Although I've singled out the African continent in this article, I think some of the advice given here would also apply to any third world country.

Finally, if you're wondering what "mgonjwa" means, it's Swahili for "sick person."

The topics I cover are shown below. You can click on their hyperlinks to jump to their respective sections.

So we did numerous things to try to prepare for our trip.

First and foremost, we pursued getting injections as recommended by the CDC. Even though we've spoken to people who have managed to travel to Africa without getting injected, we figured it's better to be safe than sorry.

So what did we get pricked for?

Well since we didn't recall when was the last time we got immunized (we were little children at the time), we ended up getting the full battery of vaccines. However, some required repeat visits to get maximum immunity so the sooner you get vaccinated prior to knowing when you'll go, the better. Don't wait until the last minute when immunity might not kick in by the time you arrive to the at-risk area.

These vaccines were for:

• Measles/Mumps/Rubella (MMR)
• Yellow Fever
• Hepatitis A (2 shots 6 months apart)
• Hepatitis B (3 shots over span of 6 months)
• Typhoid

Note: Hep A/B injections are also collectively known as Twinrix.

We also brought malaria pills known as mefloquine. We couldn't use chloroquine (which we used in South America) because it isn't effective against East African strains of malaria. There were other malaria drugs out there, but we opted to go with mefloquine because it had a less intrusive schedule as it required us to take doses of one pill each week beginning two weeks prior to going to the at-risk region until four weeks after leaving the at-risk region. Also note that this drug isn't 100% effective so you can't be lulled into a false sense of security and be complacent about mosquito bites.

Regarding the Yellow Fever Vaccination, you should receive a yellow booklet certifying that you've been vaccinated against this. If you end up in a country requiring a Yellow Fever Certification (YF Cert for short) and fail to furnish one, then you'll have to get a vaccination on the spot (if available) or get to the nearest clinic for one. Clearly, this is not a desirable situation because of availability as well as the potential of contracting HIV/AIDS (you never know if some needles are shared or re-used).

Once you have the YF Cert in possession, keep it with your passport! We committed the cardinal sin of forgetting to bring our YF Cert and we were in Zambia when we realized we didn't have it. So plenty of time, money, and piece of mind was spent trying to get replacement yellow booklets prior to our arrival to Tanzania (which we thought was where they'd enforce it). Even though Tanzania ended up not checking for our vaccination proof, they did check for it in Egypt!

Finally, even though these vaccinations are like your insurance against the health risks that Africa poses, your health insurance probably won't cover them (they didn't in our cases). So, it could be a hefty medical bill of upwards of over $630 USD per person. We weighed that against possibly paying thousands of dollars being bed-ridden with a life-threatening illness in a third-world country. Thus, we ponied up the dough up front and got vaccinated. Still, we were going to be in Africa for nearly 6 weeks so such precautions were warranted in our judgement. However, if you're on a shorter trip, perhaps this upfront cost might not be worth it against the your risk assessment of contracting something.

One thing that can put you down despite all the vaccinations and drugs you take is the water and the food.

Water is the bigger threat as stomachs of most people coming from first world countries are used to very clean standards and may not be able to handle some of the parasites or bacteria residing in the water of third world countries. So while this means you're probably going to be drinking bottled water most of the time, you also have to be cognizant of other things where bad water might creep into your system.

For example, if you eat uncooked salads or fruits, you'll have to be wary of what kind of water that they were washed in. I ate raw vegetables in Northern Peru and paid for it with bouts of vomiting and drawn out diarrhea over 3-4 days (a real bummer since I didn't really get to enjoy real Peruvian food for that time). While some resorts and restaurants in Africa claim the uncooked food is safe, the best way to make sure is to avoid them altogether. I know this can mess up intentions of eating local stuff or varying your diet, but you have to ask yourself if you're willing to risk it or not and at price you're willing to pay.

Related to uncooked vegetables and fruits are drinks with ice in them. Sometimes the ice consists of tap water and not bottled water. I know Julie was afflicted with diarrhea after drinking a cocktail in Fiji and she blamed the ice in the drink.

Another example of where bad water can sneak in is when you're using the tap water in your accommoation. In the more upscale resorts in Africa (like the Serena Lodges), they're pretty good about providing bottled water in the bathrooms. The reason why they do this is because they want you to brush your teeth with them! Now granted, not all places provide bottled water complementary (some hotels in Kampala, Uganda didn't have them). So it's best to buy up some water during your travels in anticipation of having to use them for your dental hygiene.

Finally, it's possible that the local fish might absorb some of the bad water. This might have been what ultimately got me sick in Kenya as I had some local cooked fish one evening at a Serena Lodge in Mt Kenya. As a result, I ended up spending the next two or three days vomiting, getting spots on my face, having bad stomach pains, having trouble sleeping, and losing my appetite. I don't think I fully recovered from this for another two weeks as I was suffering from "Pharoah's Revenge" (i.e. a mild case of diarrhea) in Egypt while things like water and tea seemed to have hit my stomach uncomfortably hard once in my digestive tract.

