The Travel Clinic – Africa

“Travel can be a powerful force in changing our world into one where there is more understanding and less problems.” ­- scribbled on a washroom wall at a hostel

“Only man with small penis pees in cubicle.” – also scribbled on the wall

If you go to Africa, it will change you forever.

A stranger at a dinner party once imprinted these words on me. He told tales of bribery, corruption, travel in broken-down buses, guns everywhere. It sounded like a wild and dangerous place. When he said, “Go there, man.” I swore I would – one day.

Years later, when I told people I was going backpacking, alone, in Africa, the response was always the same.

“Africa? Why on earth would you want to go there?”

Some thought I was brave, but most thought I was foolish. A few thought I was crazy.

In the past, backpackers headed to Europe, Australia, Southeast Asia, although nowadays they go pretty much anywhere – anywhere but Africa. And with good reason. Public transportation is usually uncomfortable, inconvenient and unpredictable – sometimes unavailable – often dangerous. One has to be prepared for the possibility of becoming stranded, separated from one’s possessions, or worse. You can’t just hop on a jet and fly there. Well, I suppose you could, but you probably wouldn’t come back. The potential health risks are enough to scare away the most hardened traveler. They include everything from simple diarrhea to several potentially fatal diseases, many of which have no vaccine. Multiple immunizations are required, some countries will not allow entry without proof of vaccination. That’s why I visited The Travel Clinic.

“Fill this out.” The receptionist thrust a clipboard at me. Without raising her eyes, she flicked me away with her hand. “Have a seat over there.”

The form, several pages long, asked about my medical history and my family’s medical history. It also wanted me to list every country I planned to visit, what accommodation I would be using (from bush camping to a five-star hotel), and would I be visiting rural areas.

“Hmmm,” the doctor said when she later scanned my list, “uh-hmmm, hmmm, oh! Mm-hmmm.” She finished with a loud “hmmph!” and looked up at me with raised eyebrows. “That’s a lot of countries.”

“Uh-hmmm,” I said. I wasn’t sure I would visit all of them, or any of them even, aside from South Africa where I planned to start, but I was considering traveling all the way to Egypt, so I had listed every country in between, just to be safe. I had no idea where I might end up. I was going backpacking. I wasn’t going on an organized tour. I was going to make it up as I went along. That’s what backpackers do.

It didn’t surprise me most people visit Africa on pre-arranged “safaris” or organized tours. I wasn’t interested in that type of trip, despite the dire warnings from my travel agent. An organized tour would make me a tourist. I wanted to be a “traveler", as backpackers like to call themselves. Although the distinction is sometimes blurry, I believed there is a difference. Tourists see a place. Travelers meet it. Tourists are clean. Travelers get dirty. Tourists expect security, comfort and service. Travelers expect little and often forego their comforts. Tourists have little time and large budgets. Travelers have a lot of time and small budgets. Tourists travel on package tours or arrange everything from home before they leave. Travelers fly air-only and arrange little in advance. Tourists visit. Travelers, well, travel.

In truth, I wasn’t a traveler. I’d hardly been anywhere. This was to be my first backpacker trip. I always said I would backpack around the world, and yet somehow, my twenties had slipped away. So I left my teaching position, said goodbye to family and friends and stowed everything I deemed of any value in a storage container. Then I bought a ticket to Johannesburg. I had a friend in Johannesburg. It seemed a good place to start.

“Hmmm.” The doctor shook her head. “You’re going to need a lot of needles.”

“Needles?” I gulped. Needles were the reason I avoided doctors.

“Yes, hmmm, let’s see.” The doctor began scribbling on a yellow card. “You’ll need a Yellow Fever vaccination. You’ll have to come back for that, we only do them on Wednesdays.”

“Yellow Fever?” That didn’t sound good. “There’s a pill for that, right?”

“No, I’m afraid it’s a needle, and you’ll also need polio, diphtheria and tetanus boosters. I can give you those today. We’ll also have to vaccinate you against meningitis and hepatitis, both A and B. Those require multiple shots, we’ll have to schedule a series of follow up visits.”

“You’ll give me pills for those?”

“No, I’m afraid those require needles too. Unfortunately, there’s no vaccine for C, D, E or W, so you’ll just have to hope for the best. And we’d better vaccinate you against Japanese encephalitis, Chinese chowmein and purple plague as well, just in case.”

