Health & safety
Before you go
Make sure you’re healthy before traveling. If going on a long trip, make sure your teeth are OK. If you wear glasses, take a spare pair and your prescription.
If you require a particular medication, take an adequate supply, as it may not be available locally. Know the generic name, as well as the brand, to make getting replacements easier. To avoid problems, have a legible prescription or letter from your doctor to show that you legally use the medication.
It’s usually a good idea to consult your government’s travel health website before departure (if one is available):
» Australia (www.smarttraveller.gov.au)
» Canada (www.travelhealth.gc.ca)
» UK (www.nhs.uk/LiveWell/TravelHealth)
» USA (www.nc.cdc.gov/travel)
Insurance
Make sure that you have adequate health insurance.
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Recommended vaccinations
Plan ahead for getting your vaccinations: some require several injections, and some vaccinations should not be given together or should be avoided during pregnancy and by people with allergies – discuss this with your doctor at least six weeks before travel. Be aware that there is often a greater risk of disease for children and pregnant women.
Dangers & annoyances
Just remember: most crimes and accidents can be avoided by using common sense. Ecuador is a safe and wonderful country for travel. No matter where you travel, it’s wise to get some travel insurance.
Drugs
Imbibing illegal drugs such as marijuana and cocaine can either land you in jail, land your money in the hands of a thief, or worse. Unless you are willing to take these risks, avoid illegal drugs.
Lonely Planet has received a couple of letters from travelers who were unwittingly drugged and robbed after accepting food from a stranger. You can see the mistake that was made here.
Scams
Be wary of false or crooked police. Plainclothes ‘policemen’ may produce official-looking documents, but always treat these with suspicion, or simply walk away with a smile and a shrug. On the other hand, a uniformed official who asks to see your passport in broad daylight in the middle of a busy street is probably just doing a job.
Theft
If travelers had to confess their top five stresses, one would surely be Backpack Separation Anxiety (BSA). It’s most commonly experienced when travelers are required to place their backpacks in a bus’s luggage compartment or overhead rack. Aside from craning your neck at every stop until it snaps, there’s little you can do to prevent it being stolen. But rest assured – for the most part, the bag-checker is on your side and knows whose bags are whose. Definitely keep your eye on it (or carry a pack small enough to bring on the bus), but don’t worry yourself silly. Bag theft occurs, but not very often. Some people buy a grain sack in the market and pack their bag in it so it will blend in with the cargo.
Long-distance, nighttime bus robberies occasionally occur, and have been reported in the province of Guayas, in the area surrounding Guayaquil; and on buses between Quito and Riobamba. If you can take a day bus to avoid the risk.
If it can be avoided, do not carry valuables on day hikes, especially in areas commonly visited by tourists. Armed attacks have been reported on the hikes near Baños (central highlands). Robberies have also occurred on the trails near Vilcabamba (southern highlands).
Armed robbery is rare in Ecuador, although parts of Quito (especially the Mariscal Sucre neighborhood) and some coastal areas are dangerous.
Sneak theft is more common, and you should always watch your back (and back pockets) in busy bus stations, on crowded city buses and in bustling markets. All of these places are worked by bag-slashers and pick pockets. But you can avoid playing victim to them by being smart.
Carrying your wallet or passport in a back pocket is advertising. But also avoid lifting your shirt and whipping out your money pouch in public. Instead carry a wallet with a small amount of spending money in your front pocket and keep the important stuff hidden in your money pouch beneath your clothes.
Leaving money in the hotel safe deposit boxes is usually reliable, but make sure that it is in a sealed, taped envelope. A few travelers have reported a loss of money from deposit boxes in the cheaper hotels. Theft from hotel rooms happens only on those rare occasions when Bad Worker and Careless Tourist (who leaves valuables in the open) cross paths.
Hotel rooms near bus stations will often save you a couple bucks, but can be dangerous and often double as brothels. If you are driving a car in Ecuador, never park it unattended. Never leave valuables in sight in the car – even attended cars will have their windows smashed by hit-and-run merchants. On the off chance you are robbed, you should file a police report as soon as possible. This is a requirement for any insurance claim, although it is unlikely that the police will be able to recover the property.
Trouble spots
Due to the armed conflict in neighboring Colombia, areas along the Colombian border (particularly in the northern Oriente) can be dangerous. Tours into the Oriente are almost invariably safe, but there have been a few isolated incidents of armed robbery in which no one was hurt. Lago Agrio is dodgy once you leave the main drag.
In transit
Deep Vein Thrombosis (DVT)
Blood clots may form in the legs (deep vein thrombosis) during long plane flights, chiefly because of prolonged immobility. Though most blood clots are reabsorbed uneventfully, some may break off and travel through the blood vessels to the lungs, where they could cause life-threatening complications.
