Medical Cover working in Africa

[wheels up]

Going to fly up in W Africa and was wondering if any of you experienced types have any suggestions re. medical / repatriation cover? Any suggestions re. avoiding malaria? What anti-malarials can pilots take - the information I have been given tends to conflict.

Any info would be very useful to me and others.

thanks.

WU

[soggyboxers]

Depending on the company you're working for, many offer emergency medical repatriation as part of the deal, although it's not always specifically mentioned in the contract. It's worth asking whoever you're going to work for if they actually do provide it.
SMI provides excellent medical cover in many west African countries and has its own clinics, doctors (many from South Africa) and drugs available. It's not cheap but, in my own experience, well worth it. Again worth checking with your employer, as some companies have a corporate subscription, but don't mention it in the contract.
The usual advice given to avoid malaria is to wear long sleeved shirts and long trousers in the evening when mosquitoes are most likely to bite. Avoid going out of doors at this time, and if you can't, spray exposed areas of the body with an insect repellent containing DEET. If you're in an area where there are large numbers of mosquitoes this should be 50% strength.
Most countries in West Africa have chloroquine-resistant strains of malaria, so chloroquine is of little use as either a prophylactic or for treatment of malaria. Halfan (halofantrine) should also be avoided because it can cause heart problems. Lariam (mefloquine), although a very effective anti-malarial, is banned by most airlines because it can have severe psychiatric effects. My own company presently advises either Malarone (atovaquone and proguanil mixed) as a prophylactic, as it is a relatively new drug and known to be effective aginst falciparum malaria (the most common form of the disease in West Africa - as well as one of the most deadly); or Vibramycin (doxycycline). Both Malarone and Vibramycin have some side effects - Malarone can give rise to nausea if taken on an empty stomach and may cause mouth ulcers (so take a tube of Adcortyl in orabase to treat them); and Vibramycin increases the possibility of sunburn, especially in fair-skinned people. Malarone is expensive, but has the advantage that if you're on tours back to your own country, you only have to start taking it a day before departure to a malarial area and for a week after return, so you can give your system a rest from it when you're on leave.
There are now test kits available which give a very quick result as to whether or not you have malaria if it's suspected, but it's recommended that they only be used by medical personnel trained in their use. The main thing if you think you may have malaria (and that includes thinking you have a cold, or any sort of fever or aching) is to seek medical assistance immediately. Most local doctors, whilst lacking in equipment or expertise to treat other diseases, are very good at treating malaria. If you return home and think you have a cold or flu, make sure you tell your doctor that you work in, and have just returned from, a malarial area. It's not a disease you can afford to take any chances with as a couple of friends of mine have found out to their (fatal) cost.
Hope that helps.
:)

[Gunship]

Lo Wheels up,

I had a good search yesterday for you without too much help. I will try my best in the mean time today.
On DSTV (SA based - Africa Sat TV) I saw a new company that started up ... I think it was International SOS but the web site I have tried did not work .. will keep on watching for you.

Cheers and make sure you have a great time !

[soggyboxers]

WU,
Further to my previous reply, I don't know if you're a woman, but if you are, another side-effect of doxycycline is that it increases the chances of your catching thrush.
Also, anti-malarials don't actually stop you from getting malaria as they don't prevent the parasites from entering your bloodstream, but they do inhibit the development of the red blood cell forms of the malarial parasites and this is why they have to continue being taken for a period after leaving a malarial area.
A couple of useful sites for up-to-date information on the states of diseases and recommendations (they do differ slightly as they reflect the views of different health authorities) are the UK Medical Advisory Service for Travellers Abroad (MASTA) and the USA Centre for Disease Control. These can be found at:-
MASTA (http://www.masta.org/home)
or:-
Center for Disease Control (http://www.cdc.gov/travel)

The emergency repatriation provider which my company uses is:-
International SOS (http://www.internationalsos.com)

I've heard that the following French company is also pretty good (especially if you're going to work in a Francophone country):-
Medic Air (http://www.medic-air.com)

One of my friends was evacuated by International SOS a few years ago and they were very good.

Hope that's of help,
Soggy
:)

[wheels up]

Once again PPrune proves to be a mine of information - thanks all for the comprehensive replies which have been a great help.

See you in darkest (and wettest) Africa.

WU

[Gunship]

Lo Wheels up,

As Soggyboggers mentioned International SOS - that is the company doing the extensive advertising on Sat TV. They specifically mentions ANY part of Africa - 24 / 7 / 365 .. most probably a Learjet being activated via Sout Africa ?

If you get prices - please post them for all of us m8.

[Gunship]

Chloroquine not enough to prevent malaria in travelers

The antimalarial drug chloroquine is no longer effective as malaria prophylaxis for travel to most regions in the world (including sub-Saharan Africa and even South Africa), according to a report by die US Centers for Disease Control and Prevention (CDC).

