I had an interesting question from someone planning a safari and thought it would be worth further investigation.

The countries asked about were South Africa, Zimbabwe, and Namibia. However, I'd like to throw Botswana, Mozambique, and Zambia into the discussion to cover all the hunting destinations in Southern Africa.

We covered the over-the-counter meds they should take. I advised them to get Malarone (Atovaquone/proguanil)rather than Larium (Mefloquine) due to its history of adverse side effects, so no need to go into all that.

Other than Doxycycline and Ciprofloxacin, are there any other PRESCRIPTION medications recommended for an extended multi-country safari?

I took Doxy as a anti-malarial ... Also took a probiotic as the Doxy kills lots of the bacteria in your stomach..

I also take a generic Antibiotic in case of Tick Bite fever and any infection

I live in rural SD, and know my PA very well. In fact, we have done an international trip together. He prescribedd is a Z-pack for general antibiotic purposes like a sinus infection. Prednisone as an antihistamine in case of an allergic reaction. A generic version of Lunesta as a sleep medication for the long flights. And Hydrocodone for severe pain relief in case of a severe injury.

I’m not trying to change your post, but taking meds can mean two different things.

The “take” as in pack, or the “take” as in prophylactic?

There are quite a few medical professionals on here, but your query may be read differently by some.

Imodium has been shown to be more effective for traveler’s diarrhea than lomotil, is not considered a narcotic, and doesn’t require a prescription. Just FYI.

Interesting query, as I'm a retired ER doc leaving Wednesday for Zim. Couple caveats. First, consult with your personal physician, especially in regards to pre-existing health conditions that might worsen or complicate travel. Second, I'm reasonably cocky that if I bring a selection of antibiotics that I might employ them appropriately, but I've had training and experience. Self-diagnosis has risks.

I concur with Malarone for prophylaxis. Doxycycline is a good drug for tick-related illness and will usually cover CA-MRSA (staph skin infections), but it often causes sun sensitivity which is problematic when hunting. Ciprofloxicin is useful for traveler's diarrhea, a lady with a UTI, a flare of prostatitis, and usually diverticulitis (though I pack along metronidazole also). I keep cefuroxime on hand for sinusitis and it is a good drug for pneumonia.

Ondansetron would be a blessing if one develops significant nausea or vomiting. Gentamicin eye drops would be useful if you develop bacterial conjunctivitis. Good old ibuprofen is a fine pain reliever and comparable to the less potent narcotics, and avoids legal issues. I also bring zolpidem to help with sleep and jet lag.

Triamcinalone cream would be wonderful if you rub up against an irritating plant, much like poison ivy. One might want an allergy medication like loratadine or fluticasone nasal spray. From hard earned experience, I also always pack my left ankle AirCast splint!

I am 71, take no prescription medication at all, have been going to Africa for 40 years, and have never gotten sick of anything except tick fever in South Africa.

It was awful.

I was either sweating like in drenching rain, or shaking with cold like being outside in minus 30 degrees!

Slowed down a bit, but did not stop me hunting.

My wife and my PH were not too happy, but I continued hunting.

Mind you, I was hunting in South Africa on a farm, mostly from the back of a truck.

We did hunt a black wildebeest on foot, in the rain, and I did lag behind my PH, who said "you are bit slow today. Unusual for you"

I told him to carry on, and we did get our black wildebeest.

My friend Walter is on so many medications he actually gets stopped at customs, as he wraps each day's meds in aluminium foil!

At Dubai airport once they checked his carry on bag, and wanted to know what all these were.

We all knew the customs officer, but he insisted on opening Walter's bag.

Walter said "but you know me"

The officer laughed and said "that is exactly why I want to look!"

After his inspection, he said to Walter "If Saeed does not kill you, nothing would!"

Then everyone laughed!

Given the side effect profiles, I'd stay away from any of the sleeping meds. Imagine trying to pass through customs with a gun while having amnesia. Also, if you drink, mixing them is potentially fatal. Not to mention, they are considered controlled drugs in most countries. I'd use melatonin or (check where you are going) benadryl.

