Safety is a major concern for everyone, and it is a recurring topic in the emails I receive. I want to emphasise two general points about this subject that are applicable worldwide. Firstly, absolute security does not exist and is largely a superstition. No matter how safe we feel, unexpected events can occur at any time and place. Secondly, to travel safely, the most crucial factors are using common sense and being attentive to it. In my experience, these qualities protect us from most potential dangers in life.
Speaking from my experience, Africa is a continent where I generally felt secure most of the time. The moments of insecurity were mostly a result of knowingly exposing myself to higher risks, even though I could have avoided them. It is important to note that I always felt safe, protected, and loved thanks to the African people in every corner of the continent.
Now, let's address specific security considerations in Africa:
1. Traffic: Traffic poses significant risks when traveling by bicycle, particularly in countries like Egypt (Cairo), Nigeria, Kenya, and Tanzania. It is advisable to avoid main thoroughfares between capital cities or major cities, as they can be dangerous. Opt for secondary or rural roads whenever possible. If necessary, exercise extreme caution on major roads and exit them as soon as you can. If the stretch is excessively hazardous, prioritise your safety and ask for a ride to a safer location. Traffic accidents are among the worst risks when cycling, so it's best to avoid them.
2. Slums in big cities: While most people living in slums are adorable and trustworthy, there may be individuals who pose a threat. In cities with a reputation for being unsafe, such as Johannesburg, Cape Town, Nairobi, and Lagos, it is better to avoid slum areas or those cities altogether. If you do visit these places, seek advice from locals, travel during daylight hours, and stick to very populated areas. Also, I believe that for every person who may be out there to harm or steal from you, there are likely thousands who would protect you in Africa.
3. Wildlife: Exploring remote regions off the beaten track exposes you to potential risks from wild animals. I’ve certainly got into really dangerous situations. Consult locals and plan your route accordingly to avoid these areas if you are not comfortable with the potential danger.
4. Camping: When it comes to camping, I follow a simple rule to maximise safety: either camp with people or camp completely away from them. Seek permission and recommendations from locals in towns or villages where you plan to camp, or camp in secluded natural areas where no one can see you. Avoid camping in areas where you are visible but separate from others. In Africa, you can always approach the village chief for permission to camp, and they will assist you or guide you to a safe camping spot.
5. Malaria: Malaria is a significant concern in many parts of Africa. There’s a dedicated section on this disease below, but for now, be aware that it requires necessary precautions.
6. Regions with political or social instability: It goes without saying that venturing into such areas is ill-advised. Again, I have done it many times but just because I am alive and have never been kidnapped does NOT mean it was safe and that it was not a STUPID risk to take. That said, although some regions in Africa may have instability, access is often restricted, and the instability is limited to specific spots, not the entire country or region. Stay informed, always ask the locals, and relevant authorities as you approach areas with potential instability. Always, I stress: ALWAYS follow common sense and your gut. It is important to remember that stability in various countries can change rapidly. Stay vigilant, consult locals and authorities, and make informed decisions accordingly.
The situation regarding visas and entry permits in African countries varies widely, ranging from easy and accessible to virtually impossible and inaccessible, with numerous levels of bureaucratic challenges in between. It would be impractical and time-consuming to discuss visas individually, as policies in much of Africa tend to be unpredictable and subject to frequent changes. Rules may fluctuate from one day to the next, depending on the president's mood or whims. Such unpredictability can even force us to alter our entire travel plans. Requirements, prices, and points of entry can change unexpectedly. It is important to note that my experience and information are valid only for the period when I was on the continent between 2014 and 2017.
Furthermore, visa requirements and regulations vary based on our country of origin and the passport we hold. In my case, I travel with Argentine and Italian passports, and I have used both without significant difficulties, depending on the particular benefits each provides. Generally, I did not encounter any significant differences between the two nationalities, but it is crucial for each individual to research the visa policies that apply to their specific country. Please refrain from asking me questions about individual countries that is your job.
