Health & Safety

Staying Healthy

General Availability of Healthcare -- Visiting southern Africa should pose no serious threat to your health: Hospitals are efficient (though in an emergency you'd be better off going to a private hospital -- facilities are better and you'll avoid a lengthy wait), hygiene is rarely a problem, tap water is safe, stomach upsets from food are rare, there are no weird tropical viruses, and medical aid is generally always within a 2-hour drive. Procedures, particularly dental and plastic surgery, are, in fact, so highly rated (and relatively inexpensive) that there is now a roaring trade in safari-surgery holidays. That said, there are a few things to watch out for. Malaria in certain areas is problematic, AIDS is rampant, bilharzia and tick-bite fever can be unpleasant, and precautions against the summer sun are essential. Plus, if you're used to civilized, law-abiding drivers, you'll find South African road manners leave a lot to be desired, and drunk driving can be a problem.

Unless you're already covered by a health plan while you're abroad, it's a good idea to take out medical travel insurance, particularly if you're going to participate in adventure activities. Be sure to carry your identification card in your wallet.

Pack prescription medications in your carry-on luggage. Carry written prescriptions in generic, not brand-name form, and dispense all prescription medications from their original labeled vials. Also bring along copies of your prescriptions, with the generic name, in case you lose your pills or run out. If you wear glasses or contact lenses, pack an extra pair.

Contact the International Association for Medical Assistance to Travelers (IAMAT; tel. 716/754-4883, or 416/652-0137 in Canada; www.iamat.org) for up-to-date tips on travel and health concerns. They will also supply lists of local, English-speaking doctors (though your host or concierge will do same, and the reference is probably even more reliable). The United States Centers for Disease Control and Prevention (tel. 800/311-3435; www.cdc.gov) provides up-to-date information on health hazards by region or country and offers tips on food safety. The website www.tripprep.com, sponsored by a consortium of travel-medicine practitioners, may also offer helpful advice on traveling abroad. You can find listings of reliable clinics overseas at the International Society of Travel Medicine (www.istm.org).

Of Special Concern

AIDS -- South Africa has more people living with AIDS than any other country in the world -- if you're entering into sexual relations, use a condom. There's no real risk that you'll contract the virus from medical treatment.

Bilharzia -- Do not swim in dams, ponds, or rivers unless they are recommended as bilharzia-free. Symptoms are at first difficult to detect -- tiredness followed by abdominal pain and blood in the urine or stools -- but are effectively treated with praziquantel.

Creepy Crawlies -- You are unlikely to encounter snakes -- they are shy, and, with the exception of puff adders, they tend to move off when they sense humans approaching. If you get bitten, stay calm -- very few are fatal -- and get to a hospital. Scorpions and spiders are similarly timid, and most are totally harmless. To avoid them, shake out clothing that's been lying on the ground, and be careful when gathering firewood. If you're hiking through the bush, beware of ticks; tick-bite fever is very unpleasant, though you should recover in 4 days -- to remove ticks, smear Vaseline over them until they let go.

Inoculations -- No shots are necessary, unless you're from a country where yellow fever is endemic, in which case you'll need a vaccination certificate. As a general precaution, you might want to make sure your polio and tetanus shots are up-to-date, and ask your doctor or a travel-health specialist about vaccinations for hepatitis.

Malaria -- Parts of northern KwaZulu-Natal, the Kruger National Park and surrounding reserves, Zimbabwe, and Botswana are all high-risk malaria zones, though some become low-risk areas in the dry winter months (visit www.travelclinic.co.za for a map). Both Hluhluwe-Umfolozi (KwaZulu-Natal) and the Kruger are usually low-risk areas from May to September (generally, this means no medication is necessary, though other protective measures are advisable), but please note that this depends on the rainfall during the previous summer. Always check with a travel clinic or contact malaria@mweb.co.za. Another useful website is www.meditravel.co.za.

Do I need to take drugs?

If you are entering a high-risk zone for the first time, a course of antimalarial tablets (prophylactic), for which you will need a prescription, is essential. What is prescribed is dependent on your health profile, but the latest antimalarial drug, Malarone (or Malanil, as it also known), is the most effective (98%) and has the fewest side effects, and you have to take it only 1 day before entering a malarial area and continue the course for only 7 days after you leave the area. The downside is, at R35 to R40 ($4.90-$5/£2.50-£3) a tablet, taken daily, it's quite expensive. Larium is 91% effective but has strong potential side effects and should be started 2 weeks prior to entering the area, to allow you to switch if necessary (this should happen within 3 days). Side effects may include depression, anxiety, disorientation, dizziness, insomnia, strange dreams, nausea, or headaches; the principal contraindications are a history of anxiety, psychiatric problems, or epilepsy. If you've taken Larium before and suffered no side effects, you can start the course 1 week before. If you do suffer side effects, the medication is usually changed to an antibiotic containing Doxycycline -- a daily tablet taken 1 day before. Both Larium and Doxycycline need to be taken for 28 days after leaving the area -- and make sure to take your full course of tablets.

