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Gambia is a fairly safe place to travel, but travellers should still use common sense. Groups of beggars squat near traffic lights and will walk up to your car when it stops. This can be intimidating - while you can't help everyone, you don't have to refuse to give completely. Bribery is also a way of life in Gambia: poorly paid officials may use 'rich' tourists to top up their salaries. The best method is to feign ignorance, bluff your way through and always stay polite. Sometimes, however, you have to play the system. For example, if officials are slow in processing a visa request, offering a small dash or cadeau (literally 'gift') may help. Another annoyance is local people (not beggars) asking for gifts. This comes from a belief that anyone God has been good to should be willing to spread some wealth around. You're not expected to give anything, and polite refusal will rarely offend.
Robbery is more prevalent in cities and larger towns than in rural areas. In resorts near Banjul, attacks are slightly rarer but not unknown. Police and military stops are everywhere - they seem to exist solely for the purpose of extracting bribes. Stay calm, smile, don't be intimidated and don't offer money quickly. And never drive past a stop as this will always result in you having to pay a bribe, possibly after a slow bag search and some shouting.
The hustlers of Banjul, and other places frequented by tourists, have perfected a dazzling array of scams and tricks. For example, you may be invited to stay in someone's house in exchange for a meal and drinks, but this may be more expensive than staying at a hotel. If you buy grass or other drugs from a dealer, don't be surprised if he's in cahoots with the local police who then find you 'in possession'.
In brief, don't display money and signs of wealth, don't look as though you're lost, don't walk in the backstreets (or even some of the main streets) at night, and take someone you trust if you need to travel to a risky area of town.
This is the worst of the watery diarrhoeas and medical help should be sought. Cholera is mostly transmitted via contaminated human excrements. This might sound like a rather unlikely source of infection - but beware, an infected person preparing meals without having washed their hands properly might transmit the disease. Infection is unlikely outside known problem areas, but if you really want to be safe, prepare your own food and choose restaurants with excellent standards of cleanliness. Fluid replacement is the most vital treatment - the risk of dehydration is severe as you may lose up to 20L a day. If there is a delay in getting to hospital, then begin taking tetracycline. The adult dose is 250mg four times daily. It is not recommended for children under nine years or for pregnant women. Tetracycline may help shorten the illness, but adequate fluids are required to save lives.
This viral disease is transmitted by mosquitoes and is fast becoming one of the top public-health problems in the tropical world. The disease has been reported in small numbers in Gambia. The Aedes aegypti mosquito, which transmits the dengue virus, is most active during the day (unlike the malaria-carrying mosquito), and is found mainly in urban areas, in and around human dwellings. Symptoms of dengue fever include a sudden onset of high fever, headache, joint and muscle pains (hence its old name, breakbone fever) and nausea and vomiting. A rash of small red spots sometimes appears three to four days after the onset of fever. In the early phase of illness, dengue may be mistaken for other infectious diseases including malaria and influenza. Minor bleeding such as nose bleeds may occur in the course of the illness, but this does not necessarily mean that you have progressed to the potentially fatal dengue haemorrhagic fever (DHF). This is a severe illness, characterised by heavy bleeding, which is thought to be a result of secondary infection due to a different strain (there are four major strains) and usually affects residents of the country rather than travellers. Recovery even from simple dengue fever may be prolonged, with tiredness lasting for several weeks. There is no vaccine against and no specific treatment for dengue. Aspirin should be avoided, as it increases the risk of haemorrhaging. The best prevention is to avoid mosquito bites.
This is a mosquito-transmitted parasitic infection found in many parts of Africa, including Gambia. Possible symptoms include fever, pain and swelling of the lymph glands; inflammation of lymph drainage areas; swelling of a limb or the scrotum; skin rashes; and blindness. Treatment is available to eliminate the parasites from the body, but some of the damage already caused may not be reversible. Medical advice should be obtained promptly if the infection is suspected.
These occur more commonly in hot weather and are usually found on the scalp, between the toes (athlete's foot) or fingers, in the groin and on the body (ringworm). You get ringworm (which is a fungal infection, not a worm) from infected animals or other people. Moisture encourages these infections. To prevent fungal infections wear loose, comfortable clothes, avoid artificial fibres, wash frequently and dry yourself carefully. If you do get an infection, wash the infected area at least daily with a disinfectant or medicated soap and water, and rinse and dry well. Apply an antifungal cream or powder such as tolnaftate. Try to expose the infected area to air or sunlight as much as possible. Wash all towels and underwear in hot water, change them often and let them dry in the sun.
