Although not of the same standard as some 'more developed countries, healthcare in Ecuador has come on leaps and bounds since the turn of the 21st century.

There's been a lot of investment in the country's healthcare infrastructure, which shows. From the major cities of Quito and Guayaquil to more rural and remote destinations, there are ample hospitals and clinics to tend to you in case of accident, illness, or injury.

As a backpacker, the last thing you want to worry about is medical emergencies. But it's reassuring to know that if something goes somewhat wrong, Ecuador's healthcare system is there to support you.

On this page, we'll run through everything you need to know to stay healthy in Ecuador, from what parts of the healthcare system are available to you, what jabs you'll need, what diseases you need to be aware of, and preventing altitude sickness.

As already touched upon, the healthcare system in Ecuador has markedly improved in recent years; in 2019, it was ranked by the WHO as the 49th best in the world and the best in Latin America.

Ecuador's healthcare system is split into two components, the public healthcare system – known as the IESS – and the private healthcare sector.

Barring emergency circumstances, access to IESS facilities is restricted to legal residents who contribute to social security — we'd wager that most of our readers won't fall into that category, meaning you'll rely on the private healthcare sector.

Ecuador's private healthcare sector tends to boast state-of-the-art facilities and highly trained professionals – many of whom have studied abroad and are bilingual. In addition, private healthcare in Ecuador isn't that expensive compared to private healthcare in the US or Europe. Typically, a consultation with a general practitioner will cost between $30 and $40, while a specialist consultation tends to cost between $40 and $70.

While the damage to your bank balance from a consultation isn't too bad, treatments and medications can quickly add up. It's for this reason that, as well as being a requirement for travel in Ecuador, travel insurance is absolutely crucial.

Private hospitals in Ecuador typically require payment upfront, even in emergency situations. Always have proof of your travel insurance or a debit card readily available so you're prepared should the need arise.

Vaccinations will be a controversial topic for some. So now is the time to point out that we are not medical specialists. We offer advice on vaccines to the best of our knowledge on the back of hours of research. Still, we're no substitute for actually talking to a specialist. Always seek professional medical advice before venturing out to a new country.

Compulsory Vaccinations

COVID-19

All foreign travelers entering Ecuador must provide proof of full vaccination against COVID-19.

The Ecuadorian government also requires that the final dose of your COVID-19 vaccine be administered at least 14 days before arriving in Ecuador.

The Ecuadorian government will accept vaccination cards or digital certificates for vaccines recognized by the WHO to prove your vaccination status.

Whether you're for vaccination or against it, this is the reality we now live in. The bottom line is that foreign nationals not vaccinated against COVID-19 will not be allowed to enter Ecuador.

Recommended Vaccines

Vaccination against COVID-19 is the only requisite for entry into Ecuador. However, you are at risk of various diseases traveling in Ecuador, and vaccination against many is recommended.

In addition to the vaccines mentioned below, officials advise being up to date with routine vaccinations like Mumps, Measles, Rubella, Polio, Diptheria, Tetanus, and whopping cough. Sometimes, your doctor might recommend top-ups of these vaccines before traveling to Ecuador.

Hepatitis A

Hepatitis A is an incredibly contagious disease spread through contaminated food and water consumption.

Symptoms of the disease include:

• Fatigue

• Nausea and Vomiting

• Fever

• Joint and abdominal pain

• Yellowing of the skin

• Intense itching

• Loss of appetite

Though the symptoms of Hepatitis A can last for several months, it is unlikely to be fatal. However, the disease can bring about long-term liver damage and even liver failure. Liver Failure, in particular, is very dangerous and will leave you needing a transplant.

The Hepatitis A vaccine is a one-dose job. Officials recommend getting the jab at least two weeks before traveling to Ecuador.

Hepatitis B

Hepatitis B is a blood-borne pathogen that can develop into a chronic, lifelong ailment.

The disease spreads through sexual contact, contaminated needles, and blood-to-blood contact.

The symptoms of short-term hepatitis B are identical to those of Hepatitis A. If infected, you can expect symptoms to include:

• Fatigue

• Nausea and Vomiting

• Fever

• Joint and abdominal pain

• Yellowing of the skin

• Intense itching

• Loss of appetite

If you develop chronic Hepatitis B, the symptoms can be much more serious, and you may not realize it's chronic until it's too late. Chronic Hepatitis B leads to Cirrhosis (scarring of the liver) and liver cancer, of which Hepatitis B is the leading global cause.