I’d lost track of what she was saying. Actually, I’d lost track from about when she said, “You’re going to need a lot of needles.”

“And while we’re at it, we might as well give you a flu shot.” She dotted her pen on the card with an air of finality.

“Um, just how many needles will that be?”

“Well, let’s see…” She began silently counting. My eyes grew wider with every count. “Shouldn’t be more than a couple,” she said.

I sighed. I could endure a couple.


I gulped, “Couldn’t you give me the vaccines some other way?”

She looked amused. “What other way?”

“I don’t know. How about with a hypo-spray like they have in Star Trek?”

“I’m afraid I’m all out of hypo-sprays.” She smiled at me. “But I do have some lovely needles. How about a nice red one?”

I pouted.

“I’ll also have to prescribe an anti-malarial prophylactic.” She handed me a fact sheet that described the effectiveness and possible side effects of each drug. “I recommend either doxycycline or mefloquine, which is more commonly known by its brand name, Lariam.”

“A propha – what?” That didn’t sound good at all.

“It’s just a pill. Lariam is considered more effective, but it has more side effects.”

I sighed. Finally a pill. Side effects didn’t scare me.

“Doxycycline’s main side effect is photosensitivity. Lariam’s possible side effects include headaches, nausea, dizziness, difficulty sleeping, anxiety, vivid dreams, hair loss. ”

“I’ll take the doxy… thing,” I said with a sudden interest in side effects. I didn’t need to hear the rest of the list, which I later learned included seizures, depression and psychosis. Lariam’s side effects have become the stuff of urban legend. Stories abound about people going mad, running down streets naked, freaking out on airplanes, or jumping out of hotel room windows. I even heard conspiracy theories – like it was secretly developed by the U.S. military for reasons unknown (it was developed by the Walter Reed Army Institute of Medical Research to protect Peace Corps volunteers). I was told no one is really sure how Lariam works (which is somewhat true) and no long term tests have been done on the drug (which is not so true, Lariam is one of the most extensively evaluated drugs in history and the most widely prescribed malaria prophylactic in the world). She wrote me a prescription for doxycycline and another for an antibiotic for diarrhea. Then she handed me an armload of brochures with various titles like, “Bon Voyage But… Information for the Traveler” and “Son of Scam: How to avoid being Robbed, Beaten, Imprisoned, Sentenced to Death and other Travel Nuisances.”

“And we should discuss sex.”

This got my attention. This was usually my line.

“Of course.” I winked at her and nodded toward the couch. She wasn’t bad looking, a little older than most women I’d dated…

She gave me a puzzled look. “AIDs is rampant in Africa,” she continued, her tone strangely businesslike, “as many as one in four people are infected with HIV, so you’ll want to exercise extreme caution where sexual matters are concerned.”

She turned her back to me.

“Just so you’re aware.” She faced me again, now armed with a needle. My eyes widened and fixated on the long piercing steel shaft. “Your visit is covered by your medical insurance, but not the vaccinations.”

“And how much will the vaccines cost?”

She placed a sheet of paper in front of me itemizing the cost of each vaccine. “It shouldn’t come to more than five hundred – ”


It was an effective distraction. I hardly noticed the cold chill of the steel entering my body. Only the faintest “mommy” escaped my lips.

“That was just the alcohol swab,” she said. “Are you ready?”

Bravely, I squeezed my eyes shut. “Ready.”

Several jabs later, in each arm – I felt like a human pincushion – she walked me outside to the waiting room and instructed me to wait ten minutes before leaving, to make sure I didn’t have any “adverse reactions” to the vaccines. She didn’t specify what these adverse reactions might be. Clearly, she preferred to allow my imagination to supply the images of bubbling skin, festering growths and crippling deformities.

“Help yourself.” She pointed to a basket of lollypops.

I plopped a lollypop into my mouth and sat down rubbing my bandaged arms. I shuddered to think how many more jabs I would have to endure.

“Enjoy your trip,” she said with a smile. She began to walk away, then stopped and turned to me.

“I was just curious? Africa? Why on earth would you want to go there?”


This is Chapter One of Ron Ruby's nonfiction narrative, Africa’s not for Sissies, A traveler's Talethe story of one traveler’s misadventures from Cape to Cairo. No Guidebook. No Map. No Clue.

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