AFRICAN ADVENTURE:
Kilimanjaro and the Serengeti
Trip Newsletter #4, May 2004
TRIP UPDATE
There has been a slight change to the
original itinerary. Instead of going directly
into a camp when we arrive we will travel
to Arusha and spend the first two nights
there in a hotel. This will give us one full
day to explore Arusha, the gateway to the
Serengeti and Arusha National Park. You
will be able to take showers (yippee!!)
before we depart on our climb. Arusha
offers lots of shopping, so you may want to
take advantage of the full day to get that
tedious chore out of your way. You can
also book tours to visit local villages. I will
be looking into some options for us and
will let you know as I get the information.
PREPARING FOR OUR CLIMB
Time is flying by, and hopefully all of you
have already started your physical
preparation. In addition to our group trips,
I wanted to give you some specific
recommendations. The very best way to
prepare for climbing to high altitude is to
climb to high altitude. Although this is
difficult for most of us, remember that the
higher the altitude and the longer the
hikes, the better. If you cannot hike to
higher altitudes, (Mt. Washington at
6,000+ ft is the highest in New England),
a local hill three times a month or a
monthly trip to the Whites or Adirondacks
is great. Running and biking are also very
good and at least take you outdoors so
you can test your endurance. Stair
masters and climbing machines at the
gym will work if outdoor hiking isn’t an
option. Try not to go for short hard blasts
of exercise but long sustained workouts
instead. An adequate training regime is to
maintain 80% of your max heart rate (220
minus your age) for an hour, three to four
African Adventure Newsletter #4, April ’04
days a week. Remember high altitude
mountain climbing requires
acclimatization and a strong mind is as
important as a strong body. We have an
itinerary that will allow us to acclimatize.
If we are physically fit we have a definite
formula for success!!
HEALTH AND MEDICAL
INFORMATION
In the first newsletter I gave
you basic information about
immunizations. This issue of
the newsletter contains
more specific details about
all health and medical concerns. The
immunization recommendations appear
again at the end, and please refer to
Newsletter #2 for a list of first aid and
drug kit items I strongly recommend you
bring.
FOOD AND WATER
Too many people spend thousands of
dollars on their "dream" trip only to have it
ruined by invisible parasites and bacteria,
common in developing countries that can
wreak havoc on your health. Tanzania,
being relatively sparsely populated, is a
fairly clean country by most “third world”
standards. Nevertheless, poor sanitation
and cooking practices are probably the
most common cause of failure on
Kilimanjaro and misery on safari.
Although many people research the
menus that they will have while traveling,
very few research the sanitation practices
of the company preparing the menus.
African Environments (AE) considers this
an important “behind the scenes” service.
AE’s cooks are well trained and
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experienced and they have all had classes
in the importance of proper hygiene. They
are careful to disinfect all dishes and
cooking utensils and all fresh vegetables
that are served. This requires sending
ample disinfectant on your trip and having
plenty of assistant cooks available to help
disinfect everything.
Even more important than food is your
water source while traveling. Plenty of
pure water keeps you healthy and moving
toward the summit or enjoying the plains.
As in America, all the surface water in
Tanzania is likely to harbor parasites such
as giardia or amoebas. AE stocks all of
their trips, both mountain and safari, with
expedition quality World Health
Organization approved Katadyn water
filters. These filters can produce up to 10
litres of crystal clear pure water in a
minute. The cost of these filters is
prohibitive for most safari and mountain
operators so they resort to boiling water,
which is often not boiled to completion
and uses a massive amount of fuel. There
are a wide variety of "local" filtering
systems available in Tanzania but none of
these filters can take out all the parasites
found in the water.
VEHICLE SAFETY
Roads in Tanzania are generally unsafe as
they are full of potholes, poorly lit and
rarely marked with signs. AE takes the
safety of clients and vehicles very
seriously:
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AE vehicles are fitted with seat belts
for every passenger.
Vehicles are maintained after every
safari and tires are changed regularly.
Safari vehicles are equipped with VHF
radios and all camps have HF radios
for communication with the Arusha
base station.
AE drivers all have more than 15 years
experience driving, most of them have
more than 10 years experience with
AE. Most drivers were mechanics
before they were drivers.
African Adventure Newsletter #4, May ’04
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All drivers have taken first aid courses
and carry first aid kits.
MOUNTAIN SAFETY
At 19,300 feet
Kilimanjaro poses
some serious
potential health
risks. Your climbing adventure will be
undertaken with the guidance and support
of a company experienced and serious
about high altitude climbing.
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AE trip leaders are Wilderness First
Responder certified - this is an 80hour intensive American 1st aid
course offered by the Wilderness
Medical institute focusing on high
altitude and wilderness medicine.
All trip leaders have the experience of
more than 50 Kilimanjaro climbs
under their belt; many have climbed
internationally as well.
AE provides all trips with trip leaders
and enough assistant trip leaders to
ensure a ratio of at least 1 guide per 3
participants. In the event that a
participant is hiking slow or needs to
be evacuated there is plenty of back
up to meet their needs.
All trips are equipped with solar and
battery powered HF radios and
communicate twice daily with our
Arusha base.
