In general, you can not expect Central European or Northern American cleanliness and hygiene standards in Ecuador.
Both, exaggerated preventive measures, as well as foolishness in health questions are to avoid on a travel to Ecuador. The country isn't on any risk list of epidemics. Whose generally feeling well, doesn't have to think too much about eventual tropical diseases. A strong UV rays protector shouldn't be missing in any travel case, because of the equatorial insolation. An efficient mosquito defense preparation , best is an ecologically friendly roll stick, helps to prevent serious diseases, that are passed on by tropical insects.
Because of the fast changes in climate, a bad cold can be a reason to make you bed-ridden for some days. A weak heart, an extreme high blood pressure or an asthma ailment, are not the best conditions for a landing in Quito, the capital, that is located at 2800m of altitude and is low in oxygen. After arriving, during the first few hours and days, it is possible that you don't feel very well (altitude sickness), in terms of intensified breathing, palpitation, headaches, sleep disturbance, vertigo, absence of appetite or sickness. It is also possible, that your feet and arms swell. In most cases, this kind of illness is the consequence of a deficit of liquid in the body. That's why you should drink more than usually (water without gas, tea, juices, soups). Many, small and light meals are recommended.

Yellow fever
A yellow-fever vaccination is no more obligatory, but recommended if you go to the jungle for a long time. Also a refreshment of polio-tetanus or diphtheria can be useful. But in general, no vaccinations are obligatory if you go to Ecuador. The medical care is at least in the two metropolis Quito and Guayaquil, in the private domain, more than satisfying. Modern, expensive clinics, and medical specialists who did their doctorate overseas, render a good service in emergencies (see addresses!). The things look different in public hospitals, provincial hospitals and rural health authorities. Old, insufficient, not available or even dirty equipment can cause problems in these institutions.
It is inevitable to conclude already in your home country a travel health insurance . You should clarify before you leave the coverage of costs of consultations, accidents, hospitalization or rescue operations.

Hepatitis
Besides the perilous hepatitis B, that is passed on through blood (blutwegen ), the widespread hepatitis A is relatively easy to cure. The first symptoms of this contagious disease are slackness, absence of appetite and a bad temper. Than follows brown-colored urine, white-colored diarrhea, a yellow coloring of the eyes and the face, as well as a painful pressure on the liver.
The only correct strategy to combat the sneaking illness of a hepatitis infection, are a strict prohibition of alcohol lasting months, fatless food (as vegetables, oat flakes, diet yogurt), bed rest and no agitations.

The reasons for an infection with the hepatitis virus could be contaminated food, rank edible oil or dejection containing drinking water. A preventive vaccination against hepatitis is Havrix and is recommended if you stay long and repeated times in a country with bad hygienic conditions. Travelers who already had a hepatitis infection have produced antibodies and won't get this virus once again in their live.

Malaria
Malaria or ague, belongs to the most frequent tropical infectious diseases on our planet and represents a serious health problem in most countries of the „Third World“. In Ecuador, particularly the following regions are affected: Populous areas in the dirty suburbs of the interior and northern coast region, settlements in the area of the mangrove swamps and people who live at the shallow river shores in the deep „Oriente“ (Amazon region). In the Andean highland, this disease doesn't appear. The infection and the diffusion is therefore limited to less traveled regions, aloof most touristy routes.
The intake of preventive malaria tablets during a longer period could cause awkward side-effects. To take this medicament already two weeks before the travel and still four to six weeks after the travel, only makes sense if you are in a downright endangered malaria zone. For short stays on the coast or in the jungle, conventional preventive measures are in any case the most rational solution. The leggy, nocturnal anopheles mosquito, only pricks after nightfall and this only in tropical areas under 1300m of altitude. During walks in the evening, long-sleeved shirts and long trousers are recommended. Also a chemical mosquito protection for neck and ankles could be useful in the evening. A dense mosquito net over the bed, at least in not air-conditioned tropical hotels, provides an undisturbed sleep.
A zoological advice: Normal mosquitoes have a tight bearing, coinciding with the skin surface they want to prick. The mosquito that passes on the malaria disease, stretches the abdomen and the hind legs up to the air and almost performs a handstand while pricking.

Dengue
Like malaria, dengue is passed on by a mosquito (aedes aegypti, white leaves). Also the symptoms of dengue are similar to the malaria symptoms: ague, high fever, sweating, gone feeling and absence of appetite, as well as almost unbearable muscle pain in thigh, knees, ankle and pain in the frontal sinus region. Bed rest and a lot of fluid is the only advisable measure. Don't take aspirin, it could have deadly consequences! After 7 days, dengue disappears as fast as it came, within a few minutes. If you get pricked a second time, you are running mortal danger because of the more heavy onset of the disease.
Dengue is a relatively new tropical disease, that appeared till a short time ago only at altitudes under 1000m. Recently, there were cases of dengue also in the subtropical areas up to 2000m. A seasonal spreading of the transmitters is a determined fact.

Cholera
Aggressive educational campaigns with illustrated hygienic advices to protect the people, have succeeded to preliminary wipe out the disease. An epidemic where many people died, a few years ago, in the southern coast region and the Chimborazo highland was originally introduced by Peruvian border crossers. Contaminated fish was the transmitter. Cholera is a infectious disease of the intestinal area. The infection is always oral. Either through the contact with an acute sufferer, or through a chronic eliminator as for example with agents contaminated water, food and also flies.

If the following hygienic measures are considered, an infection is practically impossible:
1. Drink only absolute clean water (boil it 20 min.)

2. Cooked and well fried food is no problem. If you are doubtful, don't eat unpeeled fruits and raw salads. But it would be a pity not to try some of the tropical fruits, that are really delicious.

3. Avoid swimming pools with dirty water.
4. A vaccination against cholera is not enough protection and can not substitute the hygienic preventive measures.

Altitude sichness
In Ecuador, the name of the acute altitude sickness is “soroche”, of which primarily mountain climbers are affected. The symptoms are vertigo, feeling of sickness and a terrible tiredness that can be life-threatening during a climbing tour in the snowy Andes.

The liability to the acute altitude sickness depends on the individual disposition (for example natural breathing difficulties, cardiovascular diseases or renal function disorder) and also on the altitude of the starting point for mountain climbs, the tempo of ascension and the degree of the physical effort. Halts and augmented hydration help to reduce the appearing symptoms. Additional oxygen is only necessary in a few individual cases.

Rabies
At the end of 1996, in the urban center of Guayaquil, several persons fell victim to rabies. As a consequence, there was a radical dog elimination action, where a lot of “street dogs” were killed. As hard as it sounds, this measure delivered the populous pacific port from the straying quadruped plague. Today, Guayaquil is a downright „cat metropolis“ (contrary to the capital).

For the rest of Ecuador counts: Who is bitten by a dog should immediately consult a doctor or at least call on the dog's owner to show you the official vaccination card.

Pharmacies and dentists
Farmacias (drugstores) you will find in cities and villages in almost every street. The offered medicaments are usually famous pharmaceutical products, with brands like Bayer, Hoechst, Hoffmann-Laroche, Grünenthal, Ciba, Geigi, etc., but without any supplemental sheet with instructions. Many of these, in other respects only available on prescription, are sold without any medical prescription.
Nobody has to be afraid of dentists in Ecuador's big cities. The equipment and the methods of treatment are comparable to the ones in Europe, only the prices are much cheaper.