Cholera

Cholera is caused by a bacteria and spread via contaminated drinking water. You should avoid tap water and unpeeled or uncooked fruits and vegetables, although tap water, especially in Namibia, is sometimes safe. The main symptom is profuse watery diarrhoea, which causes debilitation if fluids are not replaced quickly. An oral cholera vaccine is available in the USA, but it is not particularly effective. Most cases of cholera can be avoided by close attention to drinking water and by avoiding potentially contaminated food. Treatment is by fluid replacement (orally or via a drip), but sometimes antibiotics are needed. Self-treatment is not advised.

Dengue Fever

Dengue fever, spread through the bite of the mosquito, causes a feverish illness with headaches and muscle pains similar to those experienced with a bad, prolonged attack of influenza. There might be a rash. Mosquito bites should be avoided whenever possible. Self-treatment: paracetamol and rest.

Filariasis

Filariasis is caused by tiny worms migrating in the lymphatic system, and is spread by the bite of an infected mosquito. Symptoms include localised itching and swelling of the legs and/or genitalia. Treatment is available. Self-treatment: none.

Hepatitis A

Hepatitis A, which occurs in both countries, is spread through contaminated food (particularly shellfish) and water. It causes jaundice and, although it is rarely fatal, it can cause prolonged lethargy and delayed recovery. If you’ve had hepatitis A, you shouldn’t drink alcohol for up to six months afterwards, but once you’ve recovered there won’t be any long-term problems. The first symptoms include dark urine and a yellow colour to the whites of the eyes. Sometimes a fever and abdominal pain might be present. Hepatitis A vaccine (Avaxim, VAQTA, Havrix) is given as an injection: a single dose will give protection for up to a year, and a booster after a year gives 10-year protection. Hepatitis A and typhoid vaccines can also be given as a single-dose vaccine, known as hepatyrix or viatim. Self-treatment: none.

Hepatitis B

Hepatitis B, found in both countries, is spread through infected blood, contaminated needles and sexual intercourse. It can also be spread from an infected mother to the baby during childbirth. It affects the liver, causing jaundice and occasionally liver failure. Most people recover completely, but some people might be chronic carriers of the virus, which could lead eventually to cirrhosis or liver cancer. Those visiting high-risk areas for long periods or those with increased social or occupational risk should be immunised. Many countries now routinely give hepatitis B as part of the childhood vaccination program. It is given singly or can be given at the same time as hepatitis A (hepatyrix). A course will give protection for at least five years. It can be given over four weeks or six months. Self-treatment: none.

HIV & AIDS

HIV, the virus that causes AIDS, is an enormous problem in Botswana and Namibia, with a devastating impact on local health systems and community structures. Botswana in particular has one of the highest rates of infection on the continent, with an HIV-positive incidence of 25.16%, second only to nearby Swaziland. The rate is more than 15.97% in Namibia. The virus is spread through infected blood and blood products, by sexual intercourse with an infected partner, and from an infected mother to her baby during childbirth and breastfeeding. It can be spread through ‘blood to blood’ contacts, such as with contaminated instruments during medical, dental, acupuncture and other body-piercing procedures, and through sharing used intravenous needles.

At present there is no cure, but medication that might keep the disease under control is available. In 2002 the Botswana government elected to make antiretroviral drugs available to all citizens free of charge, becoming the first country in the world to offer this treatment for free. Still, for people living in remote areas of the country access to such treatment is a problem, as is the continuing stigma attached to ‘owning up’ to having the infection. In Namibia, antiretroviral drugs are still largely unavailable, or too expensive for the majority of Namibians.

If you think you might have been infected with HIV, a blood test is necessary; a three-month gap after exposure and before testing is required to allow antibodies to appear in the blood. Self-treatment: none.

Malaria

Apart from road accidents, malaria is probably the only major health risk that you face while travelling in this area, and precautions should be taken. At the time of writing, the northern half of both Botswana and Namibia were considered areas of medium to high malaria risk. The disease is caused by a parasite in the bloodstream spread via the bite of the female Anopheles mosquito. There are several types of malaria; falciparum malaria is the most dangerous type and the predominant form in Botswana and Namibia. Infection rates vary with season and climate, so check out the situation before departure. Several different drugs are used to prevent malaria and new ones are in the pipeline. Up-to-date advice from a travel-health clinic is essential, as some medication is more suitable for some travellers than others (eg people with epilepsy should avoid mefloquine, and doxycycline should not be taken by pregnant women or children aged under 12).

