Risks

We will be happy seeing you travel back home, sun tanned, content and healthy, after a fulfilling stay in Cape Verde.

The risks are few, most of them are controllable, easily controllable even, if you knew them before and followed basic rules to avoid them or to mitigate them by seeking and finding the appropriate solution in time.

No doubt, the tourism industry rightly underpins that no mandatory vaccinations are required and that a modern health service system cares for local people and travelers on all islands.

Nevertheless, Cape Verde is a poor country with many limitations.
Some additional information to travelers from industrialized countries makes sense:

• infection risks, especially from water and food are higher
• intervention capacity is lower
• there is no search and rescue system in the mountains

After having spent holidays in a tropical country, one in four travelers looses a day of work or more due to a health problem acquired there.

Epidemics seem to be rare in Cape Verde after a devastating Cholera-epidemy in 1995, short outbrake of Polio in 2000 and a Dengue-fever outbreak in 2009. Worse for travellers in Cape Verde and similar countries are endemic diseases:

Hepatitis A and B are frequent.
Children in Cape Verde are vaccinated agains, while their European and american peers normally aren´t!

The following website reflects the actual epidemiological situation worldwide:
http://www.fit-for-travel.de/en

General Recommendations

An Overseas - Travel Insurance, covering risks outside the European Union and eventually an emergency flight back home, is highly recommended. Standard mandatory health insurance contracts do not include those benefits!

Sun Protection

Cape Verde has more days of sunshine than the desert of Arizona and there is virtually no shadow if don't bring it with you! 

Sun Creams with a protection factor of 15+ and Lipsticks of 20+ are the right. As you hardly ever find them in Cape Verdean shops, purchase them at home.

A hat or cap must sheeld the face and for hikers even a white tissue over the neck can protect from sunburn, respectively give relieve if it happend. Hats and Caps mus resist the strong wind!

Mountainbikers prefer longlegged light coloured tricots of function fibres.

The few days when the usually bright sunshine is missing and the sky is covred by clouds must be considered the most dangerous ones. UV rays are not effectivly filtered by a single layer of clouds and not feeling the sun may provide the worst sunburn ever!

Vaccinations

There are no mandatory vaccination except the rare case of sombody coming from a yellow fever country directly to Cape Verde.

Routine-Vaccinations against Tetanus, Diphteria, Pertussis and Polio should be controlled and eventually updated. Please remember that most of those "childhood"-diseases have a worse impact on the adult than on children!

Vaccinations agains typhoid and Hepatitis A and B as well as BCG against Tuberculosis are highly recommended to backpackers and others working and living close to the local popuation. 10 years after the last inoculation, the latest, update shots are needed. BCG last life-long, oral typhoid vaccines 3 years.

If you never had completed your vaccination schedule in childhood, what is not so rare in the generations born from the 1960th onwards, you should close this gap. Several different vaccines can be applied the same day without additional risks, but in order to be protected, some vaccines require a second shot after one months at least. Some vaccinations depend on previous lab test. The complete process might take several months, so please see your GP in time!

For none of the recommended vaccinations and a prophylaxis you need to go to an institute of tropical hygiene or medicine. Your GP can perform them all - with exception of the yellow fever vaccination you may need when travelling to other countries before getting to the islands.

Dengue-fever

The arthropode born Dengue virus, is one of the most frequent causes of epidemics in tropical countries worldwide. In Cape Verde, the first outbreak (serotype Dengue-3, transmitted by aedes aegyptii) was registered in Oct. 2009 on the lee-ward islands (Santiago, Maio, Fogo, Brava).

see: WHO - Dengue Fever

Malaria

is endemic in the South of Santiago Island, concentrating mainly in Praia town and the green valleys of Santa Cruz. The low incidence of a dozen to one hundred autochtonous cases per year does not justify to recommend routine malara prophylaxis with antimalarial drugs. A similar number of importet cases from the continent does not start epidemics because the mosquito population on the other islands prefers the taste of animal blood to the human.

