Altitude sickness

Altitude sickness is only likely to occur above 2500 metres, but this means that its early stages can easily be encountered in the Natal Drakensberg. Risk factors include a a high degree of activity and a rapid increase in elevation, which is exactly what fit backpackers get up to. Those most predisposed to altitude sickness generally live and work at or near sea level, are smokers, or suffer from an iron deficiency (perhaps because they are vegetarians). However, even seasoned high altitude backpackers can occasionally experience some symptoms on the Drakensberg escarpment. Being physically fit, therefore, does not necessarily reduce the risk.

The mildest form of altitude sickness is Acute Mountain Sickness (AMS). It is claimed that AMS occurs in about 20% of people after a fast ascent from sea level to 2500 metres (cf. your drive up to the Berg from the coast), and 40% of people after a fast ascent to 3000 metres (cf. climbing up to the escarpment in one day). It is caused by rapid exposure to low amounts of oxygen at high elevation. Symptoms include headaches, nausea, dizziness, fatigue, loss of appetite and insomnia. While some of these symptoms are common to dehydration and heat fatigue, it is recommended that at high altitude they should be attributed to AMS, especially in cooler weather.

AMS can usually be avoided by following these recommendations:

• Avoid alcohol and eat extra carbohydrates for at least 24 hours before climbing above 2500 metres.
• Limit your ascent above 2500 metres to 300 to 500 metres per day. In the Drakensberg, this means that you should not aim to climb to the top of the escarpment in one day, especially with unacclimatised or inexperienced hikers. Rather do your ascent over 2 days, resting overnight at the base of the escarpment if you can.
• Reduce your pace at higher altitude until your body has had time to acclimatise.
• Keep yourself hydrated.

In the Drakensberg, AMS usually disappears after spending a night on the escarpment. According to online sources, AMS headaches can be treated with ibuprofen, aspirin or paracetamol. [The author (please do not quote this) has found that aspirin is more effective for treating altitude-related headaches than paracetamol. Conversely, paracetamol seems more effective in dealing with heat-related headaches than aspirin. Compral, which contains both Aspirin and Paracetamol, is therefore a good choice to include in your first aid kit.]

The symptoms of AMS should lessen and then disappear within a day or two as the body acclimatises to the altitude. However, if the symptoms persist, especially after a second night’s rest, the treatment is to remain well-hydrated and descend from the escarpment.

Acute Mountain Sickness (AMS) can progress to High Altitude Pulmonary Edema (HAPE) with associated shortness of breath due to fluid buildup in the lungs, or High Altitude Cerebral Edema (HACE) with associated confusion caused by fluid buildup in the brain. Both can develop into Chronic Mountain Sickness (CMS) after long term exposure to high altitude, resulting in death unless the victim is extracted by helicopter to lower altitude for specialised treatment. While AMS and HACE are equally common in males and females, HAPE occurs more often in males. There are no recorded instances of HAPE or HACE in the Natal Drakensberg, however.

Hiking stoves

The author has witnessed more accidents and close calls involving hiking stoves than any type in the Natal Drakensberg, but this is likely to be true in any backpacking setting. Inexperience and thoughtlessness are the main cause of these incidents. Hike leaders and other experienced members of the group should always monitor the use of stoves, especially when youngsters are involved.

• Make sure that everyone knows how to use their stove correctly and safely by monitoring their actions with them. Experienced backpackers should render advice and assistance when it is obvious that this is required.
• The entry-level, puncture-type gas cartridge stoves are commonly used by beginner hikers and youth groups, but they are possibly the most dangerous type of all. On one occasion, a hiker left an “empty” cartridge upwind from his lit stove, and there was a huge explosion when the leaking gas reached it. On another occasion, a youngster decided to change a cartridge in a tunnel cave where candles were burning, but fortunately we recognised the danger and threw the empty cylinder outside before it could ignite. You should offer to change an empty gas cylinder for them, showing them how to do this correctly and safely:
  • Do the cartridge replacement far away from any sources of ignition such as candles and other stoves that are in use.
  • Unscrew the cooled burner head completely before swinging the clamps aside, then remove the used cartridge.
  • Check the condition of the o-ring seal and puncture pin underneath the burner head. Do not replace the cartridge if either of these is damaged.
  • Insert the new cartridge, close the clamps, slide the cartridge to the bottom of the clamps, then quickly screw the burner head down onto the cartridge.
  • The used cartridge will leak gas, so it should be left overnight far from any ignition sources. It should not be left inside a tent either – the leaking gas could asphyxiate the occupants or be ignited by static electricity. In the morning, squash it flat height-wise by repeatedly dropping a heavy rock on it. This way there should be a minimum of residual gas left in it.
• Liquid fuel stoves should never be used in the bell (vestibule) of a tent, especially if they burn highly flammable benzine (white spirit). These stoves are sometimes difficult to light, often unpredictable or even downright dangerous, and should only be used in the open far from tents and anyone else. Benzine contains benzene, a known carcinogen, so even the fuel is dangerous to one’s health. Avoid contact with the fuel, and try not to breath its fumes. Unfortunately, these stoves tend to vent copious amounts of fumes after being turned off.
• When stirring the contents of a billy while cooking, either hold the billy with one hand and stir with the other, or remove the billy and stir it while it is on the ground. Never stir a billy while it is on the stove using just one hand – it  will inevitably slide off, or the whole stove will fall over. Either you, someone else or something else is likely to be burned by scorching hot food, flame or both.
• The screw or twist-type removable cartridge stoves are probably the safest and simplest to use, but these are particularly prone to falling over because of their height. This usually happens when the contents of a billy on top of the stove start to boil, because the vibration upsets the cartridge’s balance.
• Always clear an area around your stove before you use it, and never light it on top of a ground sheet because the heat will melt the sheet. Straw and other combustible vegetation must be removed from around the stove, otherwise you may inadvertently start a veld fire if you are tenting in the open. Ideally, stoves should not be used upwind from tents.
• Beware of the wind when using a stove. Wind may topple the billy and stove. Wind reduces the effectiveness of the burner, but may also cause the flame to melt any connecting hoses or control knobs and possibly cause a raging fire. To avoid this, always use a wind shield when it is breezy. If you don’t have a wind shield, build a low rock wall around the stove.

