Don’t think about visiting Ethiopia without a comprehensive medical travel insurance, one that will fly you home in an emergency.
It is strongly advisable to be vaccinated against yellow fever, typhoid, meningitis, polio, tetanus-diptheria and Hepatitis A. You should also consider measles, mumps, rubella and Hepatitis B. You may be required to show an international immunisation certificate as proof of your yellow fever vaccination. If you intend travelling far from medical facilities, consider rabies immunisation.
A useful starting point for British travellers are the British Airways Travel Clinics, telephone 01276 685 040.
Take a small medical kit with you. This should contain malaria tablets, soluble aspirin, plasters, potassium permanganate crystals or another drying antiseptic, iodine for sterilising water and cleaning wounds, sunblock, and condoms or femidoms.
Diarrhoea and related illnesses
The best solution for diarrhoea is to rest up for a day, and to stop eating your normal diet, avoid alcohol, and take lots of clear fluids. If you are hungry take bland light food, e.g. plain biscuits and boiled potatoes.
Blockers such as Imodium should only be taken if you have no access to sanitation, for instance, if you have to travel by bus. This is because blockers generally keep the poisons in your system, and so make you feel bad for longer.
When you have diarrhoea, it is important you drink a lot. Paediatric oral rehydration salts (ORS) such as Dioralyte are excellent, or you can make your own salt and sugar rehydration fluid.
In Ethiopia, diarrhoea that persists beyond 48 hours could be giardia, a protozoan infection that, in addition to diarrhoea, often causes severe flatulence, abdominal distension and sulphurous belching. Although it is not a serious illness, it is unpleasant enough that you will want treatment as quickly as possible.
Salads are a likely source of diarrhoea, as is tap water. In Ethiopia, one should tend to assume that all tap water is unsafe to drink, except perhaps in Addis Ababa. Cheap bottled mineral water is available everywhere, and as far as one is aware, is perfectly safe.
Malaria is present in most parts of tropical Africa below 1800-2000m, and the Anopheles mosquito which transmits the malaria parasite is most abundant near the marshes and still water in which it breeds. In other words, malaria is most prevalent in low-lying areas where there is water, and especially after rain.
Malaria is often considered absent from the Ethiopian Plateau, which includes the Bale Highlands, the central highlands around Addis Ababa, the western highlands around Jimma, and the northern historical circuit. A tourist who flies into Addis Ababa (2400m), then travels by plane around the historical circuit of Lake Tana (1830m), Gondar (2223m), Axum (2133m) and Lalibela (2630m) is at no significant risk, with the only place to be conscious of mosquitoes being near the lake in Bahir Dar.
Malaria is present in most parts of Ethiopia that lie below 1800m. In the Rift Valley, malaria is generally seasonal, with spasmodic and localised outbreaks taking place during the rainy season (roughly between June and October).
The two areas of Ethiopia that are most likely to be visited by tourists and where malaria is a definite threat are the Omo Valley (Omo and Mago National Parks) and the western lowlands around Gambela.
So do you take malaria pills or not? Definitely, if you are visiting a high risk area like the Omo Valley or Gambela at any time of the year, or if you are travelling in the Rift Valley during the wet season. On the other hand, if your travels will be restricted to highland areas, or you visit in the dry season and avoid high-risk areas, there is a case for not taking them.
The malaria tablets which are generally recommended for use in East Africa are Doxycycline or Malarone. Larium (Mefloquine) used to be the preferred choice but it has received a lot of bad press in Britain due to side effects which, if they occur, can be severe, so only take it on a doctor’s recommendation.
Equally as important as taking malaria pills is making every reasonable effort not to be bitten by mosquitoes.
The Anopheles mosquito which spreads malaria emerges at dusk, as do sandflies and most other disease-carrying mosquitoes. You will thus greatly reduce your chances of being bitten and contracting insect-borne diseases if you wear long trousers and socks in the evening and cover exposed parts of your body with insect repellent, preferably a DEET-based preparation such as Jungle Jell. Sprays of this sort are not available in Ethiopia; bring one with you.
Bilharzia or schistosomiasis
This is carried by a worm which spends part of its life inside freshwater snails, and infects people when they swim or paddle in still or slow-moving, well-oxygenated, well-vegetated fresh water. As a rule, a fast-flowing mountain stream is very low risk, while a sluggish river or lake is high risk. If you dry off promptly after spending ten minutes or less in the water, the parasite does not have time to penetrate your skin and so cannot infect you.
AIDS and venereal disease
HIV and other venereal diseases are, by all accounts, widespread in Ethiopia.
A vaccination protects against the common and serious bacterial form in Africa, but not against all of the many kinds of meningitis.
Rabies can be carried by any mammal. The domestic dog is the species which most often passes it to humans. The most common route of infection is a bite from an infected animal, but a scratch or a lick on an open wound can do it too.
Tetanus is caught through deep, dirty wounds, so ensure that any wounds are thoroughly cleaned.
Most doctors in Ethiopia speak good English and are very helpful. In most larger towns there are hospitals where outpatients can be treated and they have basic laboratory facilities for blood and stool tests.
Sun and heat
The equatorial sun is vicious. Although it is impossible to avoid some exposure to the sun, it would be foolish to sun-bathe needlessly. If you are coming to Ethiopia from a less harsh climate, let your body get used to the sunlight gradually or you will end up with sunburn. Wear sunscreen and build up your exposure gradually, starting with no more than 20 minutes a day.
Always wear clothes made from natural fabrics such as 100% cotton. These help to prevent fungal infections and other rashes.
Even small cuts are inclined to go septic in the tropics. Clean any lesion with a dilute solution of potassium permanganate or iodine 2-3 times daily.
There are very few parts of Ethiopia where you are likely to come into contact with potentially dangerous large animals. The large mammal that you need most concern yourself with is the hippopotamus, which is reportedly responsible for more human deaths than any other African mammal. You should be cautious around any lake or large river.
Another animal you should watch out for near water is the crocodile, although only a very large croc is likely to attack a person, and then only if you are actually in the water or standing right on the shore.
Although poisonous snakes are present throughout Ethiopia, they pose little real threat to humans. The reason for this is that most snakes are very shy and secretive, and will move off at the slightest sign of human activity.
The one place where you should be conscious of the possible presence of snakes is on rocky slopes and cliffs, particularly where you are scrambling up or down using your hands. As a general rule, you should wear trousers, socks and solid boots when you walk in the bush.