Medical Matters

MEDICAL MATTERS

(as of 2010)

If you are on regular medication you’ll need to take sufficient to cover any trip – don’t rely on getting them in southern Africa, apart from the bigger places in South Africa and the other more developed countries. We spoke to our doctor who had a very commonsense approach and issued us with several prescriptions that we submitted over the weeks prior to departure in order to build up a stock to cover the year.

As part of our Expedition First Aid course the doctor running it provided a comprehensive list of suggested medical and dental drugs and equipment and supplied a list of drugs only available on prescription, signed as a prescription. This allowed us to obtain supplies in our own time. The non-prescription drugs and equipment were obtained over the internet from SP Services (UK) Ltd or from a chemist.

The NHS has medical advice www.fitfortravel.nhs.uk for each country. Practice nurses and doctors are able to give professional advice.

Some of the items taken would probably have been beyond our capabilities but medicines and equipment can be supplied to a competent doctor for use on oneself, especially sterile needles etc. Included was a Minor Surgery Pack Standard with various sterile implements and dressings that can be taken with you into a hospital or doctors – make sure it isn’t ‘exchanged’ for another without your knowledge!

We carried the bulk of the drugs in a cool box in the rear of the vehicle and had a large First Aid box for use slow-time, together with a readily available First Aid kit in the front of the vehicle for emergency use.

Take all the paperwork to prove you are entitled to be in possession of the drugs and equipment in case you are challenged at border crossings or road checks.

Malaria

You do not want to catch malaria. Our doctor prescribed Lariam to cover the year. Although Lariam has had some bad press, and don’t read the side-effects, the advantage is it is a weekly dose rather than a daily one, but take your doctor’s advice. It also covers the whole of the region we were visiting, unlike some other brands that are area specific as the mosquito parasite has become resistant. Best also to take precautions to reduce the likelihood of being bitten such as covering up and sprays, etc. It must be said we were very lucky in not being troubled by mosquitoes throughout the year. We both experienced unusual dreams and some way into the trip thought we might be getting more argumentative on Lariam days but we continued taking them.

Rabies

Generally only recommended for those likely to be working with animals but we decided to take the course of injections despite the cost. Our reasoning being that we were going to be camping in the wild, close to wild animals, where baboons and monkeys can be a pest and bold around humans: a bite could be a distinct possibility (as happened to one of our convoy party in Morroco). You still need to seek medical attention but in slower time than without, when urgent attention is needed and finding a competent doctor with the vaccine could be a challenge. Without the initial vaccination the post-exposure course of up to five injections is spread over thirty days, meaning you’ll need to stay put. Pre-exposure treatment consists of three painless injections in the arm at one week and three week intervals giving three years protection.

Yellow Fever

All southern Africa countries require a yellow fever certificate but only if entering from, or have visited, a country with the risk of yellow fever. In the area we visited, the vaccine is only recommended for Tanzania. The further north you go it appears the greater the risk but to be on the safe side we had our vaccinations which last 10 years* and a certificate to produce if required; it never was. (*Now valid for life by WHO. Not recommended for the elderly)

Sleeping Sickness [Human African trypanosomiasis]

Transmitted by the Tsetse Fly, a large fly that can inflict a painful bite even through thick clothes, they have an uncanny knack of getting inside the vehicle even with the windows shut and on the move – they are used to flying after moving big game. We kept fly swats handy and they took some killing and just when you thought you had succeeded they would suddenly revive. Can be identified by size and fact they fold wings into a triangular shape.

We encountered them in Zambia and Tanzania and in some areas they transmit Sleeping Sickness also called Human African trypanosomiasis. Check out disease areas, symptoms and treatment.

Other vaccines

Make sure the usual vaccines are current for the period of your trip: we also had a course of Hepatitis B injections. We didn’t bother with a cholera vaccine as it seems it doesn’t last long and sensible precautions make it unlikely to be caught.

Consult a doctor on all aspects of vaccinations and medication as it will vary from country to country and person to person.

Medical printout

We obtained a printout from our doctor of our medical history that we could produce as required should we, for example, end up in hospital. We never did.

Snake bites

This aspect wasn’t covered on our medical course. Snake bites are a distinct possibility, especially camping out in the wild and probably concern more people than anything else. Most snakes will make themselves scarce on the approach of humans with the exception of the puff adder. The puff adder stays put and relies upon its camouflage; unfortunately it likes to bask on paths and hence are often stepped on – they strike with lightning speed. They are responsible for more deaths in Africa than any other snake, with death resulting in 50% of untreated cases. We did purchase a snake bite treatment kit, in two sizes, for small or large bites that creates a vacuum over the bite slowing the spread of the venom. There are mixed views on its efficacy but it helps to calm the patient who thinks he or she is being treated and it is this calmness that is probably the biggest aid.

Actual treatment will depend upon the type of snake as each type can envenomate different venom, each of which attack the body in different ways – identification of the snake is important but I wouldn’t recommend killing the snake and taking it to the hospital with the patient – it may turn out to be not actually dead and the time taken to dispatch it may be better spent getting to the hospital. If you can, get a photograph of the snake. Best to have a book or research papers to hand for reference. Providing medical treatment is sought quickly, chances of survival are good. We saw very few snakes as it happens and most of them were from the car, ignoring the black mamba in Tanzania and the green mamba in Malawi, so the dangers need to be put into perspective.

Medical Check-up

Sensible to have a medical and dental check-up prior to departure but in plenty of time to have any work or treatment carried out. South African dentists can provide cheap treatment but you’ll probably have to tarry to await completion. Away from South Africa and probably the major cities in other countries, don’t depend on getting treated by orthodox methods!

Medical Course

Arranged through Paul Blackburn at OneLife Adventure and run by Doctor Dick Morgan expedition medical services. A one day course covering most aspects of expedition first aid including suturing, injection practice and emergency dental treatment. Although quite expensive we both attended even though we had both been trained First Aiders in the past: whoever was out of action needed the other to be able to deal with the situation. We also had Doctor Morgan’s cell number in the satellite phone memory, just in case.

One useful piece of advice was the use of superglue instead of suturing; you can get medical superglue but shop bought stuff is just as good – we used that technique, with ordinary superglue, a few times with great success and no; it doesn’t sting!

Literature

Knowledge gained on the course will probably go out the window in a crisis so have written details readily to hand for reference. We carried the course handbook readily to hand (also electronically) with the small First Aid kit, a medical dictionary, an old copy of the British National Formulary (intended for professionals regarding the use of drugs), a small Medicines book covering over 3000 drugs and their effects, and a ‘symptoms’ book.

Don’t rely on the internet – you may well not have a signal.