The Ministry of Environment and Tourism (MET) is the government department responsible for all the national parks. It is generally efficient, if sometimes apparently over-zealous about its bureaucracy. Its system insists that advance bookings for accommodation are made through the Windhoek office.
You can, theoretically, reserve accommodation by post or fax. However, you must pay for it in advance. From overseas this can require a telex transfer of money. To start this process, write to the Director of Tourism, RESERVATIONS, Private Bag 13267, Windhoek; tel: 061 236975–8, 233845, 223903 or 224097; fax: 061 224900.
If you are booking less than 25 days ahead, then you must pay for everything in full. This system is most easily mastered by visiting the office in person in Windhoek. Alternatively book in advance through a tour operator that understands the system.
Entry permits for most parks are available at the gates, provided you're there before they close and there is space left. The exceptions are permits for the Naukluft, Terrace Bay and Torra Bay, which can only be obtained from Windhoek. Permits to drive through the Namib section of the Namib-Naukluft Park are available at most tourist offices.
During Namibia’s public holidays the towns shut down, though the national parks and other attractions just carry on regardless.
There is always great danger in writing about health and safety for the uninitiated visitor. It is all too easy to become paranoid about exotic diseases that you may catch, and all too easy to start distrusting everybody you meet as a potential thief – falling into an unfounded us-and-them attitude toward the people of the country you are visiting.
As a comparison, imagine an equivalent section in a guidebook to a Western country – there would be a list of possible diseases and advice on the risk of theft and mugging. Many Western cities are very dangerous, but with time we learn how to assess the risks, accepting almost subconsciously what we can and cannot do.
It is important to strike the right balance: to avoid being excessively cautious or too relaxed about your health and your safety. With experience, you will find the balance that best fits you and the country you are visiting.
BEFORE YOU GO
Visitors to Namibia should always take out a comprehensive medical insurance policy to cover them for emergencies, including the cost of evacuation to another country within the region. Such policies come with an emergency number (often on a reverse-charge/call collect basis). You would be wise to memorise this, or indelibly tattoo it in as many places as possible on your baggage.
Personal effects insurance is also a sensible precaution, but check the policy’s fine print before you leave home. Often, in even the best policies, you will find a limit per item, or per claim – which can be well below the cost of a replacement. If you need to list your valuables separately, then do so comprehensively. Check that receipts are not required for claims if you do not have them, also that the excess which you have to pay on a claim is reasonable.
Annual travel policies can be excellent value if you travel a lot, and some of the larger credit-card companies offer excellent policies. However, it can often be better to get your valuables named and insured for travel using your home contents insurance. These year-round policies will try harder to settle your claim fairly as they want your business in the long term.
Having a full set of immunisations takes time, normally at least six weeks, although some protection can be had by visiting your doctor as late as a few days before you travel. Ideally, see your doctor early on to establish an inoculation timetable.
No immunisations are required by law for entry into Namibia, unless you are coming from an area where yellow fever is endemic. In that case, a vaccination certificate may be required.
Preparations to ensure a healthy trip to Namibia require checks on your immunisation status: it is wise to be up-to-date on tetanus (10-yearly), polio (10-yearly) and diphtheria (10-yearly). Most travellers are best to have Hepatitis A immunisation with Havrix, which costs about £40 but protects for 10 years. Typhoid immunisation is rather ineffective; it needs boosting every three years unless you are over the age of 35 and have had four or more courses; such travellers do not need further immunisations. Immunisation against cholera is no longer required anywhere in Africa.
Vaccination against rabies is unnecessary for most visitors, but would be wise for those who travel for extended periods, or stay in rural areas.
Note that getting vaccinations at these specialist centres can be more costly than using your GP, but often their specialists will be more up-to-date on the latest advice.
British Airways Travel Clinics There are 32 throughout the country. Call 01276 685040 to find your nearest. Apart from providing inoculations and malaria prophylaxis, they sell a variety of health-related travel goods.
MASTA (Medical Advisory Service for Travellers Abroad) working with the London School of Hygiene and Tropical Medicine (Keppel Street, London WC1 7HT) has a touch-tone advice line (0891 224 100). It is a premium line number, charged at 50p per minute. You can get information about your particular trip, and be sent further written advice. There is no clinic here.
Hospital for Tropical Diseases 4 St Pancras Way, London NW1 0PE. This also has a touch-tone advice line, with information prepared by the Malaria Reference Laboratory; tel: 0891 600350.
Trailfinders Travel Clinic 194 Kensington High St, London W8 7RG; tel: 0171 938 3999. This centre has a doctor on site and most vaccinations are available immediately.
