Travel prepare, be insect aware!

March 05, 2015  •  Leave a Comment

Disclaimer: I am not a medical professional, and anything I write in this blog should NOT be taken as advice. This blog is simply about my experiences of travelling to Africa and some of the precautions that I take. If you are affected by issues in this blog I encourage you to seek advice from your general practitioner. 

The reason I write a blog is to share my experiences. Not just my photographic experiences but subjects that surround the very nature of wildlife photography; cameras, gear, but also travel. With this blog I wanted to address a topic that can be easily overlooked by travellers going on Safari: health. 

It goes without saying, I would hope, that if you plan on travelling to Africa, you will at the very minimum take out good healthcare insurance. For European's, given the repatriation distances and costs this is an absolute must. It is important to do your homework about the specific destination you will be heading to. If for some reason you get sick during or after your return, and you make a claim on your insurance, it is important you have taken the necessary precautions prior to travel. For example, if you get sick with something that you should have been vaccinated for, and you didn't have that vaccination, then the chances are your insurance provider won't cover you. Always double check well before travelling and read the small print in your policy!

After 4 trips in the last 18 months to South Africa, this summer I will be heading to Kenya. A new country, I have never been to. And whilst I am well aware of the health issues you may face in South Africa, I cannot assume that they will be the same in Kenya. It is for this reason that next week I am going to the University Hospital Travel Clinic to have a consultation, and if needed get inoculated against Yellow Fever. I say "if needed", in fact I am going to insist that I get it. You see the Travel Clinic are the experts, but they won't inoculate you unless it is a requirement. I had this experience two years ago before my first visit to South Africa, where we (my wife and I) wrongly believed that you needed yellow fever to travel to South Africa. The Doctor dispelled this myth, and despite my wife being fairly instant she wanted the vaccination anyway, the doctor refused. Lesson learnt.

However, in my case, I know that in the future I will potentially be travelling to other areas at risk. And I would rather get it done and out of the way now, so I don't have to worry about it in the future. It is no fun having a needle stuck in your arm, but I can attest that getting sick is even less fun...so sometimes we just have to suck it up and get on with it!

On my last trip to South Africa I got unlucky. Of my previous 3 trips, 2 were in Sabi Sands, a malaria risk zone and 1 was in Madikwe, a malaria free zone. My last trip was a dual stay in Ngala and Sabi Sands. So I went back to my doctor to get the malaria tablets that I had taken without any issue on my previous two trips. These tablets are fairly standard, you take one a day, starting 1 day before your arrival and continue until 1 day after your return. For me it was all run of the mill stuff and off I flew to Jozi taking my first tablet on the flight there. 3 nights later after that flight, I was horribly sick. I spent a whole day in my tent feeling nauseous and vomiting. The lodge were great and drove to Hoedspruit to see a local doctor. The doctor was great too and told me that the malaria tablets were reacting with another medication I was taking for my general health. He advised to stop taking both for the duration of my trip and on my return to a) see my doctor and b) if I get any flu like symptoms between 1 week and 3 months on my return to get tested for Malaria. Other useful advice he gave was to wear long trousers, long sleeves shirts and use mosquito repellent on hands and the neck. The mosquito repellent I was already using, but in the warm African sun it was disappointing to have to go from shorts to long trousers, but I heeded the advice. 

The day before I became sick in Ngala. I am pictured on the left: shorts and short sleeves but solid walking shoes.

The same day, the staff prepared a bush drinks break with lanterns. It was then I really noticed the high concentration of insects which I had never experienced during my other visits to South Africa.

 

Sure enough the next day I was queasy but feeling a lot better. I was back on drive and telling my insurance providers things seemed to be ok...no need for any help. 

I returned to Europe, memory cards full of great images and I was straight into Lightroom and was contently editing away. 6 days later on a Saturday evening I started to get shoulder pains, the ones you get when its a sure sign of flu. Then by the Sunday morning I started to get what felt like a temperature. As I was making my breakfast, bare foot in the kitchen, I looked down at my foot and noticed a small black spot on the top of my foot. I thought nothing of it at that time. The warning from the Doctor in Hoedspruit was on my mind and so on Monday morning I went to my Doctor explained the situation and was straight off to the hospital for a Malaria test, which proved negative. Phew! Good news. However, I started to feel even worse on the Tuesday.

By Wednesday, that small black spot on my foot had declared itself as a bite and was now swollen and painful, to the point I could hardly walk. I was running a horrible fever and having cold sweats. I started Googling on line to try and find something that looked similar to what was clearly an insect bite. I couldn't find anything. I quickly ruled out Lyme's - it wasn't the same type of bite. 

symbiotic relationship - the oxpeckers have a diet of mainly, ticks. So whilst this Kudu has to support a minor inconvenience with a perched oxpecker, overall its a win-win. I could have done with an oxpecker for my foot!