The Hepatitis B vaccine is three doses. Officials recommend that the doses be administered evenly over three months. If necessary, you can have all three doses administered in three weeks, though this isn't recommended.

Typhoid

Typhoid – also known as Typhoid Fever – is particularly nasty. This bacterial infection can be contracted through contact with another infected individual or contaminated food and drink.

If you contract Typhoid, the initial symptoms are mild, including:

• Aches and pains

• A fever that worsens day by day

• A persistent cough

• Constipation

• Development of a rash

• Diarrhea

• Fatigue

• Feeling Sick

• Headaches

• Loss of appetite

• A tummy ache

Failure to seek medical help after recognizing the symptoms of Typhoid can lead to fatal health complications.

The two most common complications brought about by Typhoid Fever are internal bleeding and multiple organ failure.

Vaccinating against Typhoid Fever requires a single dose. The Typhoid vaccine is commonly combined with vaccination against Hepatitis B, killing two birds with one stone. There is also the option of taking oral capsules to vaccinate against Typhoid.

Whichever immunization method you opt for, health officials recommend that you are vaccinated against Typhoid two weeks before arrival in Ecuador.

Yellow Fever

This one is sort of compulsory – depending on where you've traveled from. If arriving from a country from which the Yellow Fever disease is endemic – such as Brazil, the Dominican Republic, the Republic of Congo, and Uganda – you must be able to prove vaccination against yellow fever before arriving in Ecuador. For all other travelers, vaccination against Yellow Fever comes highly recommended if intent on traveling to anywhere in Ecuador below 2,300 meters altitude, particularly the Amazonian region.

Yellow fever is a nasty disease transmitted through mosquitos in tropical regions. Once infected, there is no cure for Yellow Fever. One in four who contract the disease display serious symptoms, and half of those with serious symptoms will die. That's a 12.5% mortality rate if infected.

Symptoms of Yellow Fever initially include:

• A high temperature

• Headaches

• Loss of appetite

• Muscle pain and backache

• Nausea and vomiting

• Photosensitivity

In most cases, where more serious symptoms are absent, you'll fully recover in 3-4 days.

The more serious and potentially fatal symptoms include:

• Jaundice (yellowing of the skin and eyes)

• Bleeding from the mouth, nose, eyes, and ears

• Vomiting blood

You should be vaccinated against yellow fever at least ten days before traveling to Ecuador. Once vaccinated, you'll receive a small yellow booklet with your vaccination details. You must keep this document safe.

Rabies

Rabies is a viral infection transmitted when coming into contact with the saliva of an infected animal. Saliva can be transmitted through bites, scratches, and open wounds. The most common carriers of Rabies are dogs and bats.

On a broad scale, South America has a problem with stray, feral dogs. This is considered the biggest risk of contracting Rabies on the continent.

If you become infected with Rabies, treatment is possible. Vaccinating against the disease will extend the time to receive treatment, though it does not guarantee immunization. You will die if you start to show symptoms, which manifest between three and twelve weeks after infection.

Symptoms of Rabies begin with:

• Discomfort at the site of infection

• A feeling of anxiousness

• A headache

• A high temperature

The initial symptoms are mild. However, within a few days, they will progress to:

• An aversion to water

• Confusion and aggressive behavior

• Difficulty swallowing

• Frothing at the mouth

• Hallucinations

• Paralysis

If you suspect that you've come into contact with Rabies via an animal in an at-risk area, proceed to:

• Clean the wound, running it under water and soap for several minutes.

• Disinfect the wound with an alcohol disinfectant and apply a dressing.

• Make a beeline to the nearest medical center, hospital, or doctor's surgery.

• Explain that you suspect you have come into contact with Rabies and fear you may be infected with the virus. At this point, post-exposure treatment will begin.

The good news is that post-exposure treatment for Rabies is nearly always effective if it begins before symptoms develop. Post-exposure treatment involves:

• Further cleaning and disinfection of your wound.

• Administration of the Rabies vaccine.

• If you've already had a Rabies vaccine, you'll be administered two additional doses within a few days.

• If you've not had a Rabies jab before traveling to Ecuador, you'll need four doses administered over the next month.