The CDC issued this warning in the July 20th issue of the CDC's Morbidity and Mortality Weekly Report, after two Americans died after visiting Nigeria and East Africa.

Even a combination of chloroquine with proguanil might not be sufficient to prevent malaria. The CDC expressed concern that nearly 20 % of American travelers to malaria regions had used inappropriate prophylaxis, and 56 % had used none.

The geographic spread of P falciparum resistance to chloroquine is increasing, according to the CDC. Chloroquine resistance already exists throughout sub-Saharan Africa, southeast Asia, the Indian subcontinent, and large portions of South America.

In November, the CDC began recommending Malarone (a combination of atovaquone and proguanil), mefloquine, or doxycycline as options for people traveling to chloroquine-resistant areas.

[Boss Raptor]

Avoid Larium - see the UK AIC's on the subject - took it once gave me mood swings and skin rashes...made otherwise normally placid colleagues aggressive!

I live in UK and have 'off the shelf' medical insurance that covers me for everything all over the world inc. repatriation on up to 90 day trips - unlimited number per year, just renewed at £54 per year!

[Gunship]

Boss Raptor,

Any more info and contact details / web site perhaps please ?

Here is a wee more about Malaria : The green coils was banned in 1982 in the SAAF if I remember correctly ?

Those GREEN Mosquito coils

When one enters many Ghanaian homes in the evenings, especially in the slums and low-income areas in the cities and towns, one is met with pungent scents emanating from smoke coming from burning coils.

These are mosquito repellents that keep burning throughout the night and are supposed to give residents sound sleep.

Causing other health problems
In the tropical West African country where mosquitoes are a major health menace, the coils have for many years saved people from malaria or even death that mosquitoes cause.

However, there are growing concerns that the smoky mosquito repellents may be doing well in the battle against mosquitoes, but may also be causing humans problems such as catarrh and skin diseases.

"Anytime we use mosquito coils, everybody develops a cold in the house," a housewife said. "They repel the mosquitoes, but they lead to another health problem," she added.

Trade of coils doing well
The health authorities have yet to make absolute pronouncements on the health-related problems of the smoky repellents.

The mosquito coils have become very popular in Ghana because they are cheap and can be afforded by the poor instead of insect sprays that are equally effective against the dangerous mosquito.

Traders confirm that have been making fast turnovers in the sale of the smoky repellents, especially as radio and television advertisements have been extolling their potency.

Indeed, there are about 50 brands in the country, many imported from Asia. And their names suggest just how powerful they are against the insects or how comfortable it is after using them. They go under names like Lion, Tiger, Dagger, Raid or Attack to show potency and Lord, Good Night or Angel to show comfort after use.

Prevention efforts have failed
Efforts by the health and environment ministries to carry the campaign to the people to stop the breeding of mosquitoes by keeping their environment clean have failed.

The drains are choked, puddles of water and mountains of rubbish, which are just what the mosquitoes need to continue to bother the people.

Cost of malaria high
The cost of malaria to the economy is rather high. About 44 per cent of all out-patient cases and nearly 22 per cent of deaths among children under five are caused by malaria.

What is worse is that in the past few years, medical experts have been deeply concerned about the development of new strains of malaria parasites, which have developed resistance to the orthodox drugs in treating the disease, especially chroloquine.

In fact, over the past three years or more, what has become known as chroloquine resistant malaria (crm) has become a known terminology in medical circles.

Standard treatment not being followed
Health Minister Kweku Afriyie said this has resulted in several different drugs being used for the treatment of malaria.

In one hospital with about 12 doctors, he said, a study found that there were 32 different combinations of drugs and dosages in the treatment of malaria.

Afriyie said the Ghana Medical and Dental Council should therefore work out and enforce a new national standard for malaria treatment in the face of reports that doctors have been deviating from standard guidelines for the treatment of the disease.

In the meantime, there are no vaccines against malaria. The mosquitoes continue to be a menace and smoky repellents remain popular with the poor. – (Sapa)

Sorry to long to publish ... so here goes ... FULL article on MALARIA

HEALTH 24 Link (http://www.health24.co.za/Default.asp?action=article&ContentID=11956)

[soggyboxers]

Yes Guns,
The green coils are not so good, but those little electrically activated blue pads are reasonably effective. The trouble is, of course, that in many of the poorer African countries, the electricity is off for many hours a day.
Under no circumstances take Larium (mefloquine) as a prophylactic - whilst an effective antimalarial it is not recommended for pilots because of the problems with psychiatric disturbance. In extremis, it can be used for treatment of the disease if you have nothing else.
If you can, make sure that the windows of your room are covered with fine gauge mesh to prevent entry of mosquitos that way, and try to make sure that your room is sprayed with an insecticide early in the evening before you retire to bed. In areas of very heavy mosquito activity, use a mosquito net over the bed. This should be impregnated with DEET by soaking it in a solution of it, and the treatment should be carried out every time it's washed. Make sure that the net is large enough to completely cover the bed and that your bare skin is not in contact with it otherwise mosquitoes can still bite you through it!

