HEALTH IN GABON
For visitors to Shell Gabon
1 March 2012
Andrew Benc,
Chief Medical Officer
On arrival in Gabon you will likely find the living conditions somewhat different
from your home location. One of the major differences is the climate, with the
rainy season from October until June, when heavy rainstorms alternate with days
full of sunshine, and the dry season for the rest of the year with grey skies most
days. The temperature rarely exceeds 30oC and does not often fall below 20oC.
The humidity is high most of the year.
In Gabon you will be living close to tropical rainforest with its unique fauna and flora
and near the long beautiful beaches of the Atlantic Ocean. You will be exposed to
diseases typical for the tropics as well as health problems experienced elsewhere.
This guideline had been written with the objective of giving you the basic information
concerning the possible health hazards and how to combat them in order to help you
to remain healthy during your stay in Gabon. - Andrew Benc
Malaria
Please note the key principals of malaria protection:
A)
Be aware of the risk, the incubation period, and the main symptoms.
B)
Avoid being bitten by mosquitoes, especially between dusk and dawn.
C)
Take anti-malarial drugs (Chemoprophylaxis) when appropriate, to
prevent infection from developing into clinical disease. Remain aware that
anti-malarial drugs do not guarantee 100% protection.
D)
Immediately seek Diagnosis and treatment if a fever develops one week or
more after entering an area where there is a malaria risk, and up to three
months (or, rarely later) after departure from a risk area.
E)
If immediate medical care is not available/accessible during/after visits to
designated Malaria Risk Zone IV areas (which includes Gabon), use the
Curative Malaria Kit (MCK) for self diagnosis and Emergency selftreatment. You will be given a kit, and shown how to use it either prior to,
or soon after arriving in Gabon. Contracting companies should ensure
their employees are provided with a MCK.
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Malaria
Symptoms
Malaria is a parasite disease which is transmitted by mosquitoes. The risk of
malaria is highest between dusk and dawn, because the Anopheles mosquito
usually feeds at night. There are generally four types of malaria, one of which –
Falciparum malaria- is a potential killer. Symptoms of malaria may resemble those
to the flu. They may include fever, chills, muscle aches, headache, vomiting,
diarrhoea, and coughing. At first, symptoms may be mild. Patients with severe
Falciparum malaria develop liver and kidney failure, convulsions, and coma.
Vivax malaria and Ovale malaria cause less serious illness, but parasites may
remain dormant in the liver for a long time, causing a reappearance of symptoms
months or even years later. Treatment with primaquine can prevent such
reappearance.
Malaria should be suspected if fever or any of the above symptoms occur between
one week after fist possible exposure to infected mosquitoes and three months
after leaving the malarial area. This also applies if anti-malarial drugs were
regularly used, because it is still occasionally possible to develop malaria even if
preventive medicines are taken. If malaria is suspected, medical help should be
sought immediately.
Delayed treatment of Falciparum malaria can be fatal.
Personal Bite
Control
Keep in mind that preventing insect bites is an effective way to avoid insect borne
diseases.
To avoid get bitten:

Wear long sleeves shirts and long trousers when outdoors.

Shirts should be tucked in when worn.

When exposure to ticks or biting insects is a possibility, travelers should
tuck their pants into their socks and to wear boots, not sandals.
Permethrin-based repellents applied as directed will enhance protection.

Prompt removal of attached ticks can prevent some infections. Travelers
should be advised to inspect themselves and their clothing for ticks, both
during outdoor activity and at the end of the day. Ticks are detected more
easily on light-colored or white clothing.

Tick and mite borne diseases are typically associated with specific areas;
whenever possible known foci of disease transmission should be avoided.

Usage of insect repellents.
How to use insect repellents:

Apply repellent sparingly, only to exposed skin or clothing. Follow the
instructions on the bottle.
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
Do not apply DEET containing repellent to portions of the hands that are likely
to come in contact with the eyes and mouth. With simultaneous use of
sunscreen, apply this first, several hours before application of DEET.

Use of DEET should be minimized with infants, and when pregnant or breast
feeding.