Mosquitos are rare due to the drought. If your encounter some, try to hinder them from byting you by:

• wearing long white trousers and white socks in the last hour befor sunset and at night.
• using repellents recommended by your doctor or farmacist

The strain of the malaria parasite plasmodium falciparum is higly resistant to Chlorquine and other anti-malarials. In case a person fall sick with heavy fever, headake, backpain and other unspecific symptoms, the diagnosis must be done and eventually the treatment started immediately, as plasmodium falciparum is able to kill within 24 hours after onset of the first symptoms! There is no time to loose!

The interval between the mosquito-byte and the first symptos is 7 to 14 days (in average 11 days). Under certain circumstances, like an unspecific treatment with antibiotics, initial symptoms might dwindle and the lab test become negative for weeks or month before they return.

Falling seriously sick within a year after a stay in the south of Santiago or after a (however short) stop over on the african continent (Banjul, Dakar), please INFORM YOUR PHYSICIAN THAT YOU HAVE TRAVELLED TO MALARIA REGIONS!

 

Public Hygiene

Standards of Public Hygiene, especially the drinking water supply, sewage and litter removal and nutrition hygiene continue on lower levels than in the countries most visitors come from. Awareness and improved personal hygiene can compensate for good part of the risks.

Personal Hygiene

The basic rules of our grandmothers are the best to stick to when travelling to poor countries:

• wash hands
• iron clothes
• don't make friends with every Aircraft-Carrier for lice, bugs and flees (dogs, cats, guinee-pigs)
• weat shoes (injuries, hookworm and chiggers)
• no camping! Where a goat has died of Anthrax 50 years ago, there still are spores in the ground.
• desinfect bathing water for small children
• don't use baby bottles or toys children take constantly in their mouthes

Follow granma's nutrition rule: Cook it, Peel it of Forget it!

• prefer fruits you can peel
• wash salad and fruits in desinfection solutions (the easiest chlorine)
• your steakwell done (port. bem passado)
• use pasteurized cheese and milk (Brucellose, Tuberkulose)
• avoid sea-fruit and crustaceas when you are not sure that they have spent weeks in deep frezer with the legendary blackouts of Praia town.

Drinking Water Desinfektion

All kind of drinking water must be desinfected before use 
Water imported in plastic bottles look great, but according to studies from Europe and the US, they are not safe!
Frequently they are infected while filling. Refilling is not considered a crime or bad service in poor countries. And they are a horror to the environment. In the sea they survive for centuries, are eaten by turtles confounding them with yelly-fish. Within the next few years, tourism will bring 40 Million+ of those bottles per year to Cape Verde alone. And all of them will blame their neighbour when seeing just 1000 on a beach.

Desinfection with Lixivia (chlorine) oder Silver Nitrate

chlorine is the best know and most economic means to desinfect chemically surface- or tank waters to prepare them for human or animal ingestion.

A droplet dispensing device as used for eye-drops, filled with chlorine (Lixivia)¹⁾ lasts for months and guarantees safe water and fruits at any place.

Lixivia is the gernal name for a variety of brands of chloide solution, people buy for washing cloth. Packs for 120 CVE contain much to much for the needs of a traveller.Best is to bring a droplet bottle or two and ask the first B&B owner to fill it for you. Otherwise you have lots of it left over.

1) Katadyn markets a mix of chlorine and silver nitrate under the name
    Micropur Forte flüssig® .
    One droplet bottle is good for 1000 Liter of water.

Use	Drops / Liter
clear water for drinking or bathing children	2
Washing of fruits etc. (wash afterwards with drinking water)	4

Note:
The concentration of Lixiia products in Cape Verde is always the same!
Sie products like Chloroform etc are low in concentration and would pass EU standards for drinking water.

Travelers Diarrhoea

is caused by the oral intake of substances polutec by feces of other peole or animals. It can provoce symptoms ranging of from noisance to life-threatening.
Almost all travellers diarrhoea can be prevented by the simple rules and means already introduced!

The objective of treatment is not to stop the diarrhoea immediately, but to keep water and minerals in the body in a balance. This is done by Oral Rehydratation and the least of interruption of normal diet possible!

Drugs againt Diarrhoea are very little convincing in their principles and effects.