Doctors may also give you a medicine known as Immunoglobin. Immunoglobin is applied to your wound and provides immediate short-term protection against the disease.

Meningitis

The chances of contracting Meningitis in Ecuador are, admittedly, slim. But it is possible. For those planning an extended trip to Ecuador or, more generally, South America, health officials recommend vaccination against Meningitis.

Meningitis is caused by a bacterial or viral infection, although bacterial infection is rarer. Typically, Meningitis is spread through coughing, sneezing, and kissing.

If you contract Meningitis, you can expect to develop symptoms that include:

• Development of a rash

• Drowsiness and unresponsiveness

• Feeling sick

• Headaches

• A high temperature

• Photosensitivity

• Seizures

• A stiff neck

The majority of these symptoms may seem quite mild. However, if not urgently treated, Meningitis can become a life-threatening illness that causes septicemia and permanent brain and nervous system damage.

You may even lose a limb with amputations sometimes required to halt the spread of infection.

Bacterial Meningitis infections are particularly dangerous, killing one in ten people.

Even if you survive your bout of Meningitis, the disease may onset several long-term health complications, including:

• Arthritis

• Epilepsy

• Hearing loss

• Issues with concentration, coordination, and movement

• Kidney problems

• Learning difficulties

• Vision loss

There are several meningitis vaccines currently in circulation. However, the one likely recommended before traveling to Ecuador is the ACWY vaccine. The ACWY vaccine offers protection against four different groups of Meningitis.

Malaria

The risk of Malaria in Ecuador is small. The disease is caused by a parasite known as Plasmodium, carried by mosquitos.

The symptoms of Malaria begin to manifest 7-18 days after infection. It is easy to mistake the early symptoms of Malaria for the flu. Expect a high temperature, hot and cold sweats, headaches, vomiting, muscle pain, and diarrhea.

If left untreated, the symptoms of Malaria can progress, bringing the onset of all sorts of complications, namely:

• Anemia: the Malaria parasite destroys red blood cells, meaning less oxygen is transported through your body. Anemia will leave you feeling tired, weak, and faint.

• Acute Respiratory Distress Syndrome (ARDS): A life-threatening symptom where the lungs can't transport enough oxygen to your body's vital organs.

• Cerebral Malaria: A rare complication where the malaria parasite attacks the brain, causing it to swell. Cerebral Malaria leads to permanent brain damage and can cause seizures and comas.

• Hypoglycemia: Abnormally low blood sugar

• Jaundice: Yellowing of the skin and whites of the eyes

• Kidney Failure

• Liver Failure

• Pulmonary Oedema: A build-up of fluid in the lungs

• Swelling and Rupturing of the Spleen

The mosquitos that carry the Plasmodium parasite can't survive at altitudes higher than 1,600 meters, meaning that Ecuador's Andean regions are Malaria free.

Elsewhere, the risk is very remote, but you must be careful if planning an excursion into Ecuador's Amazonian Region. Doctors advise taking anti-malarial tablets or getting the newly approved RTS,S vaccine.

Remember, some vaccines require more than one dose, so plan ahead. This is not medical advice, and you should consult with your healthcare provider to determine what's best for your health and safety based on the most current information.

Dengue Fever

Dengue fever is a viral infection for which there is no known cure. The infection is carried and spread by mosquitos. Usually, the disease is not life-threatening, and symptoms will pass within a week. However, it is not unheard of for the virus to cause fatal health complications, known as severe Dengue Fever.

Symptoms of Dengue Fever initially include:

• A high temperature or feeling hot or shivery

• A severe headache

• Pain behind the eyes

• Muscle and joint pain

• Feeling or being sick

• A widespread red rash

• Tummy pain and loss of appetite

Severe, life-threatening Dengue fever usually only occurs when the individual contracts the virus for a second time. Signs of severe Dengue Fever can include:

• Severe tummy pain

• A swollen tummy

• Being sick repeatedly and vomiting blood

• Bleeding gums or bleeding under the skin

• Breathing difficulties or fast breathing

• Cold, clammy skin

• A weak but fast pulse

• Drowsiness or loss of consciousness

If you suspect you have severe Dengue Fever, you must immediately check in at a hospital.

The best way to prevent contracting Dengue Fever is to wear appropriate clothing in environments where mosquitos are common and to stock up on insect repellant.

