Continuing Medical Education in Peru:
Machu Picchu – Inca Trail – Sacred Valley – Amazon Rainforest

This Continuing Medical Education (CME) class in Wilderness and Travel Medicine while hiking Peru’s Inca Trail and visiting Machu Picchu is a true classic that should be on every adventurer’s “to-do” list. It is difficult to describe the magnificence of Machu Picchu, a stone fortress city nestled below stunning peaks. It is perhaps the greatest mystery of the Inca Empire. The four-day trek on the Inca Trail to reach this pre-Columbian site is a pilgrimage through time. Beautiful Andean scenery, as well as cultural history, unfolds as we hike up and down steep stone staircases past ancient Inca outposts.

Our guides and porters will carry all of your gear and prepare delicious meals on the trail. After hiking the Inca Trail and exploring Machu Picchu, you’ll fly from Cuzco to Puerto Maldonado. From there, you will take a boat ride to the fantastic, Refugio Amazonas, where you’ll stay 2 nights. Naturalists will take you on walks and boat trips to explore some of the natural wonders the Tambopata National Reserve, including Oxbow Lake, a canopy tour and farm visit with ethnobotanical tour. Wilderness Medicine Continuing Medical Education seminars will typically take place in the afternoons between 5 and 7pm, before dinner is served.

WILDERNESS & TRAVEL MEDICINE CLASSES: COURSE INFORMATION
Accreditation – 15 Hours AMA PRA Category I

WILDERNESS MEDICINE COURSE CONTENT INCLUDES:

• Altitude Illness
• Hypothermia
• Frostbite
• Heat Illness
• Snakebites
• Travelers Illnesses
• Marine Envenomations
• Trauma Management
• Wilderness Orthopedics
• Water Disinfection
• Swiftwater Safety and Rescue
• Basic Wilderness Survival
• Wilderness Medical Kits
• Wound Management
• Patient Assessment
• Wilderness Dermatology
• Wilderness Pediatrics

CME ACCREDITATION INFORMATION
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint providership of the Center for Emergency Medical Education and Wilderness and Travel Medicine. The Center for Emergency Medical Education is accredited by the ACCME to provide continuing medical education for physicians.

The Center for Emergency Medical Education designates this live activity for a maximum of 15 AMA PRA Category 1 CreditsTM.

Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Day 1
Arrive in Cusco, Peru. This usually requires departing from North America the previous day. A Bio Bio Expeditions guide will meet you at the airport. Look for the Bio Bio logo. You will be taken to the Hotel Casa Andina Private Collection. Please be sure Bio Bio Expeditions has your flight information.

A few words about Cusco…
If the Incas were the Romans of pre-Columbian America, Cusco was their Rome. The Incas built a vast empire that stretched from modern Ecuador and Colombia to southern Chile. The empire, much larger in size than any previous new-world empire, was called Tawantinsuyo (the “Four Quarters of the Earth”). Cusco was the heart of the empire, and its exact center was considered to be the main square of the city. Today, Cusco is still laid out much as it was in Inca times. Seen from above, it takes the form of a puma, with the river Tullumayo forming its spine, the ruins of Sacsayhuaman the head, and the main city center the body. The center, or torso, was a tongue of land bordered on the east side by the Tullumayo and on the west by the Huatanay. These two rivers now run under concrete. Cusco was more than just a capital city to the Incas and the millions of subjects in their realm. Cusco was a holy city, a place of pilgrimage that was as important to the Quechuas as Mecca is to Moslems.

Cusco is a thriving marketplace where goods and services of all kinds tempt the eye and the pocketbook. The city has an impact on all the senses: sounds greet the ears and the aromas of spicy local kitchens tantalize the nose. The colorful locals draw our attention as they display their wares. Merchants smile and make a sale with characteristic cheerfulness. A good place to take it all in is the central “Plaza De Armas”, where on the second floor balconied terraces of the many restaurants, you can enjoy a beer or a cool drink and see the action from above.

Day 2
We start today with an excursion up to the ruins of Sacsayhuaman, led by one of our local guides. Over a period of 50 years, 20,000 men were employed in the construction of this site. Here at Sacsayhuaman, you will see stone blocks 8.5 meters high weighing more than 361 tons. It has been said that these ruins are one of the most astounding megalithic structures of the ancient world. However, this is only a preview of what you will see at Machu Picchu!

