Like most expats, I’m big on lists. When you have moved across continents with a family in tow, you learn to live by a ginormous checklist to keep your hectic life organized.
The problem with lists is that you never prioritize them properly. Things that are most decidedly not a matter of life and death are invariably at the top. Finding an internet provider so that your kids don’t have to go without Snapchat for a minute too long, assembling the paperwork for your Traffic Register Number, booking your first safari because you can’t wait to find out what the big fuss is about the Big Five – those are most likely the issues you’re grappling with during your first week in South Africa.
The topic that actually can be a matter of life and death – your health – often gets pushed further down the totem pole.
It happened to me after just a few weeks in South Africa. I brought back tick bite fever from our first foray into the Waterberg, and I was so miserable I wanted to crawl into a hole and die. I had no idea what ailed me or where to go for relief. While you’ll be happy you did prioritize the internet connection so that you can research doctors online, it’s no joy doing it while your head feels like it’s split open by a cleaver. Much better to have all your healthcare ducks in a row before disaster strikes.
Here are the top five ways you should prepare for your health when moving to South Africa:
1. Diseases and immunizations
The good news is, South Africa isn’t a particularly disease-ridden country. But you need to be aware of what lurks out there so you can be prepared. And you need to be up-to-date on your immunizations.
Let’s start with the aforementioned tick bite fever. As the name suggests, it’s transmitted by ticks. But unlike its ugly American cousin, Lyme disease, it’s relatively harmless and can be treated with antibiotics. When you go hiking in the bush in the wet season, wear long pants to protect against tick bites. Some seasoned Africa travelers often carry antibiotics with them just in case they’re needed when there is no access to doctors, but it’s never a good idea to take them preventively. Also note that pets can be infected by tick bite fever as well, so treat your cats and dogs against fleas and ticks regularly.
Malaria is practically non-existent in South Africa. If you go to Kruger Park during summer from October to March, you should consider taking malaria prophylaxis such as Malanil (or Malarone in the U.S.). Other than that, South Africa is malaria-free year-round.
You will need immunizations for Hepatitis B, DTP, MMR, and Polio before moving to South Africa. Hepatitis A is recommended but not required. (If you travel to a yellow fever risk area outside the country, such as Angola, the Democratic Republic of Congo, or Kenya, see a doctor before you leave to obtain a certificate.)
In rural areas, you might be exposed to typhoid fever, cholera, and rabies – take the necessary precautions before prolonged stays in such parts. If you’re not in South Africa for missionary or humanitarian work, most likely you will live in a metropolitan area and this will be of no concern to you.
The tap water in South Africa is absolutely safe to drink and quite delicious.
HIV/AIDS poses a very small risk for expats. If you have small children and consider employing a nanny, tuberculosis is a larger risk factor. It is recommended to request TB screenings before hiring domestic help (maid referral services typically provide them).
2. Health insurance
Don’t go to South Africa without having researched and obtained the proper health insurance, or medical aid, as South Africans call it.
Many expats have a global health plan that allows them to keep the same insurer as they go from one assignment to the next. In that case, you usually pay for your medical bills up front and claim your refund later by providing the invoice.
Local medical aid plans likely offer better rates – with the exception of orthodontists, doctor and hospital fees are generally much lower in South Africa than in many Western countries – and let you avoid having to pay upfront, but if you’re expecting to move again in the not too distant future, having to switch plans again might be cumbersome.
Your best option might be a combination of the two, like Hollard Cigna Health, a partnership between local underwriter Hollard and global health service provider Cigna, offering you both local know-how and global reach. This merger hadn’t happened at the time we lived in South Africa so I don’t have first-hand experience, but we did use Hollard to cover our house inventory and car insurance, and were very happy with their prompt and professional service.
Make sure you research your options while you plan your move and set up an appointment with a local broker for your first week in South Africa if you haven’t already obtained coverage before your move.
3. Doctors and emergency rooms
Your first week in South Africa, you should set aside time to research both nearby doctors’ offices and hospitals.