The early stages of malaria include headaches, fevers, generalised aches and pains, and malaise, which could be mistaken for flu. Other symptoms can include abdominal pain, diarrhoea and a cough. Anyone who develops a fever in a malarial area should assume malarial infection until a blood test proves negative, even if you have been taking antimalarial medication. If not treated, the next stage could develop within 24 hours, particularly if falciparum malaria is the parasite: jaundice, then reduced consciousness and coma (also known as cerebral malaria) followed by death. Treatment in hospital is essential, and the death rate might still be as high as 10% even in the best intensive-care facilities.

Many travellers think that malaria is a mild illness, and that taking antimalarial drugs causes more illness through side effects than actually getting malaria. This is unfortunately not true. If you decide against antimalarial drugs, you must understand the risks, and be obsessive about avoiding mosquito bites. Use nets and insect repellent, and report any fever or flu-like symptoms to a doctor as soon as possible. Some people advocate homeopathic preparations against malaria, such as Demal200, but there is no evidence that this is effective, and many homeopaths do not recommend their use.

Malaria in pregnancy frequently results in miscarriage or premature labour, and the risks to both mother and foetus during pregnancy are considerable. Travel throughout the region when pregnant should be carefully considered. Adults who have survived multiple bouts of early childhood malaria will have developed immunity and usually only develop mild cases of malaria; most Western travellers have no immunity at all, thus the need for precautions. Even if you've recently had malaria you are still vulnerable to a serious infection, so don't think that you are immune.

Rabies

Rabies is spread by receiving bites or licks from an infected animal on broken skin. Few human cases are reported in Botswana and Namibia, with the risks highest in rural areas. It is always fatal once the clinical symptoms start (which might be up to several months after an infected bite), so postbite vaccination should be given as soon as possible. Postbite vaccination (whether or not you’ve been vaccinated before the bite) prevents the virus from spreading to the central nervous system. Animal handlers should be vaccinated, as should those travelling to remote areas where a reliable source of postbite vaccine is not available within 24 hours. Three preventive injections are needed over a month. If you have not been vaccinated, you’ll need a course of five injections starting 24 hours or as soon as possible after the injury. If you have been vaccinated, you’ll need fewer postbite injections, and have more time to seek medical help. Self-treatment: none.

Schistosomiasis (Bilharzia)

This disease is a risk in parts of Botswana and Namibia. It’s spread by flukes (minute worms) that are carried by a species of freshwater snail, which then sheds them into slow-moving or still water. The parasites penetrate human skin during swimming and then migrate to the bladder or bowel. They are excreted via stool or urine and could contaminate fresh water, where the cycle starts again. Swimming in suspect freshwater lakes or slow-running rivers should be avoided. Symptoms range from none, to transient fever and rash, and advanced cases might have blood in the stool or in the urine. A blood test can detect antibodies if you might have been exposed, and treatment is readily available. If not treated the infection can cause kidney failure or permanent bowel damage. It’s not possible for you to infect others. Self-treatment: none.

Tuberculosis (TB)

Tuberculosis is spread through close respiratory contact and occasionally through infected milk or milk products. BCG vaccination is recommended if you’ll be mixing closely with the local population, especially on long-term stays, although it gives only moderate protection against the disease. TB can be asymptomatic, only being picked up on a routine chest X-ray. Alternatively, it can cause a cough, weight loss or fever, sometimes months or even years after exposure. Self-treatment: none.

Typhoid

This is spread through food or water contaminated by infected human faeces. The first symptom is usually a fever or a pink rash on the abdomen. Sometimes septicaemia (blood poisoning) can occur. A typhoid vaccine (typhim Vi, typherix) will give protection for three years. In some countries, the oral vaccine Vivotif is also available. Antibiotics are usually given as treatment, and death is rare unless septicaemia occurs. Self-treatment: none.

Yellow Fever

Although not a problem within Botswana and Namibia at the time of writing, you’ll need to carry a certificate of vaccination if arriving from an infected country. For a list of countries with a high rate of infection, see the website of the World Health Organization (www.who.int/en/) or the Centers for Disease Control & Prevention (wwwnc.cdc.gov/travel).

