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.
Your doctor or travel clinic is your best first source of advice and probable supplier of jabs and prescriptions. Ensure you consult them at least four weeks prior to your departure from home so that you have enough time for vaccinations and/or a course of malariaprophylactics. If you’re going to Kenya for longer than a short holiday, get a thorough dental checkup before leaving home.
Sexually transmitted diseases, including HIV, are rife. 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. 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.
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 on arrival. You may also be required to show an IVC for yellow fever when returning home from a country that requires one (such as Uganda or Tanzania). Effective protection takes some time to develop after vaccination, so plan ahead and start organizing your jabs at least four 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.
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 – particularly if working locally or travelling extensively – doctors recommend jabs for typhoid, hepatitis A and hepatitis B (or a combined vaccination course).
Malaria is endemic in tropical Africa. 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 are 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. 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), which can cause a swelling of the brain and induce coma.
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 or travel clinic 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 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. Typically, the time between being infected and when symptoms start (incubation period) is seven to eighteen days, but it can be up to several weeks. If you suspect anything, even after returning home, seek medical attention immediately. You will be rapidly tested and sold the appropriate treatment. If you are in Kenya and 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 further supplies of anti-malarial tablets there. They’re all available over the counter and can be much cheaper than at home – a box of one hundred doxycycline, for example, costs less than Ksh1000.
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, even at buffets in safari lodges and beach resorts.
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 transmitted by tiny worm-like flukes that live in freshwater snails and burrow into animal or human skin to multiply in the bloodstream. The snails only favour stagnant water and the chances of picking up the disease 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 quickly curable with the right medication.
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. Remember too that rabies can also be carried by monkeys and baboons, which should never be approached in any case. 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.
For serious treatment Kenya has too few well-equipped or well-staffed state hospitals, and travellers with adequate insurance should always head for the private hospitals if possible. These can be found in Nairobi, along the coast and in some of the upcountry towns. In most you’re expected to pay for all treatment and drugs up front and make a claim from your insurance at a later date – always keep receipts. Among the better private hospitals in Kenya are Nairobi Hospital, which is in fact considered the best hospital in East Africa and admits patients with serious medical conditions from all over the region; The Aga Khan Hospital in Nairobi, Mombasa or Kisumu; Kijabe Hospital on the east side of the Rift Valley near Naivasha; Mombasa Hospital; Diani Beach Hospital, which also offers cosmetic surgery for people on holiday at the south coast beach resorts.
Kenya’s flying doctors air ambulance service (020 6992299 or 6992000) offers evacuation by air to the nearest suitable hospital, which is very reassuring if you’ll be spending time out in the wilds. Tourist membership costs $16 per person per month to cover Kenya and Tanzania, though check whether medical air evacuation (and medical repatriation in general) is already covered under your travel insurance as adequate provision may already have been made; tour operators may also have cover for their clients on organized safaris. The flying doctors’ 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.