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Ecuador has its fair share of scary-sounding tropical diseases, but there’s no reason to be paranoid. Most are rare and pose much more of a threat to residents – especially those from poorer communities with limited access to clean water and health care – than tourists. The two illnesses you should be especially vigilant against, however, are stomach upsets caused by contaminated food and water, and malaria. You can dramatically cut the risks of getting either through simple, practical steps.

Before you go

Consult your doctor or a travel clinic at least two months before you leave to discuss whether you need vaccinations or malaria prophylaxis. If you’re travelling for more than a few weeks, it’s also worth having a dental check-up. Spectacle and contact lens users should bring spare glasses and their prescription.

The only inoculation you are required to have by Ecuadorian law is for yellow fever – but only if you’re coming from a tropical African or South American country, when (in theory, at least) you’re supposed to show a vaccination certificate. It’s a good idea to have the jab anyway if you’re planning to visit the Oriente, where the disease is rare but present. The vaccination lasts for ten years. You should also make sure you’re up to date with your vaccinations and boosters for polio, tetanus, diphtheria, hepatitis A and typhoid. Also consider jabs for rabies, tuberculosis and hepatitis B if you anticipate spending a long time in rural areas or with animals, if you’re doing work in health care, or if you’re planning on lots of long hikes in the wild; those consistently occupationally exposed to wild rodents for long periods in Loja, Tungurahua or Cañar provinces might also ask their health professionals about a plague vaccine.

Food and water

The traveller’s commonest health complaint is an upset stomach, usually caused by contaminated food or water. Tap water is unsafe to drink in Ecuador; bottled water and soft drinks, widely available in all but the remotest places, are safe alternatives, but always check that the seal is intact. Wash your hands before meals and use bottled or boiled water to clean your teeth. You can also pick up stomach upsets from swimming in unclean water; only use chlorinated swimming pools and avoid beaches near large population centres or sewage outlets.

For food and drink, avoid the following: ice made from tap water; fruit juices with tap water added; raw vegetables and salads; undercooked, partly cooked or reheated fish, crustaceans, meat or eggs; dairy products and ice cream made from unpasteurized milk; and food that’s been lying around uncovered where flies can get at it. Food that’s freshly prepared and hot, and fruit and vegetables that you can peel yourself, rarely cause any harm.

If you plan to visit remote areas or want to avoid relying on bottled water, you may have to purify your water. Bringing water to a good rolling boil for a minute (3min at altitude) is extremely effective, though anyone travelling without cooking equipment will find chemical purification is simpler. Chemical and iodine tablets are small, light and easy to use, and iodine tincture is particularly effective against amoebas and giardia; iodine is unsafe for pregnant women, babies and people with thyroid complaints. Portable water purifiers give the most complete treatment but are expensive and relatively bulky to carry.

A bout of diarrhoea, sometimes accompanied by vomiting and stomach cramps, is an annoyance most travellers have to suffer at one time or another. In most cases it passes within a couple of days and is best remedied by resting and taking plenty of fluids. Avoid milk, alcohol and caffeine-based drinks; still drinks are preferable to fizzy. Rehydration salts are widely available in Ecuadorian pharmacies and are very helpful in replenishing lost salts. You can make your own solution by adding a generous pinch of salt and three to four tablespoons of sugar to a litre of clean water – aim to drink at least three litres a day if you’re unwell, or a couple of glasses for every loose movement. Current medical opinion is that you should continue to eat normally as opposed to fasting, if you feel like eating. Anti-diarrhoeal drugs only suppress symptoms rather than solving the underlying problem, but can be useful when you’re on the move and don’t know when the next toilet stop might be.

Consult a doctor if symptoms last for longer than five days, there is blood in your stools, you also have a high fever or if abdominal pain is severe and constant. Most towns have facilities for testing stool samples; tests often only take a matter of hours, cost a few dollars and are invaluable for diagnosis. You’ll usually have to buy your own sample pot (caja de muestra) from a pharmacy.

Diarrhoea caused by bacteria can be treated with a course of antibiotics like Ciprofloxacin (available over the counter in most Ecuadorian pharmacies). Ciprofloxacin does not work against amoebic dysentery (amoebiasis), which can become very serious if it’s not treated with metronidazole (Flagyl) or giardia, a parasitic infection that induces sudden, watery and extra-bad-smelling diarrhoea, bloating, fatigue and excessive rotten-egg-smelling gas. Symptoms wax and wane but can last for weeks if left untreated with a course of metronidazole or tinidazole (Fasigyn); you should avoid alcohol if taking either of these medications.