Higher concentrations of DEET do NOT afford greater protection. A higher
concentration only provides a longer duration of effect.

Never use repellents on wounds or irritated skin.

Wash repellent treated skin after coming indoors.

If a reaction occurs, wash with water and consult a doctor.

For greater protection clothing and bed nets can be soaked in or sprayed with
Permethrin, which is an insect repellent licensed for use on clothing for several
weeks.

Use a mosquito net over the bed if the bedroom is not air-conditioned or
screened. For additional protection, treat the mosquito net with the insecticide
Permethrin. Insecticide treated nets are now available commercially.

Spray Permethrin or a similar insecticide in the bedroom before going to bed.
Note: Vitamin B and ultrasound devices do not prevent mosquito bites.
Anti-Malaria Shell staff and dependents on transfer to Gabon and other malarial areas where
malaria parasites are resistant to chloroquine, are normally advised to take either
Medication
Mefloquine, Malarone or Doxycycline.
Business travellers to areas where malaria parasites are resistant to chloroquine are
normally advised to use malarone or mefloquine.
Anti-malarial drugs provide approximately 90% protection if taken regularly. They are
an important safeguard against malaria.
The most commonly prescribed anti-malarial drugs are:
Malarone: a combination of atovaquone and proguanil, is effective against
chloroquine- and mefloquine resistant malaria.
 Take the first dose 1-2 days before travel
 Take malarone once a day for 7 days after leaving malaria-risk area
 Take the dose at the same time each day with food or milk
Mefloquine (Lariam): For areas such as sub-Sahara Africa where highly chloroquine
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resistant Falciparum malaria occurs, weekly mefloquine is currently a recommended
anti-malarial drug for transferees and business travellers. Mefloquine should
preferably be started 3 weeks before entering the malarial area to check out possible
intolerance and side effects, and build up a sufficient blood serum concentration. It
should be continued for four weeks after leaving the malarial area.
Doxycycline prophylaxis should be started one day before entering the malarial area,
and continued for 4 weeks after leaving.
Vaccinations Vaccinations required for Gabon include:







