South Africa is a modern country, but Africa still poses certain health risks even in the most developed areas.
These days everyone is sun sensitive (and sun can be a big issue in South Africa), so pack plenty of your favorite SPF product from home, and use it generously. And drink plenty of water to avoid dehydration.
The drinking water in South Africa is treated and, except in rural areas, is absolutely safe to drink. Many people filter it, though, to get rid of the chlorine, as that aseptic status does not come free. You can eat fresh fruits and salads and have ice in your drinks.
It is always wise for travelers to have medical insurance for travel that will also help with emergency evacuation (most safari operators require emergency evacuation coverage and may ask you to pay for it along with your tour payments). If you don't want general travel insurance, many companies offer medical-only policies.
Although there are some nonmalarial safari regions in South Africa, the most serious health problem facing travelers is malaria, which occurs in the prime South African game-viewing areas of Mpumalanga, Limpopo Province, and northern KwaZulu-Natal and in the countries farther north. The risk is medium at the height of the summer and very low in winter. All travelers heading into malaria-endemic regions should consult a health-care professional at least one month before departure for advice. Unfortunately, the malarial organism Plasmodium sp. seems to be able to develop a hardy resistance to new prophylactic drugs pretty quickly, so even if you are taking the newest miracle drug, the best prevention is to avoid being bitten by mosquitoes in the first place. After sunset wear light-color, loose, long-sleeve shirts, long pants, and shoes and socks, and apply mosquito repellent generously. Always sleep in a mosquito-proof room or tent, and if possible, keep a fan going in your room. If you are pregnant or trying to conceive, avoid malaria areas entirely.
Generally speaking, the risk is much lower in the dry season (May–October) and peaks immediately after the first rains, which should be in November, but El Niño has made that a lot less predictable.
Many lakes and streams, particularly east of the watershed divide (i.e., in rivers flowing toward the Indian Ocean), are infected with bilharzia (schistosomiasis), a parasite carried by a small freshwater snail. The microscopic fluke enters through the skin of swimmers or waders, attaches itself to the intestines or bladder, and lays eggs. Avoid wading in still waters or in areas close to reeds. If you have been wading or swimming in doubtful water, dry yourself off vigorously with a towel immediately upon exiting the water, as this may help to dislodge any flukes before they can burrow into your skin. Fast-moving water is considered safe. If you have been exposed, pop into a pharmacy and purchase a course of treatment and take it to be safe. If your trip is ending shortly after your exposure, take the medicine home and have a checkup once you get there. Bilharzia is easily diagnosed, and it's also easily treated in the early stages.
Be aware of the dangers of becoming infected with HIV (which is a big problem in Africa) or hepatitis. Make sure you use a condom during a sexual encounter; they're sold in supermarkets, pharmacies, and most convenience stores. If you feel there's a possibility you've exposed yourself to the virus, you can get antiretroviral treatment (post-exposure prophylaxis or PEP) from private hospitals, but you must do so within 48 hours of exposure.
Rabies is extremely rare in domesticated animals in South Africa but is more common in wild animals—one more reason you should not feed or tease them. If you are bitten by a monkey or other wild animal, seek medical attention immediately. The chance of contracting rabies is extremely small, but the consequences are so horrible that you really don't want to gamble on this one.
Insects and Other Pests
In summer ticks may be a problem, even in open areas close to cities. If you intend to walk or hike anywhere, use a suitable insect repellent. After your walk, examine your body and clothes for ticks, looking carefully for pepper ticks, which are tiny but may cause tick-bite fever. If you find a tick has bitten you, do not pull it off. If you do, you may pull the body off, and the head will remain embedded in your skin, causing an infection. Rather, smother the area with petroleum jelly, and the tick will eventually let go, as it will be unable to breathe; you can then scrape it off with a fingernail. If you are bitten, keep an eye on the bite. If the tick was infected, the bite will swell, itch, and develop a black necrotic center. This is a sure sign that you will develop tick-bite fever, which usually hits after about 8 to 12 days. Symptoms may be mild or severe, depending on the patient. This disease is not usually life-threatening in healthy adults, but it's horribly unpleasant. Most people who are bitten by ticks suffer no more than an itchy bump, so don't panic.
Also, obviously, keep a lookout for mosquitoes. Even in nonmalarial areas they are extremely irritating. When walking anywhere in the bush, keep a lookout for snakes. Most will slither away when they feel you coming, but just keep your eyes peeled. If you see one, give it a wide berth and you should be fine. Snakes really bite only when they are taken by surprise, so you don't want to step on a napping adder. If on safari or camping, check your boots and shake your clothes out for spiders and other crawlies before getting dressed.
You can buy over-the-counter medication in pharmacies and supermarkets, and you will find the more general remedies in Clicks, a chain store selling beauty products, some OTC medication, and housewares. Your body may not react the same way to the South African version of a product, even something as simple as a headache tablet, so bring your own supply for your trip and rely on pharmacies just for emergency medication.
Shots and Medications
South Africa does not require any inoculations for entry. Travelers entering South Africa within six days of leaving a country infected with yellow fever require a yellow-fever vaccination certificate. The South African travel clinics and the U.S. National Centers for Disease Control and Prevention (CDC) recommend that you be vaccinated against hepatitis A and B if you intend to travel to more isolated areas. Cholera injections are widely regarded as useless, so don't let anyone talk you into having one, but the newer oral vaccine seems to be more effective.
If you are coming to South Africa for a safari, chances are you are heading to a malarial game reserve. Only a handful of game reserves are nonmalarial. Millions of travelers take oral prophylactic drugs before, during, and after their safaris. It's up to you to weigh the risks and benefits of the type of antimalarial drug you choose to take. If you're pregnant or traveling with small children, consider a nonmalarial region for your safari.
The CDC provides up-to-date information on health risks and recommended vaccinations and medications for travelers to southern Africa. In most of South Africa you need not worry about any of these, but if you plan to visit remote regions, check with the CDC's traveler's health line. For up-to-date, local expertise, contact Netcare Travel Clinics.
Medical Care in South Africa
South African doctors are generally excellent. The equipment and training in private clinics rivals the best in the world, but public hospitals tend to suffer from overcrowding and underfunding. So if you need to seek medical treatment, ask your hotel or safari operator to get you to a private hospital. In South Africa, foreigners are expected to pay in full for any medical services, so check your existing health plan to see whether you're covered while abroad, and supplement it if necessary.
On returning home, if you experience any unusual symptoms, including fever, painful eyes, backache, diarrhea, severe headache, general lassitude, or blood in urine or stool, be sure to tell your doctor where you have been. These symptoms may indicate malaria, tick-bite fever, bilharzia, or—if you've been traveling north of South Africa's borders—some other tropical malady.
National Centers for Disease Control and Prevention. 800/232–4636; www.cdc.gov/travel.
World Health Organization. www.who.int.
International Medical Group. 866/368–3724; www.imglobal.com.
International SOS. 011/541–1000; 011/541–1300; 800/523–8662; www.internationalsos.co.za.
Wallach & Company. 800/237–6615; www.wallach.com.