Inoculations
Although no specific inoculations are compulsory if you arrive from the West, it's wise to ensure that your polio and tetanus vaccinations are up to date. A yellow fever vaccination certificate is necessary if you've come from a country where the disease is endemic, such as Kenya, Tanzania or tropical South America.

In addition to these, the Hospital for Tropical Diseases in London recommends a course of shots against typhoid and a Havrix injection against hepatitis A , which is caught from contaminated food or water. This is a worst-case scenario, as you probably won't be travelling in areas where these illnesses pose a serious threat. The cholera vaccination is unpleasant, pretty ineffective and not recommended unless you are going to be working for a period in very deprived areas. In any case, despite their terrible reputation, typhoid fever and cholera are both eminently curable and few, if any, visitors to South Africa ever catch them. Hepatitis B vaccine is essential only for people involved in health work. The disease is spread by the transfer of blood products, usually dirty needles, so most travellers need not worry about it.

If you decide to have an armful of jabs, start organizing them six weeks before departure. If you're going to another African country first and need the yellow fever jab, remember that a yellow fever certificate only becomes valid ten days after you've had the shot.

Water and stomach upsets
Stomach upsets from food are rare. Salad and ice - the danger items in many other Third World countries - are only found in hotels and restaurants, and both are perfectly safe. As anywhere, though, don't keep food for too long, be sure to wash fruit and vegetables as thoroughly as possible, and don't overindulge on fruit - no matter how tempting - when you first arrive.

If you do get a stomach bug , the best cure is lots of water and rest. Papayas, the flesh as well as the pips, are a good tonic to offset the runs. Otherwise, most chemists should have name-brand anti-diarrhoea remedies. These - Lomotil, Codeine phosphate, etc. - shouldn't be overused.

Avoid jumping for antibiotics at the first sign of illness: keep them as a last resort - they don't work on viruses and annihilate your "gut flora" (most of which you want to keep), making you more susceptible next time round. Most upsets will resolve themselves by adopting a sensible fat-free diet for a couple of days, but if they do persist without improvement (or are accompanied by other unusual symptoms), then see a doctor as soon as possible.

The sun
The sun is likely to be the worst hazard you'll encounter in southern Africa, particularly if you're fair-skinned. The danger of overexposure to the sun is something white South Africans haven't yet caught onto, and locals still regard their tans as more important than their health.

The sun in the southern hemisphere is far more intense and transmits far more ultraviolet than it does in the north (even in the sunshine states of the USA). It's wise to limit your exposure to this major cause of skin cancer . If on returning home you notice any changes to any mole on your body you should see your doctor, as melanomas can be removed if caught early, but malignant melanomas can prove fatal if ignored.

Short-term effects of overexposure to the sun include burning, nausea and headaches. This usually comes from overeager tanning, which can leave you looking like a lobster. The fairer your skin, the slower you should take tanning. Start with short periods of exposure and high protection suncreen (at least SPF 15), gradually increasing your time in the sun and decreasing the factor of your screen. Many people with fair skins, especially those who freckle easily, should take extra care, starting with a very high factor screen (SPF 25-30) and continue using at least SPF 15 for the rest of their stay. There's no shame in smearing sensitive areas of your face with total block cream, which contains zinc and has been made fashionable by cricketers and skiers.

Overexposure to the sun can cause sunburn to the surface of the eye, inflammation of the cornea and can result in serious short- and long-term damage. Good sunglasses can reduce ultraviolet light exposure to the eye by fifty percent. Look for a pair that absorbs at least 95 percent of UVR (which is invisible to the human eye) as well as UVB. A broad-brimmed hat is also recommended.

These last measures are especially necessary for children, who should ideally be kept well covered at the seaside. Don't be lulled into complacency on cloudy days, as this is when UV levels can be especially high. UV-protective clothing is available locally, but it's best to buy before you arrive; some excellent ranges are made in Australia. If you don't come with this gear, make sure children wear T-shirts (preferably a close-weave fabric) at the beach, and use SPF 30 sun screen liberally and often

AIDS and sexually transmitted diseases
Your biggest chance of catching HIV in South Africa is through unprotected sex. HIV/AIDS and other venereal diseases are widespread in southern Africa amongst both men and women, and the danger of catching the virus through sexual contact is very real. Follow the usual precautions regarding safer sex: abstain - or at the very least use a condom. There's no special risk from medical treatment in the country, but if you're travelling overland and you want to play it safe, take your own needle and transfusion kit.

Bilharzia
One ailment that you need to take seriously throughout sub-Saharan Africa is bilharzia , carried in most of South Africa's fresh waterways except in the mountains. Bilharzia (schistosomiasis) is spread by a tiny, waterborne parasite. These worm-like flukes leave their water-snail hosts and burrow into human skin to multiply in the bloodstream; they then work their way to the walls of the intestine or bladder, where they begin to lay eggs.

