Packing List & Vaccinations

**Ghana lies just north of the equator.  The rainy season lasts from April to June and again from September to October in the south.  The rest of the year, when we will be there, is hot and dry with temperatures reaching up to 100°F (38°C).  Variations between day and night are small.

Packing List (not exhaustive)

  • Passport and Yellow Fever Certificate
  • Photocopy of passport and Yellow Fever Certificate
  • Ghanaian money is called the cedi and the exchange rate is about ¢9000 to the dollar. The bills there are ¢20,000, ¢10,000, ¢5000, ¢2000, and ¢1000. So if you have $100 in cedis.  That’s about 50 to 100 bills that’s a lot of bills and a lot of money by Ghanaian standards.  One traveler recommended a waist money belt and a neck pouch and put some in each and some in his pack. He personally found the neck pouch to be more useful.
  • YOU ARE ONLY REQUIRED TO BRING A MAXIMUM USD AMOUNT OF $200
  • Money belt and/or security pouch
  • Prescription medications (See “Personalized Medicine Kit” below)
  • Skin insect repellent (wipes or spray): 25-50% DEET or 20% picaridin (Bayrepel)
  • Clothing insect repellant (permethrin based)
  • Sunscreen
  • Mosquito net for bed and head
  • Scrubs (if applicable)
  • Comfortable shoes
  • Gaiters
  • Light clothing (long pants, t-shirts, shorts)
  • Plenty of long layers, long socks and long pajamas.
  • No short shorts or tank-tops in the community
  • Hat
  • Sunglasses
  • Snacks
  • Shower shoes
  • Rain Poncho
  • Hand sanitizer/wet wipes
  • Water bottle
  • Camp towels
  • Expendable funds for souvenirs
  • Small daypack to bring on brigades
  • Ziploc bags/plastic bags to keep things dry
  • Headlamp or flashlight
  • T-shirts as gifts
  • Notebook
  • Small lock(s) (lock valuables in your suitcase during the day)
  • Travel Adapter/AVR (Automated Voltage Regulator): highly recommended.  These can be bought in Ghana for around 35-50 GHS or from a departing volunteer.   http://www.adaptelec.com/index.php?main_page=document_general_info&products_id=227
  • Visa Card: Visa is the only widely-accepted credit card in Ghana.
  • Personal First Aid Kit

What Not to Bring

  • High heels, expensive jewelry, hair dryers, most major electronics. Try to pack light. A large backpack or duffel bag should provide plenty of room for everything that you need to bring. Bags will need to be loaded/unloaded many times — consider this when packing a suitcase.


 

Personalized medicine kit

The prescription medicines you take every day. Make sure you have enough to last during your trip.  Keep them in their original prescription bottles, clearly labeled.  Carry a signed, dated letter from the primary physician describing all medical conditions and listing all medications, including generic names. Note: Some drugs available by prescription in the US are illegal in other countries. Check the US Department of State Consular Information Sheets for the country(s) you intend to visit or the embassy or consulate for that country(s). If your medication is not allowed in the country you will be visiting, ask your health-care provider to write a letter on office stationery stating the medication has been prescribed for you.  Pack all medications in hand luggage. Carry a duplicate supply in the checked luggage.  Follow all security guidelines, if the medicines are liquids.  If you wear glasses or contacts, bring an extra pair.

 

Additional Medication Information

Anti-Diarrheal Medication and Oral Rehydration Solution.

Unfortunately, and as with any international travel, the chance of coming down with an unpleasant digestive illness is fairly high.  Travelers’ diarrhea is the most common travel-related ailment. The cornerstone of prevention is food and water precautions. Drink only bottled water, be wary of your meal choices and how they’re cooked, and pack a diarrhea kit and oral rehydration solution to ease any uncomfortable symptoms you might experience.  If not provided by GB or Brigade meds, each traveler should bring along an antibiotic and an antidiarrheal drug to be started promptly if significant diarrhea occurs.  A quinolone antibiotic is usually prescribed: either ciprofloxacin (Cipro) (PDF) 500 mg twice daily or levofloxacin (Levaquin) (PDF) 500 mg once daily for a total of three days. Quinolones are generally well-tolerated, but occasionally cause sun sensitivity. Alternative regimens include a three day course of Rifaximin (Xifaxan) 200 mg three times daily or azithromycin (Zithromax) 500 mg once daily.  Antidiarrheal drugs such as loperamide (Imodium) or diphenoxylate (Lomotil) should be taken as needed.

