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 HEALTH AND MEDICAL CONSIDERATIONS
Vaccinations are not required for Ecuador in general.

However, Ecuador authorities may require a Yellow Fever vaccination and Certificate for travellers arriving from infected areas in countries currently infected with yellow fever.

Yellow fever is a viral disease transmitted between humans by a mosquito. General precautions to avoid mosquito bites should be followed. These include the use of insect repellent, protective clothing, and mosquito netting. Yellow fever occurs in certain jungle locations of South America where the virus is maintained in a cycle among forests, mosquitoes, and monkeys. In South America sporadic infections occur almost exclusively in forestry and agricultural workers who are exposed occupationally in or near forests.

Malaria is a preventable infection that can be fatal if left untreated. Prevent infection by taking prescription anti-malarial drugs and protecting yourself against mosquito bites [see below] Malaria risk in this region exists in some urban and many rural areas, depending on elevation.

Maliaria risk
Risk in all areas in the provinces along the eastern border and the Pacific coast: Canar Cotopaxi, El Oro, Esmeraldas, Guayas [including Guayaquil], Los Rios, Manabi, Morona-Santiago, Napo, Pastaza, Pinchincha, and Zamora-Chinchipe. Quito and vicinity, the central highland tourist areas, and the Galapagos Islands are not risk areas.

The use of protective clothing, mosquito netting where provided, and mosquito repellent is also advised; one can still contract malaria while taking the prophylactic although the severity of the case maybe lessened. Since the mosquitoes that transmit malaria are most active between dusk and dawn, we recommend that you wear long sleeves and long pants, and use a strong insect repellent at those times. The most effective insect repellents contain the product DEET, which can cause severe skin rash and other problems if absorbed through the skin in high concentrations. The optimal concentration is approximately 35 percent in a lotion base, such as Cutter's brand. Avoid using colognes, hair spray, or scented lotions or shampoos that may attract mosquitoes.


Although dengue fever poses relatively little risk to travelers except during occasional, sporadic, epidemics, it does occur in many tropical areas of world. Carried by mosquitoes, dengue causes high fever, severe headache and joint and muscle pain; no immunization is available. The best protection is to avoid bites from the mosquitoes which occur in populated areas and feed during the day, primarily at dusk and dawn.

Although the risk of infection to travelers is very low, cases of cholera have been reported in Ecuador The CDC considers the vaccination against cholera to be of limited use and does not recommend it routinely for travelers. Cholera is an acute intestinal infection transmitted by a bacterium in contaminated food and water.

Food and water-borne diseases are the most common cause of illness to travelers, and it is prudent to be cautious about what you eat and drink. Food at the facilities on this program is carefully prepared and should not give you trouble. The safest means of minimizing exposure to cholera, and other illnesses as well, is to avoid eating uncooked food or unpeeled fruits and vegetables, to drink only bottled or purified water or other bottled beverages, and to use no ice in beverages. Raw or undercooked sea-foods should also be avoided. Care should be taken not to swallow untreated water when brushing teeth or showering.

If you visit the Andes Mountains, ascend gradually to allow time for your body to adjust to the high altitude, which can cause insomnia, headaches, nausea, and altitude sickness. In addition, use sun-block rated at least 15 SPF, because the risk of sunburn is greater at high altitudes. Visitors with heart conditions should be aware that Quito's altitude [close to 10,000 feet] may cause serious health risks. Travellers are encouraged to consult with their personal medical provider before undertaking high-altitude travel.
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Recommendation
We recommend that you consult your personal physician for medical advice on travel to South America. Show him or her the trip brochure that indicates the places you will be visiting. Your physician is most familiar with your personal medical history and is best qualified to determine your particular needs. Since you will be traveling in remote areas, it is advisable to have physical and dental check-ups before your trip.

If your personal physician is not familiar with travel-related medicine, other resources for obtaining information and immunizations include your state or county public health department, and travelers clinics usually associated with university medical centers. The Centers for Disease Control and Prevention [CDC] in Atlanta offer excellent, up-to-date information on health precautions for travelers by fax; call toll-free 888/232-3299 and follow the recorded instructions. Or visit the CDC's web site at www.cdc.gov. Your library may have a current edition of Health Information for International Travel, published annually by the U.S. Department of Health and Human Services.

The trip will be fast-paced and active, requiring you to be in good health and physical condition. The schedule will include some long days, with early departures from hotels, and activities scheduled throughout the day.

Be sure to indicate on your participant's questionnaire if you have a medical condition which might limit your participation in group activities. Let us know there, too, if you have any special dietary requirements.

Medical care is available in South America, but it varies in quality and generally is below U.S. standards. Serious medical problems requiring hospitalization and/or medical evacuation to the United States can cost thousands of dollars or more. Doctors and hospitals often expect immediate cash payment for health services, although some hospitals do accept major U.S. credit cards.

U.S. medical insurance is not always valid outside the United States. U.S. Medicare and Medicaid programs do not provide payment for medical services outside the United States. Uninsured travelers who require medical care overseas may face extreme difficulties. Please check with your own insurance company to confirm whether your policy applies overseas, including provision for medical evacuation.

Please ascertain whether your insurance company will make payments directly to the overseas hospital or doctor or whether you will be reimbursed later for expenses that you incur. Some insurance policies also include coverage for psychiatric treatment and for disposition of remains in the event of death. Useful information on medical emergencies abroad, including overseas insurance programs, is provided in the Department of State’s Bureau of Consular Affairs brochure Medical Information for Americans Traveling Abroad, available via the Bureau of Consular Affairs home page.

We recommend that you pack an ample supply of basic health and first-aid needs, including any prescription drugs and vitamins you use, over-the-counter medications for common ailments such as colds or stomach disorders, aspirin or other analgesic, band-aids and topical antibiotic, insect repellent and insect-bite relief products, and sunscreen and sunburn relief products. Some travelers use a product such as Pepto-Bismol [available as chewable tablets] as a preventive medication to safeguard against the common digestive ailments associated with travel.

You might consider taking a traveler's emergency medical kit, including syringes and other instruments. These kits are available from International SOS Assistance, Inc. [800/523-8661] for about $40, and in an emergency can be a safer alternative to medical equipment used in many developing areas.

If you wear prescription glasses or contact lenses, please bring an extra pair. It is also useful to carry a copy of your eyeglass prescription in the event of a loss; however, replacement may prove impossible because of the destinations and pace of this itinerary. A strap to prevent accidental loss of eyeglasses may prove useful; "Croakies" and other brands are readily available at most sporting goods or outdoor outfitters stores.

We also recommend you carry a list of the generic names of any drugs that you use, although since the standards of pharmacology vary greatly for medications produced overseas, it is best to carry an adequate supply and to take precautions against loss of your prescriptions. Packing them in your carry-on luggage is always recommended. It is also advisable to carry with you an up-to-date record of your allergies or chronic medical problems so that emergency treatment, if necessary, can be carried out without endangering your health. Your physician can prepare a summary record for you. You should also carry with you the phone number for your physician's 24-hour answering service.
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