Drive to the Sacred Valley stopping at Awana Cancha (a Quechua name meaning “The Palace of the Weaver”), to view the beautiful Exhibition Centre of Textiles and South American Camels before moving on to the ruins and market place of Pisac.

Day 3
We travel high into the Andes to visit the Inca ruins of Moray. Moray is the site of an experimental farm where natural depressions in the earth have been transformed into huge, circular agricultural terraces. From Moray we get another chance to stretch our legs and enjoy a 5km hike through the high Andes. Along the hike we get impressive views of the 18,000 foot peaks in the distance and close up encounters with locals plowing their crops with oxen. We eventually arrive in the town of Maras, famous for it’s impressive salt mines. This culturally enriching day ends at the quaint and ancient town of Ollyantaytambo.

Overnight at the Urubamba Boutique Lodge.

Day 4
It’s time for the Inca Trail!

A few words about the Inca Trail…
The whole of Peru was once criss-crossed with Inca and pre-Inca highways paved with thick interlocking blocks of stone. Sometimes these highways followed the valleys, but just as often they traversed the high mountainsides, tracing impossible pathways and forming narrow ledges over the bottomless gorges of the Andes. The trails were built for men on foot and lightly burdened llamas.

Frequently, their gradients gave way to steps, tunnels and long zig-zag trajectories down steep faces. The part of the trail that we will hike was formerly the royal highway to Machu Picchu. The explorer, Hiram Bingham, rediscovered the trail in 1915. Few relatively short hikes in the world can offer such a variety of scenery, staggering views, and such a mix of jungle and high sierra. Certainly no other walk known to us will lead you along an ancient highway from one secluded ruin to another, each in a breathtaking setting, each almost perfectly preserved, offering shelter, solitude, and views that no pen or camera can ever adequately record.

The adventure continues as we take our private van to “Kilometer 82” where the local porters are waiting for us. The porters will carry our duffle bags (18 pound limit) and we will carry our own daypacks stocked with water, snacks, cameras, and extra clothes. The weather can change quickly so it’s best to carry with you cold weather and rain gear. We visit archeological sights at Wilkaray and pass numerous ancient terraces. Today’s hike is easy going with a gradual incline with incredible views of the snow capped Wecheywilk. We arrive at camp well below the first pass at 7000 feet. Luckily, we’ll be able to call on the strength of the legendary

Quechua whose high altitude lungs bear our burden more easily. We’ll be camping in 3 season tents every night on the trail. (From Km 82 to Huayllabamba / 11km / 5-6 hours of hiking.)

Day 5
We pass through the incredible cloud forests of Yunkachimpa and Corralpunku, and slowly work our way up the first pass – 14,000 feet! The views from here are impressive, as if we’ve landed on a condor’s perch above the clouds. We then descend down to the ruins at Runkurakay and sleep for the night. (From Huallabamba to Pacaymayo / 12km / 6-7 hours hiking.)

Day 6
We ascend the second pass of 13,000 feet visiting the archeological sites of Sayacmara located out the brow of the jungle. Plant and bird life become more varied and amazing spectacle of the Urubamba Valley comes into view. We camp on the ridgeline at Puyapatamarca with a 360-degree panorama of the magnificent Andes. (From Pacaymayo to Phuyupatamarca / 8km / 4-6 hours hiking.)

Day 7
This is a spectacular day of hiking as we marvel at the engineering feats of the Incas. We descend into the rainforest upon the ancient stone stairs; tunnels and bridges carved right into the mountain. We take a 15- minute detour to visit the empty and haunting ruins of Winay Wayna (meaning “Forever Young”) where a well-deserved catnap is a welcome afternoon treat. We arrive at the spectacular Sun Gate of Machu Picchu in the golden light of afternoon after the last tourist buses have left the ruins. Machu Picchu, the lost, mysterious city of the Incas now lays in front of us. One of the seven wonders of the ancient world, Machu Picchu is a perfectly preserved Inca city that was lost in the dense jungle for hundreds of years. This is perhaps the most famous and awe-inspiring of all the ruins discovered in the 20th century. Machu Picchu allows us to step back in time and experience the wonder of living in a stone-hewn, ancient Incan city that continues to mystify scholars with its spectacular engineering. After our brief initial visit, we take a bus to the clean little town of Aguas Calientes, nestled in the steep Urubamba River Valley. We check into the beautiful 5-star Pueblo Hotel to rest up with a hot shower and then a delicious group dinner. (From Phuyupatamarca to Machu Picchu / 10km / 6 hours hiking.)