I then emailed a good friend of mine who is an ex-field guide. I described what I had. He replied within the hour "Yep, sounds like you have tick bite fever"...eish!

African tick bite fever, if you didn't know, is when a tick bite creates a bacterial infection. Incubation can take 5 to 7 days after the bite has occurred. Symptoms include fever, headaches and skin rash.

I went back to my Doctor...on the Wednesday afternoon. Its now 10 days since my return from South Africa. I tell him the story, and I explain my theory. He listens, but as there is a flu pandemic going round he seemed doubtful about my story and my suspicions of tick bite fever. Anyway, he prescribes me antibiotics and refers me to a Tropical Medicine Doctor with whom I get an urgent appointment the next day on Thursday. I am now on day 5 of constant fever and cold sweats, and no closer to a diagnosis or the right treatment. The Tropical Medicine Doctor would't be drawn on whether it's tick bite fever, but does give me a different prescription; super strong "slow-fast" antibiotics, design to work fast, and then stay in your blood stream to continually act over a long period of time. He also gives me a gel for the bite itself, a horrible smelly back paste that stains all textiles and linen and should be handled with caution. Great! 

So on day 6, which is now the Friday of that week, I started a 7 day course of 4 grammes of antibiotics a day. FOUR GRAMMES! 2 grammes in the morning and 2 grammes in the evening. These pills were enormous and impossible to swallow. I still felt grim, and the prospect of wrestling antibiotic pills the size of my glasses case was pretty demoralising (I exaggerate for effect). 

The days tick by, I am bed ridden with fever and advised to take soluble paracetamol to ease the fever. By the Sunday morning which is now day 8, I am in really bad shape. I have been on the antibiotics 3 days and it doesn't feel like anything is improving. I have cold sweats and horrible nausea. It was the worst I had felt in a long time and my wife was ready to take me to the Tropical Medicine institute that afternoon. That didn't happen in the end. I came round and by the following Wednesday when the antibiotics were over, my fever stopped, 12 days after my first fever broke. 4 days later with my immune system depleted, I came down with flu. I spent Christmas Eve and Christmas Day in my pyjamas drinking Lemsip and taking loads of paracetamol. 

All this happened at the end of November and for the month of December I was off sick for the full 4 weeks; first with tick bite fever and then flu. 

If you head over to wikipedia and take a look at the photo there, this is exactly what the bite looked like. 2 months later I still have a scare where the bite happened. I only wished I had seen this photo sooner as I would have known exactly what to look for. 

Well it was a lesson in life. It was only thanks to my friend in South Africa I was able to pin it down and have educated discussions with my doctors. Even then, they wouldn't commit to saying what I had, and this was my #1 lesson in the whole episode: if you get sick in Africa you have to think like an African doctor, not like a European doctor. It took me 5 days before I got the treatment I needed, simply because everyone thought after my malaria test proved negative, I just had flu. Even friends and family dismissed my state and thought I was over dramatising what I had. It wasn't until that Sunday when I turned yellow and looked truly awful that it dawned on my wife it was serious. 

It has made me wonder just how I got bitten. As it occurred 6 days after my return, I must have got bitten during the second half of my trip in Sabi Sands and not in Ngala. On drive I always wore socks and walking boots. This was because of the advice from the doctor in Hoedspruit as I had stopped taking the malaria tablets...and in any case, I always wear closed shoes on drive. So the only way I could have got bitten was at the lodge and probably in the room at days end. Bottom line is I was just plain unlucky.

I had my own pool in Sabi Sands and wanted to take the plunge. But after my bout of sickness and stopping the malaria tablets I just didn't want to take the risk.

Could it have been prevented? I don't think so. I think you can try and reduce the risk of a tick bite, but at the end of the day its down to luck. My learnings from this are;

  • Wear sensible clothing. Long sleeves and trousers are best, with closed shoes and light socks. 
  • The season plays a part. I noticed end of November with the warmer weather and the odd rain shower, there were a lot more insects in general than the cooler winter and spring seasons. 
  • You can get citronella anti insect bracelets. I wore those on my previous trips and they worked a treat. The issue I had in November was it was low season in Europe so pharmacies were out of stock! They are not just good for mosquitos they also repel ticks. 

I think its really important to be insect aware. I was pretty well aware before my trip, but my experience means I'll now be making a few more extra preparations for my next trip(s). 

So if you happen, by chance to be on a photo safari in Kenya this summer and bump into a photographer wearing long sleeved everything and citronella bracelets - please excuse me. I'm not paranoid, I just know from experience that tick bite fever really sucks, and I don't want to get it again!

 

Cheers Jon

 

 


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