South Africa is a culturally diverse region that provides several notable advantages for businesses to add operations in the country. With its strategic geographic location and export capabilities, the market for expatriates continues to increase. As with any foreign assignment, there are certain risks that can be avoided. Colona and Turner write that receiving proper inoculations, being cautious of the surrounding environments, and understanding the difference in health carepractices are important to preparation for a successful assignment to South Africa.
While driving down the streets of Johannesburg, locally known as “Joburg,” it is easy to forget that you are in the subtropical highland climate of South Africa. High rises and skyscrapers cast shadows over a financial district booming with activity that you would expect in a European nation. That is until you notice a flange of baboons on the side of the street.
South Africa—a Growing Expatriate Destination
South Africa is nicknamed the “rainbow nation,” an acknowledgement of the country’s diverse cultural environment. With one of the most complex populations in the world, South Africa is comprised of approximately 40 million citizens ranging in race and religion, and speaking 11 official languages.
The cultural diversity of South Africa is a contributing factor to the heavy investments of numerous well-known international companies during the past 20 years, such as BMW, General Electric, and Levi Strauss. There are several advantages for companies to host operations in South Africa, including lower labor costs and the ability to export the products to an international market.
According to the American Chamber of Commerce in South Africa, nearly 50 percent of the chamber’s members are Fortune 500 companies, and that more than 90 percent operate beyond South Africa’s borders into southern Africa, sub-Saharan Africa, and across the continent. South Africa’s strategic geographic location provides access to the expansive African coast lines, the Middle East, Asia, Australia, Europe, and the Americas along well-established maritime trade routes.
The businesses that make up the American Chamber of Commerce in South Africa are, in part, strengthening the Johannesburg Stock Exchange (JSE), which operates as the 18th-largest stock exchange in the world. The JSE supports the cycle of raising capital and filtering it through cash resources, which continues to strengthen South Africa’s economic status while simultaneously creating opportunities for jobs and wealth.
Malaria Awareness
Although malaria continues to be a potential health threat to more than 90 countries in the world, the greatest risk occurs in sub-Saharan Africa. And while the malaria parasite is transmitted through the bite of an infected female mosquito, expatriates in South Africa can take certain precautions toward protecting themselves.
The Department of Health in South Africa suggests the following preventative measures:
- remain indoors between dusk and dawn;
- wear long-sleeved clothing, long trousers, and socks when going out at night;
- cover doorways and windows with screens and, if unavailable, close windows and doors at night;
- apply a DEET-containing insect repellent to exposed skin and repeat as recommended on the container label; and
- use a mosquito-proof bed net over the bed, with edges tucked in.
Preparing for Assignment
Before leaving for assignment, expatriates should receive specific vaccines for preventable diseases and other diseases that present higher risks of contraction in South Africa including hepatitis A, hepatitis B, typhoid, rabies, malaria, as well as routine vaccines. For the most beneficial treatment, the Center for Disease Control and Prevention (CDC) recommends visiting a doctor who specializes in travel medicine at least four to six weeks before leaving on assignment. This allows time for the vaccines to take effect. This also is the time to start taking preventive medicine against malaria.
If you or any family members who may be traveling on assignment with you take prescription medication, it is important to make sure you have enough to last the duration of the trip. The CDC recommends keeping the medication in its original packaging or bottle and storing it in your carry-on luggage. It is important to note that some prescription drugs in the home country are considered illegal in other countries. For this reason, it may be beneficial to ask your physician to write a letter specifying your medical need for the prescription on office stationary and print the original prescription on office stationery.
Available Health Care to Expatriates and Standards
As an expatriate or business traveler working in South Africa, a big question may concern the health care system. The health care system in South Africa primarily consists of a larger public sector and a quickly growing private sector that offer a combined range of services.
“The health care available in the private sector of the urban centers in South Africa is excellent and on a par with developed countries; however, expatriates should be aware that access to specialists and expectations for payment may be different from home countries,” says Lyndon Lamicack, M.D., senior medical director at CIGNA International Expatriate Benefits, Claymont, DE. “To ensure that expatriates receive proper care, it’s important for them to have guidance from a knowledgeable source, such as an international medical insurer.”
The growth of the private sector is attributed to several factors, including the exhaustion of resources in the public sector, a higher quality of doctors and hospitals, and an influx of international organizations and expatriates assigned to the region. A high number of travelers also are visiting South Africa for “health safaris,” commonly known as medical tourism, from North America and Europe for comparable services at a cheaper price.
The number of private hospitals and clinics continues to grow. There were 161 private hospitals four years ago. Now there are 200. Netcare operates the largest private hospital network in South Africa and also is the biggest private trainer of emergency personnel and health care workers. Among all of the hospitals in the Netcare network, Milpark Hospital and Sunninghill Hospital stand out for exceptional care in specific situations.
Aside from having a world-renowned Level 1 Accredited Trauma Unit with highly specialized cardiology and cardio-thoracic services, Milpark uses the whole-body x-ray technology to assess trauma. This technology was first developed by DebTech, the research and development arm of De Beers. The company says that these machines produce images of such high resolution that tiny diamonds can be detected on or inside the human body. When used in a hospital environment, the digital x-ray system can produce clear, diagnostic whole-body pictures in just 13 seconds. The use of whole-body x-ray machines allows emergency room doctors and nurses, also referred to as “sisters,” to continue providing critical care in urgent situations.
The Expatriate Pre-departure Checklist
- obtain all inoculations required for assignment in South Africa such as hepatitis A, hepatitis B, typhoid, rabies, malaria, and all other routine vaccinations.
- Assess and plan for potential environmental risks.
- Arrange for a 12-month supply of all prescription medications.
- Locate and become familiar with a family physician and the closest hospital while on assignment.
- Ensure all visas and work permits are valid.
Travel Risks as an Expatriate
Expatriates should take precautions to protect themselves from infectious diseases. The number one infectious disease in South Africa currently is AIDS, and it continues to kill 1,000 people a day in South Africa.
Expatriates also need to be cautious of general crime and scams during their assignment in South Africa. The U.S. Department of State reports that criminal activity, such as assault, armed robbery, and theft, is particularly high in areas surrounding certain hotels and public transportation centers, especially in major cities such as Johannesburg. ATM scams account for most of the petty crimes in South Africa involving either the machine “swallowing” your ATM card or a person offering to “help” you at the machine. As an expatriate, it is advised to use only ATM machines in well-lit public places, those attached to banks, or machines that are attended by a security guard.
This material is provided for informational purposes only. It is believed accurate as of the date of publication and is subject to change. Such material should not be relied on as legal, medical, or tax advice. As always, we recommend that you consult with your independent legal, medical, and/or tax advisors.
Michelle Colona is vice president of new business, west region, for CIGNA International Expatriate Benefits, Houston, Texas. She can be reached at +1 713 576 4330 or michelle.colona@cigna.com.
Danielle Turner is senior new business manager for CIGNA International Expatriate Benefits, Houston, Texas. She can be reached at +1 713 576 4467 or danielle.turner@cigna.com.