Maintaining health is of concern to all travellers and especially those travelling to underdeveloped countries where the availability of treatment is inversely proportional to the chances of contracting an illness. However, with a few simple precautions it is not difficult to remain healthy. I have been living in west Africa since 2000 and have yet to become seriously ill. This may be due in part to good fortune or a strong constitution but here are some information and guidelines to help you maintain your health. This includes some information on self-treatment. Be aware that it is always better to have a professional medical opinion, laboratory analysis, and so on, but you may find yourself in a position where these are impossible to obtain, at least in a timely manner, so treatment should not be delayed. This information is also far more complete than needed by the average traveller. It is meant to cover all situations including those people planning prolonged stays.PERSONAL AND DENTAL HYGIENE
One of the most important ways to stay healthy is by maintaining personal hygiene. Here are some tips for doing so.
- Always wash your hands with soap when you get up in the morning, after using the toilet, before preparing or eating food, and after handling raw meat.
- Bathe often, everyday when the weather is hot. In the dry climate you will perspire without being aware of it but the build up of sweat and dust will still be there. Bathing regularly cuts down on fungal and bacterial skin infections, pimples, and infected hair follicles. Learn to ration water and take sponge baths if your source is limited. If you have to get your water from a river or lake, let it sit overnight so parasites like schistosomasis will sink to the bottom.
- Wear only cotton underwear. Both men and women can suffer when sweat accumulates on nylon and cannot be absorbed. Cotton absorbs sweat and reduces the chance of jock itch and vaginitis.
- Take care of your feet. The heat and lack of humidity can cause feet to become hard and crack, especially heels. The cracks can easily become dirty and then infected. If you are going to be in the area for a long time, weeks or months, soak your feet and use a pumice stone to keep down the build-up of dead skin. At night use Vaseline or shay butter to hydrate, and socks (if you can stand to).
- During the cold season use plenty of lotion to keep skin from chapping. Shay butter is a good local product, if you don’t mind it’s particular odour.
- The heavy wind and dust can cause some eye problems. It may be inadvisable to wear contact lenses. At least bring a pair of regular glasses with you, in case you need them. If you are going to try contacts, bring plenty of lens cleaner solution, wear sun glasses and try a turban too. If your eyes become red and scratchy rinse them with cool clean water or an eye rinse solution.
- Brush your teeth at least once or twice a day, and if possible after meal. The high sugar, high carbohydrate diet in this area increases the risk of tooth decay. If you lose your brush try using a twig broken off a local tree or shrub to rub the teeth or even your finger and some baking soda.
- Floss or use toothpick to clean between teeth and around gums.
- Beware of stray dogs and cats, they can carry fleas and other insects that can spread disease.
- If you do not buy sealed bottled water make sure you drink from a pure water system. If not, your water should be treated before drinking. This is especially important if there are reports of typhoid, hepatitis or cholera in the area. Water from rivers, watering holes and lakes is probably contaminated even if it looks clean.
- Store foods in insect-proof, rodent proof containers to prevent contamination. Keep food covered to prevent wind contamination.
- Disinfect any fresh fruits or vegetables with chlorine or iodine before eating.
- Wash dishes with soap and water especially ones used by a sick person.
- Don’t eat food that is old or smells bad. Don’t eat caned food that is swollen or squirts when opened. Be especially careful with canned fish. These can be poisonous.
Many diseases are waterborne. The organisms leave the sick person through the intestine and the infected faeces contaminate the water. The contamination can happen many ways and at many points between the source and your mouth. Even clean looking water may be contaminated and cause illness. Unless the water has been tested and found safe you should purify if before drinking, washing raw fruits and vegetables, mixing with powdered milk or other beverages, making ice, or brushing your teeth.
Choose the best available water source to start with and store the purified water in a clean covered container.
If you find yourself without any treated water it is better to risk an illness drinking untreated water than death or kidney failure due to dehydration!
filtering You can get a variety of filters at outdoor gear stores, most combine some sort of micro-pore filter to block such parasites as giardia and amoebaes and some sort of iodine or other chemical treatment to kill the bacteria and viruses that get through, as well as a carbon filter to remove any residual taste. There are portable pump varieties that are convenient for travelling.
boiling for one minute (3 min at elevations over 6500 feet) kills everything. Once you have boiled the water, store it in a disinfected covered container. If you boil large quantities store in a container with a dispensing tap to avoid contaminating it.
bleach eau de javel in French, add two drops per litre of water, mix well and let stand for 30 minutes before drinking. You should taste the chlorine in the water, if you don’t there is not enough. Ideally this should be combined with a micro-pore filter of some sort as bleach does not kill giardia cysts or guinea worm eggs. A cloth filter will get rid of dirt and large eggs but will leave giradia cysts if you are getting water from a source that may have these and have only chlorine to treat with, let the treated water stand overnight to have a chance to kill the cysts. Bleach does not keep forever; make sure yours still smells like chlorine. If is doesn’t, it is no good. For cloudy water double the dose to 4 drops per litre.