One important point to note is that South Africa does not recognise dual citizenship, making it impossible to switch passports upon entering the country. This also applies to neighbouring countries like Lesotho and Eswatini (Swaziland). I had this problem in all of them, in which I couldn’t switch back to my Argentine passport coming out of Mozambique where I had used my Italian one.
As a general rule, visas in the eastern half of Africa are often easier and less expensive to obtain compared to the western half. In many eastern African countries, visas can be obtained at the borders by simply filling out a form and paying on the spot. In addition, regional visas such as the East African visa, which covers multiple countries, are available. However, in many countries in the western half, the visa application procedures are complex, requiring extensive documentation, letters of invitation, substantial funds, and considerable time, along with patience, resourcefulness, and perseverance.
It is important to understand that visas are typically obtained as we progress through our trip. Applying in advance for multiple visas simultaneously is practically impossible when traveling by bicycle. Therefore, this is a matter that needs to be addressed individually by contacting embassies directly, either by phone or in person. You can also run internet searches, and try to connect with fellow travellers who have recently been or are currently in the regions you plan to visit. As much as I despise Facebook, there’s a very useful group called Every Passport Stamp, that has great resources.
Planning a route that perfectly aligns with favourable climate conditions can be exceedingly challenging. However, there are general guidelines that can help optimise the experience. Two key factors to consider for most trips are the summer in the Sahara and the prevailing wind in North Africa. Consequently, many people choose to commence their African journey from either the east or the west, traveling from north to south (with the dominant wind at their backs) during the beginning of winter or late autumn in Egypt or Morocco. This strategy avoids the unbearable and perilous heat of the long Saharan summer, as well as the relentless and arduous headwinds encountered when approaching from the south. Naturally, this is more straightforward for those cycling only one half of the continent or a few countries.
For those embarking on a full-length African cycling adventure, compromises must be made, and inevitably, challenging conditions will be faced. In my case, I encountered both extremes. Departing late from Cairo exposed me to temperatures of up to 60°C (140°F) in Sudan during April and May ( Before some jerk points out that nothing above 45°C has been registered in the history of the region, I’m talking about cycling under the sun temperature, it is less in the shade when stopped, but you are cycling, right?). In addition, I endured the infernal northerly winds in Senegal, Mauritania, and Western Sahara, which presented one of the most demanding physical and mental trials I have ever experienced on a bicycle.
Regarding sub-Saharan Africa, the decisive factor is the rainy season, which renders many sections of tropical regions and equatorial rainforests impassable outside of the main roads. While it doesn't hinder the continuation of the journey, it significantly restricts the overall experience and heightens the risk of contracting malaria due to increased mosquito presence.
In conclusion, it is essential to acknowledge the inherent difficulty in planning a perfect route. Unless one has several years to travel and can adjust the pace to align with optimal seasons in each region, there will always be instances where the weather's harshness must be faced. The key is to organise as thoroughly as possible to minimise exposure to these challenging conditions.
As evident from BBC and National Geographic documentaries, Africa is home to many regions where encounters with wild animals are possible, especially when travelling by bicycle. It often leaves me dumbfounded when people reading my stories about direct encounters with lions or elephants say, "Wow, that's so cool!" And I can't help but think, "Are you stupid or what?”
Let me make it clear: even if you venture into regions known for wild animals, YOU DO NOT WANT to find yourself face to face with lions, elephants, hippos, hyenas, or others.
Yes, it is freaking fascinating I will concede that, but it’s also unbelievably stupid. I’m nothing but extremely lucky for having made it alive in so many cases, and the terror I experienced a couple of times was awful. It’s one thing to be amazed and fascinated while reading from the safety and comfort of your home, and another to be defenceless in front of these magnificent yet potentially lethal creatures. They can end your life in an instant. I'm sure you don't aspire to be devoured by a pride of lions or trampled by elephants.
Having crossed almost all the wild regions of the continent, I've had encounters, particularly two, during which I genuinely believed I might not survive to recount them. Enduring such encounters is far from pleasant, even if they make for incredible anecdotes afterwards.
