THINGS YOU NEED TO KNOW BEFORE TRAVELING TO RWANDA
Things you need to be with while traveling on the safari – Uganda – Rwanda tour OR any other safari
Before traveling to the land of a thousand hills known as Rwanda or on any safari/vacation/holiday, below are important things you need to know or to be equipped with:
Before you travel, make sure that you have adequate medical insurance – choose a policy with comprehensive cover for hospitalization as well as for repatriation in an emergency. Now days the range of cover available is very wide- choose whatever suits your method of travel. Be aware (if you plan to use motorbike taxis in Rwanda) that not all policies cover you for this form of transport. Remember to take all the details with you, particularly your policy number and the telephone number that you have to contact in the event of a claim.
ESSENTIALS TO CARRY ON THE SAFARI
*Personal First-aid kit. The more you travel the less I take. The minimal kit contains:-
– Good drying antiseptic, e.g.: iodine or potassium permanganate ( don’t take antiseptic cream)
-a few small dressings (Band-Aids)
-Insect repellent; malaria tables; impregnated bed net
-aspirin or paracetamol
– Antifungal cream (e.g. Canesten)
-Ciprofloxacin antibiotic (take 500mg followed by a second tablet six to twelve hours later for diarrhoea with blood and /or slime and or a fever. Norfloxacin may be prescribed as an alternative in countries outside the United Kingdom.
-Tinidazole (2g taken in one dose then repeat seven days later) for amoebic dysentery or giardiasis another broad-spectrum antibiotic like amoxicillin (for chest, urine, skin infections, etc) if going to a remote area pair of fine-pointed tweezers (to remove hairy –caterpillar hairs, thorns, splinters etc) condoms or femidoms
-possibly a malaria treatment kit a travel thermometer (not containing mercury; airlines ban these)
COMMON MEDICAL PROBLEMS
Travellers’ diarrhoea – this is caused by eating unfamiliar food, unused climate and weather among others. At least half of those travelling to the tropics/developing world will experience a bout of travellers’ diarrhoea during their trip. On the other hand, travelers should also avoid typhoid, cholera, hepatitis, dysentery, worms, etc.
To avoid diarrhea and other related diseases, all travellers are advised to eat hot and fresh food and all fruits should be washed before eating them.
Make sure that you drink safe and clean water, it is also possible to get sick from drinking contaminated water, so try to drink from safe sources and boiled water is recommended. Tap water is supposedly safe in Kigali but not elsewhere in Rwanda. If you buy bottled water (which is widely available in Rwanda) make sure the seal is intact. Iodine is not recommended in pregnancy so you should ask a doctor what you should do.
This mosquito-borne disease resembles malaria but there is no prophylactic available to deal with it. The mosquitoes which carry this virus bite during the daytime, so it is worthy applying repellent if you see them around. Symptoms include strong headache, rashes and excruciating joint and muscle pains with high fever. Dengue fever lasts for only a week or so and is not usually fatal if you have not previously been infected. Complete rest and paracetamol are the usual treatment. Plenty of fluids also help. Some patients are given intravenous drip to keep them from dehydrating.
It is crucial to avoid mosquito bites between dusk and down; as the sun is gong down, don long clothes and apply repellent on any exposed flesh. This will protect you from malaria, elephantiasis and a range of nasty insect-borne viruses. Malaria mosquitoes are voracious, hunt at ankle-level and can penetrate through socks. Sleep under a permethrin-treated bed net or in an air-conditioned room. During the day it is wise to wear long, loose (preferably 10% cotton) clothes if you are pushing through scrubby country; this will deter ticks as well as tsetse flies and day-biting Aedes mosquitoes which may spread dengue and yellow fever. Tsetse flies hurt when they bite and are attracted to the colour blue; locals will advise on where they are problem and where they transmit sleeping sickness.
Or putsi area are a problem in areas in eastern, western and southern Africa where the climate is hot and humid. The adult fly lays her eggs on the soil or on drying laundry and when the eggs come in contact with human flesh (when you put on clothes or lie on a bed) they hatch and burry themselves under the skin. Here they form a cop of ‘boils’ each of which hatches a grub after about eight days, when the inflammation will settle down. In putsi areas either dry your clothes and sheets within a screened house, or dry them in direct sunshine until they are crisp, or iron them.