Nomad Traveller’s Store and Medical Centre 3–4 Wellington Terrace, Turnpike Lane, London N8 0PX; tel: 0181 889 7014. This private pharmacy, specialising in travel medicine, is linked to the next-door centre selling travel equipment.
Tropical Medecin Bureau This Irish-run organisation has a useful website specific to tropical destinations: www.tmb.ie
Centers for Disease Control This Atlanta-based organisation is the central source of travel health information in North America, with a touch-tone phone line and fax service. Traveller’s Hot Line: 404 332 4559. Each summer they publish the invaluable Health Information for International Travel which is available from the Center for Prevention Services, Division of Quarantine, Atlanta, GA 30333.
IAMAT (International Association for Medical Assistance to Travellers) 736 Center St, Lewiston, NY 14092, USA. Tel: 716 754 4883.
Also at Gotthardstrasse 17, 6300 Zug, Switzerland.
A non-profit organisation which provides health information and lists English-speaking doctors abroad.
TMVC has 20 clinics in Australia, New Zealand and Thailand. For the nearest clinic, phone 1300 658844, or try their website www.tmvc.com.au
Malaria is the most dangerous disease in Africa, and the greatest risk to the traveller. It occurs in northern, and occasionally central, Namibia, so it is essential that you take all possible precautions against it.
Prophylaxis regimes aim to infuse your bloodstream with drugs that inhibit and kill the malaria parasites which are injected into you by a biting mosquito. This is why you must start to take the drugs before you arrive in a malarial area – so that they are established in your bloodstream from day one. Unfortunately, the malaria parasites continually adapt to the drugs used to combat them, so the recommended regimes must adapt and change in order to remain effective. None is 100% effective, and all require time to kill the parasites – so keeping up the prophylaxis regime for some weeks after you leave the infected area is usually recommended.
It is vital that you seek current advice on the best antimalarials to take. If mefloquine (Lariam) is suggested, start this two weeks before departure to check that it suits you; stop it immediately if it seems to cause vivid and unpleasant dreams, mood swings or other changes in the way you feel. Anyone who is pregnant, has been treated for psychiatric problems, is epileptic, has suffered fits in the past, or who has a close blood relative who is epileptic should avoid mefloquine. The usual alternative is chloroquine (Nivaquine) weekly plus proguanil (Paludrine) daily.
Prophylaxis does not stop you catching malaria, however it significantly reduces your chances of fully developing the disease and will lessen its severity. Falciparum (cerebral) malaria is the most common in Africa, and usually fatal if untreated, so it is worth your while trying to avoid it.
It is unwise to travel in malarious parts of Africa whilst pregnant or with young children: the risk of malaria in many areas is considerable and such travellers are likely to succumb rapidly.
Because the strains of malaria, and the drugs used to combat them, change frequently, it is important to get the latest advice before you travel. Normally it is better to obtain this from a specialist malaria laboratory than from your local doctor, who may not be up-to-date with the latest drugs and developments. In the UK, call the recorded message at the Malaria Reference Laboratory in London (tel: 0891 600350). In the USA call the Center for Disease Control in Atlanta, Georgia (tel: 404 332 4559).
Pharmacies in the main towns in Namibia generally have very good supplies of medicines, but away from these you will find very little. If you’re venturing deep into the wilds, then you should take with you anything that you expect to need. If you are on an organised trip, an overlanding truck, or staying at hotels, lodges or safari camps, then you will not need much, as these establishments normally have comprehensive emergency kits. In that case, just a small personal medical kit might include:
· Antihistamine tablets
· Aspirins or paracetamol
· Condoms and contraceptive pills
· Lip-salve (ideally containing a sunscreen)
· Malaria prophylaxis
· Insect repellent
· Micropore tape (for closing small cuts – and invaluable for blisters)
· Moisturising cream
· Sticking plaster (a roll is more versatile than pre-shaped plasters)
However, if you are likely to end up in very remote situations, then you should also consider taking the following:
· Burn dressings (burns are a common problem for campers)
· Strong painkiller (codeine phosphate – also use for bad diarrhoea)
· Tweezers (perhaps those on a Swiss army knife)
· Water purification equipment (2% tincture of iodine and dropper is ideal)
· Several different malaria treatment courses and broad-spectrum antibiotics – plus a good medical manual (see Further Reading).
If you wear glasses, bring a spare pair. Similarly those who wear contact lenses should bring spare ones, also a pair of glasses in case the dust proves too much for the lenses. If you take regular medication (including contraceptive pills) then bring a large supply with you – much easier than hunting for your usual brand in Namibia. Equally, it’s worth having a dental check-up before you go, as you could be several painful days from the nearest dentist.