This is a general term for inflammation of the liver. It is a common disease worldwide. There are several different viruses that cause hepatitis and they differ in the way they are transmitted. The symptoms are similar in all forms of the illness and include fever, chills, headache, fatigue, feelings of weakness and aches and pains, followed by loss of appetite, nausea, vomiting, abdominal pain, dark urine, light-coloured faeces, jaundiced (yellow) skin and yellowing of the whites of the eyes. People who have had hepatitis should avoid alcohol for some time after the illness, as the liver needs time to recover.
Hepatitis A is transmitted by contaminated food and drinking water. You should seek medical advice, but there is not much you can do apart from resting, drinking lots of fluids, eating lightly and avoiding fatty foods. Hepatitis E is transmitted in the same way as hepatitis A; it can be particularly serious in pregnant women. There are almost 300 million chronic carriers of hepatitis B in the world. It is spread through contact with infected blood, blood products or body fluids; for example through sexual contact, unsterilised needles and blood transfusions, or through contact with blood via small breaks in the skin. Other risk situations include shaving, tattooing or body piercing with contaminated equipment. The symptoms of hepatitis B may be more severe than those of type A and the disease can lead to long-term problems such as chronic liver damage, liver cancer or a long-term carrier state. Hepatitis C and D are spread in the same way as hepatitis B and can also lead to long-term complications.
There are vaccines against hepatitis A and B, but there are currently no vaccines against the other types of hepatitis.
This is a group of parasitic diseases transmitted by sandflies, which are found in many parts of the Middle East, Africa, India, Central and South America and the Mediterranean. Cutaneous leishmaniasis affects the skin tissue causing ulceration and disfigurement, and visceral leishmaniasis affects the internal organs. Seek medical advice, as laboratory testing is required for diagnosis and correct treatment. Avoiding sandfly bites is the best precaution. Bites are usually painless, itchy and are yet another reason to cover up and apply repellent.
This serious and potentially fatal disease is spread by mosquito bites. Nowhere in Gambia is completely free of malaria so it's extremely important to avoid mosquito bites and to take tablets to ensure a good degree of protection. Symptoms range from fever, chills and sweating, headache, diarrhoea and abdominal pains to a vague feeling of ill-health. Seek medical help immediately if malaria is suspected. Without treatment malaria can rapidly become more serious and can be fatal.
Antimalarial drugs do not prevent you from being infected, but kill the malaria parasites during an early stage in their development and significantly reduce your risk of becoming very ill or dying. Expert advice on medication should be sought as there are many factors to consider, including the area to be visited, the risk of exposure to malaria-carrying mosquitoes, the side effects of medication, your medical history and whether you are a child or an adult or pregnant. Travellers to isolated areas in high-risk countries may like to carry a treatment dose of medication for use if symptoms occur. If medical care is not available, malaria tablets can be used for treatment. You need to use a malaria tablet different from the one you were taking when you contracted malaria. The standard treatment dose of mefloquine (Larium) is two 250mg tablets and a further two six hours later. For Fansidar, it's a single dose of three tablets. If you were previously taking mefloquine and cannot obtain Fansidar, then other alternatives are Malarone (atovaquone-proguanil; four tablets once daily for three days), halofantrine (three doses of two 250mg tablets every six hours) or quinine sulphate (600mg every six hours). There is a greater risk of side effects with these dosages than in normal use if used with mefloquine, so medical advice is preferable. Be aware also that halofantrine is no longer recommended by the WHO as emergency standby treatment because of side effects, and should only be used if no other drugs are available.
Travellers are advised to prevent mosquito bites at all times. You should: wear light-coloured clothing; wear long trousers and long-sleeved shirts; use mosquito repellents containing the compound DEET on exposed areas (prolonged overuse of DEET may be harmful, especially to children, but using it is preferable to being bitten by disease-transmitting mosquitoes); avoid perfume and aftershave; use a mosquito net impregnated with mosquito repellent (permethrin) - it may be worth taking your own; and impregnate your clothes with permethrin effectively deters mosquitoes and other insects.
In Gambia, you absolutely need to take precautions against malaria. Malaria is a killer. It is essential that you take appropriate precautions.
This is a serious disease that attacks the brain and can be fatal. There are recurring epidemics in various parts of the world, including the interior regions of Gambia. A fever, severe headache, sensitivity to light and neck stiffness that prevents forward bending of the head are the first symptoms. There may also be purple patches on the skin. Death can occur within a few hours, so urgent medical treatment is required. Treatment is large doses of penicillin given intravenously, or chloramphenicol injections.
