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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.
Preparations to ensure a healthy trip to Sierra Leone 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 Sierra Leone even if you are arriving from an area where the disease is not endemic. The World Health Organization (WHO) recommends that this vaccine should be taken for Sierra Leone by those over nine months of age, although proof of entry is only officially required for those over one year of age. If the vaccine is not suitable for you then obtain an exemption certificate from your GP or a travel clinic, but as the disease is potentially fatal, careful consideration should be given as to whether travel without vaccination is safe. Immunisation against cholera may be recommended for Sierra Leone if you are travelling to more remote parts of the country. The vaccine (Dukoral) is available as an oral preparation which comprises two doses for those aged six and over taken at least one to six weeks apart and at least one week before entry into the affected area. For those under six a third dose is required so ensure that you leave enough time before you travel.
Hepatitis A vaccine (Havrix Monodose or Avaxim) comprises two injections given about a year apart. The course costs about £100, but 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 if time is short for those aged 16 or over. Longer schedules give more sustained protection and are therefore preferred if time allows. 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. This vaccine can only be used for those aged 18 or over.
The newer injectable typhoid vaccines (eg: Typhim Vi) last for three years and are about 85% effective. Oral capsules (Vivotif) are available in both the US and UK 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. 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, ideally the conjugate form (eg: Menveo), 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, particularly 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.
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 you are daring to venture into a one-time warzone, 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 only international military presence today comes from the dwindling numbers of the British-led International Military and Advisory Training Team (IMATT). Now a small team of UN core staff focuses on governance, peacebuilding and promoting human rights, and all police and security advisors have left.
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.