Hospitals, dentists and pharmacies
Should you need one, the main hospitals are good and will treat you first and ask for money later. However, with comprehensive medical insurance as part of your travel cover, it is probably better go to one of the private clinics. The main ones are in Windhoek and Otjiwarongo, and these are capable of serious surgery and a good quality of care. Outside of these, there are private medical facilities in Karibib, Swakopmund, Tsumeb and Walvis Bay.
Pharmacies in the main towns stock a good range of medicine, though often not in familiar brands. Bring with you a repeat prescription for anything you may lose or run out of.
Namibia is probably the healthiest country in sub-Saharan Africa for visitors. It has a generally low population density and a very dry climate, which means there are comparatively few problems likely to affect visitors. The risks are further minimised if you are staying in good hotels, lodges, camps and guest farms, where standards of hygiene are generally at least as good as you will find at home.
The major dangers in Namibia are car accidents caused by driving too fast on gravel roads, and sunburn. Both can also be very serious, yet both are within the power of the visitor to avoid.
The following is general advice, applicable to travelling anywhere, including Namibia:
Food and storage
Throughout the world, most health problems encountered by travellers are contracted by eating contaminated food or drinking unclean water. If you are staying in safari camps or lodges, or eating in restaurants, then you are unlikely to have problems in Namibia.
However, if you are backpacking and cooking for yourself, or relying on local food, then you need to take more care. Tins, packets, and fresh green vegetables (when you can find them) are least likely to cause problems – provided that clean water has been used in preparing the meal. In Namibia’s hot climate, keeping meat or animal products unrefrigerated for more than a few hours is asking for trouble.
Water and purification
Tap water in Namibia’s major towns and borehole water used in many more remote locations is perfectly safe to drink. However, even the mildest of the local microbes may cause slight upset stomachs for an overseas visitor. Two-litre bottles of mineral water are available from most supermarkets; these are perfect if you’re in a car.
If you need to purify water for yourself in the bush, then first filter out any suspended solids, perhaps by passing the water through a piece of closely woven cloth or something similar. Then bring it to the boil, or sterilise it chemically. Boiling is much more effective, provided that you have the fuel available.
Tablets sold for purification are based on either chlorine, iodine or silver, and normally adequate. Just follow the manufacturer’s instructions carefully. Iodine is the most effective, especially against the resilient amoebic cysts which cause amoebic dysentery and other prolonged forms of diarrhoea.
A cheaper alternative to tablets sold over the counter is to travel with a small bottle of medical-quality tincture of iodine (2% solution) and an eye dropper. Add four drops to one litre of water, shake well, and leave to stand for ten minutes. If the water is very cloudy (even after filtering) or very cold, then either double the iodine dose, or leave to stand for twice as long.
This tincture of iodine can also be used as a general external antiseptic, but it will stain things deep brown if spilt – so seal and pack its container exceedingly well.
Heat and sun
Heat stroke, heat exhaustion and sunburn are often problems for travellers to Africa, despite being easy to prevent. To avoid them, you need to remember that your body is under stress and make allowances for it. First, take things gently; you are on holiday, after all. Next, keep your fluid and salt levels high: lots of water and soft drinks, but go easy on the caffeine and alcohol. Thirdly, dress to keep cool with loose-fitting, thin garments – preferably of cotton, linen or silk. Finally, beware of the sun. Hats and long-sleeved shirts are essential. If you must expose your skin to the sun, then use sun blocks and high factor sun screens (the sun is so strong that you will still get a tan).
Avoiding insect bites
The most dangerous biting insects in Africa are mosquitoes, because they can transmit malaria, yellow fever, and a host of other diseases. Research has shown that using a mosquito net over your bed, and covering up exposed skin (by wearing long-sleeved shirts, and tucking trousers into socks) in the evening, are the most effective steps towards preventing bites. Bed-net treatment kits are available from travel clinics; these prevent mosquitoes biting through a net if you roll against it in your sleep, and also make old and holy nets protective. Mosquito coils and chemical insect repellents will help, and sleeping in a stream of moving air, such as under a fan, or in an air conditioned room, will help to reduce your chances of being bitten.
DEET (diethyltoluamide) is the active ingredient in almost all repellents, so the greater the percentage of DEET, the stronger the effect. However, DEET is a strong chemical. Just 30% is regarded as an effective, non-toxic concentration. It will dissolve some plastics and synthetic materials, and may irritate sensitive skin. Because of this, many people use concentrated DEET to impregnate materials, rather than applying it to themselves. Mosquito nets, socks, and even cravats can be impregnated and used to deter insects from biting. Eating large quantities of garlic, or cream of tartar, or taking yeast tablets, are said to deter some biting insects, although the evidence is anecdotal – and the garlic may affect your social life.