Typhoid
Diphtheria, Tetanus, Polio
Hepatitis A
Hepatitis B
Yellow Fever
Rabies
Meningococcal Meningitis A/C/Y/W135*
Travellers and transferees should be up to date with routine vaccinations such as
measles/mumps/rubella (MMR), and diphtheria/tetanus/pertussis and polio
(DTaP/IPV). These vaccines are necessary for protection from diseases that are still
common in many parts of the world.
*Your doctor or health adviser will further advise on which vaccinations and antimalarials are suitable for you and your family, depending upon your personal
medical background and specific needs.
You and your family are expected to be up to date with all vaccinations, and taking
appropriate anti-malarial medication on arrival in Gabon. It is your personal
responsibility to ensure this.
Bilharzia
Bilharzia, a disease already known in Egypt in 1000 bc, is still an increasing health
problem in many parts of the tropics, e.g. South East Asia, South America and Africa,
Gabon included. There are different forms of Bilharzia affecting the bladder or the
bowels.
Transmission: The adult worms, living in the bladder and bowels of individuals
suffering from bilharzia, produce eggs which are evacuated with the urine and the
stool. If the contaminated urine or stool is voided into freshwater pools infested by a
certain snail, the eggs are ingested and transformed in the snail into minute larvae
(cercariae) which are able to penetrate the human skin within a few minutes. Via
lymph and blood vessels the larvae reach the bladder or bowels where they develop
into adult worms.
Symptoms: The penetration of the larvae through the skin often goes unnoticed. Once
settled as adult worms in the bladder or bowel they provoke a haemorrhagic cystitis
or diarrhoea. Untreated bilharzia can be complicated by damage of the kidneys
(urine infections), liver and lungs.
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For several years there has been a very effective treatment with few side effects.
However, prevention is always the best and I would like to quote the advice given by
the Institute of Tropical Medicine in Amsterdam: “People who are nervous about
contracting Bilharzia are well advised to avoid all contact with natural waters in
regions where Bilharzia prevails: those who are prepared to risk infection would be
wise to avoid water contact in the vicinity of local villages – say 200 meters out form
the immediate shoreline in sailing boats and twice as far for water skiers or surfers;
protected clothing and barrier creams are not realistic in these circumstances.”
Enquire upon arrival in Port Gentil or Gamba which places are safe to launch a boat.
Seawater is always Bilharzia free.
Filariasis
Filaria worms, in Gabon of the Loa type, can be found in the skin and lymphatic
system of a patient suffering from this disease. Transmission is by means of the bite of
a fly (gen chrysops called), in Gabon, the “mouche rouge”. Symptoms are itching,
infection of lymph vessels and small abscesses on the legs. The chances of infection in
Port Gentil and Gamba are low.
Diarrhoea
It is well known that in the tropics diarrhoea is more prevalent than in areas with a
more moderate climate. The hot climate, different food and water often result in more
frequent and looser stools, especially in the first months after arrival. Poor hygiene
standards, e.g. sewage disposal, water purification, food handler control etc., can
result in the transmission of all kinds of organism which can provoke anything from
mild viral gastroenteritis to severe dysentery. Hi standards of personal hygiene,
especially in the kitchen, are very important in the prevention of the transmission of
germs causing abdominal upsets.
Always handle poultry separately from other food as it is often contaminated with
strains of salmonella bacteria;
Defrost frozen food in the refrigerator or microwave, never in hot water, which is the
best environment for germs to multiply;
Wash and peel vegetables thoroughly – boiling will render them safe;
Peel fruits or disinfect as for lettuce;
Never re-freeze food once defrosted;
Keep left-over‟s (after allowing to cool down) in the refrigerator;
Inspect your refrigerator regularly and clean out weekly;
Keep your kitchen free of flying and crawling insects.
Some forms of diarrhoea regularly seen in Gabon
-
Viral gastro enteritis (often during the change of seasons) vomiting,
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diarrhoea, most often with no fever – clears up within 48 hours;
-
Food poisoning due to toxins produced by bacteria – occurs 6-8 hours after
ingestion of contaminated food – vomiting, diarrhoea – clears up normally
within 24 hours;
-
Amoebic dysentery – acute form symptoms: frequent diarrhoea (up to 15
times a day), stools contaminated with blood, severe abdominal cramps,
possible fever – less acute form: persistent diarrhoea without blood;
-
Lambliasis – symptoms varying from acute diarrhoea (most often in children)
to lose fatty sticky stools often accompanied by excessive wind.
Treatment: As a general rule it is best to stop all solid foods for at least 24 hours, but
to continue with and increase fluid intake, especially for babies and small children.
The most important part of the treatment of diarrhoea of any sort is to replace all the
