Health, vaccinations and medical care in Ecuador

Altitude, which is the health issue here

Quito is at 2,850 metres and it is the highest many visitors have ever slept. Almost everyone feels it.

• Headache, breathlessness, poor sleep, no appetite and a racing pulse are all normal on the first day or two.
• Do nothing on the day you arrive. No hiking, no drinking, no big meal.
• Drink far more water than usual, and coca tea if it is offered.
• Cotopaxi, Quilotoa and the Quito TelefériQo at 4,050 metres are considerably higher again, and are day trips people take on day two and regret.
• Confusion, vomiting or breathlessness at rest are not normal. That is altitude sickness proper, and the treatment is to go down, immediately.
• Ask a doctor about acetazolamide before you travel if you are heading straight to high altitude.

Vaccinations and mosquitoes

• Yellow fever vaccination is recommended for the Amazon provinces, and a certificate may be asked for if you travel on to another country afterwards.
• Hepatitis A and typhoid are routine recommendations, and rabies is worth discussing for remote travel.
• Dengue, zika and chikungunya are present in the coastal and Amazon lowlands and are daytime-biting mosquitoes, so repellent through the day rather than just at dusk.
• Malaria risk exists in parts of the lowlands and none at all above about 1,500 metres, which means Quito, Cuenca and the sierra are clear.
• There is no malaria and no yellow fever in the Galapagos.

Medical care

• Private clinics in Quito, Guayaquil and Cuenca are good and inexpensive by North American or European standards, and are where you should go.
• Hospital Metropolitano and Hospital de los Valles in Quito, and Clinica Kennedy in Guayaquil, are the ones foreigners are usually directed to.
• Public hospitals are free at the point of emergency and are overstretched.
• You pay up front and claim afterwards. Keep itemised receipts.
• The Galapagos and the Amazon have basic facilities only. Anything serious means a flight to the mainland, which is why insurance with evacuation cover matters more here than the mainland cost of treatment suggests.

Food and water

• Do not drink the tap water. Bottled or properly filtered.
• Ice and salads in established restaurants in the cities are generally fine, and at a roadside stall are not.
• Stomach upsets are common in the first days, usually from the change rather than contamination. Carry rehydration salts.
• The street food is excellent and the busy stall with a queue of locals is the safe one.
• Seafood on the coast is superb, and ceviche is safe where the turnover is fast.

The sun

• You are on the equator and at altitude. The ultraviolet index in Quito is among the highest measured anywhere on earth.
• Burning takes 15 minutes in the sierra, on a cool cloudy day, in the shade of a hat brim.
• High-factor sunscreen every day, sunglasses, and a hat. This is not optional at 2,850 metres.