Medical resources for travellers
Your first source of advice and probable supplier of jabs and prescriptions is your general practitioner. Family doctors are often well informed and are likely to charge you a (relatively low) flat fee for routine injections. For yellow fever and other exotic shots you'll normally have to visit a specialist clinic, often in the next large town if you live in the country, although city-dwellers should have no difficulty finding a vaccination centre that has supplies

Inoculations
For arrivals by air from Europe, Australia and New Zealand, or North America, Kenya has no required inoculations. Entering overland, though, you may well be required to show International Vaccination Certificates for both yellow fever and cholera.

If you fly on an airline that stops en route in Africa, you should have the yellow fever shot before you leave and preferably get a cholera vaccination exemption stamp in case some border official thinks that you need a cholera vaccination stamp to enter the country (the cholera shot is widely considered completely ineffective, and not officially required for entry into Kenya or any other East African country, although border officials may not be aware of this). You may otherwise be subjected to them at the airport. Plan ahead and start organizing your jabs at least six weeks before departure. Remember that a yellow fever certificate only becomes valid ten days after you've had the jab. You should also start taking malaria tablets before departure and don't forget to continue taking them for the prescribed time after you return.

Tetanus and polio boosters are necessary and doctors usually recommend typhoid jabs (beware that these can take you out of action for a couple of days). For hepatitis A , Havrix is now commonly prescribed, and needs a booster after six months to knock up your immunity to ten years. The much cheaper gamma-globulin (or immunoglobulin) shots are only effective for a few months.

To reduce the risk of contracting hepatitis, be extra careful about cleanliness and in particular about contamination of water - a problem wherever a single cistern holds the whole water supply in a cockroach-infested toilet/bathroom, as often happens in Lamu

Malaria
Though in Nairobi and the highlands, the malaria risk is low, on the coast, mosquito bites are assured and protection against the disease is absolutely essential.

Caused by a parasite carried in the saliva of female Anopheles mosquitoes, malaria is endemic in tropical Africa and has a variable incubation period of a few days to several weeks meaning you can get it long after being bitten. Though not infectious, the disease can be very dangerous and sometimes fatal if not treated quickly. The destruction of red blood cells by the falciparum type of malaria parasite can lead to cerebral malaria (blocking of the brain capillaries) and is the cause of a nasty complication called blackwater fever in which the urine is stained by excreted blood cells.

Other diseases
Bilharzia (medical name schistosomiasis) is a dangerous disease. It comes from tiny flukes (the schistosomes) that live in freshwater snails and which burrow into animal (or human) skin to multiply in the bloodstream. The snails only favour stagnant water and the chances of picking up bilharzia are small. The usual recommendation is never to swim in, wash with, or even touch, lake water that can't be vouched for. Most lakes and rivers harbour bilharzia, to some extent, but the possible danger of crocodile attack means you are unlikely to want any close contact with inland waters. If you feel major fatigue and pass blood - the first symptoms of bilharzia - see a doctor: it's curable.

Sexually transmitted diseases (STDs), including the HIV virus, are rife in Kenya. Four out of five deaths among 25 to 35 year olds are AIDS-related. It goes without saying that casual sex without a condom is a deadly gamble and you should assume any sexual contact to be HIV positive. Using a condom will also protect you from other sexually transmitted diseases, including Hepatitis B (HBV), which is quite widespread in Kenya and if anything even more contagious, though rarely fatal if treated. Both HIV and HepB are very easily passed between sexual partners suffering from relatively minor, ulcerous STDs, and the very high prevalence of these is thought to account for the high incidence of heterosexually transmitted HIV. These diseases are also quite easily transmitted by shared syringe or body-piercing or tattooing equipment.

Medicine bag
Various items worth taking on a trip include:

Alcohol swabs Invaluable for cleaning minor wounds or insect bites.

Antihistamine cream Apply immediately after insect bites to reduce itchiness.

Anti-malaria tablets Enough for prevention, plus extra for a cure if necessary.

Antibiotics If you are likely to be far from medical help for any length of time, your doctor should be able to prescribe you suitable antibiotics in case you need to treat a serious lower bowel crisis or dysentery.

Antiseptic cream Avoid metal tubes, which tend to puncture.

Aspirin or paracetamol for pain or fever relief.

Iodine tincture, with dropper, or water purifying tablets If you can't get clean water, these will do the trick.

Lens solution/eye drops If you wear contacts, take a good supply.

Lip-salve/chapstick

Thermometer Get a plastic one that sticks on your forehead. Ideally you'll be 37 ° C or 98.4°F

Zinc oxide powder Useful anti- fungal powder for sweaty crevices.

Water and bugs
Kenya's once fairly safe tap water is increasingly unfit to drink and the supply can be particularly suspect during periods of drought or heavy flooding. If your stay is brief, you might as well stick to the widely available bottled water (buy in bulk from supermarkets, not from your hotel). Be very cautious of rain-or well-water where there is no mains supply and always purify it first if in any doubt.

