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. They should only be used as a last resort and never if you have bad abdominal cramps with the diarrhoea.
If the diarrhoea persists for more than two days, or the stools contain blood, pus or slime, or it lasts for more than three or four days and/or you have a fever, 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 Botswana's climate, is to keep your fluid intake up. If it is not possible to reach medical help quickly then take 500mg of ciprofloxacin repeating the dose six to twelve hours later if you still haven't reached help. If the diarrhoea is greasy and bulky and is accompanied by sulphurous (eggy) burps the likely cause is Giardia. This is best treated with tinidazole (four x 500mg in one dose repeated seven days later if symptoms persist).
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 necessary 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 is excellent for this purpose.
You can still catch malaria even if you are taking anti-malarial drugs. Classic symptoms include headaches, chills and sweating, abdominal pains, aching joints and fever – some or all of which may come in waves. It varies tremendously, but often starts like a bad case of flu. If anything like this happens, you should first suspect malaria and seek immediate medical help. A definite diagnosis of malaria is normally only possible by examining a blood sample under the microscope. It is best to get the problem properly diagnosed if possible, so don't treat yourself if you can easily reach a hospital first.
If (and only if) medical help is unavailable, then self-treatment is fairly safe, except for people who are pregnant or under 12 years of age. There are a number of treatments available that can be obtained before you leave. Currently the most likely to be prescribed are quinine and fansidar or Malarone. It is always best to ask a doctor at a travel clinic for the most up-to-date advice. In Botswana you should always be able to get experienced local advice to tell you which will be the most effective.
Quinine is very strong, but often proves to be an effective last defence against malaria. Include it in your medical kit, as occasionally rural clinics will have the expertise to treat you, but not the drugs. Quinine's side effects are disorientating and unpleasant (nausea and a constant buzzing in the ears), so administering this whilst on your own is not advisable.
Sexually transmitted diseases
AIDS is spread in exactly the same way in Africa as it is at home, through body secretions, blood, and blood products. The same goes for the dangerous Hepatitis B. Both can be spread through sex.
Remember that the risks of sexually transmitted disease are high, whether you sleep with fellow travellers or locals. About 40% of HIV infections in British people are acquired abroad. Use condoms or femidoms. If you notice any genital ulcers or discharge, get treatment promptly.
This is a group of viral diseases that generally start with Coca-Cola-coloured urine and light-coloured stools. It progresses to fevers, weakness, jaundice (yellow skin and eyeballs) and abdominal pains caused by a severe inflammation of the liver. There are several forms, of which the two most common are typical of the rest: hepatitis A (or infectious hepatitis) and hepatitis B (or serum hepatitis).
Hepatitis A, and the newly discovered hepatitis E, are spread by the faecal-oral route, that is by ingesting food or drink contaminated by excrement. They are avoided in the same ways you normally avoid stomach problems: by careful preparation of food and by drinking only clean water. There are now excellent vaccines against hepatitis A (Havrix Monodose or Avaxim) and it is certainly worth getting one of these before you travel.
In contrast, the more serious but rarer hepatitis B is spread in the same way as HIV (by blood or body secretions), and is avoided the same way as one avoids HIV. There is a vaccine which protects against hepatitis B, but three doses are needed over a minimum of four weeks. It is usually only considered necessary for medical workers, people working closely with children or if you intend to travel for eight weeks or longer. There are no cures for hepatitis, but with lots of bed rest and a good low-fat, no-alcohol diet most people recover within six months. If you are unlucky enough to contract hepatitis of any form, use your travel insurance to fly straight home.
Rabies is contracted when broken skin comes into contact with saliva from an infected animal. The disease is almost always fatal when fully developed, but fortunately there are excellent post-exposure vaccines. It is possible, albeit expensive, to be immunised against rabies before you travel. You are advised to take this if you intend working with animals or you are travelling for four weeks or more to remote areas.
Rabies is rarely a problem for visitors, but the small risk is further minimised by avoiding small mammals. This is especially true of any animals acting strangely. Both mad dogs in town and friendly jackals in the bush should be given a very wide berth.
If you are bitten, scratched or licked over an open wound, clean and disinfect the wound thoroughly by scrubbing it with soap under running water for five minutes, and then flood it with local spirit or diluted iodine. Then seek medical advice.
At least two post-exposure rabies injections are needed even in immunised people. But for those who are unimmunised even more injections are needed together with rabies immunoglobulin (RIG). RIG is expensive (around US$900 a dose) and is also in very short supply – another good reason for taking pre-exposure vaccine.
You should always seek help immediately, ideally within 24 hours, but since the incubation period for rabies can be very long it is never too late to bother. The later stages of the disease are horrendous – spasms, personality changes and hydrophobia (fear of water). Death from rabies is probably one of the worst ways to go.
Bilharzia or schistosomiasis
Though a low risk in Botswana, bilharzia is an insidious disease, contracted by coming into contact with contaminated water. It is caused by parasitic worms which live part of their lives in freshwater snails, and part of their lives in human bladders or intestines. A common indication of an infection is a localised itchy rash – where the parasites have burrowed through the skin – and later symptoms of a more advanced infection may include passing bloody urine. Bilharzia is readily treated by medication, and only serious if it remains untreated.
The only way to avoid infection completely is to stay away from any bodies of fresh water. Obviously this is restrictive, and would make your trip less enjoyable. More pragmatic advice is to avoid slow-moving or sluggish water, and ask local opinion on the bilharzia risk, as not all water is contaminated. It's generally thought that that the Okavango Delta is not infected with bilharzia.
Generally bilharzia snails do not inhabit fast-flowing water, and hence rivers are free of it. However, dams and standing water, especially in populated areas, are usually heavily contaminated. If you think you have been infected, don't worry about it – just get a test done on your return at least six weeks after your last possible exposure.
Sleeping sickness or trypanosomiasis
This is really a cattle disease, which is rarely caught by people. It is spread by bites from the distinctive tsetse fly – which is slightly larger than a housefly, and has pointed mouthparts designed for sucking blood. The bite is painful. These flies are easily spotted as they bite during the day, and have distinctive wings that cross into a scissor-shape when they are resting. They are not common in Botswana, and a very low proportion of tsetses carry the disease, so a bite is not generally a cause for panic or worry.
Prevention is easier than cure, so avoid being bitten by covering up. Chemical insect repellents are also helpful. Dark colours, especially blue, are favoured by the flies, so avoid wearing these if possible.
Tsetse bites are nasty, so expect them to swell up and turn red – that is a normal allergic reaction to any bite. The vast majority of tsetse bites will do only this. However, if the bite develops into a boil-like swelling after five or more days, and a fever starts two or three weeks later, then seek immediate medical treatment to avert permanent damage to your central nervous system. The name 'sleeping sickness' refers to a daytime drowsiness which is characteristic of the later stages of the disease.
Because this is a rare complaint, most doctors in the West are unfamiliar with it. If you think that you may have been infected, draw their attention to the possibility. Treatment is straightforward, once a correct diagnosis has been made.