 

Insect and tick protection

Wear long sleeves, long pants, hats and shoes (rather than sandals). For rural and forested areas, boots are preferable, with pants tucked in, to prevent tick bites. Apply insect repellents to exposed skin (but not to the eyes, mouth, or open wounds).  Products with a lower concentration of either repellent need to be reapplied more frequently. For additional protection, apply permethrin-containing compounds to clothing, shoes, and bed nets. Permethrin-treated clothing appears to have little toxicity. DEET may also be applied to clothing.  Insect repellents are ineffective against tsetse flies, which transmit sleeping sickness (African trypanosomiasis). In areas infested with tsetse flies travelers should avoid riding in the back of open vehicles, since dust may attract tsetse flies, and should take care not to disturb bushes (where tsetse flies rest) during the warmer parts of the day.

Vaccinations/Immunizations

Travelers should visit their personal Dr. or a travel health clinic 4-8 weeks before departure.

 

Required for all travelers:

Yellow Fever Vaccination and Certification: Ghana is an endemic Yellow Fever zone. Proof of your vaccination is required for entry and exit.  Schedule your appointment to receive the Yellow Fever vaccine as far in advance of your departure date as possible.  Yellow fever vaccine (YF-VAX; Aventis Pasteur Inc.) (PDF) must be administered at an approved yellow fever vaccination center, which will give you a fully validated International Certificate of Vaccination.  Mild reactions include headaches, muscle aches, and low-grade fevers. Serious reactions are hives or asthma.

 

Recommended for all travelers:

Malaria: A Prophylaxis of either mefloquine (Lariam), atovaquone/proguanil (Malarone), or doxycycline may be given. Mefloquine is taken once weekly in a dosage of 250 mg, starting one-to-two weeks before arrival and continuing through the trip and for four weeks after departure.  Mefloquine may cause mild neuropsychiatric symptoms, including nausea, vomiting, dizziness, insomnia, and nightmares.  Rarely, severe reactions occur, including depression, anxiety, psychosis, hallucinations, and seizures.  Mefloquine should not be given to anyone with a history of seizures, psychiatric illness, cardiac conduction disorders, or allergy to quinine or quinidine. Atovaquone/proguanil (Malarone) is a combination pill taken once daily with food starting two days before arrival and continuing through the trip and for seven days after departure.  Side-effects, which are typically mild, may include abdominal pain, nausea, vomiting, headache, diarrhea, or dizziness. Serious adverse reactions are rare. Doxycycline is effective, but may cause an exaggerated sunburn reaction, which limits its usefulness in the tropics

More Information About Malaria

Chloroquine is NOT an effective antimalarial drug in Ghana and should not be taken to prevent malaria there.  Another drug, Halofantrine (marketed as Halfan), is widely used overseas to treat malaria. However, the CDC recommends that you do NOT use halofantrine because of serious heart-related side effects, including deaths. You should avoid using Halofantrine unless you have been diagnosed with life-threatening malaria and no other options are immediately available.  Malaria symptoms will occur at least 7 to 9 days after being bitten by an infected mosquito.  Therefore, fever in the first week of travel is unlikely to be malaria; however, you should see a doctor right away if you develop a fever at any time during your trip.  Malaria may cause anemia, jaundice, and if not promptly treated, may cause kidney failure, coma, and death. Despite using the protective measures outlined above, travelers may still develop malaria up to a year after returning from a malarious area. You should see a doctor immediately if you develop a fever anytime during the year following your return and tell the physician of your travel.