Day 8
In the morning, we take a bus up the twisty road back to Machu Picchu. Those who still have the energy are welcome to hike the steep staircase straight up to the ruins. We spend most of the day at the ruins with our knowledgeable Peruvian guide who will show us all the wonders of Machu Picchu. In the late afternoon, we climb aboard a first class train for a spectacular ride back to Cusco. The train tracks themselves are a miracle of human ingenuity and tenacity. The ride down the mountain will give you ample time to reflect on your journey by foot and provides us with an early evening arrival in Cusco.

Day 9
It’s a morning flight out of Cusco to Puerto Maldonado. (Again, please be sure and book your own internal flights.) A Bio Bio representative will be at the airport to provide you with a transfer to the Tambopata River Port where motorized launch will be waiting to take you to the Refugio Amazonas. On this 2.5 hour trip, you will pass the Community of Infierno and then the Tambopata National Reserve’s checkpoint. Upon arrival, the lodge manager will welcome you and brief you with important navigation and security tips. After dinner, you will have the option to hike out at night, when most of the mammals are active but difficult to see. Easier to find are frogs with shapes and sounds as bizarre as their natural histories.

Day 10
You will be awakened by the melody of the jungle sounds. After breakfast we paddle around Oxbow lake on a canoe or catamaran, looking for lakeside wildlife such as hoatzin, caiman and hornerd screamers, hoping to see the otters which are infrequently seen here. You will also be rewarded with overhead sightings of macaws. A thirty-minute walk from Refugio Amazonas leads to the 25-meter scaffolding canopy tower. A banistered staircase running through the middle provides safe access to the platforms above. The tower has been built upon high ground, therefore increase your horizon of the continuous primary forest extending out towards the Tambopata National Reserve. Here, mixed-species canopy flock as well as toucans, macaws and raptors are likely.

After lunch, you will go five minutes downriver to a farm that is owned and managed by charismatic Don Manuel, from the neighboring community of Condenado. He grows a variety of popular and unknown Amazon crops – just about every plant and tree you see serves a purpose. We will take an ethnobotanical tour where along this trail we will find a variety of plants and trees that are used by the local population with at least the same variety of purposes. We will learn about the medicinal (and other) uses of Ajo-Sacha, Yuca de Venado, Uña de Gato, Charcot-Sacha, Para-Para, among several others.

Enjoy dinner while viewing the spectacular tropical sunset. Then, nightly lectures prepared by the staff of Refugio Amazonas that cover conservation threats, opportunities and projects in the Tambopata National Reserve.

Day 11
It’s another beautiful morning in the jungle. After a tropical breakfast, we retrace our river and road journey back to Puerto Maldonado for your flight back home. You will, undoubtedly, leave this exquisite country with memories of an incredible adventure!

IN CUSCO

Casa Andina Private Collection

A beautifully renovated 18th-century manor house, just 3 blocks from Cusco’s Plaza de Armas, replete with authentic colonial character. It offers the intimacy of a boutique hotel but the comforts and services of a much larger property.The hotel is distinguished by its 3 interior patios with wooden balconies. The principal patio, featuring a gurgling stone fountain, is one of Cusco’s emblematic colonial courtyards. In the hotel’s cozy lounge and reading room is a massive stone fireplace that’s always crackling, while the romantic gourmet restaurant invites guests to dine by candlelight in one of 4 connected salons richly decorated with 18th-century Cusco School paintings. Several rooms in the original structure of the hotel feature surviving colonial frescoes unearthed during renovation.

IN THE SACRED VALLEY

Casa Andina Sacred Valley

The Sacred Valley’s most complete hotel: a mountain chalet-styled retreat with panoramic Andes views from every room and every angle. On more than 8 landscaped acres (3 hectares), it breathes an air of tranquility and relaxation. Unique among Sacred Valley hotels – most of which remain isolated in the valley, offering precious little for guests to do – it contains an extraordinary, full-service “Sacred Spa”, a domed Planetarium & Observatory for stargazing in the massive Southern Hemisphere sky, and gourmet restaurant and bar.

The 85 inviting, spacious rooms overlook the property’s extensive gardens and feature either private balconies or sunny sitting areas. Equidistant between Urubamba and Ollantaytambo, in the Sacred Valley of Cusco, the hotel is perfectly positioned for easy access to the valley’s abundant attractions and incomparable Inca ruins, including world-renowned Machu Picchu.

