Tropical Illnesses -- Malaria is responsible for more than one million deaths in Africa each year, so it is imperative to take malaria precautions seriously. The threat of infection -- the result of a bite from a disease-carrying mosquito -- is present throughout the country, though the risk reduces at higher altitudes such as the Kenyan Highlands and Nairobi. Besides using prophylaxis medication, such as Malarone or Larium, arm yourself with strong mosquito repellents that can be safely sprayed or rubbed onto exposed skin, and make use of mosquito nets (these are a standard feature of nearly every property we've reviewed in this book) when you retire at night. Mosquitoes generally appear the moment the sun goes down, and just because you cannot see or hear them does not mean that they aren't buzzing around your ankles -- stay alert and do everything in your power to prevent being bitten (even if you have taken medication). Bear in mind, too, that children are more at risk of contracting the disease. Note that prophylactics have intense side effects on a small percentage of people, including forms of psychosis and depression -- it's worth taking the medication a few days before you leave. If you become ill with either a fever or flulike symptoms while traveling -- or up to 1 year after returning home -- you should seek medical attention at once and let your physician know the details of your travel history, along with details of the prophylactics you've been taking. For additional information on malaria, protection from insect bites, and antimalarial drugs, visit the CDC Travelers' Health website at www.cdc.gov/malaria.
Although mosquito bites are responsible for the greatest number of deaths in Africa, HIV/AIDS is obviously a major health concern in both countries, and you should remain cautious of this fact if you intend to have sexual relations with locals or if you come into contact with human blood.
Less prominent, but occasionally reported, risks in Kenya include tick bite fever, Rift Valley fever, typhus (usually the result of a tick bite), African sleeping sickness, plague, and relapsing fever. None of these pose as great a threat as chloroquine-resistant malaria, but it pays to be vigilant and try to protect yourself against bites.
Cholera has been reported in certain parts of Kenya and Tanzania, but you are unlikely to encounter it on safari. Bilharzia or schistosomiasis (which spends part of its life cycle in snails and the other part in humans) is a concern in and around Lake Victoria, so it's best not to swim there or in any other lakes. Rabies is prevalent in Kenya. Avoid touching any feral animals; if you are bitten by a domestic or wild animal, clean the wound immediately and seek medical treatment. This involves taking a vaccine, and the dose depends on whether you have already been vaccinated against rabies -- not necessary for a one-off visit, but it should be considered for lengthy stays in developing countries.
For general information about outbreaks of infectious diseases abroad, consult the website of the World Health Organization (www.who.int/en), and get more health information for travelers from www.who.int/ith/en.
Dietary Red Flags -- Never drink water from any tap unless you have been assured that it is completely safe to do so (and only if the assurance comes from someone you can trust). On the whole, at every single lodge and camp you'll encounter while on safari, you'll be briefed on the quality of the water and whether it's drinkable. Most places will provide bottled or filtered water in your room or tent; this may be free or chargeable. Most food in Kenya and Tanzania is safe to eat, but be wary of ice in drinks and washed salads and fruits, and always ask where the water has come from. Also avoid reheated food or food that has been sitting around for awhile -- equally relevant to a street stall and a hotel buffet.
Kenyans and Tanzanians are big meat-eaters, but that doesn't mean that vegetarians should go hungry. When making reservations for safari lodges and camps, make your hosts aware of your dietary predilections. You can do this either directly or through your operator or travel agent. Bear in mind that many of these lodges are a great distance away from towns where special foodstuffs can be purchased, so supplies need to be purchased in advance. If there are vegetarian guests, they need to make adjustments to their shopping list ahead of schedule, and you'll enjoy a more exciting culinary experience if you give prior warning.
Bites & Other Wildlife Concerns -- Although unlikely while on safari, there is a chance of encountering snakes, spiders, or scorpions, and on the coast a variety of sea creatures that can sting. Most snakes will clear off before you have a chance to tread on them, and the old tale that snakes are more scared of humans is generally true. The most worrisome snake is the puff adder, considered too lazy to move off when they sense you coming. In the event that you are bitten, stay calm and seek medical assistance immediately. Remember, the majority of snake bites are not poisonous. Spiders and scorpions may be spotted but are unlikely to pose a threat; the general rule is to leave them alone. At the coast, certain tropical sea creatures can inject venom into bathers' feet, which can be very painful. Wear plastic shoes if such creatures are reported in the area.
High-Altitude Hazards -- Altitude sickness can be a risk for anyone heading to altitudes above 3,000m (9,840 ft.) above sea level, so hikers and climbers tackling Mount Kenya and Kilimanjaro should take adequate precautions and prepare properly for the ascent. Symptoms include shortness of breath, nausea, vomiting, headaches, and dizziness. Mild altitude sickness requires rest before ascending higher; severe altitude sickness requires medication and a slow descent in stages. It's best not to attempt a climb if you have a bad cold or chest infection, or within 48 hours of going scuba diving. It's also a good idea not to go straight from the coast to Mount Kenya or Kilimanjaro, but to acclimatize at a midway altitude, such as Nairobi or the foothills around Moshi, for a couple of days.
Sun/Elements/Extreme Weather Exposure -- It can get incredibly hot under the African sun -- particularly in arid and semi-arid areas. Arm yourself with a high-factor sunscreen, a hat that will protect your face, and good sunglasses, and be vigilant to prevent overexposure to the sun. Be especially cautious of children. At the other extreme, many people are surprised by the prevalence of extreme cold in certain parts of the country. Mount Kenya and Kilimanjaro may lie on the equator, but temperatures, particularly at higher altitudes, are freezing. If you're going to climb, you'll need special protective clothing. Temperature fluctuations are known to take travelers by surprise; because the countries are on the equator, the sun disappears rather suddenly (at more or less the same time throughout the year), and nightfall can bring quick temperature changes.