Jiggers or sand fleas
Are another kind of flesh-feaster. They hatch on if you walk barefoot in contaminated places, and set up home under the skin of the foot usually at the side of a toenail where they cause a painful, boil-like swelling. These need picking out by a local expert; if the distended flea bursts during eviction the wound should be dowsed inspirit, alcohol or kerosene, otherwise more jiggers will infest you.
With thanks to Dr. Vaughan Southgate of the Natural History Museum, London
Bilharzia or schistosomiasis is a disease that commonly afflicts the rural poor of the tropics who repeatedly acquire more and more of these nasty little worm-lodgers. Infected travellers and expatriates generally suffer fewer problems because symptoms will encourage them to seek prompt treatment and they are also exposed to fewer parasites. However, it is still an unpleasant problem that is worth avoiding.
The parasites digest their way through your skin when you wade, bathe or even shower in infested freshwater. Unfortunately many African lakes, rivers and irrigation canals carry a risk of bilharzias. In Rwanda, the bathing areas of Lake Kivu are currently said to be safe.
The most risky shores will be close to places where infected people use water where they wash cloths, etc. Winds disperse the curacies, though, so they can be blown some distance, perhaps up to 200m from where they entered the water. Scuba-diving off a boat into deep offshore water, then, should be a low –risk activity, but showering in lake water or paddling along a reedy lake shore near a village carries a high risk of acquiring bilharzia.
Although absence of early symptoms does not necessarily mean there is no infection, infected people usually notice symptoms two or more weeks after penetration. Travellers and expatriates will probably experience a fever and often a wheezy couth; local residents do not usually have symptoms.
There is now a very good blood test which, if done six weeks or more after likely exposure, will determine whether or not parasites are going to cause problems, and then the infection can be treated. While treatment generally remains effective, it does fail in some cases for reasons that are not yet fully understood; pretreatment seems to work fine and it is not known if some drug resistance is developing. Since bilharzia can be a nasty illness, avoidance is better than waiting to be cured and it is wise to avoid bathing in high –risk areas. Take local advice about this.
Avoiding bilharzia if you are bating, swimming, paddling or wading in freshwater which you think may carry a bilharzia risk, try to stay in no longer than ten minutes. Afterwards dry off thoroughly with a towel; rub vigorously. Avoid bathing or paddling on shores within 200m of villages or places where people use the water a great deal, especially reedy shores or where there is lots of water weed. Covering yourself with.
DEET insect repellent before swimming will help to protect you. If your bathing water comes from a risky source try to ensure that the water is taken from the lake in the early morning and stored snail-free, otherwise it should be filtered or Dettol or Cresol should be added. Bathing early in the morning is safer than bathing in the last hour of the day. If you think that you have been exposed to bilharzia parasites, arrange a screening blood test (your GP can do this) more than six weeks after your last possible contact with suspect water.
Any mosquito bite or small nick in the skin provides an opportunity for bacteria to foil the body’s usually excellent defences; it will surprise many travellers how quickly skin infections start in warm humid climate and it is essential to clean and cover even the slightest wound. Creams are not effective as a good drying antiseptic such as dilute iodine, potassium permanganate (a few crystals in half a cup of water), or crystal (or gentian) violet. One of them should be available in most towns. If the wound starts to throb, or becomes red and the redness starts to spread, or the wound oozes, and especially if you develop fever, antibiotics will probably be needed; flucloxacillin (250mg four times a day or cloxacillin (500mg four times a day). For those allergic to penicillin erythromycin (500mg twice a day) for five days should help. See a doctor if the symptoms do not start to improve in 48 hours.
Also get hold easily in hot moist climates so wear 100% cotton socks and underwear and shower frequently. An itch rash in the groin a flaking between the toes is likely to be a fungal infection. This needs treatment with an antifungal cream such as Canesten (clotrimazole); if this is not available try Whitfield’s ointment (compound enzoic acid ointment) or crystal violet (although this will turn you purple!).
A fine pimply rash on the torso is likely to be heat rash; cool showers dabbing (not rubbing) dry, and talc will help; if it is bad you may need to check into an air-conditioned hotel room for a while. Showing down to a relaxed schedule wearing only loose, baggy 100% cotton clothes and sleeping naked under a reduce the problem.