IN AGUAS CALIENTES

Machu Picchu Inkaterra Pueblo Hotel

In a private mountainside refuge deep in the lush Andean cloud forest, in the heart of the Machu Picchu Historical Sanctuary, lies the intimate Inkaterra Machu Picchu Pueblo Hotel. From the hotel you are only minutes away from this premier archeological adventure of the Inca Empire. In 2005, the Inkaterra Machu Picchu Pueblo Hotel was the first Peruvian hotel to be included on Travel+Leisure Magazine’s “The Best 500 Hotels in the World” list. It also appeared on the same publication’s “Top 25” list for Mexico and Central and South America.

Designed and maintained with a keen sense of beauty, the Inkaterra Machu Picchu Pueblo Hotel blends the simple lines of the Andean architecture, the exquisite handicraft of local artisans, and tasteful furnishings. Cozy one- or two-story whitewashed cottages constructed from local materials line the stone pathways, giving this intimate 85-room hotel the look of a lovely Andean village. Handmade adobe bricks, eucalyptus wood, and cut stones are some of the building materials that give this Andean retreat a feeling of quaint warmth, as well as mysterious spirituality. Colorful local crafts and authentic pre-Columbian artifacts in the public rooms bring the local culture and history to life.

Nature trail:
Miles of trails lace the grounds, winding past waterfalls and through the forest, and wandering through gardens rich with a dazzling array of 372 native orchid species, 172 bird species, 111 species of butterflies, and other natural

h2>The Amazon

Refugio Amazonas

Refugio Amazonas lodge lies deep within the rainforest — a luxurious oasis in the wilderness. With its wide variety of a la carte activities, the lodge is ideal for nature-lovers. And as the headquarters of our Citizen Science program, Wired Amazon, you even can contribute to science!

• Become a Scientific Explorer: Wired Amazon is our citizen science program. From discovering a new species to learning about Harpy Eagle behaviour, guests at Refugio Amazonas can join the Wired Amazon team and participate in ground breaking research that is advancing our knowledge of the rainforest. Each month (on average) a guest discovers a species new to science!
  See Macaws in the wild: We take a boat trip to the spectacular Chuncho Clay Lick, inside the Tambopata National Reserve, to see hundreds of Macaws descend on clear mornings. It’s an unforgettable sight!
• Canopy Tower: Our 30 meter (100 foot) Canopy Tower offers spectacular views of the vast expanses of rainforest around the lodge. There’s more than just trees to see — you’ll often be able to spot Toucans, Parrots, Macaws, and other treetop birds!
• Jungle Farm: We visit a working rainforest farm to learn about agriculture and local life. You can try exotic tropical fruits, chocolate, medicinal plants, and little-known relatives of the tomato!
• Oxbow Lake Visit: Paddle around Lake Condenado on a catamaran, spying beautiful wildlife like Hoatzins and Caimans.
• Rooms at one with nature: Our naturally-built rooms have a wall open to the surrounding jungle. This gives you a safe way to enjoy this diverse ecosystem, even during downtime. Wild animals, including monkeys, are often visible from the lodge. Our dining room is a huge open building as well, with a second floor loft for an stunning view of the rainforest canopy.
• Wellness Center: Relax with fantastic massages and aromatherapy at our on-site wellness center.
• Aerobotany: Discover where classic field biology and 21st century technology come together in the rainforest. Join our resident Aerobotanist to fly drones over the canopy and classify the photos, helping with scientific discovery!

Please note: lodging may change depending on availability

VISAS & PASSPORTS

U.S. citizens are required to have a passport that is valid for 6 months after your travel dates begin.The Inca Trail requires a permit. The passport you give Bio Bio to get this permit MUST match the passport you have with you when you are in Peru. If, for any reason, you get a new passport, it is of vital importance that you tell us and send us a copy of the new passport. This situation can arise if you, perhaps, lose your passport, get married and change your name, or use different names on different documents.

FLIGHTS & AIRPORTS

You are responsible for booking all flights, international as well as domestic.  However, if you need help, please feel free to call or email the Bio Bio office. One travel agent we often use is:Americas Travel, San Francisco

Office Hours: 10-6 pm Mon-Fri (PST), 888-703-9955
Flying In…The tour officially begins in Cusco on Day 1. You will fly into Lima and then transfer to a domestic flight. Please try not to arrive in Cusco before 10:00 AM as your hotel room will not be ready and most things are closed in the city. You may want to fly in the day before and spend the night in Lima.  We can arrange a hotel for that evening if you prefer, or we can arrange extra nights for you in Cusco.
Domestic Flights…Day 1: Lima to Cusco
Day 9: Cusco to Puerto Maldonado – mid-morning flight
Day 11: Puerto Maldonado to Cusco or Lima – afternoon flight
Flying Out…You can fly out of Cusco or Lima and then home all on the last day. Or you can choose to spend more time in either of these cities and fly home at a later date. We are happy to help you arrange tours and lodging.
When you leave Lima, there is a departure tax of approximately US$30.

