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Malawi - Health and safety
With Dr Felicity Nicholson. For up-to-date information on health issues across Africa, click here.
People new to Africa often worry about tropical diseases, but if you take the appropriate precautions, it is accidents that are more likely to carry you off. Road accidents are very common in many parts of Malawi, so be aware and do what you can to reduce risks: try to travel during daylight hours and refuse to be driven by a drunk. Listen to local advice about areas where violent crime is rife, too.
Preparations to ensure a healthy trip to Malawi require checks on your immunisation status: it is wise to be up to date on tetanus, polio and diphtheria (now given as an all-in-one vaccine, Revaxis, which lasts for ten years), typhoid and hepatitis A. Immunisations against rabies and hepatitis B may also be recommended. Proof of vaccination against yellow fever is needed for entry into Malawi if you are coming from a yellow fever endemic area. Immunisation against cholera may be recommended for Malawi, especially if there is a known outbreak.
Hepatitis A vaccine (eg: Havrix Monodose or Avaxim) comprises two injections given about a year apart. The course costs about £100 but may be available on the NHS, protects for 25 years and can be administered even close to the time of departure. Hepatitis B vaccination should be considered for longer trips (two months or more) or for those working with children or in situations where contact with blood is likely. Three injections are needed for the best protection and can be given over a three-week period if time is short for those aged 16 or over. Longer schedules give more sustained protection and are therefore preferred if time allows and have to be used for those under 16. Hepatitis A vaccine can also be given as a combination with hepatitis B as ‘Twinrix’, though two doses are needed at least seven days apart to be effective for the hepatitis A component, and three doses are needed for the hepatitis B. Again this schedule is only suitable for those aged 16 or over.
The newer injectable typhoid vaccines (eg: Typhim Vi) last for three years and are about 85% effective. Oral capsules (Vivotif) may also be available for those aged six and over. Three capsules over five days lasts for approximately three years but may be less effective than the injectable forms depending on how they are absorbed. Typhoid vaccination should be encouraged unless the traveller is leaving within a few days for a trip of a week or less, when the vaccine would not be effective in time. Vaccinations for rabies are ideally advised for everyone, but are very important for travellers visiting more remote areas, especially if you are more than 24 hours from medical help and definitely if you will be working with animals.
Experts differ over whether a BCG vaccination against tuberculosis (TB) is useful in adults: discuss this with your travel clinic.
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.
It is difficult to strike the right balance when discussing crime in a country such as Malawi. An analytical understanding of how and where you are most likely to become a victim of crime will not only help prevent such an experience, but it will also allow you to relax in situations where it isn’t a serious concern. African cultures are inherently honest, more so perhaps than ours, and to the average Malawian theft is unspeakably wrong, to the extent that petty thieves are regularly killed by mob justice. Because of this, small-town and rural Malawi remains very safe for travel, because Malawians in general wouldn’t think of robbing a tourist, or anybody else for that matter.
On the other hand, crime abounds in the cities, where petty thieves often work the markets and bus stations targeting any likely victim, and tourists are easily identified as such. Even so, there is no significant risk attached to walking around the city centres by day, though the market area of Lilongwe is very dodgy after dark. Elsewhere, don’t tempt fate by wandering alone along unlit streets at night, or going out with more money than you need. If you need to carry your money on your person, use a hidden money-belt. To avoid revealing its location in public, keep whatever spare cash you are likely to need elsewhere. Don’t wear jewellery of financial or sentimental value, and if you can, leave that give-away daypack in your hotel room. Finally, when in doubt, use a taxi – they are very cheap in the cities.
Many travellers routinely carry their money-belt on their person, even walking around a city at night. Anecdotal evidence gathered over years of African travel suggests this is not a good idea, as muggings, snatchings and pickpocketings are far more common occurrences than a locked room being broken into. Obviously, an element of judgement comes into this: if a room feels insecure or a hotel has a bad reputation, don’t leave anything of importance in it. And when you do leave stuff in a room, check that the windows are sealed and the door is properly locked. One factor to be considered is that some travellers’ cheque companies will not refund cheques stolen from a room.
In Malawi, crime against tourists occurs mostly in a few particular ‘trouble spots’ in the cities and along the lakeshore. The pattern appears to be a sudden outbreak of mugging and snatch thefts in one particular resort, followed by a quiet period, indicating that these robberies are largely the work of one particular gang which is eventually arrested or moves on. Lilongwe, Blantyre, Nkhata Bay, Cape Maclear and Salima have all experienced problems of this sort in the past, so your best course of action is to be cautious when you first arrive at one of these places, and to ask local advice once you are settled in. Camping wild on parts of the lakeshore is no longer advisable anywhere in Malawi, and we’ve heard of several instances of tents being broken into at ‘proper’ campsites.
Be cautious of people who befriend you on buses and offer you food or drink, because it appears that the practice of doping travellers in this manner has spread into Malawi. It’s worth noting that con tricks are most likely to be perpetrated by a smartly dressed, smooth-talking guy who can easily build up a rapport with a traveller.
For all the above, Malawi remains a remarkably friendly and honest country. What most often gets travellers into trouble is one moment of recklessness – walking around Nkhata Bay at night with a money-belt on, wandering around Lilongwe market with a daypack dangling off your shoulder, dithering in a city bus station with a map in your hand and puzzled expression on your face, arriving in a city at night and not using a taxi to get to a hotel. Focus your energy on recognising high-risk situations, and do all you can to avoid them. The rest of the time, so long as you conduct yourself sensibly, you have little to fear in terms of crime!
Sub-equatorial Africa is probably one of the safest places in the world for women to travel solo, and Malawi poses few risks specific to female travellers who apply the same common sense they would at home. Unwanted flirtation and the odd direct sexual proposition are a possibility, especially if you mingle with Malawians in bars, but a firm ‘no’ should defuse any potentially unpleasant situation. Men in Malawi probably constitute less of a sexual hassle than men in many Western countries, and for that matter than other male travellers.
Most Malawians have better things to worry about than how female tourists choose to dress, especially in established resort areas. That said, it would be insensitive to wear shorts or a revealing top in areas with a strong Islamic presence, or in villages where tourists are still relatively unusual. Unlike during the Banda era, however, it is no longer illegal or even unusual for women to wear trousers as opposed to a skirt.
Any female (or, for that matter, male) readers concerned about travelling alone in Malawi, but unable to find a travel companion, might be reassured by the thought that there are plenty of places in Malawi where it will be easy to meet with kindred spirits, and there’s a lot to be said for hooking up with people along the way – better, by far, than making an advance commitment to travelling with somebody who you don’t know well enough to be sure they’ll be a suitable travel companion.