Tick bite fever

Small red ticks about the size of a sesame seed are endemic to the Natal Drakensberg and can be active whenever the temperature is above freezing. Their greatest concentration occurs around the end of winter as the weather starts to warm.

Ticks are are usually quite easy to spot because they cling to blades of grass overhanging well-used animal tracks which hikers also make use of. As you brush past them, they transfer to your legs and arms. They usually crawl about before lodging their mouth parts into your skin. The favourite location seems to be the boundary between exposed skin and your socks or undergarments. Once they have bitten you they can be difficult to remove without leaving some of their mouth parts behind, so ideally this should be done by carefully burning their butts. This usually makes them let go completely.

Young ticks called nymphs or pepper ticks are much more troublesome. They are usually so tiny that they cannot be seen with the naked eye, and one tends to get covered in a large number of them. They will even get onto your chest and abdomen through a button-up shirt. Once they have latched onto you, they cause intense and insatiable itchiness which can lead to bleeding. When left alone, the bite site oozes a small amount of interstitial fluid which hardens into a tiny, translucent yellow bead.

The greatest problem with ticks in the Natal Drakensberg is that they can transmit African Tick Bite Fever (ATBF), which is a spotted fever caused by tiny bacterial organisms called rickettsias. Wild and domestic animals can also be infected and act as reservoirs for the disease. Both pepper and adult ticks transmit ATBF, but it is most often the adults that do so. The incidence of ATBF in the Natal Drakensberg is relatively rare though, and you may get bitten on many occasions and never fall ill.

After being bitten by an infected tick, the bite site develops an eschar, which is a small dark brown or black scab, surrounded by painful and sensitive inflammation. Symptoms present within 5 to 7 days of the bite and include swollen, painful lymph glands in the affected limb, muscle pain, a sore neck, a continuous and severe headache accompanied by excruciating stabbing pain behind the eyes, and very high fever that can result in hallucinations and nightmares. Being one of the spotted fevers, ATBF often causes skin rash, skin spots and small blisters too. In very severe or neglected cases, the victim may develop a haemorrhagic state and start bleeding under the skin.

If left untreated, recovery is slow and very uncomfortable, but the body’s immune response should prevent any future occurrence. However, complications can include pneumonia, encephalitis and damage to the brain and heart. The antibiotic doxycycline is most often used to treat ATBF and is very effective. The worst of the symptoms will start to subside with a few hours of the first dose, but it may take a day or two for the victim to fully recover.

To avoid tick bite fever:

• Cover up your legs by wearing proper hiking boots, technical longs and gaiters.
• Use an insect repellent such as Tabard or Mylol on exposed skin and reapply it often. Zam-Buk is quite effective on pepper tick bite sites and also reduces the urge to scratch them. If you apply the Zam-Buk generously, it smothers the pepper ticks without you having to try to remove them. They can be so small that you most likely will not find them anyway. They usually disappear after two applications with no further complications.
• Be on the lookout for adult ticks clinging to grass overhanging your route. If you see any, you will need to check yourself regularly and carefully remove any that latch onto your skin.
• When you wash at the end of each day on your hike, and after you return home, inspect yourself for adult ticks. Remember to check carefully at the top of your sock line, behind your knees, and in your groin area.

Fortunately, the many other tick-borne diseases encountered in other countries around the world have never been recorded in the Natal Drakensberg, although there has been an increasing incidence of Lyme disease in other parts of South Africa in recent years.

Berg tummy

“Berg tummy” is a layman’s term for a range of stomach ailments that can arise from drinking contaminated water collected from streams, rivers and ponds in the Natal Drakensberg. Its symptoms range from diarrhoea, nausea and fever to agonising stomach cramps like those associated with food poisoning.

Berg tummy is very rare, but you need to take precautions when you encounter the conditions favouring it. These are very low water levels and high water temperatures – conditions mostly associated with a summer drought. At all other times in the Drakensberg, the water is usually flowing too fast or it is too cold to give rise to Berg tummy. Beware of tap water at entry points though. This water is taken directly from streams and rivers, and is stored in water tanks without any treatment. This water can become quite warm and may become a source of Berg tummy.

To avoid Berg tummy, always collect drinking water from a flowing stream or river above human habitation. Avoid stagnant ponds, puddles and tarns. If you can choose between water from a storage tank or a stream, rather collect from the stream. If there is any doubt about the water quality, use purification tablets or a filtering straw if you have these, otherwise boil the water first before drinking it.

Imodium tablets or a generic like Betaperamide are very effective at treating Berg tummy and should be included in your first aid kit.