The Travel Doctor

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My father worked on the gold mines in Johannesburg, a good kick from the now world famous Soccer City at the time of my birth. When I was only nine months old my father’s ‘long leave’ fell due and my parents packed their Volkswagen Beetle, setting off on a six week grand tour of our beautiful country. Two other Beetles accompanied us – transport for boxes of baby’s powder milk and nappies (No  disposable nappies in those days –  or should we say we were PC and Green, even then?). A Granny and an Aunt were included to help take care of the young mother and her baby, sterilize bottles and wash nappies.

And so it came to pass that I ingested a good dose of wanderlust along with the dust that inevitably seeped into the milk powder – and being deprived of breast milk forming the  foundation so to speak, of my other lifelong travel companion, Irritable Bowel Syndrome…

The latter fact bears reference in that I am living proof that although one should recognize your shortcomings and pre-existing conditions in live and travel, the latter should not deter you  from traveling at all: One simply needs to be aware of the problems it may cause away from home and travel well prepared, watching your diet and stocking your personal medical kit with the right muti to solve the problem irrespective of the language or level of expertise of the doctor in the country you happen to be in.

In a brand new, just declared bankrupt hotel in Nairobi twenty years ago I had to resort to a very hot bath in the absence of anti-spasmodic medication in my kit –  since then I go nowhere without it. Not that it helped much for memorable attacks in Chichester and on the Damrak in Amsterdam – note that there is no pharmacy open on the Hoofstation in the Dutch capital on a Sunday. They are all in church or recovering from a long night in de Walletjes…

In between the dusty roads of early sixties South Africa and the cobbles of European cities I have had the privilege of travelling near and far across the globe for business and pleasure –  and mostly a mix of the two. But mostly business and mostly in Africa –  at least when one refers to road travel.

I do recall that David Livingstone walked across the African continent a couple of times – I think a total of 47 000km or close to that by the time he died on his knees next to his camp bed in Bagamoyo. Having driven almost that far on African ‘highways’ I would probably also die on my knees for one’s behind is to sore to sit or lie on after a good day on the average stretch of African autostrada (Except for the private one’s you  dearly pay for)

My travels have been mostly in search of good medical facilities  –  I am still looking –  and to obtain an impression of public health threats that would affect our clients and their employees in any way.

I would be boring you to mention that the most important immediately life-threatening phenomenon in Africa is trauma –  mostly road traffic accidents, occasionally inter-personal violence and even more seldom (But do I think  with increasing frequency due to the increase in eco-tourism?) injuries due to wildlife encounters.

We may have a good portion of the world’s gold resources –  but we do not have a Golden Hour when it comes to rescuing those injured in accidents. Avoid them –  use that uncommon resource, common sense. Don’t drive at night, wear a seat belt, don’t travel on your own, don’t go if you don’t know. Etc etc.

So you thought I was going to state the most common life-threatening thing in Africa is? Malaria?

Well it is. Sort of. It is the most common immediately life-threatening disease that is NOT vaccine preventable. Avoiding it is 100% up to education and personal behaviour. Three simple rules: Don’t get bitten; seek early treatment; take The Pill (Malaria prophylaxis off course, not the other Pill…)

It kills in three days if not diagnosed and treated correctly. It is often missed by doctors in regions where it does not occur. It is very often OVER diagnosed by doctors in areas where it does occur, very often with equally sad consequences: spoiled holiday and business trips cut short or worse: A traveler dying from a disease that could have been treated effectively had the correct diagnosis been made in the first place. Just this year I saw no less than three persons between the ages of six and thirty-six who  had been evacuated from Liberia, Angola and Ghana with “complicated malaria” that turned out to be vaccine preventable Hepatitis A in all three cases. Luckily none of them died but it did cost in excess of US$100 000-00 to med-evac them all.

Which reminds me of travel insurance –  don’t go anywhere without it. Especially if you  are traveling by road in your own vehicle and do not have the back-up  of insurance provided by your credit card on the basis of the air tickets you  bought with it. Both in-country and cross-border travel warrants travel insurance cover for yourself AND your vehicle.

Travel insurance in turn reminds me of another essential form of medical insurance –  travel vaccines.

Being up  to date with your childhood vaccines goes without saying but in addition to this you  should pay attention to vaccines that protect you  from diseases that are directly related to travel. Before Influenza took centre stage as the most common vaccine preventable travel related illness in the world, the position was held by Hepatitis A. …  and it was Hepatitis A that the three patients mentioned earlier had.

No one should ever not be up to date with their Tetanus boosters –  one contracts that in your backyard anywhere in the world –  and those of us who  venture into Yellow Fever affected countries to our north have to, in accordance with the International Health Regulations, show proof of Yellow Fever vaccination. The latter vaccine is only available from Government sanctioned Yellow Fever Vaccination Centres. Anyone reading this and planning a trip to or through South America should note that similar Yellow Fever Vaccination requirements exist in parts of that great continent. (You cannot drive it but don’t miss out on walking the Inca Trail to Machu Picchu!)

It is a sad fact of our continent that medical facilities in any shape or form are few and far between. Anyone planning to travel cross country should avail themselves of what is likely to be available or not, and plan accordingly in terms of preventive measures and stocking up  on a good medical kit. Plan for medical facilities along an overland route in the same way you  would plan for fuel. Likewise, have an idea of where adequate air strips are located –  this is from where urgent aero-medical evacuation would take place. Don’t expect your medical insurance company to know this automatically!

Taking a doctor or nurse along may be a useful and clever option provided they too are aware of what may be required of them in taking care of a group of modern day trekkers. Rural areas simply do not have useable medical facilities and much of what is available in the capitals of our continent is sadly lacking by developed world standards. Be prepared to self-medicate most things and make sure you  can call a reliable source for medical advice –  either your travel  medical insurance company or your friendly  neighbourhood travel clinic.

I still have to set foot in the following countries on this continent before my ashes  join the dust of this great continent: The Gambia, Niger, Benin, Togo and Somalia. Oh, and Lesotho! But rather than getting impatient with the time it takes to cover every  country in Sub-Sahara Africa, I remind myself of Dr Livingstone’s remark on traveling in Africa:

“(Wagon) traveling in Africa is a prolonged system of picnicking. Excellent for the health and agreeable to those who are not fastidious about trifles, and who  delight in the open air”

See you  on  the trail!

The Travel Doctor

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