AE will carry supplemental oxygen and
high altitude hyperbaric "Gamow" bags
on all mountain climbs. These are for
use in the event of acute altitude
sickness.
AE has recently worked with the
National Outdoor Leadership School
(NOLS) to perform an external review
of safety procedures and to produce a
crisis management protocol.
AE provides equipment imported from
America that is the most durable
available for harsh high altitude
conditions. Although tents are not tall
or spacious, they will keep you dry,
warm and safe in a severe storm.
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ALTITUDE ILLNESS
Altitude illness is related to the body’s
attempt to compensate for hypoxia and
decreased levels of available oxygen at
elevations greater than 8,000 feet. AE
strongly believes that slow and thorough
acclimatization, proper diet, adequate
hydration and rest can reduce the chance
of altitude related illness. Your
responsibility is to take care of important
factors such as eating properly, staying
hydrated (up to 6 litres a day!), keeping
warm and allowing your body to rest.
Acute Mountain Sickness (AMS)
Acute Mountain Sickness (AMS) is the
archrival of the high altitude hiker. AMS
occurs as a result of the body’s failure to
adapt to higher altitudes. The signs and
symptoms of AMS vary greatly in their
severity. Symptoms may take as little as 6
hours or up to several days to develop
after the climber had reached a certain
altitude. AMS can show its effects at
altitudes as low as 8,000 feet but it is
more common above 10,000 feet. The
prevention of altitude sickness comes
from adequate and slow acclimatization.
Since individuals vary in their ability to
acclimatize, you need to be able to
recognize symptoms of altitude sickness
and know the measures necessary to deal
with it.
Most people traveling to high elevations
experience one or more of the following
mild symptoms of altitude sickness:
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difficulty sleeping
darker urine
headache
mild shortness of breath
nausea
breathing irregularity during sleep
loss of appetite
dizziness or light headedness
mild weakness
slight swelling of hands and face
African Adventure Newsletter #4, May ’04
As long as symptoms remain mild, ascent
at a modest rate can continue. If several
of the above symptoms are present and
you are quite uncomfortable, further
ascent should be halted and you will be
observed closely. If there is no
improvement after a few hours, or after a
nights rest, you will need to descend as
rapidly as possible and seek medical
attention.
The following symptoms indicate a
moderate to severe level of Acute
Mountain Sickness and require immediate
attention. You should not continue your
ascent and should consider descent:
 a headache that does not respond to
aspirin or ibuprofen
 vomiting
 difficulty walking and coordination
 changes in personality such as
combativeness or impaired judgment
 severe shortness of breath while at
rest or with mild exercise
High Altitude Pulmonary Edema
(HAPE)
HAPE is a leakage of fluid into the lungs
that makes breathing difficult. It is a very
serious condition that requires rapid
detection and immediate descent. HAPE
can appear as low as 8,000 feet and is
usually associated with rapid ascent
and/or strenuous levels of exertion. The
onset of symptoms is usually not
immediate and may not appear until 6-8
hours upon arriving at an elevation. Early
symptoms resemble AMS, while later
symptoms are related to fluid filling the
lungs and are accompanied by a terrible
sense of anxiety as breathing becomes
more difficult.
The following symptoms of altitude
sickness are a serious matter and can be
signs of High Altitude Pulmonary Edema
(HAPE):
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 marked shortness of breath with only
slight exertion
 rapid breathing after resting (25 or
more breaths per minute)
 wet, bubbly breathing
 rapid heart rate after resting (110 or
more beats per minute)
 severe coughing spasms that limit
activity
 coughing up pinkish or rust colored
sputum
 low urine output (less than a pint daily)
 persistent vomiting
 gross fatigue or extreme lassitude
 delirium, confusion and coma
It is important that you should lie down
and make no effort to exert strenuously as
this will compound the problem. The
treatment for HAPE is immediate descent.
While descending it is important that you
keep your heart rate down and do not over
exert. You would be carried if a small hill
or incline is encountered while on the
descent.
High Altitude Cerebral Edema (HACE)
HACE is a relatively rare condition where
the brain swells. HACE usually takes a
couple days to develop at altitude,
although cases have occurred
immediately upon arriving. The earliest
signs and symptoms include difficulty with
walking and balance and psychological
withdrawal. Immediate descent is
mandatory if HACE is suspected.
Symptoms include:
 disorientation, confusion, or
hallucinations
 intense headache that does not go
away with a mild pain killer
 nausea and vomiting
 inability to walk a straight line walking
heel to toe
If severe illness develops, immediate
descent or medical attention is
mandatory!
African Adventure Newsletter #4, May ’04
ACLIMITIZATION RECOMMENDATIONS
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Slow ascent: ascend to altitude in
stages at a slow to moderate pace,
allowing the body time to properly
acclimatize
Increase fluid intake: This is a MUST.
Fluids ensure that you are properly
hydrated. Plan to drink four quarts or
more a day while on the climb. Urine
volume should always exceed one
pint. Urine color should be almost
clear.
Proper nutrition: caloric intake should
be maintained and your diet should be
high in carbohydrates. We will provide
a proper diet, it will be your job to eat
it.