Amoebic Dysentery

Contracted by eating contaminated food and water, amoebic dysentery causes blood and mucus in the faeces. It can be relatively mild and tends to come on gradually, but seek medical advice if you think you have the illness. It won’t clear up without treatment (which is with specific antibiotics).

Giardiasis

This, like amoebic dysentery, is also caused by ingesting contaminated food or water. The illness usually appears a week or more after you have been exposed to the offending parasite. Giardiasis might cause only a short-lived bout of typical traveller's diarrhoea, but it can also cause persistent diarrhoea. Ideally, seek medical advice if you suspect you have giardiasis, but if you are in a remote area you could start a course of antibiotics.

Heat Exhaustion

This condition occurs if heavy sweating and excessive fluid loss are followed by inadequate replacement of fluids and salt, and it's primarily a risk in hot climates when taking unaccustomed exercise before full acclimatisation. Symptoms include headaches, dizziness and tiredness. Dehydration is already happening by the time you feel thirsty – aim to drink sufficient water to produce pale, diluted urine. Self-treatment: fluid replacement with water and/or fruit juice, and cooling by cold water and fans. The treatment of the salt-loss component consists of consuming salty fluids (as in soup), and adding a little more table salt to foods than usual.

Heatstroke

Heat exhaustion is a precursor to the much more serious condition of heatstroke. In this case there is damage to the sweating mechanism, with an excessive rise in body temperature, irrational and hyperactive behaviour, and eventually loss of consciousness and death. Rapid cooling by spraying the body with water and fanning is ideal. Emergency fluid and electrolyte replacement by intravenous drip is usually also required.

Insect Bites & Stings

Mosquitoes might not always carry malaria or dengue fever, but they (and other insects) can cause irritation and infected bites. To avoid these, take the same precautions as you would for avoiding malaria. Use DEET-based insect repellents. Excellent clothing treatments are also available; mosquitos that land on treated clothing will die.

Bee and wasp stings cause real problems only to those who have a severe allergy to the stings (anaphylaxis). If you are one of these people, make sure to carry an EpiPen – an adrenaline (epinephrine) injection, especially when travelling in remote areas. This could save your life.

Scorpions are found in arid areas. They can cause a painful bite that is sometimes life-threatening. If bitten by a scorpion, seek immediate medical assistance. Medical treatment should be sought if collapse occurs.

Ticks are always a risk if away from urban areas. If you do get bitten, press down around the tick’s head with tweezers, grab the head and gently pull upwards. Avoid pulling the rear of the body as this may squeeze the tick’s gut contents through the attached mouthparts into the skin, increasing the risk of both infection and disease. Smearing chemicals on the tick will not make it let go and is not recommended.

Bedbugs are found in hostels and cheap hotels and lead to itchy, lumpy bites. Spraying the mattress with crawling-insect killer after changing bedding will get rid of them. Scabies are also found in cheap accommodation. These tiny mites live in the skin, often between the fingers, and they cause an intensely itchy rash. The itch is easily treated with malathion and permethrin lotion from a pharmacy; other members of the household also need treating to avoid spreading scabies, even if they do not show any symptoms.

Snake Bites

Basically, avoid getting bitten! Don’t walk barefoot, or stick your hand into holes or cracks. Boomslangs (venomous Southern African tree snakes) tend to hang out in trees, especially on overhanging limbs, so also exercise caution when walking in forests. However, about half of those bitten by venomous snakes are not actually injected with poison (envenomed). If bitten by a snake, do not panic. Immobilise the bitten limb with a splint (such as a stick) and apply a bandage over the site with firm pressure, similar to bandaging a sprain. Do not apply a tourniquet, or cut or suck the bite. Get medical help as soon as possible. It will help get you the correct antivenene if you can identify the snake (although antivenene has some potentially serious side effects and may not always be given); try to take note of the snake's appearance just in case.

Traditional Medicine

According to estimates, as many as 85% of residents of Botswana and Namibia rely in part, or wholly, on traditional medicine. Given the high costs and unavailability of Western medicine in many rural areas, traditional healers are the first contact for many when falling ill. The sangoma (traditional healer) and inyanga (herbalist) hold revered positions in many communities, and traditional medicinal products are widely available in local markets. Unfortunately, some traditional medicines are made from endangered or threatened species like aardvarks, cheetahs and leopards.