With Dr Felicity Nicholson. For up-to-date information on health issues across Africa, click here.
Sensible preparation will go a long way to ensuring your trip goes smoothly, so make sure all your immunisations are up to date. A yellow fever certificate is required from travellers coming from yellow fever areas, but there is no risk from the disease in Madagascar itself. Make sure you also have insurance covering the cost of helicopter evacuation and treatment in Réunion or Nairobi, which offer more sophisticated medical facilities than are available in Madagascar.
The biggest health threat is malaria and while there is no vaccine against this dangerous mosquito-borne disease, malarone, mefloquine (Lariam) and doxycycline are reasonably effective preventative drugs against the strains found in Madagascar. Madagascar is also classified as a high-risk country for rabies, so vaccination is advisable, which involves three doses taken over a minimum of 21 days. This is particularly important if you intend to have contact with animals, or are likely to be 24 hours away from medical help.
Anybody travelling away from major centres should carry a personal first aid kit. Contents might include a good drying antiseptic (eg: iodine or potassium permanganate), Band-Aids, aspirin or paracetamol, antifungal cream (eg: Canesten), ciprofloxacin or norfloxacin (for severe diarrhoea), antibiotic eye drops, tweezers, a digital thermometer and a needle-and-syringe kit with an accompanying letter from a healthcare professional. Also remember your suncream, insect repellent, mosquito net, anti-malarial prophylaxis and contraceptives, as appropriate.
Tablets do not give complete protection from malaria (though it will give you time to get treatment if it does break through) and there are other insect-borne diseases in Madagascar so it is important to protect yourself from being bitten. The Anopheles mosquitoes that spread malaria usually bite from dusk to dawn, so it is wise to dress in long trousers and longsleeved shirts, and to cover exposed skin with insect repellent especially in the evenings. In most countries, malaria transmission is rare in urban environments, but it does occur around Antananarivo because rice fields are so close to the city. Most hotels have screened windows or provide mosquito nets, but bring your own freshly impregnated net if staying in cheap hotels. Check the walls of your room for mosquitoes at bedtime and consider burning mosquito coils overnight. The symptoms are fevers, chills, joint pain, headache and sometimes diarrhoea – in other words the symptoms of many illnesses including flu. Malaria can take as little as seven days to develop but consult a doctor if you develop a flu-like illness within a year of leaving a malarial region. The life-threatening complication of cerebral malaria will become apparent within three months and can kill within 24 hours of the first symptoms (extreme shaking, fever and sweating; seizures; impaired consciousness; and neurological abnormalities).
The combined medicine artemether and lumefantrine, available in Malagasy pharmacies under the name Coartem, is an effective treatment for uncomplicated infections by the most serious strain of malaria. Mosquitoes also pass on Rift Valley fever, elephantiasis, dengue and other serious viral fevers.
Travel clinics and health information
A full list of current travel clinic websites worldwide is available on www.istm.org. For other journey preparation information, consult www.travelhealthpro.org.uk (UK) or http://wwwnc.cdc.gov/travel/ (US). Information about various medications may be found on www.netdoctor.co.uk/travel. All advice found online should be used in conjunction with expert advice received prior to or during travel.
Before launching into a discussion on crime, it’s worth reminding that by far the most common cause of death or injury while on holiday is the same as at home: road accidents. Violence is rare in Madagascar and most visitors return home after a crime-free trip, with fond memories of touchingly honest locals. But this is one area where being forewarned is forearmed: there are positive steps that you can take to keep yourself and your possessions safe.
Tips for avoiding robbery
- Remember that most theft occurs in the street not in hotels; leave your valuables hidden in a locked bag in your room or in the hotel safe.
- If you use a hotel safe at reception, make sure your money is in a sealed envelope that cannot be opened without detection. There have been cases of the key being accessible to all hotel employees, with predictable results.
- If staying in budget hotels bring a rubber wedge to keep your door closed at night. If you can’t secure the window put something on the sill which will fall with a clatter if someone tries to enter.
- Carry cash in a moneybelt, neck pouch or deep pocket. Wear loose trousers with zipped pockets. Keep emergency cash (dollars/euros) in a very safe place. Keep a small amount of cash in a wallet that you can give away if threatened.
- Divide up cash and cards so they are not all in one place. Keep photocopies of important documents in your luggage.
- Remember, what the thief would most like to get hold of is money. Do not leave it around (in coat pockets hanging in your room, in your hand while you concentrate on something else, in an accessible pocket while strolling.
