Here are 7 common sense rules
to prevent you from going home in a box or getting medevac’d early.

1) HAKUNA MATATU

The ubiquitous matatu is not designed as a people carrier and they are dangerous. The seats are sometimes simply pot-riveted to the floor and when they have a collision they rip out and everything is thrown forward in a tangle of twisted metal, broken bones and crushed skulls. The drivers often chew Qat to stay awake, they overtake on corners and the tops of hills, and every week there is a report of 10 or 15 dead in a matatu accident. Almost always the police blame driver error. For long journeys buses are far safer. Fortunately, in Kampala the roads are so congested they seldom go fast enough to kill anyone. Boda Boda drivers are also reckless and dangerous. There are old drivers and bold drivers but no old bold drivers. If he is not wearing a helmet he is telling the world that he has chosen to be irresponsible. As for you, in Europe who goes on a motorbike without full protective gear? So why do it here when the drivers are far more irresponsible?

2) Murder

Murder is rare but violent robbery and rape are more common. So, rule number 2 is “sheer common sense”. Do not do in Uganda what you would not do at home. You would not ride a motorbike without a helmet. You would not get on a motorbike outside a nightclub at 2.00 am with a man you have never met. Do not leave your drink. If you go out together, make a pact that you go home together. Almost every rape victim we see says “how could I have been so stupid”.

3) The commonest cause of going home early is tired all the time.

Fatigue is worldwide the commonest reason for seeing a doctor and Uganda is no different. There are many reasons for fatigue, but rule no 3 is “if you are tired go to bed” Sounds rather pathetically simple but if applied would greatly reduce the number of people who quit, get medevac’d or stay but have a miserable time. Causes include constant minor infections such as the common cold. Post-infection chronic fatigue syndrome is real. Many parasites cause fatigue. Add to that unfulfilled expectations and disappointment. Come in and see us but still common sense says when you have a cold don’t be a hero, go to bed.

4) The commonest real disease we see is diarrhoea

Literally see it, as regular patients bring it in small pots for us to examine. Most visitors will get an attack of travellers diarrhoea in the first 2 or 3 weeks, or even days. Door handles and bank notes are more likely sources of infection then food, but again sheer common sense should warn you against eating something you buy on the side of the road. The fact is you can wash your hands like lady Macbeth and you are still going to get a dose of travellers diarrhoea eventually. The best option is always having a dose of treatment with you. If you see a doctor up country they will probably say you have malaria. One of the common reasons for someone from up country coming in to see us is that they had “malaria” and didn’t get better on treatment. Sheer common sense suggests that if you have fever and watery diarrhoea it is likely to be a stomach infection.

So, rule number 4 is if you get sudden onset watery diarrhoea take the medicine. We use azithromycin 500mg as a single once only dose. Double if you are rather more traditionally built. 95% are better in 24 hours. An alternative is aminosidine. Cipro doesn’t work. Nor do most other antibiotics. Furthermore, if you have a specific strain of the common E. coli, those treated with Cipro can get a potentially fatal reaction called HUS. We’ve seen it in children given Cipro for standby medication. Google it. If you do nothing most people will be better in 5 days, but most of us have better things to do than sit on the toilet for 5 days so take the medicine. Get it from us and keep it next to the bed.

There are a number of parasites that give rather vague chronic diarrhoea. 30% of visitors go home with amoeba or Giardia. Amoeba often gives vague on off not quite right bad guts but mostly tired all the time. Giardia gives explosive gassy diarrhoea with a smell of bad eggs and eggy burps. But mostly tired all the time. Intestinal candida is very common in new arrivals in the first 2 years. It gives vague on off gassy diarrhoea but mostly tired all the time. The only way to diagnose it is by a stool sample so if you have diarrhoea that doesn’t get better or if you are always tired come in with a sample. There is a strong local culture of diagnosing “bacterial infection” and giving antibiotics for any illness. That in itself is a very common cause of candida and chronic diarrhoea. Sheer common sense tells you that constant use of antibiotics is harmful. You do not have to go retro: in Europe you didn’t take antibiotics every time you were sick so why here? We advise every person going home to come in for a departure medical and bring a stool sample. 30% have a parasite. You could be tired and vaguely unwell for 5 years after going home to Europe and no-one will ever expect something as simple as amoeba.