Iodine tablets are available for sale. They are also very effective in treating water. One tablet per litre and let it stand one hour or 1/2 tablet and let is stand two hours - this will reduce the taste. Or 2% tincture of iodine available in most pharmacies treats water with 5 drops per litre of clear water and double for cloudy water. Iodine should only be used for short-term as long use can cause or exacerbate thyroid problems.
When you travel from one place to another carry several litres of treated water with you. But if you find yourself without any water it is better to risk an illness drinking untreated water than death or kidney failure do to dehydration.
Restaurant water and ice cubes Water is rarely treated in restaurants. It will be the plain tap or well water that serves the location it is in. Ice will be made by freezing this water. Freezing does not kill various pathogens in the water, nor does alcohol. When asking for water specify “eau mineral” which will be pure bottled water.
Local beverages will be made with local water. Drinks sold in little plastic bags or reused bottles in the market will have the additional risk of the the ever present dust and in the case of reused containers the possibility that they have not been well cleaned. The local tea, however, is safe, as it is well boiled. Water for coffee or tea is also boiled and so safe.
A Note About Water in Timbuktu most of the water in the city is provided through taps both public and private. The water in the city's water towers has been liberally treated with chlorine; you can often smell it in the water. This makes it reasonably safe, but drink at your own risk. And don’t forget that even if it comes out of the tap clean if can easily be contaminated in transit or by use of contaminated storage containers or drinking vessels. For people planning to stay for extended periods it is probably worthwhile to slowly acclimate yourself to the local tap water, since it is reasonably safe, purchasing bottled water for months can be costlyy, and consuming iodine for long periods can be a health risk in itself.
Food that has been cooked and served hot is safe. Food that has been cooked and left to sit at room temperature (even if this seems hot too) is questionable. It should be completely reheated for at least five minutes prior to consumption.
Vegetables parasites live on the outsides of vegetables that have been grown with sewage as fertilizer or have been kept moist by contaminated water at the market. You must either peel them or treat them before consumption. Even in better restaurants there is a good chance they have not been treated prior to serving as a salad. Cleaning is done by soaking for thirty minutes in a solution of 3 iodine tablets/litre or 10 drops chlorine/litre. Then rinse in treated water. These same solutions can be used to disinfect cutlery, dishes, glasses and food preparation areas. Soak cabbages in salt water to draw out insects or grubs prior to cooking.
To choose vegetables in a market: heavier greens, crisp, non-wilted with no yellowing edges are the freshest. Wrinkled discoloured root vegetables should be avoided, Discolouration in the inside means they are spoiling.
Fruit may be contaminated by the dirty hands that handle them and by the flies that land on them. They too should be cleaned, if not pealed prior to consumption. In fact even if you peal it is not a bad idea to rinse fruit first otherwise your hands that pealed will contaminate the pealed fruit. At least wash the exteriors of all fruit well. If possible treat as with vegetables.
buying fruits Buy what is in season, it will be cheaper and in better condition. Choose fruits that are heavy, firm but not hard, and unblemished. Hard fruit is still green while too soft is over ripe and possibly spoiled. Blemishes indicate places where it could be spoiled or contamination could enter. Some green fruits may be used in cooking.
Meat Some parasites, like tapeworm, may infest meat, not to mention exterior contamination from flies etc. while waiting to be sold. If you are ordering it in a restaurant have it well done “bien cuit” in French.
buying meat Choose meat that is firm and has no unpleasant odour. Cow, camel and goat meat are bright red with cream coloured fat, sheep meat may be paler red with white fat. Any meat with a brown or greenish tinge, or dark, discoloured fat is spoiled. Choice meat from an adult animal will be marbled with fat. Leaner meat will often be tougher and require longer cooking unless from a younger animal. Darker red meat often comes from older animals and will be tougher. Note most animals slaughtered for consumption in this part of the world are older as a matter of course.
Fish In shopping for fresh fish look for bright eyes and red gills, firmness in general and scales tightly attached, deep red blood and little odour. For dried fish, avoid soft flesh and unpleasant odours, check for maggots.
Eggs sometimes sit around for a while before selling. Test for freshness: it should not rattle in it’s shell, the yoke should be yellow, and very distinctly separate from the white, it should be free of discoloured patches if held up to the light. A fresh egg will sink to the bottom of a bowl of cool water, if it stands on one end it is getting old but still edible, if it floats discard. Wash the shells of soiled eggs.
Dairy local raw milk from any animal should be boiled (at least brought to a bubble of a boil) because there is a possibility of brucellosis and tuberculosis. Other dairy products should be avoided unless they are known to be hygienically prepared and properly refrigerated. Local yogurts are tasty but potentially dangerous.
Oil Choose cooking oils that are clear. Avoid cloudy or rancid smelling oils or anything with sediment at the bottom of the bottle. Avoid cotton oil in Mali; it is rarely refined for human consumption and is thus mildly toxic.
