With Dr Felicity Nicholson. For up-to-date information on health issues across Africa, click here.
Rwanda itself isn’t a particularly unhealthy country for tourists and you’ll never be far from some kind of medical help. The main towns have hospitals (for anything serious you’ll be more comfortable in Kigali) and all towns of any size have a pharmacy, although the range of medicines on sale may be limited. In Kigali, the pharmacy in Boulevard de la Révolution is open 24 hours.
Away from Kigali, district hospitals and health centres are spread countrywide. A health centre generally has around five nurses, supported by a doctor and community health workers. In rural areas traditional medicine is also widely used. The ratios of about 1,300 inhabitants per nurse and 12,000 per doctor are high; however, in July 2012 former US president Bill Clinton announced a seven-year programme, supported by the medical faculties of 13 US universities, to train up existing medical personnel so that they in turn can train effectively. The growing private sector has more than 310 clinics and dispensaries. The incidence of HIV/AIDS is hard to estimate accurately but seems at last to be falling, thanks to preventive measures and the wider availability of antiretroviral drugs.
The most serious health threat to travellers in Rwanda is malaria. Akagera National Park and other low-lying parts of the east qualify as high risk malarial areas, especially in the rainy season. The risk exists but is far lower in highland areas such as Kigali, Butare, Nyungwe National Park, the Virunga Mountains and foothills, and the Lake Kivu region. Nevertheless, all visitors to Rwanda should take preventative measures against malaria, and be alert to potential symptoms both during their trip and after they return home.
Other less common but genuine health threats include the usual array of sanitation-related diseases – cholera, giardia, dysentery, typhoid etc – associated with the tropics (though these seem to affect visitors to Africa less than they do travellers in Asia), and bilharzia, which can only be caught by swimming in freshwater habitats inhabited by the snail that carries the disease.
If you do get ill in Rwanda, bear in mind that the most likely culprit – as in most parts of the world – will be the common cold, flu or travellers’ diarrhoea, none of which normally constitute a serious health threat. However, travellers with overt cold- or flu-like symptoms might not be allowed to track gorillas or chimpanzees, both of which are susceptible to infectious airborne human diseases and may lack our resistance.
Preparations to ensure a healthy trip to Rwanda 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, that lasts for ten years), and hepatitis A.
Immunisations against meningococcus and rabies may also be recommended. Proof of vaccination against yellow fever is needed for entry into Rwanda for all travellers over one year of age, regardless of where you are coming from. If the vaccine is not suitable for you, discuss your options with a travel-health expert; if you decide to visit Rwanda regardless, obtain an exemption certificate from your GP or a travel clinic, and try to avoid the day-biting mosquitoes that spread the disease. Immunisation against cholera may also be recommended for Rwanda.
Hepatitis A vaccine (Havrix Monodose or Avaxim) comprises two injections given about a year apart. The course costs around £100, but in the UK may be available on the NHS; it 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 for those aged 16 or older if time is short. Longer schedules give more sustained protection and are therefore preferred if time allows and must 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 can only be used by 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. A dose of three capsules over five days lasts for approximately three years but may be less effective than the injectable forms. They 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. Meningitis vaccine containing strains A, C, W and Y is recommended for all travellers, especially for trips of more than four weeks. Vaccinations for rabies are ideally advised for everyone, but are especially 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.
In addition to the various vaccinations recommended above, it is important that travellers should be properly protected against malaria. Ideally you should visit your own doctor or a specialist travel clinic to discuss your requirements, if possible at least eight weeks before you plan to travel.
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.
So far as tourists need be concerned, Rwanda is among the most crime-free of African countries. Kigali is a very safe city, even at night, though it would probably be courting trouble to stumble around dark alleys with all your valuables on your person. Be aware, too, that this sort of thing can change very quickly: all too often, as tourism volumes increase, so too does opportunistic and petty crime.
The following security hints are applicable anywhere in Africa:
- Most casual thieves operate in busy markets and bus stations. Keep a close watch on your possessions in such places, and avoid having valuables or large amounts of money loose in your daypack or pocket.
- Keep all your valuables and the bulk of your money in a hidden money belt. Never show this money belt in public. Keep any spare cash you need elsewhere on your person – a button-up pocket on the front of the shirt is a good place as money cannot be snatched from it without the thief coming into your view. It is also advisable to keep a small amount of hard currency (ideally cash) hidden in your luggage in case you lose your money belt.
- Where the choice exists between carrying valuables on your person or leaving them in a locked room I would favour the latter option (thefts from locked hotel rooms are relatively rare in Africa). Obviously you should use your judgement on this and be sure the room is absolutely secure. Bear in mind that some travellers’ cheque companies will not refund cheques which were stolen from a room.
- Leave any jewellery of financial or sentimental value at home.