fluids lost to prevent dehydration. The introduction and promotion worldwide of oral
rehydration solutions has dramatically reduced morality rates. If the diarrhoea
contains blood or is accompanied by vomiting or fever or does not improve within 24
hours contact the clinic for medical treatment and investigation.
Intestinal
Parasites
Ascaris and strongoloides – transmission by faecal contamination of food, by flies
and dirty hands – can give complaints of vague abdominal pain;
Hookworm transmission via larvae, which can penetrate the skin of the human feet,
living in wet soil contaminated by the faeces of a hookworm sufferer – symptoms are
abdominal pain and, in heavy infestation, anaemia;
Oxyuris – also well known in Europe as “pinworm” in the UK and as “maden” in
Holland and is common in toddlers – symptoms: perianal itching, especially at night
time as adult worms, thin white threads 1 cm long, leave the bowels to lay eggs in the
perianal region – reinfection occurs by swallowing eggs trapped under the nails of
fingers after scratching of the anus, or picked up from dirt on the floor – therefore
keep the fingernail of your children short and in a case develops it is often advisable
to treat the whole family.
Skin
Disorders
Prickly heat caused by a hypersecretion of the sweat glands characterized by a red,
itchy blistery rash especially on the neck, chest, back and armpits. Treatment: The use
of talcum powder, preferably mentholated, and a stay in a well air-conditioned room
normally give fast relief; bath without a soap.
Fungal infections: Athletes‟ foot is very common in hot climates and is often acquired
by use of communal bathing facilities; Pityriasis versicolor – also very common – can
cover large areas of the chest, back, face and shoulders – appears as scaly circular
patches with discolouration of the skin (versicolor = changing colour). Dobie itch –
fungal infection of the groin – reddish itchy patches with a scaly surface and raised
edges. Treatment: the use of an antifungal cream/powder/lotion is necessary in the
acute stage; do not use soap on the affected areas; wear only cotton clothes and
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change frequently if wet (wet skin loses its natural defence).
Impetigo: Small wounds become infected easily in hot climates and are often the
source of a staphylocci or streptococci infection of the skin characterized by blisters
with or without pus and/or scabs; The infection can spread quickly by scratching the
healthy skin with contaminated nails. Treat all wounds, even minor ones, by
disinfecting with betadine or cetavlon and protect the wound against secondary
infection.
Sunburn: On the equator the exposure to ultra violet light is very high, even if the sky
is overcast. Be careful about sunbathing, especially for children. Prolong the exposure
very gradually and use protective lotions. Prolonged exposure to UV light prematurely
ages the skin and increases the risk of skin cancer. Avoid exposure to UV light
especially during the hottest period i.e. 12 noon – 3p.m.
Skin
disorders
caused by
parasites
Jiggers: Live in sand, especially common in the dry season, penetrating the skin of the
bare foot in order to lay their eggs, resulting in a small cyst – first symptom is a local
itch and later localized swelling and pain – common throughout Africa. Treatment
consists of removing the cyst under sterile conditions.
Tumbo Fly: Lays its larvae on the ground and on laundry drying in the sun – can
penetrate the skin and develop into a painful boil – to prevent, iron all clothes well or
use a tumble dryer – prevalent in Port Gentil but not in Gamba or Rabi.
Larva migrans: A benign skin disorder caused by the incidental penetration of the
skin by the larvae of different animal parasites – the larvae migrates under the skin
and is visible as an irregular track in the skin – treated with oral Mintezol and
Mintezolointment.
Scabies: A disease of poor personal hygiene characterized by generalized itching
caused by small parasites penetrating the skin – treatment with application of antiscabies lotion.
Lice: Itching of scalp with scratching – easily caught in hot climates – treatmentwith
anti-lice lotion e.g. Prioderm.
Ticks: In the dry season while walking through the bush you can pick up these small
creatures – remove them as soon as possible before they become well attached to the
skin.
Tse Tse Fly: The sting of the tse tse fly is rather painful and can cause in some
individual a rather nasty swelling; they are the transmitters of sleeping sickness but in
Gamba region no case of this disease has been seen for many years; there are small
areas in Gabon where it is known that tse tse flies can transmit the disease – the
estuary Sigh of Libreville and in the neighbourhood of Lambarene.
Fourous: These are very small insects, hardly visible, found especially near banana
plantations. They are active 1 hour before sunrise and 1 hour after sunset. The bite
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burns rather strongly for about 15 minutes.
Venereal
Diseases
Venereal diseases are common in Gabon. Most frequently seen are gonorrhoea,
syphilis and chlamydiasis. The AIDS virus can only be spread in 3 ways: sexual