Snakes, spiders and scorpions...
Encounters with aggressive snakes, angry spiders or vindictive scorpions are more common in horror films than in Africa. Most snakes will flee at the mere vibrations of a human footstep whilst spiders are far more interested in flies than people. You will have to seek out scorpions if you wish to see one. If you are careful about where you place your hands and feet, especially after dark, then there should be no problems. You are less likely to get bitten or stung if you wear stout shoes and long trousers. Simple precautions include not putting on boots without shaking them empty first, and always checking the back of your backpack before putting it on.
Snakes do bite occasionally, and you ought to know the standard first-aid treatment. First, and most importantly, don’t panic. Most snakes are harmless and even venomous species will only dispense venom in about half of their bites. If bitten, you are unlikely to have received venom; keeping this fact in mind may help you to stay calm.
Even in the worst of these cases, the victim has hours or days to get to help, and not a matter of minutes. He/she should be kept calm, with no exertions to pump venom around the blood system, whilst being taken rapidly to the nearest medical help. The area of the bite should be washed to remove any venom from the skin, and the bitten limb should be immobilised. Paracetamol may be used as a painkiller, but never use aspirin because it may cause internal bleeding.
Most first-aid techniques do more harm than good; cutting into the wound is harmful and tourniquets are dangerous; suction and electrical inactivation devices do not work; the only treatment is antivenom. In case of a bite which you fear may be both serious and venomous then:
· Try to keep calm. It is likely that no venom has been dispensed
· If you have a crepe bandage, firmly bind up as much of the bitten limb as you can. Release the bandage for a few minutes every half-hour
· Keep the bitten limb below heart height to slow spread of any venom
· Evacuate the victim to a hospital that has antivenom
· Never give aspirin. You may offer paracetamol, which is safe
· Do not apply ice packs
· Do not apply potassium permanganate
If the offending snake can be captured without any risk of someone else being bitten, take it to show the doctor. But beware, since even a decapitated head is able to dispense venom in a reflex bite.
When deep in the bush, heading for the nearest large farm or camp may be quicker than going to a town: it may have a supply of antivenom, or facilities to radio for help by plane.
DISEASES AND WHEN TO SEE A DOCTOR
There are almost as many names for this as there are travellers’ tales on the subject. Firstly, do resist the temptation to reach for the medical kit as soon as your stomach turns a little fluid. Most cases of travellers’ diarrhoea will resolve themselves within 24–48 hours with no treatment at all. To speed up this process of acclimatisation, eat well but simply: avoid fats in favour of starches, and keep your fluid intake high. Bananas and papaya fruit are often claimed to be helpful. If you urgently need to stop the symptoms, for a long journey for example, then Lomotil, Imodium or another of the commercial anti-diarrhoea preparations will do the trick. They stop the symptoms, by paralysing the bowel, but will not cure the problem. (If you do decide to take these, they are best taken in conjunction with an antibiotic like ciprofloxacin – 500mg twice a day for three days.)
When severe diarrhoea gets continually worse, or the stools contain blood, pus or slime, or it lasts for more than three or four days, you must seek medical advice. There are as many possible treatments as there are causes, and a proper diagnosis involves microscopic analysis of a stool sample, so go straight to your nearest hospital. The most important thing, especially in Namibia’s climate, is to keep your fluid intake up.
The body’s absorption of fluids is assisted by adding small amounts of dissolved sugars, salts and minerals to the water. Sachets of oral rehydration salts give the perfect biochemical mix you need to replace what is pouring out of your bottom but they do not taste so nice. Any dilute mixture of sugar and salt in water will do you good so, if you like Coke or orange squash, drink that with a three-finger pinch of salt added to each glass. The ideal ratio is eight level teaspoons of sugar and one level teaspoon of salt dissolved in one litre of water. Palm syrup or honey make good substitutes for sugar, and including fresh citrus juice will not only improve the taste of these solutions, but also add valuable potassium.
Drink two large glasses after every bowel action, and more if you are thirsty. If you are not eating you need to drink three litres a day plus whatever you are sweating and the equivalent of what’s going into the toilet. If you feel like eating, take a bland diet; heavy greasy foods will give you cramps.
If you are likely to be more than a few days from qualified medical help, then come equipped with a good health manual and the selection of antibiotics which it recommends. Bugs, Bites & Bowels by Dr Jane Wilson Howarth (see Further Reading is excellent for this purpose.