Grains look for heavy grains with a minimum of stones or grit. light grains may have been attacked by insects. Brown rice has more nutritional value than white rice. Dried beans are often bug infested, roast them for about 10 min and then place in water and stir. The bugs will float to the top and are easy to skim off. A couple bay leaves in a closed container holding grains will kill existing bugs or arrest the development of large colonies.
Canned Foods avoid cans that are rusted, dented, leaking or have bulging ends. Check the expiration date. Tap both ends, they should sound the same.
Spoilage Creams and creams sauces, mayonnaise, and raw meat, especially chopped in small pieces does not last long in the heat. It should not be kept more than a day. Keep meat in whole chunks to decrease the risk of spoilage and maggots. Or cut in small pieces and put in a pot with no water and a little salt cook it until all moisture is gone. Set out in a protected area to cool. This will last longer and can be a nice snack, or added to meals in place of fresh meat.
Remember the food is only as clean as the person who prepared it, the dishes it is served in and the person eating it. Keep yourself and your utensils clean. Wash before and after preparing and before eating. Store food in clean containers. Cook thoroughly and serve immediately. Don’t save leftovers unless you have access to a refrigerator.
When on vacation, we often take the opportunity to indulge in junk food and that is not the subject of this section. Rather, in places like Timbuktu variety in meals is often difficult to obtain and you may find it hard to get a balanced meal if you want one. For people on extended stays here or extended travels in the region, this can eventually lead to deficiencies unless you take some measures to ensure proper nutrition.
PROTEIN getting enough protein can be hard even for non-vegetarians. Meat portions in meals are often small, if eating with a local host family they may not have the means to put in more. You can contribute to the cost of meals and this may increase the amount of meat. Here are other sources of protein:
Yogurt if you are unsure of the safety of locally available yogurt MaliLait produces commercial yogurt or you can prepare your own. Buy a sack of plain yogurt from a shop as starter. Heat milk to almost boiling and then add some of the starter. Only a teaspoon for 6 cups of milk, the more starter the more liquid it will be. Bundle the container in towel, coat, clothes, whatever, to insulate it and keep in the heat for several hours till it sets. Don’t dip in a used spoon, saliva enzymes breakdown the the yogurt bacteria.
Peanut Butter is available in the market(locally produced). Again, if unsure of the sanitation, you can buy fresh peanuts, and have them ground. To have that roast peanut flavour, roast the peanuts first put in a pan with some clean sand over low heat stir regularly, when done sift the sand out and get rid of the papers around the nut; these can contain some toxins if there is any mould. Pound it up yourself or have it ground in the market.
Manioc (Cassava) leaves have seven times the protein as the root, as well as other vitamins.
Beans and Split Peas and Melon Seeds are available and can be added to rice of millet dishes to provide meat-free proteins.
MINERALS Calcium and iron are two of the main minerals needed, sources of each are as follows
Calcium Besides milk, the traditional source, calcium is found in dark leafy green vegetables. Here you can try preparations with manioc, squash, bean or baobab leaves. Sardines have high quantities as well, due to the bones cooked in.
Iron is of special concern to women who lose a considerable amount each month. Natural sources are organ meat such as liver and heart, dark leafy greens like baobab leaves(which also contain folic acid the essential ingredient to be able to use iron), raisons, dates, melon seeds, baobab fruit “pain de singe”, and sweet potatoes.
Vit A: In a pure form it only occurs in products of animal origin, but your body can turn carotene into vitamin A. Dark greens, palm oil, sweet potatoes, carrots, squash, lettuce, tomatoes, oranges, bissap, sardines, and milk.
Vit B there are several, and they are found in meats, milk, whole grains, dry beans, and peas.
Vit C is found in citrus fruits (oranges and lemons), dates, potatoes, sweet potatoes, tomatoes, greens, raw cabbage and a small local fruit called the jujube.
Vit D is in sunlight so you should have no problem.
Vit E is found in vegetable oils, meat, milk, and eggs.
Vit K greens, tomatoes, egg yokes, and liver.
Cook vegetables in as little water as possible and don’t overcook. This will prevent loss or destruction of nutrients. Use the water for cooking rice or in soup stocks.
Sugar spoils the appetite and rots the teeth. Avoid huge amounts of cookies and sweets and soft drinks. The local tea has a lot of sugar too and may also stain your teeth.
Flours can be ground from millet, sorghum, peanuts, beans and rice etc. Millet and sorghum have higher nutritional content than white flour available in shops. Whole grains also absorb more water so need less than a recipe for white flour.
SOME HEALTH PROBLEMS
Even though it is a dry heat it is still very hot. Don’t overdo things, especially at first. Let yourself acclimate. Drink plenty of water, you can’t overdose, and even with little activity you should drink three litres a day, more if you are sweating or active. Wear a hat and protective clothing. Put sunscreen on unprotected areas. Remember the sun is much more direct than at higher latitudes; you can burn quickly. Always carry water with you when you go out. And avoid the sun between 11 a.m. and 2 p.m.