Are tablets enough?

Keep in mind that as no prophylactic is totally effective, your best protection is to avoid being bitten. Sleep under a mosquito net if possible; burn mosquito coils or plug in mosquito destroyers if you have electricity; wear loose, full-length clothing; and cover exposed skin with insect repellent.

How do I know if I've got it?

The flulike symptoms -- fever, diarrhea, headaches, and joint pains -- can take up to 6 months to develop. Consult a doctor immediately -- a delay in treatment can be fatal.

What if I'm traveling with kids or I'm pregnant?

Taking medication is not advisable for children under the age of 5 and pregnant women. Your best bet is to choose a malaria-free Big 5 reserve: Pilanesberg and Madikwe in the North-West, Welgevonden in the Limpopo Province, and those located in the Eastern Cape. In the dry winter months, the Kruger and the Hluhluwe-Umfolozi reserve in Zululand (3 hr. from Durban) have a very low risk.

Sun -- Remember that the sun doesn't have to be shining for you to burn -- wear a broad-brimmed hat at all times, and apply a high-factor sunscreen or total block -- at least initially. Wear sunglasses that reduce both UVA and UVB rays substantially, and stay out of the sun between 11am and 3pm. Children should be kept well covered at the beach; it can take as little as 15 minutes for an infant's skin to develop third-degree burns.

Staying Safe

In the Cities -- The rules are the same as all over the world, though the high incidence of crime warrants extra caution in southern African cities. Always be aware of the people around you, whether you're walking down a busy city street or driving through a deserted suburb -- if you sense danger, act on your instincts. Don't flash expensive jewelry or fancy cameras; wear handbag straps across the neck, and keep a good grip on items. Don't walk any of the major city-center streets after dark, especially if you're alone. Be on guard if you are alone on an empty beach or mountainside near urban areas. When driving, keep your car doors locked at all times, particularly in Johannesburg (it's a good idea to also lock your room, even in hotels, and don't open the door unless you're expecting someone). Avoid no-go areas like Hillbrow and Berea, the inner-city suburbs of Johannesburg, and find out from your hotel or host how best to get where you're going and what's been happening on the streets recently. Finally, if confronted by an assailant, keep calm, and don't resist in any way.

With such widespread poverty, you will inevitably have to deal with beggars, some of them children. Money is often spent on alcohol or drugs; should you feel the need to make a difference, donate to a relevant charity. Some beggars offer services, such as watching or cleaning your car. There is no need to feel intimidated, and how much you decide to tip them is entirely personal, though with unemployment running as high as 40%, this is the best way to help the many who need the dignity of some semblance of employment as much as your small change.

On the Roads -- Do not pick up hitchhikers, and if you're on a self-drive holiday, hire or keep a cellphone with you to call the Automobile Association of South Africa (AA; tel. 0800/03-3007), should you break down, or the police, should you feel under threat. If you are at a remote site or beach, be aware of who is there when you approach the spot, and don't leave your car if you don't feel safe. Also be aware of suspicious persons approaching you at a remote site; again, a cellphone, with the correct emergency numbers on speed dial, is recommended for peace of mind.

In the Game Reserves -- Visitors to the national parks and reserves should bear in mind at all times that they are in a wilderness area: Even those animals that look cute are wild and should not be approached. If you're on a self-drive safari, make sure you get out of your vehicle only at designated sites. While most rest camps in the national parks are fenced for your protection, this is not the case with lodges and camps situated in private reserves: Animals, including dangerous ones like hippos, lions, and elephants, roam right through them. After dark it's essential that you are accompanied to and from your room by a guide. Even when you're in a safari vehicle on a game drive, your ranger will caution you not to stand up, make sudden or loud noises, or otherwise draw attention to yourself. Occasionally, the ranger may leave the vehicle to track game on foot; always remain seated in the vehicle. It is probably not necessary to point out that lions and crocodiles are dangerous; however, hippos kill more humans in Africa than any other animal, and you should take this seriously. Hippos may look harmlessly ponderous, but they can move amazingly fast and are absolutely lethal when provoked. Even some of the smaller animals should be treated with a great deal of respect: The honey badger is the most tenacious of adversaries, and even lions keep their distance.

Dealing With Discrimination

South Africa has come a long way since 1994, and is generally speaking home to some of the world's most politically sensitive communities. That said, you will still come across some die-hard racists and homophobes, usually (but by no means exclusively) outside of the urban areas. This should not be the case with any of our recommendations; if you encounter problems, let us know in writing and we'll take it up. As a general note, Americans are, as elsewhere, currently viewed with genial suspicion, but that should all change when Bush steps off the podium.