If, like me, you choose to take the risk and venture through wild regions, the key to standing a chance of survival is learning extensively about animal behaviour beforehand. That's precisely what I did. However, it's important to emphasise that despite thorough research and knowledge, no method is foolproof, as animals are inherently unpredictable. As a Tanzanian park ranger wisely told me when he found me cycling in the middle of Katavi National Park (a remarkably stupid thing to do): "When you come face to face with a lion, you are not the one who decides how lives.”
Each individual must take responsibility for their actions and ensure they have a sufficient understanding of animal behaviour. Here are some brief tips I've learned from experts along my journey. However, please note that these tips should not replace your own research.
In general, fire is the most effective form of protection against wild animals, as most of them fear fire. If you want the highest degree of safety during nights in wild regions, keep a fire burning throughout the night.
ELEPHANTS: Interestingly, while many people outside Africa fear lions the most, ask any African, and they'll tell you that elephants are the greatest danger. Elephants do not hunt humans for food. They only become aggressive when they feel threatened or endangered, which is entirely justifiable, given that we’ve been exterminating them to get their ivory tusks. Elephants have an exceptional sense of smell. If the wind carries our scent towards them, they can detect us from several kilometres away. This will put them on high alert.
If you encounter elephants on the road, face to face, it is crucial to come to a complete stop and remain still, refraining from any actions that could be perceived as threatening. You must be 100% predictable. It's an incredibly nerve-wracking experience to be so close to them, and it's tremendously challenging to suppress your instinct to flee, but it's absolutely necessary. Attempting to escape by pedalling quickly greatly increases the risk of an stampede. Keep in mind that despite weighing up to 7 tons, elephants can reach speeds of 40 km/h (25 mph), leaving you with little to no chance of escape. When the elephant feels secure again, it will move on, allowing you to continue.
LIONS: The most dangerous lions for humans are the older ones that have lost the necessary speed to hunt prey. These aging lions are also often isolated from the pride and resort to seeking easier targets to avoid starvation. This is where we come in. Although young lions are generally not interested in hunting humans, an encounter with them can still be fatal.
Lions primarily hunt from dusk until dawn, and they spend most of the day resting. It is rare for them to be interested in humans during daylight hours, unless they are old and desperate. Nevertheless, it is crucial to avoid encounters with lions at all costs.
If you spend nights in lion territory, IT IS IMPERATIVE to keep a fire burning throughout the night if you want to be on the safer side.
Whether you have a fire or not, lions generally do not break into tents. If you are inside your tent and remain unseen by them, they will likely disregard it as any other inanimate object. Therefore, after finishing cooking and eating, preferably before sunset, enter your tent and refrain from leaving until the following morning unless you are keeping your fire going.
In the event of a lion sighting, a Namibian conservation expert who gave me advice in a lion-infested area I cycled through, echoed by several others, said: "If you are on a bicycle and spot a lion ahead, DO NOT stop. Keep pedalling at a constant speed, neither speeding up nor slowing down. This will confuse the lion, as it will mistake you for a vehicle and ignore you. If the lion is behind you and you accelerate, you will undoubtedly become its prey, as your flight will trigger its hunting instinct." The same advice applies to encounters with hyenas. Although I never experienced this myself, needless to say, when I cycled through lion territory, the mere thought of being next to one terrified me. Let alone maintaining a constant speed without succumbing to a nervous breakdown. As I mentioned earlier, YOU DO NOT WANT to run into them.
HYENAS: One hyena alone is not typically dangerous, but running into a group can result in certain death. Unlike lions, hyenas will break into tents, providing no protection. They will tear your tent apart to devour you, as tragically happened to a motorcyclist camping in a remote area of Kenya. Fire offers the best chance of protection since you cannot predict whether one or a group of hyenas will visit during the night. If you don't have a fire, the likelihood of surviving such an encounter is slim to none. I will certainly include your story in this article to prevent it from happening to others.