Dehydration is a danger when overheated, as well as with many other illness causing heavy sweating, diarrhoea or vomiting. Signs are thirst, little or no urine, very dark yellow urine, dry mouth, lack of sweat even though it is hot, in severe cases the skin loses elasticity. To treat, drink lots of liquids, including the Oral Rehydration Salts or ORS. You can often purchase specially formulated mixes for adding to water containing salt, sugar, soda and potassium. but you can also make your own simply by adding 1/2 teaspoon of salt and 8 teaspoons of sugar (this is two pinches of salt and in Timbuktu a half a local tea glass of sugar) to a litre of water. To round out the drink add a half cup of fruit juice or mashed banana if available to give the potassium. The dehydrated person should sip this every five minutes until s/he starts urinating normally.
Sunburn Over exposure to the sun results in burn from mild (red skin) to severe (blisters). This is dangerous as repeated burns can increase the risk of skin cancer. Severe sunburns or burns covering a large area should be treated. Try aloe creams that draw out the heat, cool water soaks or mild vinegar and water solution and drink plenty of water including ORS.
Prickly Heat is an itchy rash or little red bumps caused by excess sweat under the skin. Keep affected areas clean and dry; use talcum powder or specially formulated powders for heat rash. Fan the area, to help dry it out. This usually decreases as you acclimatize.
Heat Cramps People who work hard and sweat a lot in hot weather may get painful cramps in arms and legs or stomach. This is due to lack of salt. Drink ORS
Heat Exhaustion People who work and sweat a lot in hot heather may become pale, weak, nauseous and feel faint. The skin is cool and moist and the pulse rapid and weak, while the body temperature is normal. Lie down in a cool place, raise feet over heat and have someone rub your legs. Drinks lots, including ORS.
Heat Stroke is much less common but much more dangerous. It is more common in older people and alcoholics during hot weather, but if you are really pushing yourself it could happen. The skin becomes red and very hot and dry, not even armpits are moist. Temperature may go as high as 42 C, 108F, and this is because the body's natural cooling system has shut down. Unconsciousness often follows. The body temperature must be lowered immediately. Put the person in the shade, soak him in cold water (icy if possible) and fan him. Seek medical help; fluids may have to be given by IV.
There are not so many in the north as there are in wetter areas to the south, however some of them are worth knowing about, even if they seldom affect visitors.
Insect Bites. Except for some people who are seriously allergic, the biggest problem with insect bites is the inflammatory response which results in itching. Itching should be controlled to reduce infection from scratching. If you are bitten, clean the area, apply calamine lotion, caladryl cream or cool compresses, alcohol or vinegar may also reduce itching. If itching is severe take Benadryl, one every 4-6 hrs while symptoms last.
With some insects painful swelling and redness results and should be controlled. Take Benadryl and aspirin, Tylenol, or Ibuprofen. Apply ice if possible. If you know you have severe allergic reactions to insect bites or stings travel prepared with epinephrine injections.
Bees There is a variety of wasp here, a big, black, mud-hut-building wasp. It is not aggressive, but can sting if provoked. If you are stung, scrape the stinger off with a sharp object like a knife bade with a sideways motion. Don’t grasp the sac of the stinger as this will squeeze more venom into the skin.
Blister beetle this is much more prevalent in wetter areas but does come out some during the rainy season. A cylindrical beetle about an inch long, black or beige with iridescent green overtones. They come out at dusk and are attracted to light. When threatened (ie: you brush them off) they secrete an acid which can cause burning and stinging. Although you may not notice it right away in a few hours a blister will appear. If you think you have been touched try washing the area immediately with soap, it may prevent the blister or decrease its size. Avoid breaking the blister as the fluid inside will cause more blisters. Put a gauze dressing over it with some antiseptic and let the blister go away in a few days on its own. Or carefully open the blister under running water or with gauze handy to wipe up all liquid. Don’t let it touch you. Wash it well with soap and water. Keep it clean, cover with antiseptic and band-aid or gauze to avoid infection.
Scorpions those present in Timbuktu are typically yellowish and maximum size is 4 inches 10cm from tip of stinger to pincers, usually less. The sting is not fatal, however it is very painful. Usual reaction is intense burning pain and swelling at the site of the sting. There will be redness and possibly blisters, numbness and tingling in the area. Occasionally weakness of the affected limb and some nausea. To relieve pain, apply a cold pack, elevate the limb and take Benadryl. To avoid stings, shake out your shoes before putting them on. Shake out your sleeping bag before getting in if you’re camping out on the ground. Be cautious lifting boxes, or mats that have been sitting on the ground or floor a while. Scorpions are nocturnal and seek dark hiding places during the day.
Ticks are major carriers of disease. They are said to be prevalent in Mali but I have personally never encountered one. They are probably more prevalent in southern Mali where there is more vegetation. You should remove them as soon as you discover them. To remove them smother them first in Vaseline or some heavy oil. After 20 minutes pull off gently with tweezers. Don’t yank as this could leave the head behind and cause a nasty infection.