Z pack has a lot of interactions (like QTc prolongation, a la chloroquine) and everything is essentially resistant to it. Use the Cipro if you need to take an oral antibiotic.

Doxy has some assoiciation with severe phototoxicity, so it can be an option, and does cover tick fever, which cipro doesn't, but it has a lot of side effects and intolerance is high.

Immodium is a better choice than lomotil. (and is OTC.)

I always take some higher potency steroid cream, it works for a lot of thinks like buffalo bean, etc.

A good antibiotic eye drop.

If your provider trusts you to follow directions, a course of prednisone can be very useful.

A strong narcotic can be helpful if you have a major injury, but if you use it, don't hunt for a day after taking it. It can also get you in some trouble in some places- I figure if I am using it, I am going to the hospital via health evac flight, and they can give me IM morphine.

If you have asthma or significant (anaphylactic) allergies, take an epi pen.

Chewable aspirin and nitroglycerin can be very important as well.

Really, it makes a lot of difference what your underlying health issues are...

Agree with both Saeed and England. I always take anti-biotics, just in case, but I never get sick, so I leave them behind. Don't have 40 years experience though, and don't have time to go every year.

Picking up my Malarone and Cipro prescriptions this week for the next one.

quote:

Originally posted by DCS Member:
I’m not trying to change your post, but taking meds can mean two different things.

The “take” as in pack, or the “take” as in prophylactic?

There are quite a few medical professionals on here, but your query may be read differently by some.

Yes, I see your point. I meant "take" as in pack in your luggage in case of a minor medical problem.

Ideally, it is up to the individual to understand what their underlying conditions are and what to “take” as in prophylactic.

However, that may be wishful thinking because, as we all know, you just can't fix stupid. I just wanted to put together a list of a few meds that would save you from having to leave the safari camp and find a doctor.

Thank you to everyone who took the time to reply and offer their experience and advice.

A special shout-out to Zephyr for the probiotic tip and jdollar for pointing out the benefits of Imodium over Lomotil.

Also, I appreciate Drs. England and crbutler for their detailed professional opinions on constructing a proper personal safari medkit.

You've all covered most of the main issues a hunter should consider, however, if anyone can add anything we've overlooked, I'd like to hear what you have to say.

I can add one more useful item to the list... hemostatic agents. These are usually referred to as "blood clotting powders", such as QuickClot, WoundSeal, Celox, etc.

I took a packet of "something" to Zim and left it with Don Heath. He ended up using it on a camp worker who cut their foot chopping firewood. He reported back to me it had worked like a charm and to bring more.

Unfortunately, I don't remember the brand name, and, regretfully, my go-to safari supply store, Brigade Quartermasters, is no longer in business.

I think the average safari hunter can forego packing a suture kit, however, some (hopefully) unused blood clotting powder would be a welcome addition to your PH's first aid kit.

Any recommendations or experience using QuickClot, WoundSeal, Celox, etc.?

Alan,

What ever you decide to take, the PH & Camp will be happy for any thing you leave behind.

Besides taking any prescription medicine that you need (as we age some need more than others) you look at what one need preventative.

The above list provided by many is very good.

Also you may want to add: I put this in a zip lock bag and leave what is not use with the PH.
1. Blister or antibiotic ointment of your choosing.
2. Band aids, paper tape, mole skin, and or 2 inch athletic tape. These come in handy if you are on a blood thinner.
3. Sinus tablets or cold medication, again your choice on what over the counter med you select. This selection changes as the season change in Africa.
4. Lip Gloss with sun block. I take many as it is difficult to obtain the quality we can pick up at the local store.

I’m certainly not a doctor, but I did have the need for some medication which I wasn’t carrying when I got injured while hunting in Zambia in 2018. So, based on personal experience in needing more than the basics, here is what I typically take with me...

I don’t take any prescription meds, for which I’m fortunate. I bring Malarone, Doxycycline, Immodium, Ibuprofin, Neosporin ointment, hydrocortisone cream, Excedrin for headache, and in case I get badly injured - Percocet.

