Namibia Medical Requirements
HEALTH & MEDICAL INFORMATION FOR NAMIBIA
Health Requirements:
- A yellow fever certificate will be needed if coming from an endemic area.
- Malaria is present all year North of Grootfontein.
- Bilharzia is present as well as sleeping sickness.
- Polio recommended
- Tetanus recommended if coming from an infected area
- Hepatitis A & B recommended
- Typhoid recommended
- Rabies present
- Boiled or bottled water advised
- Unpasteurised milk bust be boiled
MEDICAL NOTES FOR TRAVELLING:
Although we have yet to have one client that has returned
home from a safari and reported to have contracted an illness
or received a snake bite, scorpion sting or any of the sort,
the following information is purely here to give you the
traveler to Africa some basic background on how to prevent
and treat any such ailments. However, you will invariably
be hosted by a safari camp, lodge or hotel at which the
staff are prepared on how to stabilize, treat as well as
prevent typical injuries, bites, stings and other conditions
that may befall a person when out in the bush.
The number of travellers is constantly on the rise. This means a greater risk of propagation and contamination by contagious disease. These risks vary however, with the region visited, the duration of stay and living conditions. The situation is sometimes worsened by the illusion of effective health protection at the borders, and by governments who delay or refute notification of the onset of an epidemic. Thus, an increasing number of those who are led to travel to tropical countries for business or pleasure, tend to consult their physician either before their departure, for qualified advice, or when a bout of fever, diarrhoea or some other symptoms occur upon returning home. While specific situations should be taken into account, physicians should be guided by the basic rules:
- general hygiene
- chemoprophylaxis
- immunization
Additionally, consideration should be made of:
- any chronic disorder you may have i.e. asthma, diabetes, hypertension, cardiac disorder, epilepsy, porphyria etc.
- any medication you may be taking
- pregnant women, or anyone planning a pregnancy
- children under five, or breast-fed children
- pilots, mountaineers, divers
- allergies i.e. to insects (bees), foods (nuts), medication
1. GENERAL HYGIENE
Basic hygiene measures include cleanliness of hands, food
and body.
Hints for travellers to avoid food-borne infections
(a) Water - avoid drinking or brushing
teeth with tap water.
Ice - common source of contamination (including iced lollipops
or frozen flavoured ices)
Water purification by heat (boiling) is the preferred method
of purifying water. If impractical, chemical disinfection
using iodine-based products (2% tincture of iodine). Apply
certain caution for prolonged periods i.e. women who are
pregnant, in children, and travellers with thyroid disease.
Alternatively use chlorine tablets. Portable filters are
currently not recommended (these may only remove suspended
materials, and to clarify water).
(b) Food - Avoid eating unpasturized
dairy products (e.g. milk, cheese, ice cream, creamy desserts,
yoghurt). Milk should be boiled before consumed.
- Avoid eating uncooked foods, leftovers, or cooked foods
that have been kept for some time at room temperature (especially
important with minced meat dishes, e.g. hamburgers)
- Avoid eating salads, raw fruits and vegetables not peeled.
- Avoid purchasing food from street vendors.
(c) Hands - Should be washed thoroughly
and often, using soap. Do this diligently, when dealing
with infected adults, children, toilet visits, or animal
contact.
- Remember the old adage "boil it, cook it, peel it,
or forget it."
2. CHEMOPROPHYLAXIS
Remember to take enough of your own usual medication i.e.
for asthma, diabetes, hypertentios, depression, epilepsy,
known allergies etc.
A. In addition you may require medication to relieve common symptoms of probable illness e.g.:
- Antidiarrhoeals
- Anti-emetics - For nausea, vomiting, abdominal cramps and dehydration
- Rehydration electrolytes
- Antispasmodics
- Anti-inflammatories
- Analgesics - To manage pain, fever, inflammation (e.g. sprains etc)
- Antipyretics
- Antihistamines for known serious allergies
- Antipruitics for skin itches
- Sunblock/lipice for excessive sun exposure
B. If required, a prophylactic course of antibiotics for:
- diarrhoea
- respiratory infections
- skin infection
- hypnotics: to provide a more comfortable sleep during journey (i.e. aeroplane) or at your destination.