Lice are pretty common here. They can be spread by personal contact or sharing items like combs, hats, bedding and clothing. There are three types: head, body and pubic. They all itch, and can result in such serious diseases as typhus and relapsing fever.
Head Lice infest the scalp, eyebrows, eyelashes and beard. You can see both louse and eggs (nits) which are attached to the hair shaft and look like dandruff. Treat with Lindane shampoo or lotion and treat bedding and clothing as with body lice. Repeat the Lindane treatment once 7 days later if necessary.
Body Lice can be seen in the underwear and lesions are often seen on shoulders, bottoms and abdomen. You only need to treat bedding and clothing on this one, Boil all clothing and bedding for 2 to 5 minutes and air dry.
Pubic Lice are spread by sexual contact they are bigger than the others and can be easily found by looking. Treat as with head lice.
Scabies is a tiny parasite that tunnels into the skin and reproduces there. It is transmitted by direct contact with the infected person, not in bedding or clothing. Symptoms are intense itching at night, and visible burrows in the webs of fingers or bend of wrists, elbows and armpits, aureole of female breast, penis or buttocks. Treatment is with one application of Lindane lotion. Follow the instructions. If you apply it to your hands, reapply after washing, if is has been within eight hours.
SNAKES I have never seen a snake in Timbuktu and I have been here since 2003. I do not know anyone who has been bitten by a snake in Timbuktu. But there do exist some venomous varieties in the region, so be cautious. Do not stick your hand down a hole or burrow and do not try to kill a snake if you come across it. Leave it be, it will leave you be. Do not bother apparent corpses of snakes, they may not actually be dead.
are not uncommon here, the blowing dust may be one reason. The symptoms are the same as anywhere: sore throat, runny nose, sneezing, cough, headache etc. There are no cures for the cold but you can treat some of the symptoms. Consume plenty of fluids, rest, eat well, consume vitamin C either in supplements or in food sources such as citrus fruits, or bisap juice. Try Aspirin or Tylenol for headaches and fevers, lozegnes or hard candy for sore throat.
Bronchitis sometimes a cold will get complicated by secondary bacterial infections. Usually a cold that gets in the lungs is viral but if it persist it may be bacterial and you will need antibiotics. Symptoms are a cough, dry or wet, wheezing, fever, achy tiredness. Treatment is the same for a common cold, unless it is bacterial then you need antibiotics too.
Throat infection This may be strep or something else you can’t tell without a laboratory test. Symptoms are red swollen, painful tonsils, white spots on tonsils, fever, possible nausea and vomiting, headache and swollen glands in the neck. Treatment is Aspirin or Tylenol: 2 tablets every 2 hours, lozenges or hard candy, warm salt gargles and if it persists antibiotics.
Sinusitis the spaces in the facial bones can become inflamed or infected and usually require antibiotics. Symptoms include all cold symptoms plus the areas over the cheekbones and forehead are tender. Pain increases when you bend over putting your head lower than your chest. Thick yellow-green snot. Treatment is aspirin or Tylenol as with throat infection, rest and plenty of fluids. If it persists, antibiotics.
Earaches since the tubes of the ears are so close to the nose and sinuses they may become irritated as well. It could be a mild ache that will go away or severe pain with fever and discharge. The latter require medical treatment. Do not put anything including Q-tips in your ears!
has many possible causes and is typically defined by an increase in volume, fluidity and frequency of bowel movements relative to the normal pattern for the individual. Generally more than four liquid stools a day is diarrhoea. Unless you are in a situation where you cannot easily get to a toilet or latrine do not stop it up. Diarrhoea is the body’s way of getting rid of things that aren’t good for it.
Prevention is best: wash hands, don’t eat cold food or food that has been left uncovered, wash hands before eating and after the toilet, don’t drink untreated water, protect food, dishes and cutlery from flies and roaches. Avoid licking your lips; with all the blowing dust they can pick up nasty stuff. Rinse them regularly.
Many types of diarrhoea will clear up without treatment. The best thing to do is consume plenty of fluids including Oral Rehydration Salts (ORS) which come specially packaged or can be made by putting half a tea spoon (two pinches) of salt and 8 teaspoons of sugar in clean water. Drink some after each bowel movement or vomiting.
Travellers diarrhoea- this is very common for people under stress or changing diet and environment. It is not of major concern and will clear up in a couple of days.
Bacterial diarrhoea- General symptoms: sudden onset, fever, chills, cramps, blood or mucus in the stools, headache, nausea, vomiting.
This can be caused by several organisms. Some are normal bacteria typically causing no symptoms and are only treated if no other cause is found. These include Dientamoeba fragilis, Entamoeba histolytica, and Escherichia coli.