This fatal viral infection is found in many countries. Many animals can be infected (such as dogs, cats, bats and monkeys) and it is their saliva that is infectious. Any bite, scratch or even lick from an animal should be cleaned immediately and thoroughly. Scrub with soap and running water, and then apply alcohol or iodine solution. Seek medical help promptly to receive a course of injections to prevent the onset of symptoms and death.
Also known as bilharzia, this disease is common in Gambia. It is transmitted by minute worms that infect certain varieties of freshwater snails found in rivers, streams, lakes and particularly behind dams. The worms multiply and are eventually discharged into the water. The worm enters through the skin and attaches itself to your intestines or bladder. The first symptom may be a general feeling of being unwell, or a tingling and sometimes a light rash around the area where it entered. Weeks later a high fever may develop. Once the disease is established, abdominal pain and blood in the urine are other signs. The infection often causes no symptoms until the disease is well established (several months to years after exposure) and damage to internal organs irreversible.
Avoiding swimming or bathing in fresh water where schistosomiasis is present is the main method of preventing the disease. Even deep water can be infected. If you do get wet, dry off quickly and dry your clothes as well.
A blood test is the best way to diagnose the disease, but the test will not show positive for some weeks after exposure.
HIV/AIDS and hepatitis B can be transmitted through sexual contact. Other STDs include gonorrhoea, herpes and syphilis. Sores, blisters or rashes around the genitals and discharges or pain when urinating are common symptoms. With STDs such as the wart virus or chlamydia (both common in Gambia and Senegal), symptoms may be less marked or not observed at all, especially in women. Chlamydia infection can cause infertility in men and women before any symptoms have been noticed. Syphilis symptoms eventually disappear completely but the disease continues and can cause severe problems in later years. While abstaining from sexual contact is the only 100% effective prevention, using condoms is also effective. Gonorrhoea and syphilis are treated with antibiotics. The different STDs each require specific antibiotics.
In parts of tropical Africa tsetse flies can carry trypanosomiasis, or sleeping sickness; however it is seldom seen in Gambia. The tsetse fly is about twice the size of a housefly and recognisable by the scissorlike way it folds its wings when at rest. Only a small proportion of tsetse flies carry the disease, but it is a serious disease. No protection is available except avoiding the tsetse fly bites. The flies are attracted to large moving objects such as safari buses, to perfume and aftershave and particularly to the colours purple and dark blue (avoid dark blue hire cars). Swelling at the site of the bite, five or more days later, is the first sign of infection; this is followed within two to three weeks by fever.
This disease is caused by a germ that lives in soil and in the faeces of horses and other animals. It enters the body via breaks in the skin. The first symptom may be discomfort in swallowing, or stiffening of the jaw and neck; this is followed by painful convulsions of the jaw and whole body. The disease can be fatal. It can be prevented by vaccination.
This bacterial infection is usually transmitted from person to person by coughing, but may be transmitted through consumption of unpasteurised milk. Milk that has been boiled is safe to drink, and the souring of milk to make yogurt or cheese also kills the bacilli. TB is quite a problem in parts of Gambia, though travellers are usually not at great risk as close household contact with the infected person is usually required before the disease is passed on.
This is a dangerous gut infection caused by contaminated water and food. While it's seldom seen in Gambia, if you suspect you have typhoid seek medical help immediately.
In its early stages sufferers may feel they have a bad cold or flu on the way, as early symptoms are a headache, body aches and a fever that rises a little each day until it is around 40°C (104°F) or more. The victim's pulse is often slow relative to the degree of fever present - unlike a normal fever where the pulse increases. There may also be vomiting, abdominal pain, diarrhoea or constipation.
In the second week the high fever and slow pulse continue and a few pink spots may appear on the body; trembling, delirium, weakness, weight loss and dehydration may occur. Complications such as pneumonia, perforated bowel or meningitis may occur.
This disease is spread by ticks, mites or lice. It begins with fever, chills, headache and muscle pains followed a few days later by a body rash. There is often a large painful sore at the site of the bite and nearby lymph nodes are swollen and painful. Typhus can be treated under medical supervision. Seek local advice on areas where ticks pose a danger and always check your skin carefully for ticks after walking in areas that may harbour ticks, such as tropical forests. An insect repellent can help, and walkers in tick-infested areas should consider having their boots and trousers impregnated with benzyl benzoate and dibutylphthalate.
