugs. The Consolata Sisters’ Nazareth Hospital on Riara Ridge, northwest of Nairobi (t+254 (0)20 2017401), and in Nyeri (t+254 (0)61 2031010), are well run and modestly priced, as is Kijabe Hospital on the east side of the Rift Valley near Naivasha (t+254 (0)20 3246500). The best local hospitals are mentioned in relevant parts of the guide.

Kenya’s flying doctors air ambulance service (t020 6993000, wflydoc.org) offers free evacuation by air, which is very reassuring if you’ll be spending time out in the wilds. Tourist membership costs $16/person per month to cover Kenya and Tanzania. The income goes back into their outreach programme and the African Medical Research Foundation (AMREF) behind it. They have an office at Wilson Airport, from where most of their rescue missions take off.