Food and Water
The traveller's commonest health complaint is a stomach upset, usually caused by contaminated food or water . Tap water is unsafe to drink in Ecuador; bottled water (so long as the seal is intact) and soft drinks, widely available in all but the remotest places, are safe alternatives. Wash your hands before meals and use bottled or boiled water to clean your teeth. Avoid ice cubes; fruit juices with water added; raw vegetables, shellfish (including most ceviche) and eggs; salads; undercooked, partly cooked or reheated fish, meat or eggs; dairy products and ice cream made from unpasteurized milk; and food that's been lying around uncovered where flies can get at it. Food that's freshly prepared and hot, and fruit and vegetables that you can peel yourself rarely cause any harm. You can also pick up stomach upsets from swimming in unclean water; only use chlorinated swimming pools and avoid beaches near large population centres or sewage outlets. If you plan to visit remote areas, you may have to purify your water . Boiling water for at least ten minutes (longer if you're at altitude) is effective, though chemical purification is simpler. Chemical and iodine tablets are small, light and easy to use, and iodine tincture is particularly effective against amoebas and giardia, even if the resulting liquid doesn't taste very pleasant (note that iodine is unsafe for pregnant women, babies and people with thyroid complaints). Portable water purifiers give the most complete treatment but are expensive, fiddly to use and relatively heavy to carry. A bout of diarrhoea (sometimes accompanied with vomiting and stomach cramps) is an annoyance that most travellers have to suffer at one time or another. In most cases it passes within a couple of days and is best remedied by resting and taking plenty of fluids (avoid milk, alcohol and caffeine-based drinks; still drinks are preferable to fizzy). Rehydration salts are widely available in Ecuadorian pharmacies and are very helpful in replenishing lost salts. Alternatively you can make your own solution by adding a generous pinch of salt and three to four tablespoons of sugar to a litre of clean water - aim to drink at least three litres a day if you're unwell, or a couple of glasses for every loose movement. Current medical opinion is that you should continue to eat normally as opposed to fasting, though you'll probably find only blander foods palatable. Anti-diarrhoeal drugs, such as Imodium, only suppress symptoms rather than solving the underlying problem, but can be useful when you're on the move and out of range of a toilet. In more serious cases, such as bacterial dysentery , following a course of antibiotics (Ciprofloxacin) can be effective, though it's best to get medical advice first. Most towns have facilities for testing stool samples; tests often only take a matter of hours, cost a few dollars and are invaluable for diagnosis. You'll usually have to buy your own sample pot (caja de muestra) from a pharmacy. Ciprofloxacin does not work against giardia , a parasitic infection that induces sudden, watery and bad-smelling diarrhoea, bloating, fatigue and excessive wind. Symptoms wax and wane but can last for weeks if left untreated with a course of Flagyl or Fasigyn (metronidazole or tinidazole). Amoebic dysentery , often indicated by bloody stools and fever, requires similar medication, but you should always consult a doctor first. Cholera - transmitted through contaminated water - occasionally breaks out in rural areas, but tends to be very localized and restricted to poor communities with inadequate sanitation. As a tourist, it's unlikely you'll go anywhere near these places, but if you suspect you're infected (symptoms include profuse watery diarrhoea, explosive vomiting and fever) it's easy to treat, provided you get to a doctor immediately and keep rehydrating by drinking large quantities of bottled or boiled water. There's no point getting a cholera inoculation as the cholera germ has become resistant to the vaccine, which is generally acknowledged to be worthless.
Your Tip for Ecuador
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