You can put aside most of the health fears that may be justified in some parts of Africa; run-down hospitals and bizarre tropical diseases aren’t typical of South Africa. All tourist areas boast generally high standards of hygiene and safe drinking water. The only hazard you’re likely to encounter, and the one the majority of visitors are most blasé about, is the sun. In some parts of the country there is a risk of malaria, and you will need to take precautions.

Public hospitals in South Africa are fairly well equipped, but they are facing huge pressures under which their attempts to maintain standards are unfortunately buckling. Expect long waits and frequently indifferent treatment. Private hospitals or clinics, which are well up to British or North American standards, are usually a better option for travellers. You’re likely to get more personal treatment and the costs are nowhere near as high as in the US – besides which, the expense shouldn’t pose a problem if you’re adequately insured. Private hospitals are listed in the town and city listings throughout the Guide.

Dental care in South Africa is well up to British and North American standards, and is less expensive. You’ll find dentists in all the cities and most smaller towns, listed after doctors at the beginning of each town in the telephone directory.

Inoculations

Although no specific inoculations are compulsory if you arrive from the West, it’s wise to ensure that your polio and tetanus vaccinations are up to date. A yellow fever vaccination certificate is necessary if you’ve come from a country where the disease is endemic, such as Kenya, Tanzania or tropical South America.

In addition to these, the Hospital for Tropical Diseases in London recommends, depending on which parts of the country you’re visiting, a course of shots against typhoid and an injection against hepatitis A, both of which can be caught from contaminated food or water. This is a worst-case scenario, and in any case, typhoid is eminently curable and few visitors to South Africa ever catch it.

Vaccination against hepatitis B is essential only for people involved in health work; the disease is spread by the transfer of blood products, usually dirty needles.

It’s best to start organizing to have jabs six weeks before departure. If you’re going to another African country first and need the yellow fever jab, note that a yellow fever certificate only becomes valid ten days after you’ve had the shot.

Stomach upsets

Stomach upsets from food are rare. Salad and ice – the danger items in many other developing countries – are both perfectly safe. As anywhere, though, don’t keep food for too long, and be sure to wash fruit and vegetables as thoroughly as possible.

If you do get a stomach bug the best cure is lots of water and rest. Papayas – the flesh as well as the pips – are a good tonic to offset the diarrhoea. Otherwise, most chemists should have name-brand anti-diarrhoea remedies, such as Lomotil.

Avoid jumping for antibiotics at the first sign of illness. Instead keep them as a last resort – they don’t work on viruses and annihilate your “gut flora” (most of which you want to keep), making you more susceptible next time round. Most tummy upsets will resolve themselves if you adopt a sensible fat-free diet for a couple of days, but if they do persist without improvement (or are accompanied by other unusual symptoms), then see a doctor as soon as possible.

The sun

The sun is likely to be the worst hazard you’ll encounter in Southern Africa, particularly if you’re fair-skinned.

Short-term effects of overexposure to the sun include burning, nausea and headaches. Make sure you wear adequate sunscreen and you don’t stay too long in the sun – especially when you first arrive.

Take particular care with children, who should ideally be kept well covered at the seaside, preferably with UV-protective sun suits. Don’t be lulled into complacency on cloudy days, when UV levels can still be high.

Bilharzia

One ailment that you need to take seriously throughout sub-Saharan Africa is bilharzia (schistosomiasis), carried in most freshwater lakes and rivers in South Africa except in the mountains. Bilharzia is spread by tiny, parasitic worm-like flukes which leave their water-snail hosts and burrow into human skin to multiply in the bloodstream; they then work their way to the walls of the intestine or bladder, where they begin to lay eggs.

The chances are you’ll avoid bilharzia even if you swim in a suspect river, but it’s best to avoid swimming in dams and rivers where possible. If you go canoeing or can’t avoid the water, have a test for bilharzia when you return home.

Symptoms may be no more than a feeling of lassitude and ill health. Once the infection is established, abdominal pain and blood in the urine and stools are common. Fortunately, although no vaccine is available, bilharzia is easily and effectively treatable.