This viral disease is endemic in many African and South American countries and is transmitted by mosquitoes. The initial symptoms are fever, headache, abdominal pain and vomiting. Seek medical care urgently and drink lots of fluids.
Simple things such as a change of water, food or climate can all cause a mild bout of diarrhoea, and many people experience a few rushed toilet trips soon after arriving in Africa. If there are no other symptoms then don't worry, this is just your body dealing with the change - it doesn't mean you've got dysentery! Dehydration is the main danger with any diarrhoea, particularly in children or the elderly as dehydration can occur quite quickly. In all circumstances fluid replacement is the most important thing to remember. Weak black tea with a little sugar, soda water, or flat soft drinks diluted 50% with clean water are all good. With severe diarrhoea, a rehydrating solution is preferable to replace minerals and salts lost. Commercially available oral rehydration salts (ORS) are very useful; add them to boiled or bottled water. In an emergency you can make up a solution of six teaspoons of sugar and half a teaspoon of salt to a litre of boiled or bottled water. You need to drink at least the same volume of fluid that you are losing in bowel movements and vomiting. Urine is the best guide to the adequacy of replacement - if you have small amounts of concentrated urine, you need to drink more. Keep drinking small amounts often. Stick to a bland, fat-free diet as you recover.
Gut-paralysing drugs such as loperamide (Imodium) or diphenoxylate (Lomotil) can be used to bring relief from the symptoms, although they do not actually cure the problem. Only use these drugs if you do not have access to toilets, eg if you must travel. Note that these drugs are not recommended for children under 12 years.
In certain situations antibiotics may be required: diarrhoea with blood or mucus (dysentery), any diarrhoea with fever, profuse watery diarrhoea, persistent diarrhoea not improving after 48 hours and severe diarrhoea. These suggest a more serious cause of diarrhoea and, in these situations, gut-paralysing drugs should be avoided. A stool test may be necessary to diagnose what bug is causing your diarrhoea, so you should seek medical help urgently.
Where this is not possible, the recommended drugs for bacterial diarrhoea (the most likely cause of severe diarrhoea in travellers) are norfloxacin 400mg twice daily for three days or ciprofloxacin 500mg twice daily for five days. These are not recommended for children or pregnant women. The drug of choice for children would be co-trimoxazole with dosage dependent on weight. A five-day course is given. Ampicillin or amoxycillin may be given in pregnancy, but medical care is necessary.
Two other causes of persistent diarrhoea in travellers are giardiasis and amoebic dysentery. You should seek medical advice if you think you have either, but where this is not possible tinidazole (Fasigyn) or metronidazole (Flagyl) are the recommended drugs. Treatment is a 2g single dose of tinidazole or 250mg of metronidazole three times daily for five to 10 days.
Dehydration and salt deficiency can cause heat exhaustion. Take time to acclimatise to high temperatures, drink sufficient liquids and do not do anything too physically demanding.
Salt deficiency is characterised by fatigue, lethargy, headaches, giddiness and muscle cramps; salt tablets may help, but adding extra salt to your food is better.
Anhidrotic heat exhaustion is a rare form of heat exhaustion that is caused by an inability to sweat. It tends to affect people who have been in a hot climate for some time, rather than newcomers. It can progress to heatstroke. Treatment involves removal to a cooler climate.
This serious, occasionally fatal, condition can occur if the body's heat-regulating mechanism breaks down and the body temperature rises to dangerous levels. Long, continuous periods of exposure to high temperatures and insufficient fluids can leave you vulnerable to heatstroke. The symptoms are feeling unwell, not sweating very much (or at all) and a high body temperature (39°C to 41°C or 102°F to 106°F). Where sweating has ceased, the skin becomes flushed and red. Severe, throbbing headaches and lack of coordination will also occur, and the sufferer may be confused or aggressive. Eventually the victim will become delirious or convulse. Hospitalisation is essential, but in the interim get victims out of the sun, remove their clothing, cover them with a wet sheet or towel and then fan continually. Give fluids if they are conscious.
Filariasis, leishmaniasis, sleeping sickness, typhus and yellow fever are all insect-borne diseases, but they do not pose a great risk to travellers.
Bed bugs are a particular problem in the budget-accommodation places of Gambia. These evil little bastards live in various places but are found particularly in dirty mattresses and bedding, and are evidenced by spots of blood on bedclothes or on the wall. Bedbugs leave itchy bites in neat rows, often along a line where your body touched the mattress. They won't kill you but bites often itch for days, making sleep difficult. Calamine lotion or a sting-relief spray may help, but your best bet is to just find another hotel.
