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Sierra Leone - Health and safety
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. Particularly for first-time visitors to Africa, this includes a visit to a travel clinic to discuss matters such as vaccinations and malaria prevention.
- Don’t travel without comprehensive medical travel insurance that will fly you home in an emergency.
- Make sure all your immunisations are up to date. 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. Proof of vaccination against yellow fever is needed for entry for all travellers in to Sierra Leone regardless of age or where you are flying from. The yellow-fever vaccine is very rarely given before nine months of age as there is an increased risk of severe vaccine reactions before this age. Since July 2016, any yellow-fever certificate is considered to last for life if you are over two years of age and/or you are not immunosuppressed at the time of having the vaccine. If either of those criteria applied then revaccination is recommended at ten years. If the vaccine is not suitable for you then you would be wise not to travel, as West Africa has the highest prevalence of yellow fever and there is up to a 50% mortality rate. If the traveller insists on going then they will need a yellow-fever exemption certificate.
- The biggest health threat is malaria. There is no vaccine against this mosquito-borne disease, but a variety of preventative drugs is available, including mefloquine, malarone and the antibiotic doxycycline. The most suitable choice of drug varies depending on the individual and the country they are visiting, so visit your GP or a travel clinic for medical advice. If you will be spending a long time in Africa, and expect to visit remote areas, be aware that no preventative drug is 100% effective, so carry a cure too. It is also worth noting that no homeopathic prophylactic for malaria exists, nor can any traveller acquire effective resistance to malaria. Those who don’t make use of preventative drugs risk their life in a manner that is both foolish and unnecessary.
- Though advised for everyone, a pre-exposure rabies vaccination, involving three doses taken over a minimum of 21 days, 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, suncream, insect repellent, aspirin or paracetamol, antifungal cream (eg: Canesten), ciprofloxacin or norfloxacin (for severe diarrhoea), antibiotic eye drops, tweezers, condoms or femidoms, a digital thermometer and a needle-and-syringe kit with an accompanying letter from a health-care professional.
- Bring any drugs or devices relating to known medical conditions with you. That applies both to those who are on medication prior to departure, and those who are, for instance, allergic to bee stings, or are prone to attacks of asthma.
- Prolonged immobility on long-haul flights can result in deep-vein thrombosis (DVT), which can be dangerous if the clot travels to the lungs to cause pulmonary embolus. The risk increases with age, and is higher in obese or pregnant travellers, heavy smokers, those taller than 6ft/1.8m or shorter than 5ft/1.5m, and anybody with a history of clots, recent major operation or varicose veins surgery, cancer, a stroke or heart disease. If any of these criteria apply, consult a doctor before you 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.
Despite the raised eyebrows and occasional grunts of disbelief that greet the news that you are daring to venture into a one-time warzone and epidemic hotspot, Sierra Leone is today among the safest countries in Africa. Honestly. All arms are now banned from civilian use. United Nations troops left at the end of 2005, and the British-led International Military and Advisory Training Team (IMATT) concluded their mission in 2013. Today IMATT’s successor, the International Security Advisory Team Sierra Leone (ISAT), focuses on advising Sierra Leone’s emergency and security services, including the fire brigades, prison service and coast guard. The UN Integrated Peacebuilding Office in Sierra Leone (UNIPSIL) completed its mandate in 2014, and now the UN is active here only as part of the United Nations Development programme (UNDP), sponsoring poverty eradication and inequality reduction programmes.
Serious crime is relatively low and most people enjoy their stay with no problems at all. Many houses within compounds are guarded by round-the-clock uniformed guards and perimeter walls are often topped with rolls of barbed wire or broken glass. Very occasional armed attacks on households have occurred, but they tend to be targeted and do not normally involve visitors.
Petty crime, pickpocketing and armed mugging are sadly more common, and while still relatively rare overall they are likely to rise in line with urban poverty.
Don’t make mistakes you would never dream of making at home, such as leaving room doors unlocked, or expensive items on show – things will disappear. Plus, if something goes wrong, don’t despair of everyone. A young couple, having had a couple of bags stolen, were approached by the caretaker of the convent they had been staying in. ‘There are some really bad people in Sierra Leone,’ he said, taking them by the hand as a tear ran down his cheek. ‘But don’t forget there are some good ones too.’
Among the few potential trouble spots is the Lumley–Aberdeen beach strip in west Freetown after dark. Muggings and car break-ins are common, and phones, iPods and wallets are regularly stolen. The very southern end near the Golf Club (a regular escape route) is often targeted. Early-morning joggers and anyone on the beach from dusk onwards are at risk, with occasional threats at knifepoint. Save moonlit strolls for the Peninsula. All beach bars, however, are fenced off, with plenty of workers and customers, and are perfectly safe.
Most of the time being on foot downtown attracts a lot of attention, from petty traders, moneychangers and beggars. While some can turn thief quickly, it’s not generally a dangerous place to be in daylight hours. The national stadium – which can seat 40,000 people – offers a field day for light fingers. Burglary, sometimes armed, and street robbery spike in the lead-up to Christmas.
The only thing worse than being robbed is seeing what happens if some poor unfortunate is caught: mob justice looms large on the streets of Freetown, where suspected thieves can be beaten up, belted or worse by angry bands at a moment’s notice. Shout ‘thief’ (or, in Krio, ‘teefman’), and people are likely to give chase, and land some pretty hard punches too if they can. In rare instances teefmen have been beaten to death. The east end is considered the most dangerous part of town, with higher crime rates, and walking in the area after dark is ill-advised.
In rural areas, women should find it possible to travel on their own without encountering too much hassle. Although you are likely to be a constant object of attention, which can be wearing, respect tends to be uppermost in people’s minds. In towns, however, it’s not uncommon for men to accost women out of nowhere with phrases such as ‘I like you’, ‘I want you for friend’ and, pushing the boundaries even of Romeo-esque passion, ‘I love you’. In all cases this pretty much means they want to get it on or, sometimes just as usefully, get a visa.
Claims of a boyfriend or husband, or a strategically placed ring marginally decrease interest, although often this isn’t seen as at all relevant given your assumed mutual ardour, alongside a rather lax interpretation of fidelity. It’s fine to be firm: you won’t offend someone by making your ‘no’ unequivocally clear. As one experienced traveller put it: ‘a sense of humour and willingness to chat rubbish helped, as did claiming not to own a mobile or that it was for work.’
Often, when travelling on buses and other transport, it makes sense to try and build rapport with another friendly-looking woman and, if in doubt, follow her lead. While wearing vest tops tends to be fine, exposing knees or excessive cleavage can be seen as uncouth upcountry. Tampons are available in supermarkets in Freetown, Makeni and Bo but not elsewhere. Sanitary towels are widely available in shops and even market stalls in reasonably sized towns nationwide.