In 2018, my doc prescribed Tramadol for a painkiller in case of an injury. On the last morning of my hunt, I stupidly tried to run down a poacher in the semi-dark just as morning was breaking. I stepped into a large hole while running at full speed, crashing hard. I sprained a knee, cracked a couple ribs and tore my rotator cuff. I suddenly knew the pain of child birth, but through my shoulder. It was incredibly painful. When we got back to camp, I immediately took 2 Tramadol. For all the good Tramadol did, I might as well have used it as a suppository and shoved it up my arse. Now, I take Percocet in case of serious injury. It is kept in the prescription bottle in case there are any questions. I hope to never need it, but if I do I know it works well to kill pain. I took it after rotator cuff surgery and it was very helpful in managing the pain.

Both topical and oral steroids are a good idea.
I would add some topical lidocaine. Itching can be as bad as pain.
Might also consider some Baclofen ointment (antibiotic) and Silvidene cream for burns.
As a physician in camp I have needed those things, usually for somebody else.

I can add one more useful item to the list... hemostatic agents. These are usually referred to as "blood clotting powders", such as QuickClot, WoundSeal, Celox, etc.
____________
I know these are in military use, but I have not seen good studies in the USA demonstrating significant benefit. But I also don't follow the literature as closely as I once did. I am old enough to remember MAST (Military Anti-Shock Trousers) coming out of Viet Nam into wide civilian use. Until they were demonstrated to be detrimental.

For much less expense, once could pack a tourniquet or two, or even an Israeli battle dressing with integral tourniquet. Not sensitive to heat and pretty easy to utilize. But now we're reaching the point where I usually need to caution folks that they are not likely to need either an airway or Asherman chest seal for the dreaded "sucking chest wound" either.

quote:

Originally posted by England:
I can add one more useful item to the list... hemostatic agents. These are usually referred to as "blood clotting powders", such as QuickClot, WoundSeal, Celox, etc.
____________
I know these are in military use, but I have not seen good studies in the USA demonstrating significant benefit. But I also don't follow the literature as closely as I once did. I am old enough to remember MAST (Military Anti-Shock Trousers) coming out of Viet Nam into wide civilian use. Until they were demonstrated to be detrimental.

For much less expense, once could pack a tourniquet or two, or even an Israeli battle dressing with integral tourniquet. Not sensitive to heat and pretty easy to utilize. But now we're reaching the point where I usually need to caution folks that they are not likely to need either an airway or Asherman chest seal for the dreaded "sucking chest wound" either.

I have heard tampons can be used in certain situations. Is that correct, or just a tale?

I thought I was the one who dragged the whole CVS pharmacy with me, but some of you put me to shame!

Yep, sounds like another piece of checked luggage is needed for some of these kits!

For an extended international trip I take: Imodium for antidiarrheal, Benadryl for sleep or allergies, Zyrtec for allergies, Cipro (antibiotic that is pretty multipurpose), Doxycycline (If going to a place with ticks), Ibuprofen

I should probably add a PO steroid to the list.

I don't bring narcotics. The standard PO narcotics aren't all that much better than 800mg of ibuprofen, and then you don't have to worry about breaking any laws and getting in trouble with narcotics.

My dad (general surgeon) always takes a suture kit with some lidocaine and an assortment of sutures. He has had to use it several times over the years. I have taken Wilderness medicine courses and they no longer recommend suture kits. They recommend steri-strips, dressing supplies and dermabond. Most of these courses are taught by ER docs, however so I would take that recommendation with a grain of salt. A surgeon with some suture and lidocaine can accomplish amazing things if needed.

Here is a post from 2009 which caught my attention. Although the U.S. State Dept. Travel Advisory doesn't appear to be relevant anymore, it does illustrate the possibility of unintended consequences when traveling with prescription drugs.


