Amazingly, many people find the hygienic conditions very worrying when they think of a trip to Africa. "Was it not disgusting for you?" I get to hear all too often.
I do not know if it is because of my job as a nurse or something else, but it really takes a lot for me to be disgusted with something. I dare to say that my tolerance threshold is a lot higher than that of most of the people I meet. This can have both advantages and disadvantages.
Excessive hygiene, as we all know, is not good either. I usually acted according to this principle. I allowed myself food from the street, ice cubes, and even water from the tap or the well, because I thought: If the locals can handle it, it certainly will not hurt me either. But that is exactly what made me feel ill again and again. It expressed itself over and over with stomach and intestine discomforts. So I have to admit that I should have been more careful, especially regarding water. But still it was half as bad, after all, since most aches and pains can be treated.
Nevertheless, one's own health is our highest good, and we should by no means risk it carelessly.
In the following, I would like to introduce you to four major diseases, since I have met many people – locals as well as travelers – who have been affected by these:
Traveller’s diarrhea is almost certainly one of the most common diseases a traveler suffers from. The reason for this is usually lack of hygiene, unfamiliar food, dirty drinking water, or raw food (fruit, salad, meat, fish). Due to our high standards of hygiene in Europe, we are not used to the germs in developing countries, which often pollute the water and food. On a long-term journey, almost everyone will sooner or later be affected by stomach or intestinal problems. Mostly, however, the symptoms are mild and are not dangerous. Diarrhea usually disappears by itself within one to two days. It is only important to supply enough fluid to the body. Particularly suitable for this are electrolyte-containing drinks, which are available in pharmacies. With strong abdominal cramps, sometimes painkillers are required. However, if the diarrhea persists, seek medical advice, as antibiotics or antiparasitic agents may be necessary for treatment.
Malaria is one of the most important infectious diseases in the world. There are different types of malaria, which also lead to symptoms that differ in strength. Most dangerous is the malaria tropica. This disease is transmitted by mosquitoes, which are active at dusk and night. Therefore, the main focus in malaria prophylaxis should be to protect against stings. This extremely reduces the risk of malaria.
In high-risk areas, it is often advised to take a chemo-prophylaxis. However, this should be discussed with a tropical medicine doctor. When fever occurs, the possibility of malaria should always be considered, even up to four months after the end of your journey, as the period of infection can often be very long. In most African countries, you can get tested for malaria at virtually every doctor in the risk areas.
On my journey through Africa, I met a lot of people who had been infected with malaria. While some of them had only a bit of fever for a few days, others had to suffer from severe symptoms for weeks.
Bilharzia is a worm disease caused by freshwater larvae. Snails are intermediate hosts for them. The free-floating larvae penetrate the skin of humans. They then migrate through the blood vessels into the liver and then spread mainly in the bladder, the intestine, the liver, the lungs, and the brain. The first symptoms include itching at the point of entry, often accompanied by a rash. The larvae can also penetrate into the skin unnoticed. After a few weeks, symptoms such as blood in the urine and / or flu-like symptoms often appear. If the intestine is affected, diarrhea occurs.
Although there are drugs for the treatment of schistosomiasis, unfortunately, the disease is often discovered too late, when it has already formed late effects. It is therefore important to find out in advance, which areas may be affected of schistosomiasis. Most of the time these are standing waters. Amongst others, Lake Victoria is a risk area.
Therefore, avoid swimming there, even if the locals do it or if they claim that the waters are free of bilharzia. Inform yourself from safe sources. Incidentally, the disease can also be transmitted via drinking water.
Sand fleas may be unknown to many. I also did not know about these before my trip to Africa. They are, as the name implies, a species of flea that parasitizes mammals and humans as well. The feet are almost always affected most from this.
The flea jumps on victims passing by and then tries to drill into the skin to the next blood vessel. The posterior part of the parasite remains above the skin surface and is often seen as a small black dot. Now the sand flea begins to suck blood and swells up to twelve millimeters. If by chance, a male passes by, the female is fertilized, and this then lays several thousand eggs. The eggs fall through the exposed opening to the ground and develop into larvae within a few days.
Another three weeks later, the development of the adult sand flea has been completed, and new victims are being sought. Sand flea disease is a typical poverty disease that is extremely painful. It occurs mainly in rural areas. Affected are people who walk barefoot or in open footwear.
When I visited a very poor section of the population in Uganda, the Batwa, almost all children had tons of sand fleas in their feet. That looked terrible, as it usually came to pronounced swelling and bad infections, and the children could not even walk properly. I also saw the kids trying to cut the sand fleas out of each other's skin with a dirty little knife. Due to poor hygiene, it leads to even worse infections and diseases such as HIV being transmitted.
Unfortunately, you do not know as a traveler, in which areas the sand fleas occur. Closed shoes offer the best protection. The locals always warned me, especially in Uganda, to wear only closed shoes, when I was in a vulnerable area. Incidentally, they call the sand fleas "jiggers" there.
Some tips on hygiene and health
Whether you buy dishes on the street or not, you have to decide for yourself. Many travelers avoid this because there are always cases of food poisoning.
I personally never had any bad experiences with it. The good thing about eating on the street is that you can watch while your food is prepared. When you see how the lady in front of you prepares the empanadas fresh and fried in oil, you can eat with confidence.
However, you should not buy anything from the girl who walks the streets, selling her ready-made chicken wings on which the flies are already buzzing. The same is true for restaurants – it usually takes just a quick glance, and you know if the hygiene conditions are more or less okay. It is not in your hands a one hundred percent of times, anyway. But usually it is enough if you listen to your common sense.
At the beginning of your journey, the body first has to switch to the unfamiliar food, so initially, you should be a little more careful.