Campylobacter, a faecal bacterium found in animals, birds, humans, raw milk, chickens, meat cutting boards, and water. The incubation period is typically 2-5 days but can be up to 10. It is communicable while symptomatic and can last up to 7 weeks if not treated. Symptoms include pain, fever, nausea, vomiting, diarrhoea, fatigue, and rarely joint aches or neurological symptoms. Treatment is cipro if necessary, though it will go away on its own.
Salmonella typhimurium and paratyphi are also faecal bacteria found in food, water, eggs, raw milk, meat, fresh fruits and vegetables. The incubation period is 6 to 72 hours with an average of 12 to 36 hours. It is communicable while infected which can be days to weeks. Symptoms include sudden headache, abdominal pain, diarrhoea nausea and sometime vomiting almost always fever. Infection can move to other parts of the body, in the blood it may cause septicaemia, and in the small bowel there may be some blood in the stool. Treatment is with cipro.
Shingella (flexneri and boydii) are faecal bacteria found mainly in humans. Incubation is 1 to 3 days. It is communicable for 1 to 4 weeks and symptoms include nausea, vomiting and rectal pain. Treatment is with cipro.
Cholera Travellers are often concerned by reports of outbreaks in west Africa. They are usually in areas of flooding, overcrowding and poor sanitation. It is a very dangerous but easily avoided by following the basic guidelines for food and water consumption and therefor a low risk for travellers. Prevention is in avoiding contaminated foods and water. Always drink treated water, disinfect fruits and vegetables with iodine or chlorine and wash hands frequently. In epidemic situations avoid close contact with infected persons or if it is unavoidable get prophylactic treatment with Tetracycline. The biggest concern for infected persons is to assure continued hydration. This included drinking lots of fluids and maybe even IV.
Amoebae are found in faecally contaminated food and water, they commonly live as trophs (the active form) for 2 to 4 weeks but as Cysts (encased eggs) they can live for years. Most amoebiasis in humans in asymptotic with periodic abdominal discomfort, may be blood or mucus in the stools and alternating constipation and diarrhoea. An acute infection can have blood, mucus in stools, a frequent need to have a bowl movement even if little or nothing comes out. Treat with Fasigyn for the trophs, followed by paromycin or diorexiode for cysts.
Giardia is found in the small bowel, It can be transmitted by contaminated food or water or from person to person. Incubation is 3 to 25 days but the average is 7 to 10. It is communicable as long as there are cysts. Symptoms include chronic diarrhoea, bloating cramps, pale greasy stools, fatigue, weight loss and occasionally reactive arthritis. Typical symptoms include yellow frothy foul-smelling diarrhoea, belly swollen with gas giving rise to very stinky flatulence and and sulphurous burps. Treatment is with Fasigyn.
Acne often worsens here largely due to the dust, heavy perspiration, greasy foods and stress. Keep your face clean. Wash several times a day with an anti-microbial soap. Leave face open to the air. Avoid picking or squeezing pimples; it will make them worse and possibly cause infection.
Cuts and Scrapes In this environment it is very easy for any break in the skin to get infected, so wash a wound with antiseptic soap and clean water 3 or 4 times a day, apply antiseptic ointments or iodine, use a bandage when outside until it scabs over, keep it uncovered at night or when inside so it will dry out. Change dressings that are dirty or wet. If a wound becomes badly infected you many need oral antibiotics. Dicloxacillin is a good one 250mg 4x a day for 7 to 10 days.
Fungus Tinia Versicolour, ringworm, athlete's foot, and jock itch are fungal infections. On the head it can lead to patches with scales and loss of hair. Infected finger- and toenails become rough and thick. With tinea versicolour patches of infected skin become darker or lighter. This one does not itch. Treatment is first hygiene; keep infected areas clean and dry and exposed to the air when possible. Change underwear and socks when possible. There are many anti-fungal ointments and powders, such as salicylic or undecylenic acid or tolnaftate. Try also Selsun Blue dandruff shampoo; smear a little on affected areas and leave for 10-15 minutes, then wash. Repeat weekly for two weeks.
Gomes or furuncle is the infection of a hair follicle. Their exact cause is not clear but they seem to be more common in the hot season. The hair follicle swells and becomes a deep abscess. They are hard red and very painful. Eventually the centre will become soft and rupture allowing the puss to escape. Fever and inflamed lymph nodes can accompany. If you note one beginning, apply hot packs (a wash cloth works fine). Do not try to squeeze or pop it. When it opens continue to apply hot packs and keep it clean. When outside keep it covered and inside leave it open to the air.
Impetigo is a bacterial infection that causes rapidly spreading sores with shiny yellow crusts. It can spread easily from the sores and contaminated fingers. It is often contracted from scratching pimples or insect bites with contaminated fingers. Treatment includes washing the infected part with soap or and clean water, gently soaking off the crusts and applying a topical antiseptic. If the infection spreads or becomes systemic give dicloxicilin (try co-trimoxazole if allergic to penicillin)
Brucellosis comes from drinking unpasteurized milk from infected cows or goats. Symptoms may start with fever and chills but often progresses gradually with increasing tiredness, weakness, loss of appetite, headache, stomach ache and joint pain. Fevers typically begin with afternoon chills and sweating by morning. Without treatment it can last for years. Treatment is with tetracycline, but if you suspect it get medical advice as it is easy to confuse with others.