TRAVEL TIMES BY PLANE
Miami to Lima: 5:25 hrs
Lima to Cusco: 1.5 hrs
Cusco to Puerto Maldonado: 1 hr
Puerto Maldonado to Lima: 2.5 hrs

Peru is on Central Standard Time

PACKING INFORMATION

Baggage Allowance and Suggested Gear

Please see what restrictions your airline imposes, as the rules and allowances are constantly changing. Typically you are allowed two checked bags up to 50 Lbs each, plus one carry on bag and a purse.

You will be provided with one soft duffle bag when you arrive to Cusco to pack all your gear for the Inca trail. The porters will carry this duffle bag. Your suitcase will be left at the hotel with non-trekking clothes and items – while your suitcases are kept in safe storage we still recommend using a lock on your suitcase.  Keep all important documents, including your passport, with you in your daypack. Please note that your Inca Trail bag with your camping gear will have a weight limit of 18 lbs! This is required by law in Peru to protect the porters. That does not include your tent which will be carried in a different bag.

• Sleeping bag: A 20 or 30-degree bag is warm enough, in a compression stuff-sack.
• Sleeping pad: This is very important, and not something you want to skimp on. Thermarest makes a good inflatable pad. Thermarest Lounge chair cover, to turn your pad into a great chair! We can rent Thermarest pads for you in Peru if you’d like. Please let us know in advance so we can reserve them.
• Camp pillow
• Travel Clothing: 2-3 pairs of pants and 4-5 shirts that are lightweight and quick drying. A long skirt or nice pants are also nice for special dinners in towns.
• A day backpack: We recommend that you carry the following items in your daypack: water, sunglasses, camera and film, extra layers in case the weather turns cool, flashlight/headlamp/blister kit.
• Flashlight and or headlamp, extra batteries. The days are 12 hours long on the equator so it will get dark around 6:00pm.
• Toiletry kit, personal medicines – particularly allergy and diabetic prescriptions, shampoo, soap, toothbrush, lotion, bug repellent, one roll of toilet paper per person.
• Rain jacket and pants– lightweight Gortex or similar.
• Shoes (2 pairs)– One pair for city visits, towns, villages. One pair of lightweight hiking shoes for hiking.
• 1 fleece light or mid weight – for layering or a lightweight wool sweater.
• 1 fleece zip up mid weight jacket
• 2 pairs long underwear – synthetic material both top and bottom
• 2 or 3 T-shirts
• Hiking pants of synthetic material or fleece pants: 1 pair of pants that are comfortable to hike in, smart pants by Exoffico or similar that have zip off options.
• Hiking shorts
• Down Jacket: The temperature at certain camps can drop below freezing and a warm down jacket as well as multiple layers of fleece are important to have.
• Wide brimmed sun hat
• Lotion and sunscreen: Not much Ozone left in the southern hemisphere!
• Insect Repellent – minimum recommended 20%deet (Jungle Juice) please note: no instances of malaria have ever been registered on this trip.
• Camera and batteries – back up memory cards and batteries
• Personal Snacks- You will be provided with great snacks (energy bars, trail mix, fruits) everyday and delicious food on the Inca Trail. Only bring snacks if you have a have a favorite kind or personal preference.
• Swim Suit
• H2O bottle (water bottle or camelback) key item! You should have at least a 2-liter water carrying capacity. Filtered water is provided. You will be able to refill your bottles in the morning, at lunchtime and when you arrive to the camp in the afternoon.
• 2 heavy duty trash bags to keep your camp gear dry inside your duffel (and later for laundry)
• Ziplock bags: several sizes to help organize your camp items, lotions, socks, underwear, etc.
• Moist Towlettes: for personal cleaning
• Small wash towel
• Trekking Poles (optional) – must have rubber tips on the bottom to protect the trail

BioBio Expeditions has partnered with Tahoe Mountain Sports, our local outfitter, to help you collect the gear needed for your upcoming adventure! Use the promo code BioBio1 at checkout and receive 15% off all full priced items in your shopping cart. Click this LINK to see some products offered at TMS that are on your packing list or visit their online store at: http://www.tahoemountainsports.com

MONEY MATTERS

Currency

Peru is typical of many South American countries in that it effectively operates a dual-currency system. Both the US dollar (dólares) and the Peruvian Nuevo Sol (soles) are in circulation and although the government prefers people to use soles, most sizeable purchases are made in dollars. In practice, this means that anything costing more than, say, a meal in a nice restaurant, is paid for in dollars. The Nuevo Sol is perfectly stable so you don’t have to worry about inflation problems during your stay!