For any check-ups and minor problems such as colds and immunizations, your entire family will see a general practitioner or family doctor. Intercare, which operates offices around the country and offers a wide range of medical services such as prenatal care, psychiatry, dentistry, surgery, a travel clinic and x-ray labs all under one roof, is a solid choice if you’re looking for a larger practice. However, there are also many 1-person doctor’s offices that provide excellent care. Asking your neighbors and fellow school parents where they go is a good strategy, but try to stay relatively close to home as traffic can make your commute very lengthy.
If you need a specialist, you will most likely find them associated with a hospital.
The level of training and care at South Africa’s private hospitals is excellent. There are three major private healthcare providers: Life Healthcare, Netcare, and Medi-Clinic, each with a number of branches in the major metropolitan areas. All of these have excellent reputations and offer world-class care. Again, pick one close to where you live and make that your go-to place for emergencies. We lived in the Dainfern area and were very happy with the convenience as well as service at Life Fourways.
If you don’t have local medical aid, make sure you bring a credit card (preferably not AMEX) when checking in at a private hospital. You might have to pay each service separately, like x-rays, blood work, doctor, or anesthesiologist. Insist on a detailed receipt to submit to your health insurance. We’ve had to chase South Africa’s bureaucracy for receipts after the fact and it’s no cakewalk. If you schedule a larger procedure ahead of time, try to get approval from your healthcare provider beforehand.
Please note that the above advice is geared toward private hospitals. Even though some South African government hospitals are internationally acclaimed and well-known for their research – let’s not forget that the first human heart transplant in the world was performed by Christiaan Barnard at Groote Schuur Hospital in Cape Town in 1967 – be mindful that service quality tends to be lower than at private facilities.
First, the terminology. You won’t get far with “drug store” when looking for one. “Chemist” is what drugstores or pharmacies are called in South Africa. The major chemist chains are Dis-Chem, Clicks and MediRite. Clicks outlets are often conveniently located right next to an Intercare practice so that you can pick up your drugs right after seeing the doctor. MediRite pharmacies can often be found in Shoprite and Checkers stores. Dis-Chem is the nicest of them all and the closest to an American CVS or Walgreens, often offering additional services like mail-order and courier delivery, clinics and vision screenings.
Your first week in South Africa, make a point of visiting all three chains so you know what they carry. I ran around frantically the first few weeks looking for night lights and an electric toothbrush charger. I felt such relief flooding through me when I finally discovered them at Dis-Chem which sells more or less everything from vitamins to bags of dried mango to small appliances.
The fun part when going to a chemist in South Africa is the little metal cage. You go to the counter – even for non-prescription drugs – and ask for antibiotic cream and ear drops. The pharmacist will pull them from the shelf and drop everything into a small lunch-box sized metal cage and seal it with a zip-tie. You then wander through the store doing the rest of your errands, feeling a bit weird with your cage like Harry Potter carrying Hedwig to the Hogwarts Express, but you take comfort in the fact that everyone else carries the silly little cage too. At the cash register, the seal is broken and your items released so you can pay for them. Quaint.
5. Emergency phone numbers
I don’t think I’ve ever lived in a country with so many emergency phone numbers as South Africa. Writing them all down the very first day you arrive in the country and posting them in a central location is an absolute must.
“Call 911” is something you and your kids will have to get out of your head when living in South Africa. Many cities have different numbers for police, fire, and medical emergencies. However, if you are calling from a mobile phone the universal number for all emergencies is 112 – make sure to program it into everyone’s mobile phone the first day. While you’re at it, locate your emergency room of choice from above and save it in your Google Maps.
In addition, there are two major private ambulance services: Netcare 911 and ER24 (owned by Medi-Clinic). It is best to call them directly should you need an ambulance.
If you live in an estate, you might also write down the number of the gate, as the guards are often the quickest to arrive and can give assistance for minor emergencies.
For more information on immunizations, diseases, and medications, read this follow-up blog post on health in South Africa.