Adequate rest: this is especially
important during the first two days at
altitude.
Maintaining a slow pace: no overexertion; rest during stops, avoid
alcohol, caffeine, narcotic pain killers,
and sleeping pills that can dehydrate
or suppress the respiratory drive.
Possible use of Acetazolamide (aka:
Diamox): see below
Diamox
AE recommends that you consult your
doctor regarding the possible use of
acetazolamide to aid acclimatization.
Please let your guide know if you are
taking this or any other medication. Do
not start taking this drug before your trip
begins or at anytime on the trip without
consulting your guide. It is a sulpha-based
drug and can be contra- indicated for
people with sulpha allergy and/or women
who are pregnant.
It is suggested that, under the guidance of
your physician, you obtain a supply of
Diamox for use on the trip above 13,000
feet. Discuss getting a prescription for
eight days of this medication. The dosage
required is based on your body weight, but
current research indicates that one dose
of 60 mg., twice a day, is adequate. The
latest studies have shown that Diamox is
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just as effective when taken at onset of
symptoms and is not required to be taken
prior to gaining altitude as used to be
prescribed. Since it is a diuretic and
prevention of dehydration is already an
issue at altitude, it is recommended
Diamox be used when necessary as
symptoms occur.
Dr. Peter Hackett’s book Mountain
Sickness: Prevention, Recognition and
Treatment includes this comment about
Diamox:
“Diamox, it is now generally agreed, does
reduce the incidence and severity of acute
mountain sickness (and we also use it to teat
mild AMS). This has been determined
statistically on large numbers of people. For a
given individual, however, the medication
should in no way be thought of as a guarantee
of freedom from mountain sickness. Serious
mountain sickness has been reported,
although rarely, in persons taking Diamox.
Side effects most noted are numbness and
tingling fingers, toes or face and increased
urine output.”
**Diamox is not a substitute for good physical
conditioning and slow acclimatization**
HYPOTHERMIA AND FROSTBITE
In addition to proper
acclimatization, the
second most important
health concern to
climbers is maintaining proper body
temperature to prevent hypothermia and
frostbite. This is ensured by wearing the
appropriate clothes and by proper body
maintenance. The latter cannot be overemphasized! Keeping yourself thoroughly
hydrated, well fed, taking care of your feet,
and acclimatizing properly are much more
important than having state of the art
equipment.
Upon arriving at camp, change into dry
socks (this will prevent trench foot which
often times results in frostbite) and
massage feet to increase circulation. As a
general rule, if your feet or hands have not
African Adventure Newsletter #4, May ’04
warmed up within two hours after leaving
camp in the morning for the summit, then
cold injury can be expected. At this point,
it is common for one’s hands or feet to
feel “warm” when in reality, deep frostbite
has occurred and the tissues are numb.
Mild frostbite is most easily taken care of
by placing the affected area under a
partner’s armpits or stomach for rewarming.
TRAVEL CLINICS AND RESOURCES
Health clinics specializing in travel health
are one of the best places to visit for
immunizations and travel health advice,
although they are often more expensive
than going to your local health department
or family doctor. Check with your
insurance company to see if these
immunizations and the travel clinic
consult are covered under your policy. If
you have an ongoing medical condition or
any general health concerns, you may
prefer to go to your primary care doctor.
Some travel health clinics provide specific
travel health briefs (usually for a fee) by
mail, phone or fax, which you can then
take to your doctor.
A visit to the travel clinic is advised sooner
than later as some immunizations take up
to 4 months to administer, so start early.
Center for Disease Control – Travelers’
Health Page
http://www.cdc.gov/travel/
The International Society of Travel
Medicine – Travel Clinic Directory
http://www.istm.org/
PERSONAL HEALTH AND DENTAL
CONCERNS
It is imperative that you make your
medical conditions or problems known to
me well before our departure if you didn’t
put it on your medical form or have had
any changes to your medical condition
since you filled out the application. AE
and I must know if you are taking any
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medications of any kind. You will be
asked to review the AMC Confidential
Medical Form again to confirm accuracy
and make any updates prior to departure.
It is a good idea before any international
trip to visit your dentist for a standard
check-up. It would be really uncomfortable
to get a tooth ache on the mountain.
IMMUNIZATIONS
There are no required
immunizations for Tanzania, but
many are highly recommended.
Below is a list of recommended
vaccinations from the Center for
Disease Control and Prevention
for East Africa. Those starred (*) are highly
recommended by the CDC for East Africa.
Consult with your doctor no later than 4–6
weeks before your trip to allow time for
shots to take effect, although some series
require additional lead time.
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Hepatitis A*
Hepatitis B
Rabies
Typhoid*
Yellow Fever*
As needed, booster doses for tetanusdiphtheria, measles, and a one-time
dose of polio vaccine for adults.
Malaria. In Tanzania it is most
commonly found in lower elevations
(6,000 feet or lower). It is not so much
a danger on the Kilimanjaro hike, but
it could be a problem on the safari.
You should consult your physician to
see if malaria prophylaxis is right for
you as there can be serious sideeffects with some of the options.
African Adventure Newsletter #4, May ’04
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