The chief symptom of DVT is swelling or pain of the foot, ankle or calf, usually but not always on just one side. When a blood clot travels to the lungs, it may cause chest pain and some difficulties in breathing.
To prevent the development of DVT on long flights you should walk about the cabin, perform isometric compressions of the leg muscles (ie contract the leg muscles while sitting), drink plenty of fluids and avoid alcohol.
Jet lag & motion sickness
Jet lag is common when crossing more than five time zones and usually results in insomnia, fatigue, malaise or nausea. To avoid jet lag make sure to drink plenty of fluids (nonalcoholic) and by eating light meals. Upon arrival, be sure to get exposure to natural sunlight and readjust your schedule (for meals, sleep etc) as soon as possible.
Antihistamines such as dimenhydrinate (Dramamine) and meclizine (Antivert, Bonine) are usually the first choice for treating motion sickness. Their main side-effect is drowsiness. Ginger is a good herbal alternative, which works like a charm for some people.
While you're there
Availability & cost of health care
Medical care is available in major cities, but may be difficult to find in rural areas. Most doctors and hospitals will expect payment in cash, regardless of whether you have travel health insurance. If you develop a life-threatening medical problem, you’ll want to be evacuated to a country with state-of-the-art medical care. Since this may cost tens of thousands of dollars, be sure you have insurance to cover this before you depart. Pharmacies in Ecuador are known as farmacias.
Cholera
This is the worst of the watery diarrheas, and medical help should be sought. Outbreaks of cholera are generally widely reported, so you can avoid such problem areas. Fluid replacement is the most vital treatment – the risk of dehydration is severe, as you may lose up to 20L a day. If there is a delay in getting to a hospital, then begin taking tetracycline. The adult dose is 250mg four times daily. Tetracycline is not recommended for children under the age of nine or for pregnant women. Tetracycline may help shorten the illness, but adequate fluids are required to save lives.
Dengue fever
This viral disease is transmitted by mosquitoes and is fast becoming one of the top public-health problems in the tropical world. Unlike the malaria mosquito, the Aedes aegypti mosquito, which transmits the dengue virus, is most active during the day and is found mainly in urban areas, in and around human dwellings.
Signs and symptoms of dengue fever include a sudden onset of high fever, headache, joint and muscle pains (hence its old name, ‘breakbone fever’), and nausea and vomiting. A rash of small red spots sometimes appears three to four days after the onset of fever. In the early phase of illness, dengue fever may be mistaken for other infectious diseases, including malaria and influenza. You should seek medical attention as soon as possible if you think you may be infected.
Hepatitis A
Hepatitis A is the second most common travel-related infection (after traveler’s diarrhea). It’s a viral infection of the liver that’s usually acquired by ingestion of contaminated water, food or ice, as well as through direct contact with infected persons. The illness occurs throughout the world, but the incidence is higher in developing nations. Symptoms may include fever, malaise, jaundice, nausea, vomiting and abdominal pain. Most cases resolve without complications, though hepatitis A occasionally causes severe liver damage. There is no treatment.
The vaccine for hepatitis A is safe and highly effective. If you get a booster six to 12 months later, it lasts for at least 10 years. Because the safety of hepatitis A vaccine has not been established for pregnant women or children under age two, they should instead be given a gamma globulin injection.
Hepatitis B
Like hepatitis A, hepatitis B is a liver infection that occurs worldwide but is more common in developing nations. Unlike hepatitis A, the disease is usually acquired by sexual contact or by exposure to infected blood, generally through blood transfusions or contaminated needles. The vaccine is recommended only for long-term travelers (on the road more than six months) who expect to live in rural areas or have close physical contact with the local population.
Hepatitis B vaccine is safe and highly effective. However, a total of three injections are necessary to establish full immunity. Several countries added hepatitis B vaccine to the list of routine childhood immunizations in the 1980s, so many young adults are already protected.
HIV & AIDS
Infection with the human immunodeficiency virus (HIV) may lead to acquired immune deficiency syndrome (AIDS), which is a fatal disease. Any exposure to contaminated blood, blood products or body fluids may put the individual at risk. The disease is often transmitted through sexual contact or dirty needles – vaccinations, acupuncture, tattooing and body piercing can be potentially as dangerous as intravenous drug use. HIV/AIDS can also be spread through infected blood transfusions; Ecuador’s best clinics screen their blood supply. If you do need an injection, ask to see the syringe unwrapped in front of you, or take a needle and syringe pack with you.