State Dept Travel Advisory Regarding taking OTC Medicines into Zambia


Although there have been several comments about bringing in "strong narcotics" such as Hydrocodone, Percocet (Oxycodone/paracetamol), and Tramadol, for obvious reasons, there have also been comments urging caution about possessing opioids while entering foreign countries. On a tourist travel site, I even saw a caution about possessing Zolpidem (Ambien).


My question is... has anyone here ever had any issues or questions, been detained or jailed, or otherwise had their safari ruined by 3rd World drug smuggling charges for possession of US legally prescribed drugs?


A point of clarity in reference to the phrases "PO steroid" and "PO narcotics". In contrast to IV (intravenously), PO is an acronym for the Latin phrase "per os" which means "by mouth", i.e. a medicine taken orally vs. by a needle.

Marcus,

I've heard tampons are effective for stopping bleeding on bullet wounds in particular and that some soldiers carry them, but don't know that for a fact.

I carry a couple tampons in my first aid kit, along with a couple feminine pads. I have heard from numerous first responders and wilderness first aid providers that tampons are very effective at stopping blood loss from a large penetrating wound, like getting stabbed by a branch or knife. Luckily, I have never had to try it out. I bet it hurts like a bitch when the ER staff has to remove it too. I have had to use the feminine pads, and I can tell you that they work wonders to stop heavy bleeding from a filet knife jabbed into the palm of your hand. They're not sterile, but they soak up a lot more blood that gauze, and do help stop the bleeding in conjunction with good pressure.

Being that most meds are much, much cheaper here in Africa, and readily available without a prescription in most countries, I always wonder why travellers want to come with a bag full of pills...

Moreover, doctors here are used to local ailments, and know what works and for what. More important, they can figure out what bug you may have gotten much faster than their Western colleagues.

Why the worries?

Philip,

I'm sure you're correct that local doctors are capable, more capable than western doctors. The problem is finding a doctor. The only Tanzanian Hospital I've visited was at Emboreet in Simanjiro.
There were no doctors, just nuns, who were nurses.

Well, at least it has an airstrip.

Years ago in Zimbabwe, Walter had a kidney stone, and was pissing blood.

He asked Roy for medications against infections.

Roy brings him a small bottle of pills, gives it to him, and off we went.

Leaving Walter in camp.

Came back in the evening.

Asked Walter how was his day.

He had a small stone in his hands, “I got a baby today!”

Then he gives back Roy the medicine bottle, saying “Saeed, come look at this. Look what YOUR friend gave me”

I looked at the bottle.

The medicine had expired, two years earlier.

Also had FIR VETENARY USE ONLY!

Roy said “We are all animals!”

Hahahah!

I agree with Roy!

But even I will only take a horse pill that was recently made and that I have personally cut in half!

Among the worst things that hit me while out of the country and in remote areas are dysentery and vomiting that resulted in life-threatening dehydration. The actual causes of those conditions can vary but unless fluids can be replaced and fluid levels maintained how you initially got to that condition is irrelevant. Therefore, I always try to have a couple Lomotil tablets. I've never needed more than two. But because those are swallowed, the vomiting must first be stopped. I've always had success with Ondansetron for that. Ondansetron dissolves under the tongue and gets absorbed in the mouth. I have found it to cure the most intense case of nausea and give pause to the worst bout of the heaves. Once my stomach calms down I take a Lomotil to end the dysentery. After three cases of dehydration so bad they required emergency care, lots of IV hydration, and in one case three days of hospitalization, I discovered those meds. They have worked for me for years and I've been able to nip a few real bad cases of dehydration in the bud. Once fluid levels are stabilized the cause can be dealt with. However, in my experience, the causes usually went undetermined and just stopping the fluid loss was enough for a quick recovery.

Disclaimer: Please note, this is what I have had prescribed and what I use. I offer my experiences for informational purposes only. I am not a physician and I am not giving you medical advice. Please consult with your own physician before taking any treatment or medicine.

I would also recommend that you ask your host or PH or whoever is your guide, what medications they keep on hand.

Saeed,

Would you move this thread to the Africa - Reference And Information forum?

It could be a valuable resource for anyone planning and preparing for a safari.