Typhoid: It is generally given in an oral form (Vivotif Berna) consisting of four capsules taken on alternate days until completed. The capsules should be kept refrigerated and taken with cool liquid. Side-effects are uncommon and may include abdominal discomfort, nausea, rash or hives. The alternative is an injectable polysaccharide vaccine (Typhim Vi; Aventis Pasteur Inc.) (PDF), given as a single dose. Adverse reactions, which are uncommon, may include discomfort at the injection site, fever and headache.

Tetanus-diphtheria: Only if you have not received a tetanus-diphtheria shot within last 10 years.

Hepatitis A & B: Especially for health care workers.  Check to see if you’ve had this vaccine already

Meningococcus: recommended for travel during the dry season (November through June), especially if prolonged contact with the populace is likely. Mild redness at injection site may occur.

Measles, mumps, rubella (MMR)

Cholera: recommended only for high-risk individuals, such as relief workers, health professionals, and those traveling to remote areas where cholera epidemics are occurring and there is limited access to medical care.  Otherwise not generally recommended, even though cholera is reported, because most travelers are at low risk for infection. Two oral vaccines have recently been developed: Orochol (Mutacol), licensed in Canada and Australia, and Dukoral, licensed in Canada, Australia, and the European Union.  Note: The only cholera vaccine approved for use in the United States is no longer manufactured or sold, due to low efficacy and frequent side-effects.

Recent outbreaks

 

Anthrax outbreak was reported in April 2012 from the Upper East Region, resulting in four human deaths. A smaller outbreak was reported in June 2009 from Tindongo in the Talensi-Nabdam District of the Upper East Region, causing two deaths. In April 1997, an anthrax outbreak occurred in a village in Bolgatanga District in the Upper East Region, resulting in 26 cases and 14 deaths. Anthrax cases occur regularly in the Northern Region and the southern Volta Region (see ProMED-mail; July 1, 2003, June 25, 2009, and April 29, 2012). Most cases occur in those who have direct contact with infected animals. Most travelers are at low risk.

 

Yellow fever was reported in February 2012 from three districts: Builsa and Kassena-Nankana-West in the Upper East Region and Kitampo-South in the Brong Ahafo Region located in the mid-western part of the country. Three cases were confirmed, two of them fatal. In the year 2011, three cases of yellow fever were reported from the Upper West Region: one each from Wa Municipality, Jirapa District, and Wa East District. An isolated case was also reported from the Northern Region in 2011. An outbreak of yellow fever occurred in the Upper East Region in 1996. Yellow fever vaccine is required for all travelers to Ghana.

 

Cholera outbreaks occur regularly in Ghana. An outbreak was reported from the Northern and Western regions in August 2011, from the Central region in June 2011, and from the Eastern region in March 2011. A cholera outbreak was reported from greater Accra in February 2011, causing 4190 cases and 36 deaths by the end of March. In January 2011, cholera outbreak occurred in southern Ghana. In November 2010, a cholera outbreak was reported from the Eastern Region of Ghana. In January 2009, a cholera outbreak occurred in the Greater Accra Region, chiefly involving the Okaikoi, Ablekuma, and Ayawaso constituencies. At around the same time, outbreaks were reported from the Eastern Region and from the Anyako community in the Keta Municipality of the Volta Region, southeastern Ghana. An increase in the number of cholera cases was reported from the Greater Accra Region in September 2008 and before that in June 2006. In March 2006, a cholera outbreak was reported from Komenda and its surrounding villages in the Komenda-Edina-Eguafo-Abrem (KEEA) District of the Central Region (see ProMED-mail; April 7 and June 23, 2006). In November 2005, a cholera outbreak was reported from communities in Greater Accra, Ashanti, Eastern, and Northern Regions (see International Federation of Red Cross And Red Crescent Societies).  The main symptoms of cholera are profuse watery diarrhea and vomiting, which in severe cases may lead to dehydration and death. Most outbreaks are related to contaminated drinking water, typically in situations of poverty, overcrowding, and poor sanitation. Most travelers are at extremely low risk for infection. Cholera vaccine, where available, is recommended only for certain high-risk individuals, such as relief workers, health professionals, and those traveling to remote areas where cholera epidemics are occurring and there is limited access to medical care. All travelers should carefully observe food and water precautions, as below.