Avoid swimming in dams and rivers where possible. If you go canoeing or can't avoid the water, have a test when you return home. White water is no guarantee of safety; although the snails favour sheltered areas, the flukes can be swept downstream. The chances are you'll avoid bilharzia even if you swam in a suspect river, but it's best to be sure.

Symptoms may be no more than a feeling of lassitude and ill health. Once infection is established, abdominal pain and blood in the urine and stools are common. Fortunately, bilharzia is easily and effectively treated with praziquantel, although the drug can make you feel ill for a few days. No vaccine is available and none foreseen

Malaria
Most of South Africa is free of malaria , a potentially lethal disease that is widespread in tropical and sub-tropical Africa, where it's a major killer. In South Africa there is a risk in northern and northeastern Mpumalanga , notably the Kruger National Park , as well as northern KwaZulu-Natal , in the border regions of Northwest and Northern provinces , and in low-lying areas of Swaziland . Protection against malaria is essential if you're planning on travelling to these areas.

The highest risk is during the hot, rainy months from November to April . The risk is reduced during the cooler, dry months from May to October, and some people decide not to take prophylaxis during this period.

Malaria is caused by a parasite carried in the saliva of the female anopheles mosquito. It has a variable incubation period of a few days to several weeks, so you can become ill long after being bitten. The first symptoms of malaria can be mistaken for flu, starting off relatively mildly with a variable combination that includes fever, aching limbs and shivering, which come in waves, usually beginning in the early evening. Deterioration can be rapid as the parasites in the bloodstream proliferate: get medical help without delay if you go down with flu-like symptoms within a week of entering or three months of leaving a malarial area. Malaria is not infectious, but it can be fatal if not treated quickly.

Snakes, insects and other undesirables
Bites, stings and rashes in South Africa are comparatively rare. Snakes are present, but hardly ever seen as they move out of the way quickly. The sluggish puff and berg adders are the most dangerous, because they often lie in paths and don't move when humans approach - but they're seldom encountered by travellers. The best advice if you get bitten is to remember what the snake looked like and get yourself to a clinic or hospital. Most bites are not fatal and the worst thing is to panic: desperate measures with razor blades and tourniquets risk doing more harm than good.

Tick-bite fever is occasionally contracted from walking in the bush, particularly in long wet grass. The offending ticks can be minute and you may not spot them. Symptoms appear a week later - swollen glands and severe aching of the bones, backache and fever. Since it is a self-limiting disease, it will run its course in three or four days. Ticks you may find on yourself are not dangerous; just repulsive at first. Make sure you pull out the head as well as the body (it's not painful). A good way of removing small ones is to smear Vaseline or grease over them, making them release their hold.

Scorpions and spiders abound, but are hardly ever seen unless you turn over logs and stones. If you're collecting wood for a campfire, knock or shake it before picking it up. Contrary to popular myth, scorpion stings and spider bites are painful but almost never fatal. Most are harmless and should be left alone. A simple precaution when camping is to shake out your shoes and clothes in the morning before you get dressed.

Rabies is present throughout southern Africa. Be wary of strange animals and go immediately to a clinic if bitten. Rabies can be treated effectively with a course of injections.

Hospitals and doctors
Public hospitals in South Africa are fairly well equipped, but they are facing huge pressures under which their attempts to maintain standards are unfortunately buckling. Expect long waits and frequently indifferent treatment. Private hospitals or clinics, which are well up to British or North American standards, are usually a better option for travellers. You're likely to get more personal treatment and the costs are nowhere near as high as in the US; besides which, if you're adequately insured these shouldn't pose a problem. Private hospitals are given in the town and city listings throughout the guide.

Teeth and eyes
Dental care in South Africa is well up to British and North American standards, and is generally no more expensive. You'll find dentists in all the cities and most smaller towns, listed after doctors at the beginning of each town in the telephone directory.

You can buy cleaning kit for most types of contact lenses in the larger centres.

Medical kit
Most medicines and medical gear can be bought in pharmacies all over South Africa, so there's no need to lumber yourself with too heavy a medical kit . Only in deeply rural areas where few visitors ever go are you likely to be caught short. If you need specialized drugs bring your own supply, but any first-aid items can be easily replaced. A very basic kit should include:

" Antibiotics Potentially useful if you're heading off the beaten track; a broad-spectrum variety is best.

" Antiseptic cream Bacitracin is a reliable brand, while Nelson's natural calendula ointment is invaluable for stings, rashes, cuts, sores or cracked skin.

" Bandages One wide and one narrow.

" Eyedrops Wonderfully soothing if you're travelling on dusty roads.

" Fine tweezers Useful for removing thorns or glass.

" Insect repellent Essential in malarial areas.

" Paracetamol For pain and fever relief.

" Sticking plasters

" Lip salve/chapstick