Malaria

Most of South Africa is free of malaria, a potentially lethal disease that is widespread in tropical and subtropical Africa, where it’s a major killer. However, protection against malaria is essential if you’re planning to travel to any of these areas: northern and northeastern Mpumalanga, notably the Kruger National Park; northern KwaZulu-Natal; the border regions of North West and Limpopo provinces. The highest risk is during the hot, rainy months from November to April. The risk is reduced during the cooler, dry months from May to October, when some people decide not to take prophylactic medication.

Malaria is caused by a parasite carried in the saliva of the female anopheles mosquito. It has a variable incubation period of a few days to several weeks, so you can become ill long after being bitten. The first symptoms of malaria can be mistaken for flu, starting off relatively mildly with a variable combination that includes fever, aching limbs and shivering, which come in waves, usually beginning in the early evening. Deterioration can be rapid as the parasites in the bloodstream proliferate. Malaria is not infectious, but can be fatal if not treated quickly: get medical help without delay if you go down with flu-like symptoms within a week of entering or three months of leaving a malarial area.

Doctors can advise on which kind of anti-malarial tablets to take. It’s important to keep to the prescribed dose, which covers the period before and after your trip. Consult your doctor or clinic several weeks before you travel, as you should start taking medication a week or two before entering the affected region – depending on the particular drug you’re using.

Whatever you decide to take, be aware that no antimalarial drug is totally effective – your only sure-fire protection is to avoid getting bitten. Malaria-carrying mosquitoes are active between dusk and dawn, so try to avoid being out at this time, or at least cover yourself well. Sleep under a mosquito net when possible, making sure to tuck it under the mattress, and burn mosquito coils (which you can buy everywhere) for a peaceful, if noxious, night. Electric mosquito-destroyers which you fit with a pad every night are less pungent than mosquito coils, though note that you may not have access to a power supply at some safari lodges, or if you’re camping. Mosquito “buzzers” are useless. Whenever the mosquitoes are particularly bad – and that’s not often – cover your exposed parts with insect repellent; those containing diethyltoluamide (DEET) work well. Other locally produced repellents such as Peaceful Sleep are widely available.

Bites and stings

Bites, stings and rashes in South Africa are comparatively rare. Snakes are present, but hardly ever seen as they move out of the way quickly. The sluggish puff and berg adders are the most dangerous, because they often lie on paths and don’t move when humans approach. The best advice if you get bitten is to note what the snake looked like and get yourself to a clinic or hospital. Most bites are not fatal and the worst thing you can do is to panic: desperate measures with razor blades and tourniquets risk doing more harm than good.

Tick-bite fever is occasionally contracted from walking in the bush, particularly in long wet grass. The offending ticks can be minute and you may not spot them. Symptoms appear a week later – swollen glands and severe aching of the bones, backache and fever. The disease will run its course in three or four days. Ticks you may find on yourself are not dangerous, just repulsive at first. Make sure you pull out the head as well as the body (it’s not painful). A good way of removing small ones is to smear Vaseline or grease over them, making them release their hold.

Scorpion stings and spider bites are painful but almost never fatal, contrary to popular myth. Scorpions and spiders abound, but they’re hardly ever seen unless you turn over logs and stones. If you’re collecting wood for a campfire, knock or shake it before picking it up. Another simple precaution when camping is to shake out your shoes and clothes in the morning before you get dressed.

Rabies is present throughout Southern Africa, with dogs posing the greatest risk, although the disease can be carried by other domestic or wild animals. If you are bitten you should go immediately to a clinic or hospital. Rabies can be treated effectively with a course of injections.

Sexually transmitted diseases

HIV/AIDS and venereal diseases are widespread in Southern Africa among both men and women, and the danger of catching the virus through sexual contact is very real. Follow the usual precautions regarding safer sex. There’s no special risk from medical treatment in the country, but if you’re travelling overland and you want to play it safe, take your own needle and transfusion kit.

Tuberculosis

TB is a serious problem in South Africa, but most travellers are at low risk. At higher risk are healthcare workers, long-term travellers and anyone with an impaired immune system, such as people infected with HIV.

A BCG vaccination is recommended for children, most of whom should already have received one in infancy, but it’s not routinely given to adults since it can mask latent symptoms should you later become infected. Adults should take medical advice on the question of immunization if they feel they may be at risk.

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