Article from the series: Staying Safe and Healthy in Rwanda, Uganda and DR Congo
Wish to stay healthy while travelling in Uganda or Rwanda? As well as obvious advice such as being careful not to upset a silverback, simple measures can make all the difference to your visit. As we say in the profession, prevention is always better than cure.
Instead of giving you a long list of rather unlikely health complications, we will zero down on what matters most! This article has been written with the assistance of Dr Rogers Musafiri in Kigali, Rwanda.
1. Keep Mosquito Ladies at Bay
Sleeping under an insecticide-impregnated bed net, and regular use of insect repellent — especially in the evenings — will significantly reduce the risk of malaria. You have definitely heard of this mosquito-transmitted disease which is particularly risky for tourists who do not have the same immunity that local populations may have developed. The core of the Gorilla Highlands region lies at rather high altitudes, and you may read that there is no threat of malaria above 2,000m/6,500ft but don’t rely on that. Global warming means that malaria is spreading into previously untouched areas.
Nearly every hospitality establishment in the Gorilla Highlands will have mosquito nets installed, but cheaper places may stock old ones that have not been recently treated. If you see a mosquito resting on a net, that is a poignant indication of such a situation.
But you shouldn’t imagine swarms of mosquitoes, we don’t get much of that here! The problem are the females of the tiny Anopheles mosquito kind who prefer to fly low so your ankles are in far more danger than your shoulders.
Anti-malarial prophylaxis (medicine taken to prevent the disease) is valuable for short trips. You should consult your home travel clinic or doctor for advice on the most appropriate regime, not only according to where you are travelling but also any other treatments you may be taking.
2. Protect Yourself in Traffic
Surprised to see this as the second health point? Road traffic accidents are sadly all too common here.
In Rwanda, several control measures, for example speed governors in public transport, have significantly reduced the number of accidents. In 2019, 223 people died on the road in a population estimated at 12.63 million, compared to 465 in 2018. In Uganda, there were 3,663 deaths on the road in 2020 in a nation of about 45.74 million. To run the numbers for you, Rwanda’s percentage is 4.5 times less and close to the world average.
We previously covered the danger of passenger motorcycles, and a crash helmet is obviously recommended to greatly reduce potential injuries. Moto drivers in Rwanda will provide you with a helmet, but that is not the case with boda boda drivers in Uganda, unless the police are exceptionally vigilant at a particular moment and eager to implement traffic regulations (or get bribed).
The usefulness of safety belts is probably abundantly clear to you? In addition to that, avoid travelling in overloaded or poorly maintained vehicles, and discreetly check out your driver’s breath and eyes. Alcohol and other substances may impair their performance significantly …
3. Mind the Water, and Fridges
Do ensure that all the water you drink is safe (this includes ice cubes). Bottled water that you can purchase pretty much anywhere can be trusted, while water from other sources will need to be boiled or properly filtered. This may not apply to very remote locations like streams in national parks, but even there, park rangers will advise you not to take risks. It’s up to you.
Remember salads may have been washed in contaminated water and could be tainted too! Electricity supplies in Uganda are unstable, and power goes off in Rwanda as well, so frozen items can inadvertently thaw. Consequently, frozen goods could be adversely affected and not safe if they re-freeze, e.g. ice cream.
Still, do not run away from all the pleasures of life! At places that often cater to tourists, they certainly know how to keep you away from microbes.
4. Do Not Ignore Sexually Transmitted Diseases
Once a mass-killer called slim, HIV/Aids may now be successfully suppressed with a combination of medicines. Combine that with a prevalence of 6-7% among Ugandans aged 15-64 years and 3% among Rwandans, and you will understand why the general attitude has become rather lax. Don’t take any risks that may give you a lifelong problem, or expose you to other STDs (as sexually-transmitted diseases are widely called).
5. Be Covid-Smart
We do have Covid-19 cases in the region and the percentage of the population that is fully immunised will be low for the foreseeable future. Get yourself fully vaccinated and observe the simple precautions that reduce the risk of contracting and infection, starting with good ventilation. If you are outside or in a well-aerated area your risk is much lower than in crowded settings without windows or vents. Practice good hand hygiene (carrying hand sanitiser is sensible but soap and water are effective if you are thorough enough), while a mask will reduce transmission and infection rates — masking yourself up is in fact mandatory in Rwanda.
6. Pack What Matters
Pharmacies are exceptionally common even in rural areas, so do not worry about the basics. On the other hand, do pack adequate supplies of any specialised medications you are taking regularly. Carrying your own little first aid kit is useful for cleaning wounds promptly to reduce the risk of secondary infections. Don’t forget to come with a valid yellow fever certificate!
7. Know Your Health Providers
But what happens if something does happen to you? The answer depends on a lot of factors: what sort of problem is it, do you have pre-existing health issues, and so on.
Uganda’s health system has a range of institutions. At the national level, Kampala has the tertiary referral hospital in Mulago and there is Butabika Hospital for mental illness — but these lie many hours’ drive from gorilla national parks. This is why regional referral hospitals are key components and will usually have some intensive care facilities. In southwestern Uganda these are found in Mbarara and Kabale. To go deeper upcountry, each district has a District Health Officer with a team, but not all have government hospitals. That is why we have private-not-for-profit health institutions, such as the hospital that I head in Kisiizi; it offers good general medical, surgical, obstetric and paediatric care. Such hospitals will normally treat conditions such as appendicitis, trauma, stroke etc. and care for complications of pregnancy. They will have ultrasound and X-ray but not CT- or MRI-scans which are usually located in cities.
In addition, you will also find numerous private clinics which vary greatly in quality. In Kampala they can be world-class, in a rural town they are likely to be a side-business of a doctor who works at a governmental facility. Sadly, some have unreliable lab results and counterfeit medicines are also in circulation, so take advice to find a reputable service. But at their best, Uganda’s private health services far exceed what is available in Rwanda.
In rural Rwanda, public health care facilities are comprised of health posts where one can get basic primary care for conditions like simple malaria, diarrhoea, basic wound care and dressing and family planning. A level above health posts come health centres which can hospitalise or observe a patient for a maximum of three days for conditions that require basic support like IV fluids, injectable analgesics (pain medication) and injectable antiemetics (anti-vomiting drugs), maternity and HIV services. Higher in the hierarchy are district hospitals (36 of them), then provincial hospitals (four), regional referral hospitals (three), then five national referral and teaching hospitals, where tertiary care is provided. A robust national health insurance system is in place.
In an emergency with serious symptoms it is wise to go to the nearest functioning facility for initial stabilisation and support, followed by a transfer to a more advanced unit. For less urgent issues, travel to urban areas is suggested, especially in Rwanda because it is a more compact country with a better road system. Qualified health care staff and necessary equipment to attend to head injuries, abdominal injuries or fractures are less available in Rwanda’s rural settings, but the availability of a reliable ambulance system helps a lot.
English is an official language in both Uganda and Rwanda, and most health workers will be fluent in it. Senior Rwandan personnel went to school when French was still the national language, so that might be a limitation. In rural communities health centre staff may only speak the vernacular.
photos by Miha Logar