 

Meningococcal disease outbreak was reported in February 2010 from the Upper West Region, resulting in 96 cases and 17 deaths (see ProMED-mail). A meningococcal outbreak in early 2002 caused more than 1400 cases, including 190 deaths. The districts of Bongo, Kessena, West Gonja, Na, Jirapu-Lambus, Gushiegu-Karaga, Techiman, Krachi, East Maprusi, Builsa and Lawra were chiefly affected. An outbreak between November 1996 and March 1997 killed more than 400 people, chiefly in the Upper West, Upper East, Northern and Brong Ahafo Regions. Meningococcal vaccine is recommended for travel during the dry season (November through June), especially if prolonged contact with the populace is likely.

 

 

H5N1 avian influenza (“bird flu”) was reported in April 2007 from a poultry farm east of the capital city of Accra. A second outbreak was reported from a poultry farm north of Accra in May 2007. No human cases have been reported to date. Most travelers are at extremely low risk for avian influenza, since almost all human cases in other countries have occurred in those who have had direct contact with live, infected poultry, or sustained, intimate contact with family members suffering from the disease. The World Health Organization and the Centers for Disease Control do not advise against travel to countries affected by avian influenza, but recommend that travelers to affected areas should avoid exposure to live poultry, including visits to poultry farms and open markets with live birds; should not touch any surfaces that might be contaminated with feces from poultry or other animals; and should make sure all poultry and egg products are thoroughly cooked. A vaccine for avian influenza was recently approved by the U.S. Food and Drug Administration (FDA), but produces adequate antibody levels in fewer than half of recipients and is not commercially available. The vaccines for human influenza do not protect against avian influenza. Anyone who develops fever and flu-like symptoms after travel to Ghana should seek immediate medical attention, which may include testing for avian influenza. For further information, go to the World Health Organization, Health Canada, the Centers for Disease Control, and ProMED-mail.

 

Other infections

Schistosomiasis: (acquired by swimming, wading, rafting, or bathing in contaminated fresh water; swimming and bathing precautions are advised, as below).

African trypanosomiasis: (sleeping sickness) from tsetse flies.

Lymphatic filariasis: Many mosquito bites over months to years are needed to get it.  Short-term tourists have a very low risk.

Onchocerciasis (may be developing resistance to ivermectin, most commonuly used to treat it

Dengue fever (flu-like illness sometimes complicated by hemorrhage or shock; from mosquitoes.

Neither vaccine nor drugs for preventing infection are available. The bite of one infected mosquito can result in infection. The risk of being bitten is highest during the early morning, several hours after daybreak, and in the late afternoon before sunset. However, mosquitoes may feed at any time during the day. Aedes mosquitoes typically live indoors and are often found in dark, cool places such as in closets, under beds, behind curtains, and in bathrooms. 

Other Precautions

 

Food and water precautions

Do not drink tap water unless it has been boiled, filtered, or chemically disinfected. Do not drink unbottled beverages or drinks with ice. Do not eat fruits or vegetables unless they have been peeled or cooked. Avoid cooked foods that are no longer piping hot. Cooked foods that have been left at room temperature are particularly hazardous. Avoid unpasteurized milk and any products that might have been made from unpasteurized milk, such as ice cream. Avoid food and beverages obtained from street vendors. Do not eat raw or undercooked meat or fish. Some types of fish may contain poisonous biotoxins even when cooked. Barracuda in particular should never be eaten. Other fish that may contain toxins include red snapper, grouper, amberjack, and sea bass.

 

Swimming and bathing precautions

Avoid swimming, wading, or rafting in bodies of fresh water, such as lakes, ponds, streams, or rivers. Do not use fresh water for bathing or showering unless it has been heated to 150 degrees F for at least five minutes or held in a storage tank for at least three days. Toweling oneself dry after unavoidable or accidental exposure to contaminated water may reduce the likelihood of schistosomiasis, but does not reliably prevent the disease and is no substitute for the precautions above. Chlorinated swimming pools are considered safe.

 

 

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