HIPPOS AND BUFFALOS: Never obstruct their paths and keep a safe distance from them. These animals are highly territorial and easily irritated.
GORILLAS: If you are like me and find them in the wild instead of in a 1000$ per-day tour, keep a very safe distance from them. Be predictable and don't do anything stupid like trying to pat them. Stay away and marvel at their sheer beauty and grandiosity.
The rest of the animals are just fine. It is lovely to see giraffes and zebras staring at you, springboks, irix and other antelopes running by, warthogs and monkeys jumping across the roads.
You may be wondering how to keep a fire burning all night. Firstly, I recommend setting up camp well before sunset in an area where there is an abundant supply of dry shrubs nearby. Before pitching your tent, spend the first 15 to 20 minutes gathering firewood. Once you have a sufficient amount, ignite the fire. From then on, continue collecting additional firewood to ensure you have enough to last the entire night. Keep the pile within reach next to your tent's entrance, with the fire positioned about a meter away. Depending on the rate of consumption, set an alarm clock to wake you every one or two hours. When it starts to go off, reach out of the tent, somewhat groggy, and add more firewood to the flames. Then return to sleep for another hour, repeating the process until the morning.
This part is really personal, and it's all about what you prefer and what choices you make. Personally, I don't plan my routes too far in advance. Usually, there are specific places I know I want to visit and things I don't want to miss. Based on that, I start connecting the dots and figuring out how to get in and out of those places. Of course, there are also necessary stops, like border posts and visa applications in capital cities.
Let me give you an example of how I go from the general to the specific. I would start with the following premise: "I want to cycle across the entire African continent. I know I definitely want to visit certain countries, and within those countries, there are specific places I want to see." Let's say I have to go through Ethiopia. I know I'll be entering from Sudan and continuing all the way to Kenya. Once I'm in Ethiopia, I definitely want to visit the rock churches of the Tigray region and explore the tribal regions of the Omo Valley. Further along, I know I want to visit the tribes around Lake Turkana in Kenya. I also know that I need to get my Kenyan visa in Addis Ababa because I can't get it at the Lake Turkana border crossing. With all this in mind, all that's left is to connect the dots. It's important to note that this plan is completely flexible, and I can adjust it as many times as I want based on whatever happens along the way.
I usually don't carry maps with me, but if I come across someone who has some, I'll take pictures of them with my camera for later reference. I also take screenshots of Google Maps when I have internet access, although I don't fully trust them as a reliable source, especially in Africa where they have caused more problems than solutions for me. I do have a GPS, but I mainly use it to mark the places where I sleep, so I can look back on my route for fun in the future. If you have a GPS, I highly recommend downloading the free maps from Velomap. They're not perfect, but they're the most comprehensive ones available for Africa. If you find them useful, consider donating some money to the author for creating such a valuable resource for all of us.
But you know what my biggest and most reliable reference is? Talking to the local people as I go along. They are my true guides. If I want to avoid main roads and stick to small towns and villages, I simply ask people for their advice on how to do that. This way, I build my route as I go, making decisions day by day.
So, in a nutshell, my approach is flexible and spontaneous, relying on local knowledge and my own intuition. It keeps the adventure alive and allows for unexpected discoveries along the way.
In Africa, I have camped in the wild dozens of times. Wild camping aside, I have also slept in churches, schools, clinics, hospitals, brothels, police stations, fire stations, service stations, rangers’ posts, infirmaries, public and private offices, back and front yards, abandoned buildings, border posts, cemeteries, huts, houses of friends or local people, in the houses of members of Couchsurfing or Warmshowers, and even in a morgue once. A handful of times, I have paid for accommodation as well.
Africa is the easiest place on the planet to find a safe place to sleep every night so it should be the least of your concerns. You do need to use your imagination and improve the stretch of your flexibility. If you aren't willing to do that, pay for hotels.
Food availability, quality, and variety vary greatly across the African continent. In Arab Africa, particularly in the northern regions, the food is fantastic. There's a wide range of choices, low cost, and exquisite flavors, especially if you enjoy North African and Middle Eastern cuisine.