[Gunship]

Soggyboxer,

Yeah .. truly been there .. seen it all - you know what you are talking about.

We also use the blue electrical stuff with the gue stuff inside - but at least we have power / generator 24 hrs lately.

Our worst problem is mosquito's in the heli .. always forget about them and then while flying low level at 50' AGL at 300 km/h http://www.stopstart.fsnet.co.uk/aircraft/army2.gifand sorting out f****n mossies aint no fun ...

I personally am one of those "strong" Souf Efrikans that can "take the punch" when I get malaria (once or twice a year minimum). When I get the old cold and the body start aching ... NOT THAT ACHING :p Bert ! - then I take the Chinese tablets ARTESINATE as I take no precautions. (Right or wrong)

A friend at the UN (Souf Efrikan) - has serious mental stability problems : reason after LENGHTY checks : Larium .. luvveley Larium ! :mad:

[ZAZOO]

Try AXA-ASSISTANCE. www.axa-assistance.co.uk or www.axa-assistance.fr

Tel: 33 1 55 92 40 33
Fax: 33 1 55 92 22 33
These are the only international numbers I have from the doctors card here and its their office in France, I actually asked them for their prices as I would like to sign up with them.

They do the same job as SOS and with a lot of skilled medical professionals on their team mostly former military doctors, witnessed a few of their medivac operations at the airport.

I just visited a dutch friend in their center here in Port Harcourt with malaria and he is doing very well after 3 days (up and working around ) and will go home in the morning, apparently he has been on Quinimax infusion some kind of quinine drip for the past three days and it works.

One of the french doctors there told me that quinine was their " bras droite" after all the others.

They actually do a kind of blood test under the microscope that tells them how much falciparium is in the system and with that decide on which drug to use, depending on the severity and advise most of us not to take any medicines without first consulting a doctor, as some of us could react violently after taking them !

Regards
Zazoo

[Gunship]

Sorry 4HP not directly flying related but surely has a direct influence on any pilot in Africa at any time ... huh say that again Gunss :rolleyes:

Link (http://www.news24.com/News24/Africa/News/0,1113,2-11-1447_1288102,00.html)

Malaria: Mosquito net still best http://www.stopstart.fsnet.co.uk/smilie/whip.gif

Arusha - Malaria is killing an estimated one million Africans a year and with a vaccine still years away, experts say the best available weapon against the disease on the continent remains the mosquito net.

More than 90% of the world's estimated three million malaria cases each year are in Africa, the World Health Organisation (WHO) said. The vast majority are children under five.

In Tanzania alone, the government says 274 people are dying of the insect-borne disease every day.

Malaria, which is transmitted to humans by the anopheles mosquito, is becoming increasingly resistant to anti-malarial drugs in many areas and is harming economic development.

There is also increasing resistance to insecticides and the growth of HIV/Aids has compounded the problem of treating those affected.

Scientists say there has been considerable progress made in developing a vaccine and clinical trials on humans are already being carried out.

But it is likely to be many years before an effective vaccine is available. For countries stricken with poverty who would struggle to afford mass-vaccination of vulnerable people, experts say it may be better to focus on simpler solutions.

"There is nothing, other than mosquito nets, that can reduce child deaths (from malaria) across Africa," Halima Mwenesi, a scientist working with the Kenya Medical Research Institute told an international malaria conference in north Tanzania this week.

"Mosquitoes are most active between 17:00 and 06:00, and that's when people are most vulnerable. (Bed nets) are not a new tool, but only in the last six years has scientific evidence shown that bed nets reduce prevalence by 25%."

At a summit in the Nigerian capital Abuja in 2000, African leaders and global agencies vowed to halve malaria mortality in Africa by 2010, by improving access to treatment, reducing taxes and tariffs on nets and encouraging their use.

More than two years later, more than half of Africa's countries have still not acted on cutting tariffs.

"Very little has happened, compared to the magnitude of the disease," Magda Rubat, an official at the WHO's regional office said, adding that African governments had also failed to deliver on promises of faster treatment for those already suffering from malaria.

Researchers have also called on the donor community to give more aid to malaria projects, saying that the disease is having a devastating effect on Africa's development.

A recent report by WHO, Harvard University and the London School of Tropical Medicine showed malaria slows economic growth in Africa by up to 1.3% each year. The report adds that sub-Saharan Africa's Gross Domestic Product (GDP) would have been up to 32% higher in 2001 if malaria had been eradicated 35 years before.

