Immunisation
Before you even think of setting foot in (most of) Africa you need to start thinking about Immunisation. Even with the right precautions protection is not guaranteed - your level of protection depends on too many variables for the vaccinations to be 100 % successful in protecting you. As an example of the risks, every single French traveller we met beyond Mali seemed to have had  Malaria; they don't approve the use of Larium in France. I still picked up malaria in tyanzania even with Larium... so minimise the risks by checking out http://www.mara.org.za/mapsdownload_bmp.htm where you have the definitive malaria risk resource.

If you can live with that the you should consider getting the following shots (Info from Trailfinders - remember that I am not a doctor!):

• Yellow Fever - Obligatory in most of sub-Saharan Africa. Check your certificate is correctly filled in, stamped, and up to date. Good for 10 years

• Cholera - Not generally given nowadays, but it's a good idea to have the certificate to avoid money-grabbing officials - ask your GP for info. Good for 6 months.

• Havrix - Hepatitis A protection for 10 years if you get a second injkection  6-12 months after the first.

• Tetanus - Good for 5-10 years

• Polio - Good for 10 years

• Typhoid - Good for 3 years

• Meningitis - I believe you need the C strain for Africa, not the standard European shot - don't assume your nurse will know the difference. Good for 3 years

Also to be considered if you want to go down the travel-in-an-all-over-condom route:

• Rabies, expensice and only buys you 24 hours (I always thought that the frothing at the mouth bit would be cool)

• Hepatitis B

• Diptheria

Trailfinders, among others, can give you a vaccination card with the appropriate certificates included for you to stamp yourself if you fancy a bit of cholera certificate forgery - remember to record you blood group, though you probably want to be avoiding transfusions...

First Aid
What you carry should reflect your personal skills and needs. If you carry first aid equipment that you don't know how to use yourself the chances are that it is a waste of space - unless you first aid kit takes up half the car it will not contain anything that, generally speaking, virtually every doctor in Africa already has at hand; don't be fooled by out-of-date stories of lack of drugs or resources.

I work with two medical and first aid kits; the big ones stay with the vehicle, and the little ones stay in my day pack - they are covered in the personal equipment section.

Before the trip I took a refresher course with a doctor-friend in IV procedures which involved an evening of poking needles into things and people - Intravenous fluids are very useful in stabilising casualties in the event of an accident - and vehicle accidents are the most prevalent danger to travellers on this type of trip, so there is a definite value in learning how to set up an IV drip.

I've also had extensive training in lots of different types of first aid as a soldier and diving instructor over the years, so what I take may be a little more comprehensive than most people would want to carry. Also, I choose what I know and am familiar with - I'm no doctor and others may have better advice to offer. But in summary the first aid kit consists of:

• Emergency Dental Kit - From Boots, and get a bottle of Clove Oil too

• 2 x Resusci Face Shields - these include gloves and HIV barriers. Lots of gloves too.

• Assorted burn sheets and saline (also useful for irrigating eye injuries).

• Assorted Bandages, flexible splint (flexisplint) , tape, safety pins.

• Assorted wound/ambulance dressings.

• Assorted basic procedure or wound care packs (contain everything for dressing a wound).

• Shears (for cutting through clothing), various disposable scalpels, forceps and clamps.

• A big pot (100) of Mediwipes or similar - great for cleaning

• 6 x 500ml Haemaccel or Gelofusine - for replacing lost blood - the soft bags pack more easily.

• Giving sets and assorted needles for the above

• Good sterile needle/syringe set for all eventualities, though not as essential as it used to be now that HIV education is getting through

• Medium sized Stifneck extrication collar - the kind that you see on TV wherever there's a car accident - medium fits me...

• Assorted Plasters, steristrips, Melolin and Primapore, and sutures

• Savlon, Iodine, a space blanket and a thermometer

Medical Kit
Apart from wound cleaning I like to keep everything that could be classified as a drug in a separate pack. Again this list is what I personally like to have around - check what your GP thinks would suit you:

• Avomin 25mg - stops nausea

• Arsumax 50mg* - Also locally recommended as the best (new) way of treating Malaria with zero reported side effects. A tenth of the price of Malarone.

• Augmentin 375mg - wide spectrum antibiotic

• Ear drops - ask your chemist what is best for swimmers ear

• Eye drops - dust in eyes is a real problem - a good anitbiotic drop is worth taking.

• Ibuprofen 400mg* - generic painkiller, like Neurophen only twice the strength and a tenth of the price

• Imodium 2mg - block you up when you need to travel - I avoid it if I can and let nature take it's course (but I also haven't had any more than minor tummy problems)

• Larium 250mg - malaria protection, also taste great and make your dreams a whole lot more interesting - there are issues with this drug but it is by and large effective and my body tolerates it well - get informed before you decide as it costs a fortune.

• Malarone 250mg - suggested by Trailfinders as the best malaria cure - very expensive

• Piriton 4mg - cheap, safe and simple antihistamine - for itches, mossie rash.

• Sudocrem - From the baby section in Boots - Nappy rash cream - seriously.

• Bactiflox 500mg* - Antibiotic for bacteria in your gut.

• Fasigyne 500mg* - Treatment for Guiardia.

• Vermox 500mg* - For worms.

(Note: the three above are on recommendation from a missionary doctor working in Mali - you will need to find out how to identify the individual symptoms to use them effectively)

*I've starred the drugs that I bought en-route (Dakar) - drugs are much cheaper in Africa where they are available.

Next time I'll take along a CD that helps with diagnosis - there are a lot of resources out there and I'd welcome suggestions; it would beat the very short diarrhoea section in Lonely Planet

You should also consider putting together a personal medical and first aid kit (see below)

Ethical Issues

At some point in your journey you are almost certain to witness a serious accident or the aftermath of one (almost always involving vehicles). Before you begin your journey give some thought about how you intend to react when this happens.

Also consider whether there is a difference in a request for assistance for an injured Mandinka, a white expat, or another white traveller, because these are issues that are better addressed before you experience the shock of a real accident scene.

Remember that if you do choose to offer assistance, and blood is present, there is a very real risk if HIV infection, and protection should always be used.

A further issue for consideration is the unfortunate fact that if you are white and the victim is not, when the authorities arrive you may be held responsible for the accident - whether you were involved or not - you are simply seen as an easy target for compensation for the victim.

Likewise, you will constantly be asked by the locals to give them medicine - it's a common form of begging however genuine the need. Consider carefully the issues of responsibility if drugs you give are misused (especially antibiotics), or if they provoke an allergic reaction.

I've given cloves to a woman complaining about toothache -an effective remedy actually, and also good for cooking), but personally prefer to keep my limited medical supplies for my own use

These seem to be very negative approaches, but it is better to be aware of the risks and informed about the issues than to wade in without thinking. I know of many stories on this theme and personally think that the sight of a white person in an expensive 4x4 studiously ignoring a injured human in need is one of the cruellest images of Africa.