Provided that your inoculations are up to date, and you’re taking antimalarials if you visit malarial areas, Ethiopia is unlikely to afflict you with more than an upset stomach or two, and possibly sunburn. Prior to the trip, visit your family doctor or a travel clinic for advice, prescriptions and vaccinations: typically recommended jabs or boosters are for typhoid, tetanus, polio and hepatitis A. Those coming from a yellow fever “endemic zone” are required to show a vaccination certificate at immigration, and the jab is also recommended if you will be spending time in the far west, which falls into that zone. Rabies shots can be skipped unless you’ll be handling animals or travelling extensively by bicycle, but in the unlikely event you are bitten by any dog, monkey or other mammal, it is vital to get post-exposure treatment as soon as possible. It’s also wise to have a thorough dental check-up before leaving.
In the tropics, especially hotter lower-lying areas, take more care than usual over minor cuts and scrapes, which can easily become infected should you ignore them. Tropical conditions also favour fungal infections, which flourish perfectly well in groins, among toes, or under thick hair. To avoid them, shy away from using soap, or damp or dirty towels that are not your own. In bedrooms and bathrooms, it’s best to wear sandals or flip-flops, ideally your own, to protect yourself from any fungus on the floor. Fleas can carry diseases as well as being hell to cohabit with, so check the bedsheets in cheap hotels for tiny brown spots (fleas are messy eaters) and move on if you find any evidence.
Ethiopia lies just north of the equator, and even though much of the country comprises temperate highlands, the sun hangs near its zenith for much of the day. This makes sunburn a significant risk for any exposed horizontal skin, for instance shoulders, noses, tops of balding heads, even feet, so use a high-factor sunblock on exposed limbs and wear a hat. The intensity of the equatorial highland sun can also stoke heatstroke, a potentially dangerous condition where you stop sweating while still hot. More common but not dangerous are skin rashes.
If you swim in any of Ethiopia’s lakes or non-montane rivers, be alert to the possible risk of contracting bilharzia, a parasitic disease transmitted by freshwater snails. Although this is quite nasty, it can be tested for at specialist travel clinics up to a few weeks after exposure, and is easily treated.
Malaria is prevalent in most parts of East Africa. The commonest strain, Plasmodium falciparum, is transmitted by the bite of the female Anopheles mosquito, and can be fatal if untreated. The risk of infection is highest in low-lying moist climates, but the incidence is very low above 1500m and all but absent above the 2000m contour. This means that there is no significant risk of catching malaria in most of the highland destinations regularly visited by tourists – among them Addis Ababa, Gondar, Lalibela and the Bale and Simien mountains – and there is only a small risk, mainly in the rainy season, in the likes of Bahir Dar and Harar. The risk is far greater in the southern Rift Valley and South Omo.
If you will be visiting a malarial area, prevention is better than cure: start a course of prophylactics before leaving home (a doctor or travel clinic should be able to provide personalized recommendations based on where you are visiting), and take precautions against bites once you arrive. Anopheles mosquitoes like to bite in the evening and at night; you can minimize bites by sleeping under mosquito nets, and by burning mosquito coils, available locally. At dusk and at night, keep your limbs covered, and consider using insect repellent. Most contain diethyltoluamide (DEET), an oily substance that corrodes many artificial materials, including plastic. Natural alternatives based on pyrethrum flowers or citronella (lemongrass) are also effective.
Common symptoms of malaria include waves of flu-like fever, shivering, headaches, or joint pain. Some people also get diarrhoea. If you suspect malaria, get a blood test as quickly as possible. Local doctors will recommend treatment based on the strains most prevalent at the time. The symptoms can appear anything from a few days to several weeks after infection, so if you feel poorly after returning home, tell your doctor where you’ve been – malaria is treatable if properly diagnosed.
Water, food and stomach bugs
Many visitors to Ethiopia catch traveller’s diarrhoea, a catch-all term embracing all sorts of minor viruses and bugs caught from badly washed or spoiled food or contaminated water. Though unpleasant, it is best weathered rather than blasted with antibiotics (which don’t work on viruses anyway), and usually resolves itself after a couple of days. If you do have the runs, it is important to stay hydrated. A typical rehydration mix consists of four heaped teaspoons of sugar and half a teaspoon of salt in a litre of water; commercial rehydration remedies are much the same. Avoid coffee, strong fruit juice and alcohol.
On short trips it makes sense to remain cautious about eating foods that may make you ill, but on longer trips it’s best to “re-educate” your stomach. Tap water is generally suspect, and bottled water is widely available. More environmentally sound (avoiding the use of plastic bottles) is purifying water yourself: in the unlikely event that the water is cloudy, filter it first through fine muslin, then boil or add iodine tincture (four drops per litre), shake and wait twenty minutes. Chlorine tablets do the same but impart a vile taste.
Outbreaks of cholera (scary but actually easily treated) are rare, and tend to be limited to highly populated urban areas that lack adequate sanitation, occurring when the water supply is contaminated during periods of flooding. Also contracted through contaminated water, more frequently too, is giardiasis, which just makes you feel shitty while blessing you with horrendously smelly burps and farts. It normally clears up after three days: the definitive treatment, Metronidazole, is readily available at pharmacies in Ethiopia. Metronidazole can also be used to treat amoebic dysentery, which usually manifests as violent, foul-smelling diarrhoea with mucus or blood in the stool.
The likelihood of coming into contact with lions, elephants and other dangerous large mammals in Ethiopia is very small. The exception are the hippos that inhabit several lakes – you should never get between them and the water. More prevalent are domestic dogs, which are all over the place and might carry rabies. Snakes are mostly harmless, and to see one at all you’d need to search stealthily; walk heavily and most species obligingly disappear. In bushy or wooded areas, wear boots and long trousers to minimize the risk of bites. If someone is bitten, apply a tourniquet, but open it every fifteen minutes. Victims should be hospitalized as quickly as possible (even toxic bites are survivable if treated in time). Above all, don’t panic – shock can be just as fatal. Also, don’t try to suck out the poison like you see in films: that technique was discredited many moons ago.
Sexually transmitted diseases
HIV/AIDS and venereal diseases are widespread in Ethiopia, and the danger of catching the virus through sexual contact is very real. Follow the usual precautions regarding safer sex. There’s no special risk from medical treatment in the country, but if you want to play it safe, take your own needle and transfusion kit.
The quality of healthcare in Ethiopia is low by international standards. However, most towns have a few private clinics and laboratories that can deal with most routine diagnosis and treatment, particularly for common tropical ailments such as malaria or sanitation-related diseases. Pharmacies are also willing to diagnose and treat minor ailments, and can sell pretty much any medicine without a doctor’s prescription. If you are seriously ill, head to Addis Ababa and/or contact your embassy for advice. It is important to check that your travel insurance covers medical care, including emergency evacuation.
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