Zika Virus

Yet another disease spread through mosquitos. As is the case for Dengue Fever, there is no vaccine or cure for Zika Virus.

For the vast majority, symptoms are mild and, crucially, not life-threatening. Most infected with Zika Virus will fully recover between 2-7 days of showing symptoms.

The symptoms of the Zika Virus include:

• Conjunctivitis

• Developing a rash

• Fever and high temperatures

• Headaches

• Joint and muscle pain

• Lower back pain

• Pain behind the eyes

Sadly, there is a higher risk for pregnant women infected with the Zika Virus. Scientists conclude that contracting Zika Virus can cause congenital disabilities.

For this reason, consultation with your doctor may end with being advised against traveling to Ecuador altogether if you are pregnant.

The mosquitos carrying the Zika Virus are most active between mid-morning and dusk, so dress appropriately and keep some insect repellant handy.

Chikungunya

Chikungunya is another viral disease primarily transmitted by mosquito bites, specifically those of the Aedes species. While it is not usually fatal, the disease can cause significant discomfort and health complications. Currently, there's no specific antiviral drug treatment for Chikungunya; treatment is focused on relieving the symptoms.

Initial symptoms of Chikungunya generally occur 3–7 days after being bitten by an infected mosquito and can include:

• A high fever

• Severe joint pain often in hands and feet

• Headache

• Muscle pain

• Back pain

• Rash (typically occurs 2-5 days after the onset of fever)

• Swelling around the joints

• Nausea

Chronic symptoms can last weeks to months, even years in some cases, and include prolonged joint pain, which can be debilitating.

Signs that Chikungunya is becoming severe or complicated can include:

• Severe persistent joint pain

• Swelling in the joints

• Difficulty moving or bending joints

• Signs of meningoencephalitis in extreme cases (stiff neck, severe headache, vomiting, confusion, seizures)

If you suspect you have severe Chikungunya, it is critical to seek medical attention immediately.

As with Dengue, avoiding mosquito bites is the best way to prevent Chikungunya. Wearing long-sleeved shirts, long pants, using insect repellent, and sleeping under a mosquito net are good preventive measures, particularly in areas where the disease is common. Be especially cautious around dawn and dusk when mosquitoes are most active.

What is Altitude Sickness

Altitude sickness is a response from your body when you ascend to an area of high altitude without giving your body a chance to adjust to reduced oxygen levels.

High altitude can be divided into three sub-categories.

• High-altitude: Defined as a point between 1,500 and 3,500 meters above sea level.

• Very high-altitude: Defined as any point between 3,500 and 5,500 meters above sea level.

• Extreme altitude: Defined as any point above 5,500 meters above sea level.

Symptoms of altitude sickness begin to manifest at altitudes above 2,500 meters. But this isn't always the case. Altitude sickness affects everyone differently.

It's not just the altitude itself that brings about altitude sickness. It's also the speed of your ascent and your sleeping altitude.

If you do not allow your body to acclimate to the reduced oxygen levels, altitude sickness will follow.

AMS, HACE, and HAPE

Altitude sickness can manifest as one of three different syndromes: Acute Mountain Sickness (AMS), High-Altitude Cerebral Oedema (HACE), or High-Altitude Pulmonary Oedema (HAPE).

AMS

Acute Mountain Sickness is the mildest form of altitude sickness and the most common form travelers face. Symptoms of AMS include:

• Headaches

• Fatigue

• Loss of appetite

• Nausea

• Sleep disturbance

Generally speaking, the best remedy for AMS is stopping climbing and allowing your body to acclimate to the altitude. However, if symptoms continue, descend to a lower altitude. Alternatively, take Ibuprofen/Paracetamol and drink lots of water. Other medicines may alleviate symptoms, such as Acetazolamide or Coca Leaves – revered in Andean culture.

In most cases, it would be hard to tell the difference between AMS and a bad hangover.

HACE

High-Altitude Cerebral Oedema is a more severe manifestation of altitude sickness and can be life-threatening in extreme circumstances. If you develop symptoms of HACE, descend to a lower altitude and seek medical attention immediately.

In addition to the symptoms of AMS, the symptoms of HACE include:

• Feeling confused

• Feeling sick

• Hallucinations

• Loss of coordination

• Weakness

The most serious issue with High-Altitude Cerebral Oedema is that your brain begins to swell, which can happen rapidly over a few hours.