Avoiding "Economy Class Syndrome" -- Deep vein thrombosis, or as it's know in the world of flying, "economy-class syndrome," is a blood clot that develops in a deep vein. It's a potentially deadly condition that can be caused by sitting in cramped conditions -- such as an airplane cabin -- for too long. During a flight (especially a long-haul flight), get up, walk around, and stretch your legs every 60 to 90 minutes to keep your blood flowing. Other preventative measures include frequent flexing of the legs while sitting, drinking lots of water, and avoiding alcohol and sleeping pills. If you have a history of deep vein thrombosis, heart disease, or another condition that puts you at high risk, some experts recommend wearing compression stockings or taking anticoagulants when you fly; always ask your physician about the best course for you. Symptoms of deep vein thrombosis include leg pain or swelling, or even shortness of breath.
What to Do If You Get Sick Away from Home
While in the tourist areas, you'll have access to good medical facilities, and Nairobi has the best hospitals and private clinics in East Africa. The coast, too, has top-class facilities, which in some cases even offer cosmetic procedures to vacationers. If you are going to more remote regions, be aware that medical facilities (including drugstores) are few and far between. There may be occasional clinics, but these are poorly equipped and may not be able to dispense medicines that you might require. For minor ailments, pharmacists can assist and recommend a doctor, if necessary. Expect to pay for any medical services either upfront or immediately after treatment. If you have international medical insurance, keep the receipts so your company can reimburse you. However, if you become seriously ill and require advanced medical attention or surgery, you should definitely fly home, as local equipment and training standards are still far below those in the West. Your travel insurance should include repatriation to your home country in an emergency. Within Kenya and based at Nairobi's Wilson Airport, the Flying Doctor's Society of Africa (www.amref.org) provides evacuation from remote areas in both Kenya and Tanzania to the nearest hospital. You may want to consider a temporary membership ($50) if you are going off the beaten track, but for the more popular parks and reserves, there are adequate medical provisions in case of an emergency.
In countries with rampant poverty and police departments that are often seen to be ineffective, crime can be a problem. However, much of the crime around Kenya and Tanzania is not directed at tourists and is in areas most tourists wouldn't visit or are in transit through (the north of Kenya and Nairobi, or Dar es Salaam and Arusha). The biggest threat to visitors is petty theft, particularly in Nairobi, Mombasa, and Kisumu; along the Kenyan coast; and in Tanzania, Dar es Salaam, and Zanzibar. In Nairobi and Dar es Salaam, theft is sometimes accompanied by an armed threat and violence, and carjacking is a particular problem (although, to put this in context, this particular crime is usually targeted at expats with expensive four-wheel-drive vehicles). Nevertheless, if driving, be alert and vigilant at all times. Pickpockets operate in cities and crowded areas, and travelers should be wary of "snatch and run" thieves who routinely snatch jewelry and other objects from people in the street or through open vehicle windows. Vehicle windows should be kept up and doors locked regardless of the time of day or weather. Thieves on matatus, buses, and trains may steal valuables from inattentive passengers. Never leave any luggage unattended. It is safer not to carry valuables -- store them in your hotel room safe -- and try to limit the amount of cash and valuables that you carry with you. Make every effort not to flaunt items such as cameras and mobile phones. Walking alone or at night, especially in downtown areas, in public parks, along footpaths, on beaches, and in poorly lit areas, is dangerous and discouraged.
In the remote and sparsely populated northern parts of Kenya (which include much of the Northeastern Province, the Eastern Province, the northern part of the Coast Province, and the northern part of the Rift Valley Province), there are a number of security issues. Police escorts or convoys are a requirement in certain parts of Northern Kenya; for visitors here, air travel is the recommended means of transportation. Here, highway banditry remains an ongoing problem, and also be aware that localized violence can occur in the form of cattle rustling (a cultural tradition for a number of tribes), which is often reciprocated by counter-raids. Such activity can also precipitate ethnic or tribal conflict and even small-scale warfare. Cross-border violence is also prevalent. A key problem zone is near Kenya's border with Somalia, where criminal acts, including kidnappings, have occurred. Travelers should be aware of the dangers and seek current status updates before heading to Northern Kenya.
Be aware that political demonstrations occur from time to time in East Africa. In late 2007 and early 2008, following the presidential and parliamentary elections held on December 27, Kenya was hit by intense unrest and violence. The violence, which made its way into news headlines around the world and portrayed a situation that many believe was far worse than the reality, followed the announcement by the Electoral Commission that incumbent candidate Mwai Kibaki had retained the presidency. Violence flared up in opposition strongholds and most heavily impacted the Nyanza, Rift Valley, and western provinces, as well as Nairobi and parts of Coast Province; more than 1,000 people were killed in the conflict and 300,000 were displaced. In previous general elections in Tanzania, there were some violent protests on Zanzibar and Pemba between supporters of varying political parties, but elections have passed peacefully in recent years. That said, safari destinations are not affected in any way during political elections, and as long as you avoid lengthy stays in populated areas (and, naturally, public demonstrations, which tend to happen in public parks, near government buildings, and around university campuses), protest activity is unlikely to affect tourist attractions outside Nairobi. For up-to-date information, contact the State Department (tel. 202/501-4444; www.state.gov/travelandbusiness). For more safety tips, download the Department of State's pamphlet "Tips for Travelers Abroad," at http://travel.state.gov.
Note: This information was accurate when it was published, but can change without notice. Please be sure to confirm all rates and details directly with the companies in question before planning your trip.