In South Africa and its surrounding countries, there's a high availability and variety of food. South African supermarket chains offer everything you would find in economically developed countries, making it easy to stock up at affordable prices.
The real challenge lies in sub-Saharan Africa. In the eastern half, there is limited variety, but there is generally decent access to food in most countries, along with flavorful dishes and the availability of fruit. However, in the western half, from Namibia to Senegal, things are much more limited overall, even in the capitals. The equatorial regions and the Sahel pose even greater difficulties, with many areas lacking access to fruit. I've spent months in Central Africa and the Sahel eating the same tasteless food repeatedly, and it took a toll on my body.
In these regions, when I had to cook for myself, I relied on a basic menu of cheap pasta or rice, accompanied by processed tomato paste from suspicious sachets and cans of Moroccan sardines, which are widely available everywhere. In villages and towns across sub-Saharan Africa, the staple food often consists of dry dough made from manioc (cassava flour) in the west and center, or maize flour in the east and south, served with the typical local garnishes of each country. Meat is rare and expensive for locals, but if available, it's usually chicken or bush meats like monkey, porcupine, rodents, and small antelopes sourced from the jungle. I've tried them all.
In the west and central regions of Africa, the only relief can be found in the capitals, where Lebanese immigrants who have been settled in the region for generations own supermarkets. The costs are higher compared to African standards because most products are imported from Europe, but at least there is access to better-quality food, which is essential after weeks of poor eating.
In Africa, except for the more remote regions like the equatorial rainforest and the Sahel, it's uncommon to go a whole day without access to electricity. However, outside of North Africa and South Africa, access to electricity can be unreliable, and it's rare to find places with uninterrupted 24-hour power. Blackouts are frequent and can last for several hours or even the entire day. So, while access to electricity is generally frequent, it can also be limited.
In villages and small towns without a power grid, people often rely on electric generators to light their homes at night and charge their mobile phones. These generators are usually turned on for a few hours in the early evening.
Additionally, in many towns, you'll find small stalls where you can pay a few coins to have your electronics charged.
In remote regions, the situation becomes notably more challenging. During my three-month journey through the jungles of Central Africa, I had very limited access to electricity outside of major towns, sometimes as little as three or four hours per week. However, it's important to note that you have to venture quite deep into the wilderness to encounter such circumstances. Otherwise, the situation is not as dire.
My strategy in remote areas is simple: I become extremely cautious with the use of LCD screens on all my devices and charge my batteries at every opportunity. For example, if I come across a village or town with a canteen, service station, or public office that has electricity, I take the chance to rest, grab a meal, and plug in all my devices for as long as I'm there. I don't necessarily need everything to be fully charged, but I never waste a minute to keep adding charge since I never know when the next opportunity will arise. This approach mostly applies to charging batteries. Using a computer in remote regions is usually out of the question.
With the incredible diversity of tribes and ethnic groups in Africa, each speaking hundreds of different languages and dialects, it can feel overwhelming at first. But let me assure you, it shouldn't be. From big cities to small villages, you'll find people who speak the colonial languages most of the time. By having a good grasp of English, French, and Portuguese—the main languages of the former colonies—you can navigate the entire continent with ease. Knowing Arabic can be a great advantage in the north, but it's not absolutely necessary. The only exception would be the tribal regions where only local dialects are spoken, but most of the time you won't find yourself in those areas. In such cases, sign language is always reliable for communication if we approach it with goodwill, good humor, and a genuine desire to connect.
Note: my trip went from 2014 to mid-2016. Technology evolves at a super faster pace, even in Africa, so the information I provide here is the most likely to be outdated by the time you read this. Still, on high-level, it might remain useful.
In these times of compulsive connectivity, I have to say that crossing two-thirds of the African continent without a mobile phone and limited internet access for the remaining third has been an absolute joy for me. I'm really proud and happy about it. My only lifeline to the world was relying on Wi-Fi whenever I stumbled upon it, using my trusty computer or iPod Touch.
