Health Care Access
Visiting South Africa should pose no threat to your health: Private hospitals are efficient and the staff is of the highest caliber, hygiene is rarely a problem in tourist areas, tap water is safe, stomach upsets from food are rare, there are no weird tropical viruses, and medical assistance is generally always within a 10-minute to 2-hour drive. Procedures, particularly dental and plastic surgery, are 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, discussed below. Unless you're already covered by a health plan while you're abroad, it's probably 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. In the event of serious medical conditions in Botswana, Zambia, and Zimbabwe, every effort should be made to go to Johannesburg.
While you will find an excellent range of over-the-counter medicines in pharmacies, bring your own prescription medications as well as 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 (www.iamat.org) for up-to-date tips on travel health concerns, as well as lists of local, English-speaking doctors; of course, your local host or concierge will do same, and the reference is probably more reliable. You will find listings of clinics overseas at the International Society of Travel Medicine (www.istm.org), though, personally, I'd go straight to www.netcare.co.za, a collection of top private clinics throughout South Africa, with listings of all their specialists in every region on the website, the Netcare Hospital they practice from, and their direct telephone number. For travel-specific queries, I'd look no further than www.travelclinic.co.za, also with branches throughout South Africa.
If you need more reassurance, 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, offers helpful advice on traveling abroad. Alternatively, bear the following in mind:
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. If you need medical treatment during your stay, there's no real risk that you'll contract the virus in the process. Even so, it's best to err on the side of caution and insist on treatment at a private hospital, if possible.
Bilharzia -- Do not swim in dams, ponds, or rivers unless they are recommended as bilharzia free. Symptoms are difficult to detect at first -- tiredness followed by abdominal pain and bloody urine or stools. But they can be effectively treated with praziquantel.
Bugs, Bites & Other Wildlife Concerns -- 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. Visitors to the national parks and reserves should bear in mind at all times that they are in a wilderness area: Even animals that look cute are wild and should not be approached (this includes baboons, who will sometimes vandalize cars in search of food). 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 such dangerous ones as hippos, lions, and elephants, roam right through them. After dark, it's essential that you seek accompaniment 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 unnecessary to point out that lions and crocodiles are dangerous; however, hippos kill more humans in Africa than any other mammal, 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 from them. And of course, the most serious bite comes from a tiny female insect, known as the Anophele (mosquito).
Cholera -- There has been a big cholera outbreak in Zimbabwe, with more than 94,000 cases reported since August 2008. This has spread to the Lusaka district (Zambia) and northeastern province of Limpopo (S.A.), which border Zimbabwe. According to the UN, risk to travelers anywhere in Southern Africa is minimal, and the cholera vaccine is recommended for aid and refugee workers only.
Dietary Red Flags -- Vegetarians and others with special dietary requirements visiting game lodges and camps must let their hosts know well in advance; in fact, it is worth alerting any establishment serving dinner and/or lunch that you have dietary requirements well in advance. Note that many South Africans who describe themselves as "vegetarians" eat fish or chicken, so it's best to specify exactly what your requirements are. Outside the major cities, vegetarians may struggle to find restaurants that offer any kind of choice. Travelers with any kind of intolerance or allergy should impress upon servers the seriousness of their condition when inquiring about the ingredients in a particular dish.
Sun -- Remember that the sun doesn't have to be shining to burn you. 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.
Malaria: Frequently Asked Questions
Parts of northern KwaZulu-Natal, Kruger National Park and surrounding reserves, Zimbabwe, and Botswana are all high-risk malaria zones (transmitted only by the female mosquito, who requires blood to develop her eggs), though some areas become low-risk 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). Please note that this depends on the rainfall during the previous summer. Always check with a travel clinic or contact email@example.com. Another useful website is www.meditravel.co.za. Here are some commonly asked questions about malaria:
- Do I really need to take antimalarial drugs? -- If you are entering a high-risk zone for the first time, a course of antimalarial tablets (aka prophylactic), for which you will need a prescription, is essential. What is prescribed is dependent on your health profile, but Malarone (or Malanil, as it also known) is the most effective (98%) and has the fewest side effects. 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 that 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 no prophylactic is totally effective, so 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. If they do, 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 inadvisable 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.
What to Do If You Get Sick Away from Home
South Africa has excellent doctors and specialists throughout the country; if you're not feeling well, let your host or concierge know and they will make an appointment with a reputable professional nearby. If you're unhappy with the diagnosis, get a second opinion, like elsewhere. In an emergency, you'd be better off going to a private hospital. There are plenty in urban centers (visit www.netcare.co.za), facilities are excellent, and you'll avoid a lengthy wait. It doesn't come cheap, though, and many expect to see proof of medical insurance.
Safety rules for travelers are the same as elsewhere in the world, though the high incidence of crime warrants extra caution in southern African cities. However, most cases occur in the townships and in areas away from the main tourist destinations. The South African authorities make it a high priority to protect tourists; tourism police are deployed in several of the large towns, and the vast majority of visitors complete their travels in South Africa without incident.
Crime -- Take care, however: Criminals operate out of the airport in Johannesburg; do not accept unsolicited assistance with transport when arriving at this airport. As a general rule, 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 or phones; 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; it's worth carrying a mobile phone on you at all times, with emergency numbers keyed in for easy access. Avoid no-go areas, such as 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 you're confronted by an assailant, keep calm, don't make eye contact, don't resist in any way, and cooperate. Note also that pilfering of luggage at international airports is an increasing problem: Travelers are encouraged to secure their luggage with Transportation Security Administration (TSA)-approved locks; use an airport plastic wrapping service; and avoid placing electronics, jewelry, cameras, or other valuables in checked luggage.
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 your car while you shop or dine. 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 employment as much as your small change.
On the Road -- If you're used to civilized, law-abiding drivers, you'll find South African road manners leave a lot to be desired. Drunk driving can be a problem, so try to limit driving to daytime trips, and be extra aware of others when driving at night. When driving, keep your car doors locked, particularly in Johannesburg (it's a good idea to also lock your room, and don't open the door unless you're expecting someone or the person is known to you). Don't leave valuables in clear view in your car, even when you are in it. Do not pick up hitchhikers, and if you're on a self-drive holiday, hire or keep a cellphone with you. Call the Automobile Association of South Africa should you break down. Call the police should you feel nervous and wish for an escort or company. 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.
Discrimination -- South Africa has come a long way since 1994 and, generally speaking, is 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.