"Africa is yet to grasp the full human, social and economic toll of malaria on the continent," WHO regional director for Africa Dr Ebrahim Samba told the same conference on Tuesday.

"The impact of malaria on the economy in Africa is horrendous. It is believed that if it were not for the burden of malaria, the development of Africa would be very different."

[AfricanSkies]

"The impact of malaria on the economy in Africa is horrendous. It is believed that if it were not for the burden of malaria, the development of Africa would be very different."

ha..i can think of a few hundred million other burdens on the economy, too

[4granted]

Try BUPA International....use google to find.
£1 000 000 (pounds dudes) cover , repatriation etc etc etc...great service and all online, no medical check etc....bit expensive maybe but reliable...
9Q4g
Mabuto..call me!!!
9998907 Kin.....off to Bangui on morrow....
Have you beeen to Kimvlu/kimvula??????

[flyboy2]

One of my clients states that his staff in Tanzania get given 8 tablets of "Cotexin " when diagnosed as having Malaria.

Does anyone know this "cure " of Chinese origin ?

[flyboy6876]

I personally don't like to take prophylatics if I'm going to be in country for any length of time.

Found that dressing correctly and use of bug spray the most effective deterrant to mozzies. Sleep under a net as well.

Spent two months in West Uganda a couple of years ago in an area rife with Malaria. The medic there was using Artisenate (spelling??) which was apparently a chinese tab to effectively treat the folks that came down with a dose. Very effective and he swore by it. Would'nt have any other malarial medication around.

[wheels up]

Thanks again for all the info. Here's some info on medical/repatriation cover:

International SOS offer 2 plans. The first one offers repatriation cover (fly you back to your country of residence) and medical cover for stabilisation purposes. Once you are home you're on your own. (wonder if they leave you on a stretcher on the apron if you don't have medical aid!)

The second plan offers repatriation cover as well as medical treatment on returning home - suitable for people with no medical cover. Both the plans are reasonably priced although plan 2 is obviously more expensive. The cover can be taken for 1,2,6 months or yearly.

Discovery health offer a hospital plan with repatriation for trips < 90 days from country of residence. Monthly subscription is a reasonable R530 pm. The Discovery plan offers cover even when you are back home although the SOS plan doesn't. The lady I spoke to assured me that I would be covered whilst operating as aircrew whereas the SOS plan specifically excludes cover for injuries sustained whilst acting as a crew member.

Any suggestions for mossie repellant? My experience with Tabard is that it is not that effective and only lasts for a couple of hours.

WU.

[flyboy6876]

Wheels Up

My partner works at our local zoo (heaps of mozzies and various other bugs) and they use a non aerosol spray which lasts most of the day. I'll find out what it is they use (we have a bottle at home:) ) and get back to you.

[Gunship]

I can only agree with FLYBOY,

As soon as we get malaria here .. we grab the packet of ARTESUNATE - that is the correct spelling. Ask me I just had a rebounce of malaria ... the green and white packet is next to me :mad:

A Packet of 12 tabs will sort you out ! We immediately take 4 - yes 4 not 2 tablets if you feel a cold coming - especially when you have body ache, bones sore ... body sore .. joints sore Ok ok I know it becomes like that when you are 50 as well ! Then 2 every 4 hours - you should be fine in a day or three.

Signed : Dr Gunss (PHD Monrovia STATE University), Hounours degree Freetown Secondary School for finishing grade 12 in 12 years.

[flyboy6876]

WU

If you can get it, Johnsons OFF Skintastic, is about the best I've found for bug spray.

[flyboy2]

Anyone used "Cotexin " after getting Malaria ?

Cotexin is apparantly of Chinese origin & consists of
8 tablets taken 4 a day, after being diagnosed

I was told that there were " no side-effects "

It is seemingly only available in Tanzania for US $ 15

Thanks to everyone for sending very useful posts on the
subject of Malaria

Hi Gunship

I saw your post on using Artesunate for treatment of Malaria. Thanks

Where can one buy it ? Price ?

Is it effective throughout Africa ,or is it area specific ?

Any side-effects ?

[Gunship]

Lo Flyboy,

We buy 50 mg x 12 Tablets for L12 000.00 (about $ 5.00).
I threw the pamphlet away but it says on the box : Used in the treatment of falciparum malaria and vivax malaria and also the emergency threatment of critical cases

They also say one tab , twice per day .. I "grew up" using 4 tabs immediatley and two every four hours and have not died - uhmm yet .. :eek:

No side - effect for me or any of my friends - collugues that uses it.

We find it in any chemist / shop / around the corner kuka shop - basically anywhere.

Hope it helps !

Cheers,