Leishmaniasis
This is a group of parasitic diseases transmitted by sandflies. Cutaneous leishmaniasis affects the skin tissue, causing ulceration and disfigurement, and visceral leishmaniasis affects the internal organs. Seek medical advice, as laboratory testing is required for diagnosis and correct treatment. Avoiding sandfly bites is the best precaution. Bites are usually painless but itchy. Cover up and use insect repellant.
Malaria
Malaria is transmitted by mosquito bites, usually between dusk and dawn. The main symptom is high spiking fevers, often accompanied by chills, sweats, headache, body aches, weakness, vomiting or diarrhea. Severe cases may involve the central nervous system and lead to seizures, confusion, coma and death.
Taking malaria pills is recommended for all rural areas below 1500m. Risk is highest along the northernmost coast and in the northern Oriente. There is no malaria risk in the highlands.
There is a choice of three malaria pills, all of which work about equally well. Mefloquine (Lariam) is taken once weekly, starting one to two weeks before arrival and continuing through the trip and for four weeks after return. The problem is that a certain percentage of people develop neuropsychiatric side effects, which may range from mild to severe. Atovaquone/proguanil (Malarone) is a newly approved 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 are typically mild. Doxycycline is a third alternative, but may cause an exaggerated sunburn reaction.
In general, Malarone seems to cause fewer side-effects than mefloquine and is becoming more popular. The chief disadvantage is that it has to be taken daily.
Protecting yourself against mosquito bites is just as important as taking malaria pills, since none of the pills are 100% effective.
If you do not have access to medical care while traveling, you should bring along additional pills for emergency self-treatment, which you should take if you can’t reach a doctor and you develop symptoms that suggest malaria, such as high spiking fevers. One option is to take four tablets of Malarone once daily for three days. However, Malarone should not be used for treatment if you’re already taking it for prevention.
If you develop a fever after returning home, see a physician, as malaria symptoms may not occur for months.
Rabies
This viral infection is fatal. Many animals can be infected (dogs, cats, bats and monkeys etc), and it is their saliva that is infectious. Any bite, scratch or even lick from an animal should be cleaned immediately and thoroughly. Scrub with soap and running water, and then apply alcohol or iodine solution. Medical help should be sought promptly to receive a course of injections to prevent the onset of symptoms and/or death.
Sexually transmitted diseases
Sexual contact with an infected partner can result in you contracting a number of diseases. While abstinence is the only 100% effective prevention, the use of condoms lessens the risk of infection considerably.
The most common sexually transmitted diseases are gonorrhoea and syphilis, which in men first appear as sores, blisters or rashes around the genitals and a discharge or pain when urinating. Symptoms may be less marked or not present at all in women. Syphilis symptoms eventually disappear, but the disease continues and may cause severe problems in later years. Gonorrhoea and syphilis are treatable with antibiotics.
Tetanus
This disease is caused by a germ that lives in soil and in the feces of horses and other animals. It enters the body via breaks in the skin. The first symptom may be discomfort in swallowing, or a stiffening of the jaw and neck; this is followed by painful convulsions of the jaw and whole body. The disease can be fatal. It can be prevented by vaccination.
Typhoid
A dangerous gut infection, typhoid fever is caused by contaminated water and food. Medical help must be sought.
In its early stages, sufferers may feel they have a bad cold or flu on the way, as initial symptoms are a headache, body aches and a fever that rises a little each day until it is around 40°C (104°F) or more. The victim’s pulse is often slow relative to the degree of fever present – unlike a normal fever, during which the pulse increases. There may also be vomiting, abdominal pain, diarrhea or constipation.
In the second week, the high fever and slow pulse continue, and a few pink spots may appear on the body; trembling, delirium, weakness, weight loss and dehydration may occur. Complications such as pneumonia or perforated bowel may occur.
Typhus
This is spread by ticks, mites and lice. It begins as a severe cold followed by a fever, chills, headaches, muscle pains and a body rash. There is often a large and painful sore at the site of the bite, and nearby lymph nodes become swollen and painful.
Yellow fever
This viral disease is endemic in South America and is transmitted by mosquitoes. The initial symptoms are fever, headache, abdominal pain and vomiting. Seek medical care urgently and drink lots of fluids.
Traveler’s diarrhea
To prevent diarrhea, avoid tap water unless it has been boiled, filtered or chemically disinfected (iodine tablets); only eat fresh fruits or vegetables if cooked or peeled; be wary of dairy products that might contain unpasteurized milk; and be highly selective when eating food from street vendors.
If you develop diarrhea, be sure to drink plenty of fluids, preferably an oral rehydration solution containing lots of salt and sugar. A few loose stools don’t require treatment but, if you have more than four or five stools a day, you should start taking an antibiotic (usually a quinolone drug) and an antidiarrheal agent (such as loperamide). If diarrhea is bloody or persists for more than 72 hours or is accompanied by fever, shaking chills or severe abdominal pain you should seek medical attention.
