A Guide to Healthy Travel in South America
South America presents some unique health challenges to travelers from North America and Europe. In addition to unfamiliar diseases, travelers also have to deal with a number of other health concerns such as food and water safety, a wide variety of climate conditions, and altitude sickness. While it is easy to become overly concerned about your health when listening to anecdotal accounts, accurate information and not exaggerated precautions will help you stay healthy during your trip. Millions of travelers visit the region yearly without major incidence. Simply follow a few precautions laid out below and you should enjoy your trip.
Prepare Before You Go
Clearly, the more you learn about the health risks of your destination, the more likely you will remain healthy. The first thing you should do is research illnesses and health threats in the South American countries you plan to visit. Most health risks to travelers come from a number of diseases about which they are unfamiliar. You cannot prevent what you do not know. Consult the great resources provided by the CDC for travelers by country for more details. Then visit and consult your doctor about each of the diseases mentioned before you go. The doctor should inform you about any shots or precautions you need to take. If your doctor is does not know about certain tropical destinations, you can be referred to experts in infectious diseases for the necessary shots and preventative measures.
Bring an updated international immunization record that also lists health conditions and allergies, which can help you get the right medical treatment, if it proves necessary. If you take prescription medication, bring a supply large enough to last you for your trip. If you wear glasses or contact lenses, bring a spare pair, or write down the prescription to be able to get a replacement easily. You should also consider bringing your favorite brands of non-prescription medications, since you might not be able to find them in South America.
The best way to prepare medically for a trip is to arrive in good health. Seeing a doctor in a foreign country can sometimes be a challenge because of the language barrier as well as the uncertainty that comes with seeking medical help abroad. Again, it is very important to see your doctor or a visit a travel clinic at least one month before your departure in order to determine boosters or immunizations you will need, especially if you are traveling with children who may be less resistant.
Common Health Problems in South America
Again, keep in mind that millions of people live and travel to the region, so we are laying out possible issues for the sake of preparation and completeness and certainly not to discourage visitors. To begin with, it usually takes time for your body to adapt to the different food bacteria in any region around the world. Initial digestive problems such as diarrhea or constipation are fairly common in South America. These symptoms should go away after a few days. Infections caused by insect bites, small cuts and wounds are also common in the region. It is best to treat such small injuries with much more care than you would at home. Should your wound get infected, most are easily treated with antibiotics. Below are listed diseases about which travelers should take precautions in South America, with some far more common than others.
- Traveler’s Diarrhea is common among foreigners who are just getting used to the different bacteria contained in food. However travelers’ diarrhea usually subsides by itself after a few days. If the condition persists longer than a few days or worsens, you should see a doctor.
- Malaria is a parasitic disease that affects the liver. It is transmitted by the bite of the infected female anopheles mosquito. For short-term stays in areas with a malaria threat it is recommended that you take prophylactic drugs. It is best to bring a supply large enough to last for the period of potential exposure. But keep in mind that malaria is only present in tropical South America and is very rare in urban areas. The best malaria protection is to prevent mosquito bites. Use mosquito netting and wear long-sleeve clothing in the evenings and early mornings, in addition to mosquito repellent.
- Dengue Fever is a viral disease, common in tropical areas across South America, and it is transmitted by the Aedes aegypti mosquito. Dengue occurs most commonly in urban areas, especially during the rainy season. Since there is no vaccine, the only way to lower your risk is to avoid being bitten by mosquitoes during the day.
- Yellow Fever is a viral disease that can cause liver problems. It is transmitted by mosquitoes and occurs mainly in the Amazon region. Since a vaccine is available, you should not take any risks and get an immunization. You will be issued an international certificate of vaccination, which is valid for 10 years. Make sure you take it with you. Free yellow fever immunization is available in Brazil at local vaccination posts throughout the Amazon, at vaccination posts along bus routes to the Amazon, and at airports with flights to the Amazon region. Some countries require a Yellow Fever vaccination when entering from a neighboring country where it is known to frequently occur.
- Chagas Disease is a serious disease present in most of South America. It is caused by a parasite transmitted by contact with the feces of a reduviid beetle (also known as kissing bug), a brown oval-shaped beetle. The beetle occurs mostly in rural areas. Bed netting can help prevent infection.
- Rabies is a viral disease transmitted by bites from infected animals. Rabies cases from dog bites are decreasing in South America, but there is growing rabies risk from the bites of vampire bats. If you plan on staying in remote rural areas you might want to consider getting a pre-exposure rabies vaccination.
- Hepatitis is a viral disease that affects the liver. Hepatitis A is transmitted by consuming contaminated food and water, or by person-to person contact. Be especially aware of unsanitary conditions, where the transmission of the disease is much more likely. An active vaccine is now available. Hepatitis B is transmitted by bodily fluids, and an immunization is also available, Hepatitis C, which is transmitted by blood and through sexual contact, is the most serious type of hepatitis. It is often only diagnosed in the advanced stage, when it causes liver cancer and cirrhosis.