Extra Expenses

You are responsible for 1 breakfast, 4 lunches and 2 dinners (excluding Day 11 post-breakfast). These meals will cost between $5 and $25. And of course, you can go all out at a high-end restaurant. For meals that are included, you will need to pay for your own alcohol. You will also need money for gifts and tipping.

ATMs

Plus, Cirrus and other networks connecting ATMs are available in Peru. The exchange rates you get when withdrawing from cash machines are standard. This is the approach we usually recommend. Cash machines dispense both dollars and soles and most accept the major debit cards. Be aware of counterfeit currency and avoid being followed to and from an ATM machine! Go in pairs!

Credit Cards

If your credit card has been programmed with a PIN, it’s likely you can use your card at Peruvian ATMs to withdraw money as a cash advance. Always ask your bank before you leave home about the number of withdrawals you may make abroad, the limit each day, and also let them know where you are going so they do not put a hold on your card. You may be charged a fee for each transaction.

Most of the bigger restaurants and shops accept credit cards. If you have American Express, Visa, Master Card and Diners Club, you’re probably equipped for any establishment that takes cards. If you only have one, have VISA. A shopkeeper may require you to pay the credit card fee for purchases, so for the most ease, we recommend you use cash whenever possible.

Banking Hours

Banks are generally open from 9am to 6pm. Some banks close for 2 hours from 1pm to 3pm. Banco de Credito del Peru does NOT close. In Cusco you will find many banks on Sol Avenue, one block from the main square. It is recommended to go to an “exchange office”. You must bring your passport to exchange money. Never change a large sum (more than $100) and again, go in pairs, and avoid being followed by robbers.

Personal Checks

Personal checks are not accepted in shops or at your hotels. It’s a good idea, however, to bring a few for possible emergencies.

Travelers Cheques

Travel checks are less desirable as fewer and fewer places will change them, and you may end up in long bank lines. You will need to show your passport to cash your checks at the bank.

Tipping

Tipping is, of course, entirely voluntary and how much you give depends on how you feel about the service you have received. Typically, you should designate 10-15% of the land cost of the trip for tips. For example, a $4000 trip would mean $400 in tips. This will be split up on 2 different occasions:

1. At the end of the Inca Trail, each client should tip the porters $75-100. This will be divided up among the 20-30 staff that have made your Inca trek possible.
2. At the farewell dinner of Day 8 in Cusco, you can give the largest portion of your tip to the trip leader and he will divide it up amongst himself and the various tour guides.

Other smaller tips might be for airport luggage carriers, hotel staff and drivers. This is where $1 bills or single soles come in handy. The norm at restaurants is approximately 5-15%.

For some background information, Peru has a minimum salary of 550 Nuevo Soles (US$170) monthly for a 6-day, 48-hour week. However, in many of the lower paid jobs (e.g. waiters, porters etc) this is not always enforced. 1 Nuevo Sol (soles) is roughly the equivalent of US$30.

TRAVEL PRACTICALITIES

Trip Insurance

Bio Bio Expeditions recommends that you purchase a travel protection plan to help protect you and your travel investment against the unexpected. For your convenience, we offer travel protection through Travelex Insurance Services. For more information on the available plans or to enroll, click here or contact Travelex Insurance Services at 800-228-9792 and reference location number 05-8655. Travelex Insurance Services, Inc CA Agency License #0D10209. Travel Insurance is underwritten by, Berkshire Hathaway Specialty Insurance Company, NAIC #22276. 55Y

Immunizations

Although there are no immunizations required to travel to Peru, it is usually recommended that typhoid and diphtheria-tetanus protection be current. Hepatitis A, taken just before departure, is also recommended. The cholera vaccination is no longer officially required, and cholera can be avoided by practicing strict food and water precautions. In general, we advise that you consult your physician regarding recommended immunizations and other health precautions. Bio Bio Expeditions does not take responsibility for which medications or inoculations you and your physician deem necessary for your safe participation on the expedition in Peru.