intercourse; via blood and blood products; and from an infected mother to her infant.
Preventing the sexual spread of the AIDS virus can most effectively be achieved by
remaining with a faithful uninfected partner or otherwise reducing the number of
sexual partners as much as possible and starting or continuing the use of condoms.
Animal
Hazards
Rabies: In Gabon, rabies is a potential health hazard. Wild dogs and cats, which
wander around in an area rich wildlife, become infested with all kinds of parasites
and have to be considered as potential rabies carriers and should therefore be
approached as such. It is therefore obligatory that all pets are properly vaccinated
before being brought out to Gabon and anyone who wants to adopt an unknown pet
locally should it have examined by the veterinary surgeon in Port Gentil or Gamba.
Rabies can be transmitted by bites and scratches of infected animals and even by
licking of abrasions or wounds as the saliva is highly infective.
In case of bites or scratches of the lower extremities by unvaccinated cats, dogs or
monkeys wash the wound well with soap and water. Keep the animal under
observation for the next 10 days. If the animal escaped or shows signs of rabies, antirabies treatment should be started immediately.
In the case of multiple wounds or wounds of the face, fingers, neck, and/or head,
anti-rabies treatment should be started immediately.
Snake bites: It is helpful to put this hazard into perspective. Snakes are normally timid
creatures, only biting when trodden on or suddenly disturbed. Many bites are by nonvenomous snakes. A poisonous snake seldom injects a full dose of venom and the
overall mortality of bites from even the most venomous snakes is less then 10 percent.
Approximately half the victims bitten by poisonous snakes develop no symptoms. In
our Gamba clinic and in Port Gentil snake bites are very rarely seen.
First aid: Treat a snake bite as a fracture, i.e. immobilize the affected limb. Disinfect
the bite and apply a crepe bandage over and around the wound in order to reduce
the absorption of the venom. Bring the victim to the clinic for further treatment.
Never use a tourniquet or try to suck the venom out of the bite or make an incision
over the bite. They are all absolutely useless and even dangerous efforts.
Scorpion and Millipede Stings: The sting is often very painful but not dangerous.
Treatment with a local anesthetic can alleviate the pain. Scorpion and millipedes tend
to lurk in dark places, i.e. boots and shoes not used daily, under stones and the bark
of logs found in the jungle.
Wildlife
Buffalos: If you happen to find a herd of buffalos on your path you can observe them
without danger from a reasonably distance. However never approach a solitary
buffalo as he can be unpredictable and very dangerous. Never follow buffalos into
the forest or try to find a wounded one – wounded buffalos are by far the most
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dangerous animals of the forest and responsible for very serious and sometimes fatal
accidents.
Elephants: Be careful not to get too close to elephants and stay in your car should you
encounter one while driving. Elephants can get irritated and charge should they feel
threatened. Never follow elephants into the forest.
Hippos: When boating on the river Nyanga the chances are high that you will see
hippos – keep a respectable distance when you pass them and never stop in the
middle of a group, but cut your speed a little when overtaking them as the noise of an
engine at high speed disturbs them very much. They can turn your boat over if it is not
very happy and wound you badly. The local population fears the hippo more than the
crocodiles.
Crocodiles: The number of crocodiles in the Gamba area is slowly reducing but the
„niloticus‟ crocodile, which can reach up to 5 metres in length, is still present in the
Ndogo lagoon, the lakes of Vembo, Matsegui, Mbadinga and Yenzi. Do not swim in
these areas. There are two smaller types of crocodiles which are not considered
dangerous and can be found on the outskirts of Yenzi camp.
Monkeys and Apes: In the Gamba area there are numerous kinds of monkeys, as
well as gorillas and chimpanzees. They can be carriers of rabies and other kinds of
human transmittable viruses. We do not recommend that you keep any of them as a
pet.
Accidents
Examples of serious accidents:
A boat hitting a long floating in the river Nyanga, in the lagoon at Sette Cama or in
the bay of Port Gentil, or hitting a block of laterite at the corner of an island in the
lagoon;
Drowning due to the very strong current along the beach of the Atlantic Ocean; for
this reason, swimming in Gamba is strictly forbidden;
Crush injuries caused by the logs lying on the beach – these logs are lifted and moved
by the waves during a rising tide – do not let your children play near or between
them;
Burns caused by lighting barbecues with petrol.
Car accidents due to speeds too high for the often bad secondary roads – the road
between Mayumba and Tchibanga is especially dangerous but accidents have
happened often in the neighborhood of Gamba.
A
Be watchful for common accidents: fish hook in finger; feet burned by old campfires
on the beach; and getting lost on the Ndogo lagoon.
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