Drugs imobilizing the colon like Imodium® are a good means to overcome the nervousness of an exam day in university. In the case of an infectious agent causing diarrhoea, they mean hindering the inteestine from the getting the infectious agent out. In salmonella infection, this may lead into perforation of the guts, a severe surgical complication.
While in Europe considered counter-indicated and forbidden to be used in small children, in poor countries the substance is heavily marketed by the firm and sold over the counter of pharmacies.

Desinfectans and Antibiotics without previous high-tech exams and tests of the stool, not available in Cape Verde, are not likely to hit the nail. It is not recommended to take the risk resistency and allergy without knowing about the efficacy of the antibiotic taken.  

Vegetal coal and so called adstringierents do not have any effect beyond the "cosmetic" change of the viscosity of the feces you may equally find after taking a little banana or apple pie.

Yeast-preparations promise to grow out the pathogenous germs in a competition only they will winn. The fact is, that there is not a single study giving evicence for this protective or therapeutic effect.

Oral Rehydration with the right mix of Water and Minerals continues to be the only correct, effective and efficient solution while far from high-tech. It avoids dehydration, keeps the body in equilibrium, and in childre nit is life-saving!  

Oral Rehydration Salts(port.: ORALITE) can be purchased in farmacies and the public health services. Travelers with children should always hava a few in their luggage.  

Rice Water is of even better efficacy than the industrial products. But they are more difficult to prepare in a hotel room.
A good spoonfull (the big one for the soup) of (grinded) rice with one Liter of Water and half a tea-spoon of salt are boilt for an hour. The greyish Solution is taken in large amounts. To have enough for a night, it is wise to prepare 2-3 liters. The owner and employees of your hotel also know how to prepare it.

Diets against Diarrhoea normally are counter-productive, but they hardly ever dye, because the serve the priority of mothers to stop the diarrhoea .... mostly based on the dangerous logic that nothing will come out of a tube after having stopped to fill somethin in! This is stool-cosmetics frequently worsening the state of dehydration and disturbing the metabolism of a patient who nees a good energy intake to compensate for the enourmous losses due to fever and malabsorption.
Patients, and this applies to children as well!, are allowed to take up frequent small meals and sweets if they want. Probably they will not like fatty food.

Sportsmen who want to maintain or recover their fitness as soon as possilbe can follow the same rule.
A little malabsorption of a little food is better than no malabsorption of no food!

Acute watery diarrhoea:
Take Oral Rehydration Fluids from the very beginning and take a lot!

In the case of chronic diarrhoea ) (more than 3-4 days) or whenever there is blood in the stool (dysentery) , see a doctor! This kind of diarrhoea requires microscopic and lab exams and should be treated in the targeted application of antibiotics.

HIV / AIDS

The prevalence of people living with HIV/AIDS in Cape Verde is like in the European Union, far away from the levels found in part of the african continent.

There is no reason for panic if travelers find out, they are staying with infected people in one houshold. Because:

 

• in everyday life, without sexual contacts, there is no important infection risk, even when staying very close together.
• Blood and blood products used in emergency surgery in the central hospitals are controlled and safe. The same is true for emergency surgery.

The number of male and femal Sex Tourists in Cap Verde has recently increased and will continue to increase with the beach tourism and "investor" business. Prevalence of all kind of sexually transmitted infections among prostitutes of both sexes is hig. Even higher it is among those nice boys and girlies at the beach, the boats, the disco and everywhere where the tourists are, not being immediatly identified as occasional prostitutes.
Contacts between globetrotters are also more risky.

Finally, thera there is a risk everywhere, and the hope for a lower risk is the mother o infection.
The only logical consequence:

Use condoms
and avoid practices with direct mucousal contact.

Condoms (crioulo: camisinha) you find in Pharmacies (Farmácia) and in the Reproductive Health Centres, called PMI.

Babies and Toddlers

should follow the vaccination calender of their country of origin with one exception:
Measles vaccinaton from the 10th month onwards! It Europe it is recommended for the 13th month of life.
The likelyhood to acquire measles in Cape Verde today is low, but in other developing countries very high. There it continues to be a prime cause of mortality and blindness. Important to know that a good nutritional status does not protect the visitors child from severe measles!

Even if it becam a fashion in Europe to talk mainly about possible side effects of vaccinations, the risks that will be avoided are uncomparibly higher!