In Africa, finding Wi-Fi can be more challenging compared to accessing mobile phone networks. This will definitely put those with a severe addiction to connectivity at ease (if it's even possible for them to be at peace with this condition). The mobile phone network in Africa is highly developed, and except for the most remote regions, it's easy to get connected at a ridiculously affordable price that hardly makes a dent in your travel expenses. Every country has one or two major telecom companies dominating the whole continent—like the South African MTN, the French Orange, or the Indian Airtel—they've pretty much divided the cake amongst themselves.
However, just like with electricity, having access to the network doesn't necessarily mean it's reliable. It's only logical that you'll find the fastest speeds in the capital cities. But once you venture out of them, the speed can drop dramatically until you reach points where, despite having a signal, it's practically unusable. But I believe that this will significantly improve over time. Even in today's world, in 2019, you can already witness travelers live-streaming high-quality videos on Instagram from various regions of Africa.
So, if you're worried about staying connected, rest assured that mobile networks are prevalent throughout Africa. Just be prepared for some fluctuations in speed and availability as you venture further away from the cities. But hey, that's part of the adventure, right?
When it comes to water, the golden rule is pretty simple: wherever there are people, there will always be water to drink, and in Africa, it's rare to spend more than a day or two without finding people.
Now, here's my personal rule when it comes to water: wherever I am, I drink the water that the local people drink. It's as simple as that. If there are people around and they're drinking the water, then I can drink it too. I've never carried any kind of filters or purification tablets, and I've never bothered to filter the water I drink, no matter how murky it may look, as long as the locals are drinking it too. It may give you some diarrhoea if you are new to the region, but shouldn't be severe.
In the capital cities, I'd opt for bottled water or the water sold in plastic bags, which is so common in West Africa, unless it's water from a borehole. Outside the capital cities, you'll find hand-operated pumps in every village throughout sub-Saharan Africa, and let me tell you, that's the best water you can find on the entire continent. It's the water that the majority of Africans drink, and it's perfectly safe for any human to consume.
I do understand that some people may be more sensitive to bacteria than me and may have a harder time adapting. I know there are specific cases where travelers never seem to fully adapt and need to filter the water they drink. But aside from those cases, it's also important to know that every time you change countries or regions, you're exposing yourself to a different set of water and bacteria. It's not uncommon (or something to worry about) to experience a mild bout of diarrhoea for a day or two during these transitions. But let me tell you, it's not a big inconvenience or annoyance. The body adapts to the bacteria fairly quickly, and everything goes back to normal afterwards.
I had two debit cards with me, one on the VISA network and another on the Chinese Union Pay network. These networks are widely available throughout Africa. With a bit of resourcefulness, I was able to access my money in almost every corner of the continent.
Back in 2014, there were enough ATMs in major cities and even in several smaller ones, so I didn't have to carry large amounts of cash with me.
Since border crossings are usually far from big cities and ATMs are rare, I made sure to have enough of the outgoing country's currency to cover my expenses until I reached the border of the next country. Once at the border, I would exchange the remaining currency for the new country's money. I also made sure to have enough cash to sustain me until I reached the first town or city where I could withdraw money in the local currency. This was my routine throughout my journey in Africa.
It's also important to carry some US dollars and euros in cash, preferably in smaller denominations like $20 or $50 bills. These are useful for emergencies and for paying certain visa fees that are only accepted in those currencies. I used to carry around $300 to $500 and some euros, all well hidden in different parts of my panniers to ensure their safety.
Another very important thing to note is that, like is so many other countries in other continents, older bills are much harder or even impossible to exchange. Of those who will take your older notes, they will give you a much lower rate too. In a nutshell make sure you bring the newest issued USD with you.
This point is always subjective, and it will vary from person to person based on their desired level of comfort. But in general, you can say that costs in most of Africa are very low, regardless of the luxuries you seek, simply because there isn't much variety or availability of sophisticated things in the majority of the continent. Everything is basic, simple, and repetitive. You can find canteens selling the same menu for less than a dollar, and the cost of pasta, rice, vegetables, and fruits in villages is practically negligible. The hospitality of the people is also incredible, and invitations to eat and sleep in villages are very common.