Hepatitis is an inflammation of the liver. But often specifically refers to certain viral forms. Symptoms are similar. Transmission varies. Type A is spread through the faecal/oral route via contaminated food and water. Other types are spread through bodily fluids. Symptoms are loss of appetite, weakness, headache, joint and muscle aches, low fever and perhaps pain over the liver, nausea, vomiting, yellowing of skin and whites of the eyes dark urine, clay coloured stools. As there is no cure for viral infections, it will run its unpleasant course. Rest, eat well and increase fluids. Vaccines are available for Hep A and Hep B. Otherwise be careful to follow the basic guidelines for food and water and avoid risky situations where bodily fluids might be exchanged.
HIV and AIDS are growing problems in Mali. Always use a condom no matter who you have intercourse with and avoid risky situations like intercourse with prostitutes and intravenous drug use. At hospitals you will be sold a new sterile syringe and needle along with your injectable medication, or IV solution so that is not a concern but things like ear piercing, and tattooing of the gums are very risky and to be avoided.
Malaria is spread by mosquitoes, especially during dusk and early night hours, though some peak at midnight or early morning. Incubation is 7 to 14 days for falciparum, 8-14 days for vivax and 7-30 days for ovale. Communicable via contaminated mosquito during its lifetime, and via contaminated human blood for up to three years. Symptoms can vary including cough, diarrhoea, fever, chills, shortness of breath, headache, pulmonary and cerebral edema, coma, and death. There is typically a cyclical fever starting with chills and headache, followed by a fever of up to 40 C (104F), the person is weak, flushed and maybe delirious. The fever lasts hours or days and then the person sweats, the temperature goes down and s/he feels week but okay. The fever reoccurs every 2 or 3 days. The course of the illness gets progressively worse. Diagnosis is by blood smear. Malaria can be very dangerous so if you have unexplained high fevers, especially if you have not been taking a prophyllaxis regularly, get a blood test. If you cannot get a test done, but suspect malaria take three tablets of Fansidar all at once (for adults, for children read the notice in the package for the amount based on weight)
Rabies is a viral disease that is almost 100% fatal if contracted, due to failure of the respiratory system. It is spread by the saliva of infected animals and affects the central nervous system. Prevention is the only answer. You can get immunizations that give you a little protection and time to get treatment. The immunization is a series of three shots over 3 or 4 weeks. You will still need two boosters if you are bitten. Non-immunized people will need more shoots. Avoid strange animals, note that very few animals here will have been immunized. If you are bitten by an unknown animal scrub the bite with lots of water for at least 20 minutes and go get post exposure shots immediately.
Schistosomiasis (also called bilharzia) is caused by a parasite that has part of its life cycle in humans and part in snails. Found in standing water, where the snails live and contaminated humans have defecated or urinated in the water. Incubation is 2 to 6 weeks. Communicable via faeces and urine, up to ten years. Symptoms are rare and stem from chronic infection of the liver. They include blood in the urine or faeces, bladder cancer and obstruction, rectal cancer, infertility and cerebral symptoms. Diagnosis is by blood test and filter of urine for eggs. Treatment is with praziquantel.
Sexually Transmitted Diseases (STDs) such as gonorrhoea, herpes, and syphilis are prevalent in Mali. Some are almost asymptomatic but they can have terrible results including sterility, paralysis and death. Some can be treated but many can’t. The best course is prevention of which abstinence is the only 100% effective method. If you choose to have sex please, please use condoms, and make sure they are not expired or damaged by the heat.
Tetanus bacteria are found in human and animal faecal mater and enter the body through a wound. The most likely wounds to cause tetanus are deep puncture woods from nails, thorns or splinters, holes made by dirty needles, and animal bites. Symptoms are difficulty swallowing, stiffness of the jaw (lockjaw) followed by stiffness in the neck muscles and the rest of the body, convulsions are triggered by touch, sudden noise, or bright light. This is a deadly disease; the best treatment is prevention by vaccination, and immediate cleansing of any deep or dirty wound. Seek medical treatment immediately.
Tuberculosis (TB) is most typically of the lungs and is highly contagious. Avoid contact with people suspected of having TB. It can also be transmitted through the unpasturized milk of infected cows. Symptoms are a cough that lasts more than three weeks, pain in chest or upper back, chronic weight loss and increasing weakness, coughing up blood, pale waxy skin, hoarse voice. Risk to travellers is low unless you are living in close contact with people in high risk areas, or drinking unpasturized milk. However, it is a serious deadly disease. If you think you may have contracted it, get a test. One involves a subcutaneous injection (just under the skin) to test for a reaction. Or they can test your phlegm for the TB microbe. Treatment is long and complicated and must be taken until tests are negative. This can last up to a year. There is a vaccine against it the BCG, which is given to all children in Mali (who get vaccinated).
