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.

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.

Reproduced with permission from the Lonely Planet website www.lonelyplanet.com © 2009 Lonely Planet Publications Pty Ltd.