That being said, it's not surprising that costs increase as you get closer to South Africa. Even though prices are still very reasonable, the mere access to practically everything we desire can lead us to spend more money, especially after months of living with scarcity. So, it's natural to treat ourselves a bit more and spend a bit more in those areas, but overall, the prices remain quite affordable.
During my time cycling in Africa, I found that the availability of good quality spare parts was mostly limited to South Africa. That's the place where you can find everything you need, and the quality is top-notch. Namibia also has a great bike shop in Windhoek. In cities like Cairo, Senegal, and Luanda, and I suspect in Morocco too (although I'm not certain), you can find decent bike shops with some usable spare parts, but the selection may not be extensive.
If you need spare parts in the rest of the continent, your only option is to buy them online. However, most online shops don't ship to the majority of sub-Saharan Africa.
So, in such cases, the last resort—and this applies to finding mechanics with moderate knowledge as well—is to reach out to the local cycling clubs. Almost every capital city and even some smaller towns have cycling clubs, and they all have at least one mechanic who knows how to handle proper repairs. Not only that, but many of these clubs recycle bicycle components, so sometimes you can even get used parts from their stock. It's a great resource to tap into if you're in need.
I have not taken travel insurance of any kind during all of my 5 year-long-trip, and certainly this is one of the least intelligent things that any traveller can do. While I had my reasons and logic behind that decision, I would never recommend anyone to go without travel insurance—it's incredibly important.
When it comes to insurance, the key thing to ensure is that the policy covers bicycle accidents. Many companies don't cover this because they consider it a risky sport. But there are companies like World Nomads that include coverage for such activities, and I believe there are others out there as well.
Now, let's talk about hospitals and medical attention in Africa. It's no secret that access to medicine is very limited, and finding high-quality medical care is virtually nonexistent outside of South Africa. If you encounter complex medical problems, returning home may be the only option. Based on my interactions with western medical personnel across the continent, it's important to note that doctors in many regions have limited training, and in some cases, dangerously limited.
Facilities: Hospitals and health facilities are generally basic and often lack even the most fundamental hygiene practices. And let's not forget about the pharmacies, which are unfortunately filled with fake or expired medicines that have been sitting on the shelves for years.
If you find yourself in need of medical help, the first thing you should do is contact your health insurance company for advice. They can provide you with a list of suitable places to go. If you don't have medical insurance, another option is to reach out to your embassy for recommendations on local doctors.
In large cities, you can consider going to general hospitals or private clinics. Private clinics may offer slightly better facilities, but be prepared for higher prices that can be quite outrageous. However, in rural areas, your best bet is to approach Catholic missions. They often run small clinics with nurses who possess decent knowledge to handle common problems, including malaria. These clinics also receive donations of good-quality medicines.
Now, let me share my top recommendation. Several years before embarking on my trip, I met a renowned American doctor who had spent over 30 years providing medical care in rural regions of Asia and Africa. We became good friends, and when I shared my travel plans with him, he gave me an invaluable gift—a book. He said, "Nico, you must have this book, and remember one important thing: you don't need to be a doctor to diagnose and treat most of the things that can happen to us. Study this book thoroughly and always keep it with you, because you might be able to help others too."
The book is called "Where There Is No Doctor," and it's an extraordinary, ultra-detailed manual of about 800 pages developed by experts in rural medicine for healthcare workers in remote areas with limited resources. I can't express enough how much value this book had and still has for me. It became my go-to reference throughout my time on the continent, and I credit it for keeping my health issues to a minimum.
I used to read and study fragments of the book almost every day without fail. Unfortunately, it's no longer available for free download in PDF format, but I believe that $26 is an absolute steal for the immeasurable value it provides. The money goes to the foundation that updates and maintains it, and their work is truly extraordinary. You can find more information about it here.