For further information, call the CDC’s International Traveler’s Hotline:

Phone: 1-888-232-4636
Online: www.cdc.gov

Water

Although it requires a little extra caution when drinking fluids in Peru, it is essential to stay well hydrated. We advise that you not drink any of the tap water in Peru; this includes no ice in your drink. Bottled water is fine to drink and can be ordered at most restaurants and found in local grocery stores. Ask for “agua mineral, sin gas (non-carbonated) or con gas (carbonated)”. When ordering sodas, it is best to request them without ice (sin hielo), as the ice is usually made from tap water. Additionally, be sure to brush your teeth with bottled water.

Food

The major precaution regarding food pertains to raw, unpeeled fruits and vegetables (including lettuce) – avoid them unless you are dining in a high-end restaurant! If you can’t peel it, don’t eat it as it has probably been washed in tap water, or not washed at all, and that can make you sick. The high altitude also affects one’s digestive system so it is recommended to eat in moderation and avoid rich, thick foods (such as mayonnaise). However, don’t be afraid to try new foods and dishes – just be cautious. Peru has some of the finest, most delicious cuisine in the world! We want you to experience the many new flavors and local cuisine, but there are some things to consider when making food choices, especially where you are eating. The more high end restaurants in Cusco are fairly safe bets for trying new things. Street food should generally be avoided. This brings us to our next topic…

Digestive Worries

Traveling to Peru is going to have a notable impact on your body. Despite the many precautions we all take to stay healthy, occasionally one may experience diarrhea. The major problem associated with diarrhea is fluid loss leading to severe dehydration, so it is important to maintain plentiful fluid intake. Avoid milk and avoid caffeine, as it will only further dehydrate you. The best drinks are weak tea, mineral water, and caffeine-free soft drinks. Ideally it is best to let diarrhea run its course, however you may want to bring over-the-counter diarrhea medication to minimize your potential discomfort. We also advise that you carry your own supply of toilet paper, as most of the restrooms in South America either don’t have TP, or they charge you for it. The bottom line (no pun intended) is to drink plenty of fluids and get lots of rest! Lastly, we encourage that you, and all our staff, practice impeccable hand hygiene – you can’t wash your hands enough! Sanitizer gels are great when hand washing with soap and water is not available.

Prescriptions

If you currently take prescription medications, be sure to have a plentiful supply and also the doctor’s written prescription in case you need a refill. It is best to carry medications in your carry-on bag in case of lost luggage. Also, if you wear prescription glasses or contacts, we advise that you bring along a spare set.

Voltage

Electrical current in Peru is 220 volts AC, and the plugs are different from the USA two prong.

Safety

Although the Peruvians are a warm, friendly, fun-loving people, thievery is a common problem. Always keep your wits about you and be aware of your surroundings. When with other people, watch out for each other. Large crowds are prime locations for pick-pocketing to occur. Keep your money in a money belt or hidden pouch around your neck and under your shirt. When purchasing items, do not pull out lots of money. We advise that you leave all valuable jewelry, including watches, at home. Thieves often work in pairs or groups – one tries to distract you (e.g.: by squirting food or paint on your clothing) and in the ensuing confusion, another one makes off with your belongings. The areas around the main square in Cusco are well patrolled by police and tourist police. However, we encourage you to be very cautious and never be walking the streets alone after dark.

Jet Lag Precautions

When you cross several time zones to reach your destination, you often lose many hours of regular sleep. On arrival, your body then must suddenly adjust to new sleeping and eating patterns. The result is jet lag. Its symptoms are fatigue – often compounded by insomnia and restlessness – irritability and vague disorientation. You cannot totally avoid jet lag’ but you can minimize it. Here’s how:

• Start your trip well rested. Try to begin a gradual transition to your new time zone before you leave.
• Switch to your destination time zone when you get on the plane. Attempt to sleep and eat according to the new schedule.
• Try to sleep on overnight flights.
• Avoid heavy eating and drinking caffeine or alcoholic beverages right before and during your flight.
• Drink plenty of water and or fruit juice while flying. You should buy a large bottle of water at a kiosk right before boarding – once you have cleared inside security and are “inside”.
• After arrival, avoid the temptation to nap, unless you didn’t sleep at all on the plane.
• Don’t push yourself to see a lot on your first day.
• Try to stay awake your first day until after dinner.