C. Malaria Chemoprophylaxis
(a) assess the risk of developing malaria
i.e.:
· length of stay in the malaria area
· time of year (i.e. wet or dry season)
· type of accommodation (tent or caravan is a greater
risk than a hotel room)
· the prevalence of malaria in the area, and if the
area has chloroquine sensitive or resistant strain of malaria
parasite
· high risk group i.e. the elderly, children under
5 years, pregnant women, or patients with low immunity
(b) Precautions to be taken in all malarial
areas:
· apply insect repellents to exposed skin
· wear light cotton clothing, long sleeves, long
trousers and closed shoes after sunset
· avoid perfumes and after-shaves
· avoid going out between dusk and dawn
· use mosquito nets, treated with insecticide, or
use mosquito coils or mats
· visit malarial area during dry season, or when
the rainfall is low
(c) Chemoprophylaxis, using appropriate
anti-malarials:
In Chloroquine sensitive areas - use Chloroquine. In Chloroquine
resistant areas - the choice is a combination of Chloroquine
and Mefloquine or Proguanil. Regardless of the anti-malarial
drug, it should be taken on the day of arrival in the endemic
area, and must be continued throughout the stay, and for
six weeks thereafter. Medication will only be effective
if it is taken absolutely regularly. A single omission is
enough to interrupt the protective effect.
3. IMMUNIZATION
These vaccines are recommended for travel to developing
countries:
- HEPATITIS A - recommended for all travellers
- HEPATITIS B - suggested for persons working in hospitals, or living in endemic areas for a long period of time
- TYPHOID - (refer to information on food-borne illness, especially shellfish and raw vegetables)
- vaccination should be completed at least one week prior to travel for optimal protection
- vaccines provide only temporary protection and periodic boosters are required.
- CHOLERA - Cholera vaccine is not recommended because it is NOT effective and the protective effect is temporary and gives a false sense of security
- POLIO - adults should have a single booster before travel.
- children should have their routine immunization schedule completed
- YELLOW FEVER - strongly recommended where the virus is active, regardless of duration of stay in endemic country
- RABIES - vaccination for travellers who will stay in rural areas
- TETANUS/DIPTHERIA - boosters should be had by all people every 10 years
- MENINGOCOCCAL MENINGITIS - required only for pilgrims to Mecca and countries where it is prevalent
- JAPANESE ENCEPHALITIS - recommended for travellers to certain parts of Asia
IN CONCLUSION, A SUMMARY OF EXAMPLES OF INFECTIONS FROM VARIOUS EXPOSURES
| EXPOSURE RISK | EXAMPLE OF INFECTION |
| 1. Consumption of raw undercooked or exotic foods | a. Enteric infections b. Hepatitis c. Trichinosis |
| 2. Drinking unheated water or milk and cheese consumption | a. Salmonellosis b. Shigellosis c. Hepatitis d. Viral gastroenteritis e. Brucellosis |
| 3. Fresh-water swimming | a. Shistosomiasis (Bilharzia) b. Leptospirosis |
| 4. Sexual Contact | a. HIV b. Syphilis c. Hepatitis d.Gonococcal and non gonococcal urethritis e. Herpes simplex |
| 5. Insect Bites | a. Mosquitoes -
b. Ticks -
c. Reduvid bugs - Chagas disease d. Tsetse flies - African trypanosomaisis |
| 6. Animal exposure or animal bites | a. Rabies b. Q Fever c. Tulaeramia d. Borreliosis e. Viral haemorrhagic fever f. Plague |
| 7. Exposure to infected humans | a. Hepatitis b. Typhoid c. Meningococcaemia d. Marburg, Ebola, Lassa viruses |
TICK BITES
These bites may be painful, itchy and lead to necrotic lesions.