Parents, travelling with children without making sure they complete the vaccination calender in time, are irresponsable!

Diarrhoea in early childhood is one of the most frequent causes of death.
Children are more vulnerable to dehydration, why

• brest feeding is to be continue
• Oral Rehydration must start immediately and be persued with rigor
• New symptoms, loss of consciensness, being anable to swallow must be answered by taking the child to a health centre or hospital without delay.

Desinfection of water for the bath os part os sensible protection. Children tend to swallow a lot of water i the tub.

Nappies or Diapers

Paper and plastics have given was to the good old cloth models. The disadvantage of plastic pampers is that they for a humid chamber where microbs love to grow, leading to skin eruptions and infectinos.
We recommend to take a few cloth diapers with you for preventing and treating this on especially hot days.

Baby Food

Ready made Baby Food was unknown 20 years ago but has found his way into the middle-upper class.
The market is small and it is recommended to check the validity dates!
People still know how to prepare within minutes a porridge from maize flour and vegetables.

Breastmilk Substitutes

are poor substitutes of the ideal in readiness, quality and safety: Breastmilk.
The can be found in the bigger supermarkets and some farmacies. Beware that normal milkpowder can be dangerous if not accompanied by a special technique to mix it with the exactly right amount of water, sugar and eventually oil!
Delay weaning your child until AFTER the voyage. Being able to breastfeed can overcome many problems during the journey.

Fresh Milk

is not available on the market.

Long Live Milk

comes from Europe and is foud even in smaller shops upcountry.

Feeding bottles

under conditions of poverty are a hygienic and nutrition desaster and cost the life o many babies. Where there is no breastmilk available, even small babies can be spoonfed. The breastmilk substitute is offered from the large part of a soupspoon. The bigger the spoon, the easier to learn for both, the baby and the mother! The metal spoon is acompanied by an inox mug.

Pregnancy and travelling 

The with to become pregrant or to be pregnant should not hinder women to come to countries like Cape Verde.

Routine Vaccinations against Tetanus, Diphteria, Hepatitis B, Polio, and Typhoid as well as the passive protection against Hepatitis A by gamma-globulines are possible in phases of pregnancy. Nevertheless, some doubts remain, because topics like this are hardly ever possible to study in sufficient sample sizes, justifying the reluctancy of many medics to apply any vaccine before the 13. th week of pregnancy. Active vaccinations like Tbc, measles, parotitis and rubeola are risky and, fortunately, not needed in travel medicine. Yellow fever can be applied after the 13th week.

The fact that Malaria in Cape Verde is so limited, cuts the discussion of otherwise difficult malaria profilaxis short. Super-cautious women avoid the soutz of Santiago in the secon half of the year.

Pregnant women beyond the 35th week of gestation and parturients in the first week after delivry are not accepted by the airlines.

Delivery Care in Cape Verde is fine when compared to african standards.In comparison to Europe, it lacks behind a lot, especially on the islands where there is no operating hospital, bloodbank and anestesiologist available throughout the year. High risk pregnancies and preterm babies are cared for on a very limited level.

The world of attitudes and feelings changes during pregnancy for the woman as much as for her partner. People become, wisely preparing for childrearing times, more sensitive and coutious, more responsable and more hesitating. It is a good cultural transition going along with a physiological and social transition in life.
If you or your partner have become more carefull and a bit afraid of a holiday under unusual conditions, you may experience the challenges of heat, noise, poor higiene and poverty as an over-challenge. Then it is much better to allow for a real rest in your familiar surrounding and relax quietly before delivery and early parenthood.

There are nice locations to pass holidays close by!

A little councelling on Alcolhol and Smoking is always good in antenatal care! Now you are taking care for two lifes! Isn't this a good reason, better than ever before, to take your responsability and fight your abuse? Your doctor will help you or arrange a group helping you effectively!

In conclusion, going to Cape Verde as a Pregnant women ist fine:

• if there were no serious complications to date
• if the woman and her partner are not psychologically overburdened
• if Routine Vaccinations are complete
• if you could manage without a Stop-Over on the african continent
• if you will be back home until the 34th week of gestation - or stay there for delivery