To alleviate symptoms of HACE, you must descend immediately. If trekking, your guide may have a steroid called Dexamethasone to hand. Dexamethasone will reduce brain swelling, though it is no substitute for proper medical attention, which you should still seek. If available, bottled oxygen will also be a tremendous help.

HAPE

High-Altitude Pulmonary Oedema can be harder to spot, as symptoms may take several days to manifest. As is the case with HACE, immediate medical treatment is essential to prevent your encounter with HAPE from being a fatal one.

Essentially, HAPE is a build-up of fluid in your lungs, symptoms of which include:

• A blue tinge on your skin and lips

• A persistent cough that brings up pink or white frothy liquid

• Breathing difficulties, even when resting

• Tightness in the chest

• Tiredness and weakness

To alleviate symptoms of HAPE, you must descend to a lower altitude immediately. If trekking, your guide may have a medicine called Nifedipine with them. Nifedipine will reduce chest tightness and breathing issues. You should still seek treatment at a hospital, where a doctor will deal with fluid build-up in your lungs. As is the case for HACE, if there is bottled oxygen to hand, this will be a massive help.

Preventing Altitude Sickness

As we've discussed, there is a lot you can do to alleviate symptoms of altitude sickness, but there are many ways to prevent it.

• Spend a few days at an altitude between 2,500 and 3,000 meters before ascending further. Doing so allows your body to acclimate to the reduced oxygen levels without putting it under unnecessary strain.

• Avoid travel from less than 1,200 meters to 3,500 meters where possible. Doing so is a surefire way of experiencing AMS, at the least.

• Climbing above 3,000 meters should be a gradual process. Don't increase your sleeping altitude by more than 500 meters per day whenever possible.

• Rest every three days to allow your body to acclimate to the new altitude.

• Take Acetazolamide and Nfideipine where necessary. Not only do these alleviate symptoms of HACE and HAPE, but they can also be used to aid acclimatization. That said, neither is a substitute for a gradual, controlled ascent.

• Where possible, avoid flying directly into cities at high altitudes.

• Stay hydrated, drink plenty of water, and avoid alcohol.

• Don't smoke tobacco.

• Take Coca leaves, the base ingredient of cocaine. While illegal in most countries, Coca leaves are revered – and readily available – in the Andes for their properties in warding off the effects of altitude sickness.

Altitude Sickness in Ecuador

Within our travel guides, several locations are located at high altitudes, which could mean falling foul to altitude sickness.

Listing these locations below will help you prepare and plan for the ascent to those altitudes.

• Quito - the capital of Ecuador, situated at an altitude of 2,850 meters (9,350 feet)

• Cuenca - a colonial city in the Andean highlands at an altitude of 2,550 meters (8,370 feet)

• Otavalo - a small town famous for its indigenous market and located at an altitude of 2,532 meters (8,307 feet)

• Baños - a popular tourist destination known for its hot springs and located at an altitude of 1,820 meters (5,970 feet)

• Cotopaxi National Park - a national park that includes the Cotopaxi Volcano, located at an altitude of 4,500 meters (14,800 feet).

In Ecuador, the overall quality of food and drinking water safety is generally considered okay. Still, taking precautions to protect yourself from potential issues is always a good idea.

Food

Regarding food safety, it's recommended to stick to restaurants and food vendors that appear clean and well-maintained. Alternatively, eat where the locals eat; it's always a good gauge of whether the food is okay to eat. Always wash your hands before eating, and avoid eating raw or undercooked meat or seafood. Fruits and vegetables should be thoroughly cleaned and peeled before eating, and it's best to only drink bottled or boiled water.

A couple of other pointers would be:

• Steer clear of anything that's been hanging around outside for a while.

• Don't touch fruit that doesn't have a peel.

• Wash your hands before you eat.

Water

As for drinking water, tap water in Ecuador is generally unsafe. It is common practice for locals to boil water or buy it bottled.

Always have a Lifestraw or equivalent water purification device to hand. The importance of purifying your water wherever you find yourself in Ecuador is a luxury that can't be overstated. This will save you money buying bottled water. You'll also do your bit to help the environment by reducing your reliance on single-use plastic.