Cholera – transmitted through contaminated water – occasionally breaks out in rural areas, but tends to be very localized and restricted to poor communities with inadequate sanitation. It’s unlikely you’ll go anywhere near these places, but if you suspect you’re infected (symptoms include profuse watery diarrhoea, explosive vomiting and fever) it’s easy to treat, provided you get to a doctor immediately and keep rehydrating by drinking large quantities of bottled or boiled water.

Insect-borne diseases

Heavy rains can trigger a sharp increase in insect-borne diseases in Ecuador, particularly malaria and dengue fever in the coastal provinces. The best way of avoiding such diseases is not to get bitten in the first place. Straightforward precautions include using insect repellent, covering up as much skin as possible with light-coloured, loose-fitting but tight-cuffed clothing and sleeping in screened rooms with a mosquito net, preferably treated with permethrin repellent.

Tens of thousands of people contract malaria every year in Ecuador, about a third of them with the very serious falciparum variety. The worst-affected areas are below 1500m, especially in or around population centres and when there’s plenty of stagnant water for the mosquitoes to breed in. Above 1500m the risk falls substantially, and above 2500m the malaria mosquito cannot survive. Quito and the Galápagos Islands are free of malaria, and if you’re keeping to the highlands, the risk is extremely small. The malarial Anopheles mosquito bites between dusk and dawn, so dress and protect yourself appropriately before sunset and sleeping.

Consult your doctor if travelling in malarial areas and follow a course of prophylactic medication. There are chloroquine-resistant strains of malaria in Ecuador, meaning you’ll probably use Lariam (mefloquine), Malarone (atovaquone and proguanil) or Vibramycin (doxycyline). Malarial tablets need to be taken prior to arriving in risk areas and also after leaving them, as directed. These drugs do not completely wipe out the risk of the disease, and you should always take care to avoid being bitten. Symptoms include fever, diarrhoea, joint pain, shivering and flu-like symptoms; if you suspect you’ve caught the disease, see a doctor immediately and have a blood test. Symptoms can appear several months after leaving a malarial area. Dengue fever is a painful and debilitating disease spread by the Aedes mosquito, which bites during the day. There’s no vaccine against dengue fever and there’s not a lot you can do should you contract it, except resting and taking painkillers (avoid aspirin) and plenty of fluids. Symptoms include headaches, severe joint pain (its other name, “breakbone fever”, is indicative) and high fever, though it’s usually only fatal if caught repeatedly.

Avoiding insect bites will also provide you with protection against a number of rarer diseases such as: leishmaniasis, a parasitic disease spread by the bite of infected sand flies present in lowland Ecuador; river blindness (onchocerciasis), spread by the bite of black flies found around fast-moving water, mainly in parts of Esmeraldas province; and Chagas disease (or American trypanosomiasis), which is carried by bugs found in rural mud, thatch and adobe buildings in coastal areas, and transmitted when the bug’s faeces are unwittingly rubbed into its bite wound.

Altitude and hypothermia

If you’ve flown to Quito from sea level, you may feel a bit woozy, sleepless and lethargic – normal symptoms of the acclimatization process the body undergoes over a few days as it adjusts to reduced levels of oxygen at altitude. Symptoms, which might also include breathlessness, needing to urinate frequently, fatigue and strange dreams, will abate naturally if you rest and avoid alcohol and sleeping pills.

Acute Mountain Sickness (AMS), known as soroche in Ecuador, occurs when your acclimatization process does not keep pace with your rate of ascent. It’s a debilitating and potentially dangerous condition caused by the reduced oxygen levels and atmospheric pressure at high elevations, and if you’re going to go much above 3000m you should be aware of the risks. Your gender and fitness have no bearing on whether you will develop AMS, but children are known to be more susceptible to AMS than adults, and, if young, may not be able to tell you they’re feeling sick, in which case they shouldn’t be taken to high altitudes at all. Young adults (in their teens or even early twenties) are also more susceptible and should allow extra days for acclimatization. Symptoms include headaches, nausea and extreme tiredness, dizziness, insomnia, confusion and a staggering gait. The best way to relieve the condition is also the simplest – lose altitude.

You can minimize the risks of developing AMS by ascending to high elevations slowly and allowing yourself to acclimatize – don’t be tempted to whizz straight up the nearest volcano without spending a night or two at altitude first. You should also avoid alcohol and salt, and drink lots of water or try the local remedy for altitude sickness, coca-leaf tea (mate de coca). A course of acetazolamide (Diamox) speeds up the acclimatization process, but this is a prescription-only drug in most countries, as it can be dangerous for people with heart conditions. It’s unlikely you’ll need this drug in Ecuador, but if you’re planning to go to very high elevations, you might consider it as a precaution.