The incidence of skin cancer is rocketing as Caucasians are travelling more and spending more time in the sun. Keep out of the sun during the middle of the day and, if you must expose yourself, build up gradually from 20 minutes per day. Be especially careful of sun reflected off water and wear a T-shirt and loot of water proof SPF 15 sun cream when swimming and Bermuda shorts to protect the back of your thighs when snorkeling. Sun exposure ages the skin and causes premature wrinkles; cover up with long loose clothes and wear a hat when you can.
This is a particular nasty disease as it can kill within hours of the first symptoms appearing. The telltale symptoms are a combination of a blinding headache (light sensitivity), a blotchy rash and a high fever. Immunisation with the newer tetravalent vaccine ACWY protects against the most serious bacterial form of meningitis and is usually recommended for longer-stay trips to Rwanda or if you are working closely with the local population – in particular with children. A single injection gives good protection for three years. Other forms of meningitis exists outbreaks. If you show symptoms go immediately to a doctor.
Travel is a time when we may enjoy sexual adventures, especially when alcohol reduces inhibitions. Remember the risk of sexually transmitted infection is high, whether you sleep with fellow travellers or with locals. About 40% of HIV infections in British heterosexual are acquired abroad and AIDS is a serious problem in Rwanda. Use condoms or femidoms, preferably baring the British kite mark and ideally bought before travel. If you notice any genital ulcers and discharge get treatment promptly.
So far this has never occurred in Rwanda, but it has claimed some lives in Uganda the neighbouring country to Rwanda. It is a rare, but deadly, highly contagious, virally induced disease which causes haemorrhagic fever. In the unlikely event of an outbreak, protective measures will be taken and you should follow whatever local advice is given. Hard to come by – which is a reason why pre-exposure vaccination should be encouraged in travellers who are planning to visit more remote areas. Tell the doctor if you have had pre-exposure vaccine as this will change the treatment you receive. Remember that if you do contact rabies, mortality is 100% and death from rabies is probably one of the worst ways to go!
Rabies can be carried by all mammals and is passed on to man through a bite, scratch or a lick of an open wound. You must always assume any animals is rabid (unless personally known to you). The closer the bite is to the face the shorter the incubation time of the disease, but it is always wise to get medical help as soon as possible. In the interim, scrub the wound with soap and bottle/boiled water, then pour on a strong iodine or alcohol solution. This helps stop the rabies virus entering the body and will guard against wound infections including tetanus. If you intend to have contact with animals and /or are likely to be more than 24 hours away from medical help, then pre-exposure vaccination is advised. Ideally three doses should be taken over a minimum of three weeks. Contrary to popular belief these vaccinations are relatively painless! If you are exposed as described, then treatment should be given as soon as possible, but it is never too late to seek help as the incubation period for rabies can be very log.
Those who have not been immunised will need a full course of injections together with rabies immunoglobulin (RIG), but this product is expensive (around US$800)
Snake rarely attack unless provoked and bites to travellers are unusual. You are less likely to get bitten if you wear stout shoes and long trousers when in the bush. Most snakes are harmless and even venomous species will only dispense venom in about half of their bites. If bitten, then you are unlikely to have received verom; keeping this fact in mind may help you to stay calm. Many so-called first-aid techniques do more harm than good: cutting into the wound is harmful; tourniquets are dangerous; suction and electrical inactivation devices do not work. The only treatment is antivenom. In case of a bit which you fear may have been form a venomous snake:
Try to keep calm – it is likely that no venom has been dispensed.
Prevent movement of the bitten limb by applying splint.
Keep the bitten limb BELOW heart height to slow the spread of any venom.
If you have a crepe bandage, bind up as much of the bitten limb as you can, but release the bandage every half hour.
Evacuate to a hospital which has antivenom.
And remember this:
NEVER give aspirin; you may offer paracetamol, which is safe
NEVER cut or suck the wound
DO NOT apply ice packs
DO NOT apply potassium permanganate.
If the offending snake can be captured without risk of someone else being bitten, take it to show to the doctor – but beware, since even decapitated head is able to dispense venom in a reflex bite.