Altitude sickness
Altitude sickness may develop in travelers who ascend rapidly to altitudes greater than 2500m, including those flying directly to Quito. Being physically fit does not in any way lessen your risk of altitude sickness. Symptoms may include headaches, nausea, vomiting, dizziness, malaise, insomnia and loss of appetite. Severe cases may be complicated by fluid in the lungs (high-altitude pulmonary edema) or swelling of the brain (high-altitude cerebral edema). Most deaths are caused by high-altitude pulmonary edema.
The standard medication to prevent altitude sickness is a mild diuretic called acetazolamide (Diamox), which should be started 24 hours before ascent and continued for 48 hours after arrival at altitude. Possible side effects include increased urination, numbness, tingling, nausea, drowsiness, nearsightedness and temporary impotence. For those who cannot tolerate acetazolamide, most physicians prescribe dexamethasone, which is a type of steroid. A natural alternative is gingko, which some people find quite helpful. The usual dosage is 100mg twice daily.
To lessen the chance of getting altitude sickness, you should also be sure to ascend gradually or by increments to higher altitudes, avoid overexertion, eat light meals and avoid alcohol.
If you or any of your companions show any symptoms of altitude sickness, you should be sure not to ascend to a higher altitude until the symptoms have cleared. If the symptoms become worse, immediately descend to a lower altitude. Acetazolamide and dexamethasone may be used to treat altitude sickness as well as prevent it.
Hypothermia
If you are trekking at high altitudes, be prepared. Symptoms of hypothermia are exhaustion, numb skin (particularly in the toes and fingers), shivering, slurred speech, irrational or violent behavior, lethargy, stumbling, dizzy spells, muscle cramps and violent bursts of energy. To treat mild hypothermia, first get the victims out of the wind and/or rain, remove their clothing if it is wet and replace it with dry, warm clothing. Give them hot liquids – not alcohol – and some high-energy, easily digestible food. Do not rub victims; instead, allow them to slowly warm themselves.
Parasites
Intestinal worms are most common in rural, tropical areas. Some worms, such as tapeworms, may be ingested by eating food such as undercooked meat, and some, such as hookworms, enter through your skin. Infestations may not show up for some time, and although they are generally not serious, if left untreated, some can cause severe health problems later. Consider having a stool test when you return home to check for these.
You should always check all over your body if you have been walking through a potentially tick-infested area, as ticks can cause skin infections and other, more serious, diseases.
Snakes
To minimize your chances of being bitten, always wear boots, socks and long trousers when walking through undergrowth where snakes may be present. Don’t put your hands into holes and crevices, and be careful when collecting firewood.
Snakebites do not cause instantaneous death, and antivenins are usually available. Immediately wrap the bitten limb tightly, as you would for a sprained ankle, and then attach a splint to immobilize it. Keep the victim still and seek medical help, bringing the dead snake, if possible, for identification. Don’t attempt to catch the snake if there is a possibility of being bitten again. Tourniquets and sucking out the poison are now comprehensively discredited.
Water & sun
The number one rule is be careful drinking the water. If you don’t know for certain that the water is safe, assume the worst. Take care with fruit juice, particularly if water may have been added. Tea or coffee should also be OK, since the water should have been boiled. At altitudes greater than 2000m (6500ft), boil water for three minutes. Another option is to disinfect water with iodine pills.
In the tropics or at high altitudes you can get sunburned surprisingly quickly, even through cloud cover. Use sunscreen, a hat and a barrier cream for your nose and lips. Calamine lotion or a commercial after-sun preparation are good for mild sunburn. Protect your eyes with good-quality sunglasses, particularly if you will be near water, sand or snow.
Traveling with children
Lonely Planet's Travel with Children, by Cathy Lanigan, includes advice on travel health for younger children.
Women’s health
Antibiotic use, synthetic underwear, sweating and contraceptive pills can lead to fungal vaginal infections when traveling in hot climates. Maintaining good personal hygiene, and loose-fitting clothes and cotton underwear will help to prevent these.
Women who are pregnant need to take special care on the road. Most miscarriages occur during the first three months of pregnancy, so this is the most risky time to travel. The last three months should also be spent within reasonable reach of good medical care because serious problems can develop at this stage. Pregnant women should avoid all unnecessary medication, but vaccinations and malarial prophylactics should still be taken when possible.
Birth control pills are readily available at pharmacies throughout Ecuador.
Tampons are harder to come by than pads (which are readily available), so bring your preferred brand from home if you use the former.
Ecuador
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