If you develop AMS, it is essential you do not ascend any further. Your condition will worsen and may become life-threatening. There are two severe forms of AMS. HAPO (high altitude pulmonary oedema) is caused by a build-up of liquid in the lungs. Symptoms include fever, an increased pulse rate and coughing up white fluid; sufferers should descend immediately, whereupon recovery is usually quick and complete. Rarer, but more serious, is HACO (high altitude cerebral oedema), which occurs when the brain gets waterlogged with fluid. Symptoms include loss of balance and coordination, severe lassitude, weakness or numbness on one side of the body and a confused mental state. If you or a fellow traveller displays any of these symptoms, descend immediately, and get to a doctor; HACO can be fatal within 24 hours.

Decompression sickness is a more oblique problem associated with gaining altitude quickly. If you have been scuba diving in the Galápagos or on the coast, wait at least 24 hours before coming to the highlands or flying.

Another concern for people at altitude is hypothermia, an underestimated enemy responsible for more deaths among trekkers and climbers than anything else. Brought on by exposure to cold and when the body loses heat faster than it can generate it, hypothermia is greatly accelerated when you’re wet, tired and in the wind. Because early symptoms can include an almost euphoric sense of sleepiness and disorientation, your body’s core temperature can plummet to danger level before you know what has happened. Other symptoms are violent shivering, erratic behaviour, slurred speech, loss of coordination and drowsiness, and are much easier to spot in other people than yourself. Victims should be given dry clothes, warm drinks (slowly) and kept awake and warm.

The sun

It’s not a good idea to strip off and soak up the rays of the equatorial sun. Serious sunburn and sunstroke are real risks, particularly at altitude, when the temperature is not necessarily that high but the thin air amplifies the harm done by the sun’s ultraviolet rays. Jungle and coastal boat rides can also be dangerous, as cool river or sea breezes disguise the effects of the sun as it is reflected off the water. Use a high-factor sunscreen on all exposed skin, reapplying after bathing or exertion, and wear a wide-brimmed hat. Drink plenty of water, particularly if you’re exercising, and consider taking a rehydration solution or adding more salt to your food to counterbalance the effects of excessive sweating.

Animals

At some point you’re bound to come across unfriendly dogs, especially if you’re a hiker, as they’re often used in rural communities to deter thieves. If a dog snarls and bares its teeth at you, back off slowly, without turning your back on it, staring at it, or showing any fear. Picking up a stone and pretending to throw it sometimes works, but you don’t want to provoke an attack either. Rabies, though only a remote risk, does exist in Ecuador, with a couple of hundred cases a year: if you get bitten or scratched by a dog, cat or most other mammals you should wash the affected area thoroughly with soap and clean water and seek medical attention immediately.

Stings and bites from other creatures such as scorpions, spiders and snakes are very uncommon but can be terribly painful and, in rare cases, fatal. It’s good practice to go through your clothes, socks and shoes before dressing, and to check your bedclothes and under lavatory seats. In the rainforests, watch where you put your feet and hands, and don’t lean against trees. Walking around barefoot is an invitation to get bitten or stung and opens the door to hookworm.

Ecuador does have its share of venomous snakes, but bites are rare, and even if they do strike, there’s every chance they won’t inject any venom. In the unlikely event of snakebite, keep still. If possible, get someone to kill the snake for identification purposes, and get medical help as quickly as possible. In remote rainforest communities, following local knowledge may sometimes be better than spending hours getting to a hospital. Village doctors (curanderos) may know effective antidotes, and be able to prepare them quickly.

Volcanoes

Ecuador has several active volcanoes, some of which periodically belch clouds of ash over the surrounding countryside. In recent years the ones causing most disruption have been Guagua Pichincha near Quito, Reventador in the Oriente, and Tungurahua, which has been threatening the town of Baños for years. These are not the only active volcanoes in the country; you can keep abreast of any volcanic activity at Ecuador’s Instituto Geofísico website whttp://www.igepn.edu.ec (in Spanish), the Smithsonian Global Volcanism Program whttp://www.volcano.si.edu (in English), or through local media, authorities and your embassy.

Other health hazards

Sexually transmitted diseases are as much a threat here as in any country. Condoms (condones or preservativos) are not as widely available as in Western countries – it’s a good idea to take your own supply if you’re worried about the safety of unfamiliar brands.

Car crashes cause more injuries to travellers in Ecuador than anything else. Minimize your risks by travelling on roads only during the day, wearing seatbelts in cars or helmets on motorbikes, avoiding overloaded buses and changing vehicle if you think the driver is drunk, fatigued or unduly reckless.

 

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