Now while all this might scare you out of eating local foods, realize that we also ate local chicken, fish, and rice along with nshima (a maize-based staple food; also known as ugali in Swahili-speaking countries) in Zambia without getting sick, and I swear it was some of the freshest, tastiest food we've had on our trip. So take it for what it's worth, but keep it in mind as you weight the risks yourself when you're out eating.

Part of the reason for this is the insects. Mosquitoes are quite common in Africa, but what's scary about them is that many of them are known to spread parasites such as malaria, yellow fever, dengue fever (no vaccine for this), and more. At least with mozzies, there are things you can do like wearing long sleeves, putting on DEET, sleeping with in mosquito nets, etc. to minimize your exposure to those diseases.

Then, there are tsetse flies which also tend to draw blood from you and spread parasites (such as those causing sleeping sicknesses or other neurological disorders) as well. But what makes tsetse flies even more annoying is that DEET doesn't seem to affect them. It's said that they're attracted to the colors of black and blue because they associate them with big vertebrates (a reliable source of blood)! However, before being lulled into a false sense of security of wearing bright colors (like red, orange, white, etc.), I still got bit by tsetse flies.

So what happens if you're starting to feel symptoms? The important thing to bear in mind here is not to panic but at the same time to not ignore your them either. We're going to discuss what happened to us during the trip below and what happened thereafter as we strove to get over the afflictions. Then, we'll discuss possible solutions (even those we didn't try but were advised by others).

First off, Julie had a malaria scare as she experienced chills and fever in Uganda (keeping in mind we were bit by mosquitoes in Kampala a few days earlier since there were no mosquito nets in the place we stayed at). Having read on the web about symptoms (which turn out to be quite similar to common ailments like flu, cold, or even food poisoning so it's hard to tell which is which), we took no chances and went to a nearby clinic for blood tests the following morning. Even though we had been taking mefloquine, but we knew it wasn't 100% preventative.

Still, we were fortunate to be in the urban city of Kampala at the time so it wasn't a problem to show up to the CARE clinic and get the blood test at a reasonable price (by tourist standards) and without impacting our itinerary too much. It easily could've been worse!

The blood test is important because they can reasonably tell if you have the malaria parasite or just some other type of bacterial infection. In Julie's case, it wasn't malaria. Still, it was good to get checked out just in case; especially since the clinics in Africa seem better prepared to handle malaria than even first world clinics where malaria is rare. As for the HIV/AIDS possibility, the doctor opened up a new needle in front of us and soaked it in alcohol.

When we were in Kenya, I ate bad fish and had a severe bout of food poisoning. It resulted in multiple bouts of vomiting over the next 24-36 hour period including one painfully sleepless night. I ended up getting spots on my face as well. Diarrhea also accompanied my nauseated state.

When we spoke to other people about my food poisoning episode, we had been advised (by Westerners) to take Cipro, which is an anti-bacterial drug. Considering many of the parasites that might cause food poisoning are bacteria related, this made sense. However, it was too late for our Africa trip so this was one bit of advice we might have keep in mind for future trips to third world countries.

Another thing to try is also Airborne, which Julie swears by. I managed to catch a cold towards the tail end of our trip in Egypt, but I honestly couldn't tell if this did a whole lot to help me. In the end, I suffered symptoms for a little less than a week (perhaps it's possible the cold virus could've lasted longer if I didn't take Airborne. Who knows?).

Then, in Egypt, I had to fight off persistent diarrhea. I wasn't sure if this carried over from my food poisoning in Kenya, but in any case, everything I drank hit my stomach hard. Our tour guide called it "Pharaoh's Revenge," and he said chewing on tea leaves raw would help.

It turned out it worked for those other people who had it, but for some reason it didn't work for me. Maybe I didn't do it right. In any case, the locals know how to cope with afflictions as they've been living with them for a long time. So if they recommend something, you do it!

Finally, I think it's a good idea to get one last checkup with your doctor when you get home (just in case you managed to bring something with you from Africa). Honestly, we didn't take our own advice on this one, but in hindsight, I think it's a worthwhile investment of your time. We got lucky as over the next couple of weeks, my unsettled digestive tract slowly worked itself out as we got readjusted to more ambient conditions. Still, some parasites have long incubation and survival periods and it could be months before they recur so that's something we'll have to keep in mind since we're risking it.

And like anything where you have to trade risk versus reward, I'd say Africa is rewarding in so many ways that it will change your life in many intangible ways for the better! If you have the opportunity to do it, go for it! Who knows when this opportunity will ever come up again?