In truth, serious stomach upsets don't afflict a large proportion of travellers. If you're only staying a short time, it makes sense to be very scrupulous: if bottled water isn't available, then purifying tablets or, better, iodine (six drops per litre of water, then wait for half an hour), or boiling it for thirty minutes kills most things. For longer stays, think of re-educating your stomach rather than fortifying it; it's virtually impossible to travel around the country without exposing yourself to strange bugs from time to time. Take it easy at first, don't overdo the fruit (and wash it in clean water), don't keep food too long, and be very wary of salads served in cheap restaurants. It is also wise to eat food that is freshly cooked and piping hot, rather than things that have been lying around for hours hatching germs.

Should you go down with diarrhoea , it will probably pass of its own accord in 24-48 hours without treatment. In the meantime, and especially with children, for whom it may be more serious, it's essential to replace the fluids and salts you are losing, so drink lots of water with oral rehydration salts (if you can't get them - usually in sachets from pharmacies - use half a teaspoon of salt plus eight of sugar in a litre of water). It's a good idea to avoid greasy food, heavy spices, caffeine and most fruit and dairy products, though some say bananas and pawpaws are good. Plain rice or ugali with boiled vegetables is the best diet if you can stick to it, with maybe weak black tea if you can't survive without it. Yoghurt or a soup made with Marmite or Vegemite (the former available in Kenya) are forms of protein that can be easily absorbed by your body while you have the runs. Drugs like Lomotil and Immodium simply plug you up - undermining the body's efforts to rid itself of infection - though they can be useful if you have to travel. Stay right away from the popular Kaomycin, which isn't particularly safe to use and can even encourage diarrhoea. Avoid jumping for antibiotics at the first sign of trouble: they annihilate what's nicely known as your "gut flora" and will not work on viruses. If you continue to feel bad, seek medical help. Also note that having diarrhoea can make drugs less effective if taken orally, as they can pass straight through your system without being absorbed - this can apply to malaria pills for example, and women using the pill should note that diarrhoea can make it less reliable.

Heat and altitude
It's important not to underestimate the power of the equatorial sun at the equator and overdose on rays in the first week or two. A hat and sunglasses are strongly recommended at all times to combat the heat and bright light.

The sun can quickly burn , or even cause sunstroke , and a high-factor sunblock is vital on exposed skin, especially when you first arrive. Finally, be aware that overheating can also cause heatstroke , which is potentially fatal. Signs are a very high body temperature, without a feeling of fever but accompanied by headaches and disorientation. Lowering body temperature (by taking a tepid shower for example) and resting in a cool place is the first step in treatment.

The sun's radiation is stronger at higher altitudes, but the biggest risk if you climb to over 2500m above sea level can be altitude sickness , which may affect climbers on Mount Kenya, and even walkers in the Cherangani Hills.

Many people get occasional heat rashes , especially at first on the coast. A warm shower, to open the pores, and loose cotton clothes should help, as can zinc oxide powder. Dehydration is another possible problem, so make sure you are drinking enough fluids (but not alcohol or caffeine), especially when hot or tired. The main danger sign is irregular urination (only once a day for example). Dark urine definitely means you should drink more. Excessive sweating can also lead to the body losing a lot of salt . If this applies to you, sprinkle extra on your food.

Cuts and bites
Take more care than usual over minor cuts and scrapes . In the tropics, the most trivial scratch can quickly become a throbbing infection if you ignore it. Take a small tube of antiseptic with you, or apply alcohol or iodine.

Dogs are usually sad and skulking, posing little threat, but rabies does exist in Kenya, and can be transmitted by a bite or even a lick, so it's best to avoid playing with pets unless you know the owner and are sure they are safe. Scorpions and spiders abound, but are hardly ever seen unless you deliberately turn over rocks or logs: scorpion stings are painful but almost never fatal, while spiders are mostly quite harmless, even the really big ones. Snakes are common but, again, the vast majority are harmless. To see one at all, you'd need to search stealthily; walk heavily and they obligingly disappear.

Hospitals
For serious treatment there's a frightening lack of well-equipped hospitals and drugs, and in most you're routinely expected to pay for treatment, syringes, plastic gloves, cotton wool, drugs and other medical equipment. The Consolata Sisters' hospitals - the Nazareth Hospital on Riara Ridge, outside Nairobi (tel 02/335684), and another in Nyeri (tel 020/772032) - are well-run and modestly priced. Nairobi itself is fairly well provided: the Nairobi Hospital in Argwings Kodhek Road is reasonably good (tel 02/722160). We've mentioned the best local hospitals throughout the text in the "Listings" sections

Teeth
Get a thorough dental check-up before leaving home and take extra care of your teeth while in Kenya. Stringy meat, acid fruit and sugary tea are some of the hazards. A freshly cut "toothbrush twig" ( msuake ) is a useful supplement - some varieties contain a plaque-destroying enzyme; you can buy them at markets.

Flying doctors
Kenya's flying doctor Air Ambulance service (which also operates in Tanzania) offers free evacuation by air to a medical centre - very reassuring if you'll be spending time out in the wilds. Annual tourist membership costs $50 per person. The income goes back into the service and the African Medical Research Foundation (AMREF) behind it. You can contact them in advance (PO Box 30125 Nairobi; membership/information on 02/501301-3, fax 609518, ) or buy their insurance on arrival; they have an office at Wilson Airport, from where most of their rescue missions set out. Similar services are offered by AAR Health Services (tel 02/715318-26) and Mediplus (tel 02/714060 or 712502), both in Nairobi.