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Health and Safety

Rwanda itself isn’t a particular unhealthy country for tourists and you will never be far from some kind of medical help. The main towns have hospitals (for anything serious you’ll be ore comfortable in Kigali) and all towns of any size have a pharmacy in Boulevard de la Revolution is open 24 hours.

Outside of Kigali, Rwanda has 34 district hospitals and over 380 health centres spread around the country. A health centre is generally staffed by one or two nurse, supported by medical assistants. In rural areas traditional medicine is also wide used.
The severe shortage of qualified medical personnel – particularly doctors – caused by the targeting of professionals during the genocide has not yet been remedied: there are around 3,900 inhabitants per nurse and 50,000 per doctor. However, the private medical sector is developing fast around the country (particularly in Kigali), and now includes more than 300 private clinics dispensaries.

The incidence of HIV/AIDS is approximately 14% but hard to estimate accurately.

The guidelines below relate to tropical Africa in general, sine travellers may well want to spent time in more than one country.

BEFORE YOU GO

As you should for any trip to a tropical or remote area, visit your doctor about eight weeks before leaving for Rwanda to discuss your plans and requirements. Preparations to ensure a health trip to anywhere in Africa should include checks on your immunisation statues: it is wise to be up to date on tetanus (ten-yearly), polio (ten-yearly), diphtheria (ten-yearly), hepatitis A and typhoid. For many parts of Africa, immunisations against yellow fever, meningococcal meningitis and rabies are also needed.

In Rwanda, as with some other countries in Africa, yellow fever vaccination is required for all travellers over one year old. You are advised to carry the certificate of proof of vaccination as you may need to show it on arrival. This also applies if you arrive from another country where yellow fever is a risk. The certificate is not valid until ten days after your vaccination, so be sure to have this done in good time. This potentially lethal virus (its mortality rate can be up to 50%) is spread by mosquito bites and is currently on the increase worldwide, so keep your vaccination up to date. If you are unable to have the yellow fever vaccination (e.g.: if you are immuno-compromised, or are allergic to eggs) then you will need to obtain an exemption certificate. This usually allow you entry into one country, so if you are planning to visit more than one country you will need to check with each embassy as to whether an exemption certificate will be accepted.

Certain countries in sub-Saharan Africa also require a certificate of vaccination for cholera. There is now a more effective oral cholera vaccine (Dukoral) which can be administered if there is a known outbreak or if you are considered at risk. This would apply to people working in poorer rural areas or those with chronic medical conditions. The vaccine is given as two doses at least one week and no more than six weeks apart and should be taken at least one week before entering te area. The vaccine is considered to be effective for up two years for those aged six years and above. If vaccination is not considered necessary ten certificates of exemption can be acquired from immunisation information centres. Currently this is not necessary for Rwanda, but seek up-to-date information before you travel.

It is wise to be immunised against hepatitis A (e.g.: with Havrix Monodose or Avaxim). One dose for vaccine lasts for one year and can be boosted to give protection for up to 20 years. The course of two injections costs about £100. The vaccine can be used even close to the time of departure. Gamma globulin is no longer used as protection for hepatitis A in travellers, since there is a theoretical risk of CJD (the human form of mad cow disease) with this blood-derived product.

The newer typhoid vaccines last for three years and are about 75% effective. They are advisable unless you are leaving within a few days for a trip of a week or less, when the vaccination would not be effective in time.

Vaccinations for rabies are advised for travellers visiting more remote areas. Ideally three injunctions should be taken over a minimum of three weeks, at 0, 7 and 21 days. The timing of these doses can be extended if you have allowed more time.

Hepatitis B vaccinations should be considered for longer trips (two months or more), or if you will be working with children or in situations where contact with blood is increased. Three injections are ideally: they can be given at 0, 4 and 8 weeks prior to travel or if there is insufficient time, then on days 0, 7 – 14, and then 21-28. At the time of writing, the only vaccine licensed for the latter more rapid course is Engerix B and then only for those aged 18 or over. The longer course is always to be preferred as immunity is likely to be longer lasting. In both cases booster dose after a year would be advised.
A BCG vaccination against tuberculosis (TB) is also advisable for tips of two months or more. This should be taken at least six weeks before travel.