- In a restaurant never hang your bag on the back of a chair or lay it by your feet (unless you put your chair leg over the strap).
- For thieves, the next best thing after money is clothes. Avoid leaving them on the beach while you go swimming (in tourist areas) and never leave swimsuits or washing to dry outside your room near a public area.
- Bear in mind that it’s impossible to run carrying a large piece of luggage. Items hidden at the bottom of your heaviest bag will be safe from a grab-and-run thief. Pass a piece of cord through the handles of multiple bags to make them one unstealable unit when waiting at an airport or taxi-brousse station.
- Avoid misunderstandings – genuine or contrived – by agreeing on the price of a service before you set out.
…and what to do if you are robbed
- Have a little cry and then go to the police. They will write down all the details then send you to the chief of police for a signature. It takes the best part of a day, and will remind you what a manual typewriter looks like, but you will need the certificate for your insurance. If you are in a rural area, the local authorities will do a declaration of loss.
Foreign ladies travelling without male company are likely to encounter a few local men who think it’s worth trying their luck. A firm refusal is usually sufficient. Try not to be too offended; think of the image of Western women that the average Malagasy male is shown via the cinema or TV. A woman Peace Corps volunteer gives the following advice for women travelling alone on taxi-brousses: ‘try to sit in the cab, but not next to the driver; if possible sit with another woman; if in the main body of the vehicle, establish contact with an older person, man or woman, who will then tend to look after you’. Common advice is to wear a ring and say you are married, which most readers report to be effective in Madagascar, although reader Phoebe Mottram notes that most men are undeterred if you say you have a husband who is back home. Her advice is to perfect your story in advance, for example that your husband works in Madagascar and you are just on your way to meet him. She adds that being young, female and alone worked in her favour in the vast majority of situations, as locals would be less wary of making friendly contact and more willing to look out for you and make sure you are all right.
In tourist spots, particularly in beach resorts, lone male travellers may find themselves pursued or harassed. Prostitutes are ubiquitous and beautiful, but venereal disease is common, and prostitutes have been known to drug a tourist’s drink to render him unconscious then rob his possessions.
Authorities clamp down hard on sex tourism, especially with underage girls. Considering the risks you would be foolish to succumb to temptation.
Travelling with a disability
It is not easy to find disabled-friendly accommodation in Madagascar. An increasing number of the higher-end hotels are beginning to offer one or more ‘accessible rooms’ but what they mean by this varies widely as there is no effective Malagasy legislation that sets a standard.
At airports, there should always be help available, including wheelchairs, but if you cannot walk at all you may need to be manhandled – without an aisle chair – to and from the aircraft. Public transport is generally very crowded with no concessions to disabled travellers so, in general, a hire car would be preferable. Keep in mind that distances are great and roads often bumpy, so if you are prone to spin damage you need to take extra care. Everywhere in Madagascar, pavements are frequently unsurfaced or uneven, steps often irregular, and open drains are not uncommon, so wheelchair users and visually impaired travellers need to be aware of these challenges.
Although the majority of Madagascar’s wildlife highlights are not disabled friendly, there are two outstanding exceptions. The luxurious Anjajavy resort has villas, of which one is officially accessible and Berenty has broad, smooth, well-maintained forest paths. The ideal route for a disabled traveller would be RN7 from Antananarivo to Toliara by hired car and driver.
Across most of the country, clinics and pharmacies are often basic and poorly stocked. Make sure you can fully explain your particular medical requirements and have your own supplies of any essential medication and equipment with you.
Travelling with children
The Malagasy people are very child-friendly although facilities typically are not. Travelling with children in Madagascar should not be undertaken lightly, but with the right preparation it can be a fun and rewarding experience.
High chairs and cots are generally only found in top-end establishments and not commonly outside of the capital. But you will always find staff to be accommodating – offering to store baby formula in the chef ’s fridge or helping to organise a babysitter.
If you’ll be walking in national parks, it is useful to have some means of carrying young children when they get tired. ‘Even in towns, strollers are almost entirely useless – much better to invest in a good kid carrier/backpack to tote your little one around the island. And if you plan to travel by car, you will want to bring a car seat’ (Kyle & Monika Lussier).
Gay and lesbian travellers
Madagascar is one of the few African countries where homosexuality is not a crime, although the age of consent is higher: 21 (as opposed to 14 for heterosexual sex). There is general societal discrimination – and no laws prohibiting such discrimination – but travellers are unlikely to suffer open hostility. Public displays of affection are nevertheless best avoided.