Typhoid Fever is an infection of the gut that affects the whole body. It is spread by faecal-oral contact from contaminated food or water. It typically comes in epidemics and has been known to break out in Mali particularly among people who drink river water. It is very dangerous. Symptoms start with headache, sore throat and dry cough. Fever goes up and down but rises slowly each day, pulse is relatively slow for the fever. Take pulse and temperature regularly. If pulse gets slower as fever rises it is likely typhoid. Pink spots, delirium, weakness, weight loss, and dehydration are common symptoms. After three weeks the symptoms slowly go away. Treatment is with co-tirmoxazole for at least two weeks. Treat dehydration with plenty of liquids and ORS. A vaccination is available for this as an injection or tablets to be swallowed.
Urinary Track Infections (UTI) while they can affect men they are much more frequent in women because the urethra is much shorter and is close to the vagina and rectum. Symptoms are burning during urination; sensation of having to urinate all the time; passing only small amounts of urine; cloudy, dark or bloody urine; foul odour to the urine; sometimes a back ache over the kidneys; sometimes fever. UTIs are uncomfortable and inconvenient; as with most illnesses it is best to prevent them.
Prevention: Wear clean cotton underwear, always wipe from front to back, bathe in clean water and rinse off soap well. Reduce carbohydrate and sugar intake, urinate after intercourse, be sure your partner cleans his genitals before intercourse.
Treatment: Antibiotics: Ampicillin or Bactrim; Aspirin or Tylenol to relieve discomfort; drink plenty of fluids at least a glass an hour.
Yeast Infections, the most common one is Candida a regular inhabitant in the body. It only becomes a problem when there are changes in state (like when antibiotics kill off other normal bacteria and it can run rampant). Heavy sweating and synthetic underwear can also increase the risk. Symptoms are severe itching, burning, and red swollen labia that feel sore. Vaginal discharge is white and cheesy in appearance. Prevention is an inexact science; some women are more prone than others. Wearing cotton underwear and loose clothing helps as does consuming live culture yogurt. Treatment is with suppositories of Nystatin or clotrimazole or vaginal creams for three to seven days.
Menstrual Problems Many women travellers experience at least some menstrual irregularity. This is caused by several factors: new environment, stress, changes in diet. etc. You should not be alarmed if you miss your period, or the flow is exceptionally light It is usually not harmful. Don’t forget that even if you miss your period you can still get pregnant so if you are sexually active and wish to avoid pregnancy keep using birth control.
The stresses of travelling may compound pre-menstrual symptoms. Emotional feelings of tension, depression, anxiety or panic, irritability, angry outbursts, crying jags, fatigue, forgetfulness, clumsiness, as well as physical problems of tender breasts, bloating, head and backaches can be exaggerated by the loneliness, culture shock, and other frustrations of being in a foreign country. Try to be aware of your menstrual calendar so you can avoid sugar and caffeine during the times you are prone to PMS. Familiarize yourself with stress management techniques. If you are travelling with other women support each other, chances are you are not the only one suffering.
It is not advisable to travel to a place like Timbuktu in the late stages of Pregnancy. The medical facilities are not equipped to deal with associated problems or delivery in a manner that would be acceptable to the western mother. The potential of complications arising due to stresses of travel are also high.
A pregnant woman should take care to eat well, avoid really rough travel, and avoid all unnecessary medication, but do take malarial prophylactics as the dangers of malaria to foetal health are higher than the dangers of the medication.
There are four private pharmacies in town that offer a wide range of name brand (mostly French names) prescription and over the counter medicines and first aid supplies. They are often easy to spot as they tend to paint the shops green and have glowing signs with the snake wraped around a post symbole or flashing ones with a green or blue plus sign They are as follows:
- just south of the Maison des Artisans
- just east of the restaurant Mahraba heading towards the monument des martyrs.
- just south of the Sidi Yahya Mosque
- On the south side paved road runing east below the Post Office About even with the Catholic Mission.
There are a number of neribourhood clinics that the
locals use but for a visitor who needs to visit a doctor
You should either visit the Hospital which is south
of town; go past the post office and the justitce building
then turn left (east) go past the stadium on the south and
continue or the Centre de Sante de Reference which
is northwest of the old town right next to the monument des
Martyrs and the new Ahmed Baba Center. Here is where women
tend to go to give birth and children are most often
treated they have ultrasound, exray and can do blood tests.
If you are given a prescription at the hospital or centre
de sante they have pahrmacies in them that mostly supply
generic WHO subsedized medications that should be as good
and much less expensive than that found in the private
pharmacies. There is also a private clinic called clinic
Alafiya and uses the red corss symbole on its signs in the
Abaradiou neigbour hood opened by one of the hospital
doctors. Turn north off the pavement two bocks east of the
Flamme de la Paix monument, continue several blocks north
it will be on the east side of the road with a large sign.