Malaria prevention

Malaria is probably the greatest health risk to travellers in Rwanda, although it is less prevalent there than in some other African countries. There is no vaccine against malaria, but using prophylactic drugs and preventing mosquito bites will considerably reduce the risk of contracting it. Seek professional advice to ascertain the preferred anti-malaria drugs from Rwanda at the time you travel. Mefloquine (Lariam) is still the most effective prophylactic agent for most countries in sub-Saharan Africa. If this drug is suggested then you should start taking it at least two and a half weeks before departure to check that it suits you. Stop immediately if it seems to cause depression or anxiety, visual or hearing disturbances, fits, severe headaches or changes in heart rhythm.

Anyone who is pregnant, has been treated for depression or psychiatric problems, has diabetes controlled by oral therapy, or who is epileptic (or has suffered fits in the past) or has a close blood relative who is epileptic (or has suffered fits in the past) or has a close blood relative who is epileptic should not take Mefloquine. Malarone is another very effective alternative if Meflaquine is not recommended, but it is quite expensive and therefore is more suited to shorter trips. It is currently licensed in the UK for trips of up to three months. It is taken once a day, starting two days before arriving into a malarial area, whilst you are there and for seven days after leaving (unlike other regimes, which need to be continued for four weeks after leaving). It is well tolerated and, unlike Merfloquine, can be used by people with depression and /or epilepsy. There is also a paediatric form of Malarone, which can be used for children weighting more than 11 kg. The number of tables given is calculated by weight so it is helpful to know the weight of any children under 40kg travelling with you.

The antibiotic doxycycline (100mg daily) is almost as effective as Mefloquine and Malarone and is much cheaper than the latter so may be more cost-effective for longer trips. Like Malarone, it need only be started one to two days before travel but, like mefloquine, must be taken for four weeks after leaving. It may also be used by travellers with epilepsy, although anti-epileptic therapy may make it less effective. Also there is a possibility of allergic skin reactions developing in sunlight; this occurs in about 1-3% of users. The drug should be stopped if this happens, as there is a risk of more serious allergic reactions. You should then seek medical advice as soon as is practical as to what to do next. Women using the oral contraceptive should use an additional method of protection.

Chloroquine and paludrine should no longer be used for this part of Africa except as a last resort.

Some travellers like to take a treatment for malaria, as well as prophylaxis if they are travelling for more than six months. Whatever you decide, you should take up-to-date advice to find out the most appropriate medication.

There is no malaria transmission above 3,000m; at intermediate altitudes (1,800-3,000m) the risk exists but is low.

In addition to taking anti-malaria medicines, it is important to avoid mosquito bites between dusk and down, which is when the anopheles (malaria-carrying) mosquito is most active. Pack a DEET-based insect repellent, such as one of the Repel range, and take either a permethrin-impregnated bed net or a permethrin spray so that you can treat bed nets in hotels. Permethrin treatment makes even very tatty nets protective and mosquitoes are also unable to bite through the impregnated net when you roll against it. Putting on long clothes (including long-sleeved shirts or blouses) at dusk means you can reduce the amount of repellent needed; but be aware that malaria mosquitoes hunt at ankle level and will penetrate through socks, so apply repellent to your feet and ankles too. Travel clinics usual sell a good range of nets, treatment kits and repellents.

Important.

While you are away, assume that any high fever lasting more than a few hours is malaria, regardless of any other symptoms. Always seek medical help. And remember that malaria may occur anything from seven days into your trip to up to one year after leaving Africa.

Travel Clinics and Health Information.

A full list of current travel clinic websites worldwide is available from the International Society of Travel Medicine on www.istm.org. For journey preparation information, consult www.tripprep.coom. Information about various medications may be found on www.medicine.com. For information on malaria prevention, see www.preventingmalaria.info.