Altitude Sickness

Cusco sits at almost 11,000 feet. This is one of the highest places most of us have ever, or will ever, stay for an extended period of time. The altitude can cause some physical reaction in almost anyone. Most people experience shortness of breath, headaches, and some dehydration. We recommend taking it easy your first day and avoiding alcohol and tobacco. If you feel sick, be sure to rest, breathe deeply, drink lots of fluids (bottled water), and perhaps take a mild pain killer for headaches. Locally brewed coca tea also seems to help. True altitude sickness is rare, but if the symptoms become severe, please let a Bio Bio Expeditions representative know. The front desk of the hotel often has spare oxygen bottles if needed.

How well your individual body adapts to the thinner air depends a good deal on innate factors that you have no control over. That being said, people in top shape often acclimate better because they expend less energy hiking, leaving their bodies ready for the task of acclimatization. Proper hydration has also been proven to be essential in this task. There is no substitute for being in top shape and staying hydrated

Many altitude physicians recommend bringing the following medications for prevention and or treatment of altitude related problems:

Diamox: 125 mg, twice a day. Beginning 24 hours before ascent to a sleeping elevation of 8,000-10,000 feet and continuing through duration of climb. Please discuss with your physician.

COUNTRY INFORMATION

Demographics

Almost the same size as Alaska, Peru is the third largest country in South America, covering 496,226 square miles. Peru is divided into three distinct geographic regions: the narrow, dry coastal plain in the west; the high Andes Mountains roughly in the center; and the tropical lowlands of the Amazon Basin to the east. Peru shares with Bolivia the highest navigable body of water in the world – Lake Titicaca. There is little rainfall along the coast, although he winter is foggy, humid and cool. The capital city of Lima, the temperature is moderate year-round, averaging 65*F.

Several of South America’s most advanced cultures lived in pre-Columbian Peru. The last of these groups was the great Incan Empire, which was unsurpassed in the art of stonecutting and also achieved a high degree of economic and political development. Incan and earlier Chimu ruins, notably at Cusco, Chan Chan, and Machu Picchu, make Peru a favorite destination for archaeologists and tourists. In 1532, the Spanish invaded Peru under the leadership of Francisco Pizarro. They conquered the Incas the next year. The area soon became the richest and most powerful Spanish colony in South America because of its location and many mineral treasures.

Under the leadership of South American liberator Jose de San Martin, Peru declared independence from Spain in July 1821. With the help of Simon Bolivar, the Venezuelan general who liberated several other countries, the fight for full independence was won by 1826. For a century, Peru worked to secure its territory and build its social institutions.

Peru is a republic. It is divided into 24 departamentos (similar to states). The president holds executive power and serves a five-year term. All citizens age 18 and older are required to vote. The unicameral Congress consists of 120 members, who serve five-year terms. Major political parties include the Change 90-New Majority Party, Union for Peru, the Popular Christian Party, and the Popular Action Party.

The population of Peru is approximately 27 million and is growing at 1.75 percent annually. Population density is generally low due to the country’s large land area. Peru’s population is ethnically diverse. About 45 percent is Indian, descendants of the Incan Empire. Many ethnic and linguistic divisions exist among Indians, some of whom are still fairly isolated in the Amazon jungle. Another 37 percent is of mixed European and Indian heritage. Fifteen percent is of European descent (mostly Spanish), and the remaining 3 percent is composed of blacks (descendants of West African slaves), Japanese, Chinese and other smaller groups. About half of the population is younger than age 20. Lima is the largest city, with more than seven million residents.
Language

The official languages in Peru are Spanish and Quechua but Spanish will be your most useful language, even in the highlands. The Spanish spoken in Peru is almost identical to the Castilian Spanish of Madrid, albeit with slightly different pronunciation and a few vocabulary changes. In the high Andes, particularly around Cusco and Puno, many people still speak Aymara or Quechua (the language of the Incas) as a first language, although almost all will also speak Spanish. The good news is that in most places like restaurants, hotels, etc., there is usually someone who speaks English – and, of course, all our representatives and guides speak both English and Spanish.

If you do speak some ‘Spanish’ then you shouldn’t have too many problems speaking with the locals in Peru. The major difference in accent between Peruvian Spanish and Castilian Spanish is that the letters c and z are pronounced like the English s rather than the traditional th. In general, Peruvian Spanish is a little slower and less heavily accented than most Spanish you would hear in Spain.

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