- Tuberculosis is a bacterial infection that most frequently affects the lungs. It is transmitted through the air by coughing, or through unpasteurized milk or milk products. Tuberculosis is on the rise worldwide and treatment-resistant strains have recently emerged. If you suspect that you might have been exposed you should get a tuberculin skin test to determine if you have been infected.
- Typhoid Fever is a serious bacterial disease transmitted through contaminated food and water. Although typhoid vaccination is not completely effective, you should add it to your immunization list, especially if you intend to travel in rural and remote areas.
- AIDS is caused by the HIV virus and is transmitted through blood and sexual intercourse. It is estimated that nearly two million people in South America are currently infected with HIV. The highest number of HIV infections is among men who have sex with other men, but heterosexual women are also increasingly affected. Female sex workers also have a higher risk of contracting the virus, and since prostitution and sex tourism are present in South America, foreign travelers should take special precautions.
While this list of common diseases may seem discouraging, keep in mind that most visitors to South America have few health problems. If you take precautions and are aware of the most common health risks, you will most likely not have any serious issues.
Sanitary conditions vary drastically from country to country, but it is a good idea to be concerned about water and food safety throughout South America. Numerous diseases and germs are food-borne, and it is important to adapt your sanitary practices to the tropics where germs are more abundant. Wash your hands often and always before you eat. Hygiene standards at restaurants vary quite a bit, and a more expensive restaurant is not automatically a guarantee for food safety. Pick a busy restaurant with a high turnover of food, since that is the best assurance that the food is safe. You should be especially careful with street vendors and roadside food stalls. If you eat raw fruits or vegetables, make sure they are peeled or washed in purified water. Be careful with seafood, especially shellfish, and with lightly cooked meat dishes. Food should be cooked thoroughly and served hot. Avoid unpasteurized dairy products.
The most common health problem I have had in South America is food poisoning. At one time in La Paz, Bolivia, I was in bed for a week, and I was ready to call a doctor when my condition finally improved. It is mostly in rural areas, where sanitation is not always pristine, and the chances of catching a food-borne disease are greater. If you drink unfiltered water in rural areas you should get tested for intestinal parasites after you return home. You might want to bring water purification tablets, or a portable water filter in case you travel to areas where no purified water is available. Tap water in cities and towns is usually treated, but you should generally avoid drinking unfiltered tap water. Avoid ice cubes as well, unless you know that they are made from purified water.
There are also several environmental factors that can impact a travelers’ health. Are you sensitive to intense sunlight, humidity, or certain allergens? Does a rapid change in altitude affect you? You should keep these factors in mind when planning a trip to South America.
If you arrive in tropical South America from a temperate climate zone, be prepared to make adjustments to the heat. Seasons are reversed in the southern hemisphere, which intensives the effect of the heat and sun if you travel during the northern winter. Give your body time to adjust to the different climate and drink plenty of bottled water. Use sunglasses, sunscreen, as well as a hat to protect yourself from the effects of the tropical sun. It is best to use a sunscreen lotion with sun protection factor 30+.
Many low-lying areas of tropical South America are very humid, which also takes some time to get used to. Let your body gradually adjust to the humidity and stay in a hotel with air conditioning unless you have a very tough constitution.
A sudden change in altitude from the lowlands up to the Andean high plateau often causes altitude sickness due to the lower oxygen levels in high-altitude air. Although prescription drugs for altitude sickness are available, I have found that slowly traveling up the Andes works equally well, if you have extra time. Try to choose a destination halfway up the mountains and spend a few days there before ascending to your final destination. Coca tea, widely available and legal in Peru and Bolivia, is said to reduce the effects of altitude sickness.
Lima, Peru’s capital is at sea level and the Amazon basin has an average elevation of 300 feet. But other destinations in the Andes are significantly higher in the sky and require adjustment accordingly:
- Cuzco (Peru): 11,152 feet.
- Arequipa (Peru): 7,550 ft.
- Puno (Peru, Lake Titicaca): 12,549 ft.
- Copacabana (Lake Titicaca, Bolivia): 12,500 ft.
- La Paz (Bolivia): 13,250 ft.
- Cochabamba (Bolivia): 8,432 ft.
- Quito (Ecuador): 9,350 ft.
Getting Medical Help Abroad
If you develop a minor health problem keep in mind that across South America you can buy many prescription medications over the counter, and pharmacists often give health advice. If you decide to see a doctor, it is worth finding out about the local public health system. Most South American countries have a basic public health system where locals as well as foreigners can see a doctor or nurse at very low cost. If you prefer a private doctor or hospital, your consulate should be able to make recommendations, or you could ask at a pharmacy, your hotel, or the tourist information center. It is a good idea to learn a few phrases in the local language about your health condition beforehand so you can tell the doctor about your problem. Payment is usually expected at the time of the consultation, even if doctor’s visits are included in your health insurance at home or your travel health insurance. Make sure you get an invoice or proof of payment listing the health condition and treatment so you can be reimbursed after your return home.
For health resources worldwide as well as South America, please visit our Health, Safety, and Insurance for Travelers and Expatriates Abroad section.
Photo credit: Hospital in Buenos Aires by Robert Cutts.