Frequently, tick bites are not detected immediately. Seek
medical attention, especially if the symptoms of "tic-bite"
fever occur. To remove ticks, apply a drop of petrol, oil,
or nail varnish to smother the tick, so the head can be
successfully removed.
SNAKE-BITE
Antivenom is generally not indicated as it can be more fatal
than the bite if inappropriately administered. Before visiting
an area known for snake prevalence, record the telephone
numbers of the nearest hospital, doctor, poison centre,
transport e.g. Medical Rescue International
- Call for medical assistance and transport immediately
- Lie victim on their back, of left side position, keep them warm and immobile
- Reassure the victim all the time, observe vital signs i.e. pulse, breathing, skin colour, swelling and bruising
- Observe and record details constantly
- Time of snake bite
- Place of body where bitten
- Snake identification e.g. markings, colour, size, place of snake bite
- Do CPR if necessary and continue until medical help is available, to take over from you
- Remove rings, jewellery, tight clothing from limbs, neck and chest
- Inspect the wound, wipe away venom, rinse well with water and clean wound with antiseptic lotion, cover with gauze. If the would is very painful with associated swelling which rapidly worsens, treat as cytotoxic envenomation (puff-adder, spitting cobra) and do not apply crepe bandage. In all other cases apply firm crepe bandage to the limb, from below to above the wound, and immobilize with a splint and/or sling. If venom has entered the eyes, rinse copiously with milk, water, or any bland beverage, and cover the eye with gauze.
- Keep victim nil per mouth
- Keep recording vital signs until medical help is reached
- If you are trained and equipped, prepare to give Polyvalent Antivenom, if indicated by patient's condition (i.e. progressive nerve involvement such as difficulty in swallowing and breathing, or severe swelling spreading up a limb). Antivenom should not be given indiscriminately as adverse reactions are quite common.
BEES, WASPS, HORNETS, ANTS
The venom from such stings may be life threatening if the
victim is allergic to the stings and/or if multiple stings
have occurred. Management:
- Move away from the place of the insect sting, quietly, as panic aggravates and attracts other bees.
- Examine the wound for the sting and scrape it with something flat e.g. knife edge, nail etc. Avoid using tweezers or two fingers. Clean wound right thereafter.
- Assess the airway, breathing and cardiovascular status quickly. Call for medical help immediately and arrange for hospitalization. Do CPR if necessary, reassure patient, observe vital signs, as for a snake bite.
- If mild, apply ice to the wound, and then creams or solutions containing ammonia or aluminium sulphate which will help the burn/itch etc. Cortisone cream can be applied topically, or cortisone taken systematically if indicated. Analgesics can be given and a tetanus toxoid booster may be necessary.
SPIDER BITES
Neurotoxic spiders are the "button" and "widow"
varieties within South Africa.
Black Button Spider: Sharp burning pain, which rapidly spreads to other lymph glands in 5 - 15 minutes. Severe muscle cramps follow, especially in abdomen, chest, back and thighs. Weakness, tremors, difficulty in walking, spastic movements and profuse sweating can follow. These symptoms can be followed by severe, life-threatening problems. CALL FOR MEDICAL HELP IMMEDIATELY and arrange for hospitalization.
Cytotoxic spiders are the "sac"
and "violin" spiders. The bites swell quickly,
are angry and red, painful and develop into pustules which
can soon necrose.
Management: Clean the wound and get medical attention as
ulceration and necrosis can be severe leading to cellulitus,
which requires antibiotics and possible skin grafting. A
tetanus toxoid booster is indicated.
SCORPION BITES
Bites are similar to the neurotoxic spider bites. The pain
is extreme, swelling immediate, followed by numbness, peripheral
paralysis, muscular pain and cramps. General weakness, dizziness,
breathing difficulty and restlessness may follow. Again,
these lead to severe, life-threatening symptoms. Management:
CALL FOR MEDICAL HELP IMMEDIATELY and arrange for hospitalization. Assess the airway, do CPR if necessary, reassure the victim and observe vital signs at all times.