Vaccines: Now, let's talk about vaccines. The most important vaccine, not so much for health reasons but for bureaucratic ones, is the yellow fever vaccine. Without the certificate of that vaccine in your international vaccination card, you won't be allowed to enter many countries, and for some, it's even a necessary requirement to apply for a visa.
As for other vaccines, it's best to consult with your own doctor. In my case, I got vaccinated after already crossing half of the continent. My specialist in infectious diseases and travel medicine recommended vaccines for polio, meningitis, and a tetanus update. I should also note that several years prior, I had already received the triple dose (valid for life) of the vaccine for different types of hepatitis.
So, take medical insurance seriously, be prepared for limited medical access, and consider getting yourself a copy of "Where There Is No Doctor" for your journey in Africa. And of course, make sure you have the necessary vaccines, especially the yellow fever vaccine, to avoid any bureaucratic hassles. Stay safe and take care!
Malaria is a prevalent disease throughout Africa, and it's a constant potential risk that we must always be alert to. There is a lot of information available online (and in the book I recommended above) about malaria, and it's crucial to study it carefully and take it seriously.
Based on my experience and what I've learned, I'm happy to say that I never contracted malaria during my two and a half years in Africa, despite being exposed to it in various regions. I never took prophylaxis treatment, but I always carried several treatments with me in case of an emergency. The main medicines I relied on were Coartem and/or Artesunate, which were widely available and affordable throughout Africa at the time. It's important to research up-to-date information on effective treatments.
In my opinion, the fact that I never contracted malaria can be attributed to three factors. First, I extensively studied the disease before and during my trip. Second, I was absolutely obsessed with avoiding mosquito bites during the high-risk hours. And third, luck probably played a role too.
Knowing the hours of highest risk is crucial. It's when the female Anopheles mosquitoes, which transmit malaria, are most active. I made it a priority to avoid bites during those hours, almost obsessively. The exact hours may vary, but a good reference is the period around sunset and the hours between midnight and 4 in the morning. However, it's important to note that there is still a risk throughout the night, with those hours being the most critical. During the daytime, there is no risk of malaria transmission.
I religiously slept under my mosquito net every night, whether or not there were mosquitoes present, and I tried to minimise leaving it or getting out of it as much as possible. It is absolutely essential—I repeat, ESSENTIAL—that the mosquito net is treated with a chemical called permethrin. Without this treatment, it's almost like having no mosquito net at all, as mosquitoes will land on it and bite you through the small perforations, especially when you inadvertently touch the sides while sleeping. Some mosquitoes may even be so tiny that they can pass through the net.
Many commercially available mosquito nets come pre-treated with permethrin. Otherwise, you'll need to treat it yourself, as I did. Permethrin can be challenging to find. In Africa, it's not readily available, but in Europe, you can get it from pharmacies, and in some countries, you may even need a prescription. It's important to dilute it in water at the appropriate percentage, for which you can find tutorials on YouTube for guidance.
There are also pre-diluted versions of permethrin available for purchase at camping shops, but they tend to be significantly more expensive than the DIY version. These are often used to treat lightweight clothing like T-shirts.
During the rainy season, you'll need to triple your precautions and paranoia. Apply mosquito repellent at the end of the day and spend as much time as possible under the mosquito net during the night.
I want to emphasise once again that malaria must be taken extremely seriously. While most cases can be treated with tablets and recovery is relatively quick, there is always the possibility of contracting cerebral malaria. In such cases, unless you receive immediate intravenous quinine treatment, your life expectancy may be as short as 24 to 48 hours. This strain of malaria has claimed the lives of more than one cyclist I heard of, so it's crucial to be aware of the risks and take necessary precautions.
This is the temporary end of this series of answers to the most frequently asked questions I receive. All my answers should not be taken as established and universal truths. These are merely the result of what I have learned in my own personal experience. Many of them may not fit you, therefore, use them only as a reference.
This is an open article, which means that if you have a question or topic that I have not covered, do not hesitate to use the contact form to send it to me.