Tag Archive | cancer

Peru – Anna Kirsch (2012)

Anna Kirsch

Anna Kirschis a medical student at Georgia Health Sciences University.  Anna (Mariah) worked in Peru during the summer of 2012, leading a research team that is assessing the impact of cancer initiatives by a local clinic in the Andes.  Mariah received a $1500 scholarship from Sara’s Wish Foundation.

Here are Anna’s travel safety tips:

Peru has become a popular destination for many travelers of all ages.  Although relatively safe, when traveling to anywhere in the world, I would advise taking certain precautions in the unlikely event something unexpected happens while abroad.  In addition, it is important to remember basic awareness and common sense to keep you safe while traveling to ensure your health and safety.  Based on my recent travels to the Andean region of Peru, I have written out a few guidelines below to help ensure health and safety while enjoying your trip to Peru.

I.             Before you leave your home country:

A.             Vaccinations and Health Consideration

If you will not be traveling to the jungle on your own, yellow fever vaccination will not be necessary.  Antimalarial prophylaxis is also not necessary if you remain in the Andes Mountains (Cusco) or Lima.  However, if you will travel to Iquitos in the jungle region, malaria prophylaxis will be required.  Hepatitis A vaccination is suggested.  It is given in 2 doses spaced 6 months apart. It may be a good idea to bring:

  • Diamox (acetazolamide)- Altitude sickness: You may choose to take Diamox (acetazolamide) to help prevent acute high altitude sickness.  Diamox 125- 250mg every 12 hours should be started at least 24 hours prior to departure for Cusco.  This medication causes an increase in urination and respiratory rate.  The side effects include numbness, tingling, or vibrating sensations in your hands, feet, and lips, also an alteration in taste and a ringing in your ears.  Diamox should be continued until the second or third night at altitude.  If you are concerned with acclimatizing, talk to your doctor before you leave.
  • Ibuprofen: An anti-inflammatory and pain reliever wonderful for the first few days when adjusting to altitude!
  • A decongestant: High altitude and dry air make it very easy to get a respiratory infection (a cold) that is hard to kick.  A decongestant combined with hot, steamy showers is a wonderful relief in case you happen to catch a cold while on the trip.
  • Ciprofloxacin: Common anti-biotic for traveler’s diarrhea… something unfortunately not too uncommon while bouncing around developing countries and adjusting to the local cuisine.
  • Sunscreen/repellant: Peruvian sun, especially at altitude, is intense and sunscreen can be expensive in some touristy destinations.  Repellant is also great for Manchu Picchu, although other highland areas do not have many biting insects.  Both can be purchased in country, but may be more expensive than simply bringing a bit from home.
  • And any medications you normally take, including extra contacts/glasses.

Bring your medications in your carry on luggage.  Although most medications can be purchased in Peru, it is always better to be prepared.  You may access the CDC website (www.CDC.gov) for further information about precautions for Peru and South America.

B.             Travel and Health Insurance

MEDICAL EVACUATION INSURANCE: Call your medical insurance and ensure what is covered while traveling abroad.  In some cases, your medical insurance may not be valid outside of the US.  Consequently, it is smart to purchase short-term medical insurance from an external source, such as

  • Cultural Insurance Services (CISI) (800) 303-8120 or (203) 399-5132

Although accidents are unlikely to happen, medical evacuation insurance is strongly suggested just in case.  Short term plans are easy to sign up for and can be purchased on a trip-by-trip basis by a variety of services, such as:

Medical evacuation from Peru could cost more than $50,000 without evacuation insurance.  Although it is not something many of us like to dwell on before traveling, having insurance is a good safe guard against much hardship if an emergency does unfortunately occur.

Bring all insurance information with you, and leave another copy with someone you trust at home in case of an emergency!

C.             Political Security

Before traveling to any foreign country, it is good to know a bit about the current political security of where you are headed.  Check any news reports, upcoming election dates, and any US Dept. of State warnings, which for Peru, can be found at: http://www.state.gov/p/wha/ci/pe/

D.             Personal Documentation

  1. PassportAll travelers are required to have a valid passport (http: //travel.state.gov/passport).  If you do not have a passport, get one quickly. Check the expiration date to make sure your passport is valid at least 6 months beyond your return date to the US and that there are blank pages available for entry/departure stamps.  Be sure to have your passport with you during travel to and from Peru, although a Visa is not necessary.  Extra copies of your passport should be made prior to leaving and stored either electronically, and/or in an area separate from where your actual passport will be stored while traveling.
  2. MoneyCredit cards and ATM cards are also good to have access to funds while traveling.  Make sure you notify your bank of travels before you leave, and make a copy of all your cards to store with your passport copy while traveling.  Also, include any international numbers for the appropriate banks with this documentation in case of theft or loss of a card.  Bring an extra ATM card!  I’ve had an ATM eat my card more than once while traveling, and in many small shops/towns, credit cards are a bit harder to use and will be harder to use as a primary means of currency.Also, it is a good idea to leave copies of such important documents with someone you trust at home in case of emergency.

E.             Emergency Contacts and Itinerary

Always good to have at least one person expecting to hear from you and have a rough idea where you are, no matter where you are in the world.  Leave a rough itinerary with someone you trust at home, and keep in touch with them throughout your trip.  In addition, bring a list of emergency contacts names, phone numbers (with international calling code), emails, etc. in case someone needs to help you reach home in an emergency abroad.  Put this information in your day bag and an extra in your main pack at the start of the trip, that way it will be there if you need it.

II.             Arriving to PERU!!!

A.             Lima

Getting to Cusco can be difficult, and most travelers will first arrive in Lima, Peru in route to Cusco.  Due to flight schedules, it is likely you may spend a night, or at least several hours in this airport.  Hanging out here isn’t always fun, but Internet is available at Starbucks as well as the bar in the hotel across the street from the airport can help pass the time.  Some people chose to sleep waiting for their connection, but you are not allowed thru the security line until much closer to your flight time, so if you are solo, take care to be aware of your surroundings and keep your luggage close by.  Anyone, traveling or not, has full access to this area of the airport.

B.             Cusco and Sacred Valley

Many travel agents will be overly friendly offering tours and hotels upon arrival, sometimes rather aggressively.  Although I cannot say much for the deals they offer, know that it is extremely easy, and probably more relaxing and cheaper, to find tourists offices all around Cusco and in most tourists towns throughout Peru.  Collect your luggage and head into the parking lot to escape.  There, taxis will be waiting.  If you walk to the back of the lot, you will find bartering goes a bit further and you can get a decent price into town.  If you do not know where you are staying for the first night, the Plaza del Arms is the center of Cusco’s touristy area and an easy place to find a coffee shop with tourist’s maps that will mark several hostels and restaurants to help get you oriented for your first night.

  1. High Altitude:If you choose to fly into Cusco from Lima, the first thing most travelers will notice is the effect of the high altitude.  Cusco is situated at 11,151 feet above sea level.  High altitude sickness is characterized by a headache with associated loss of appetite, nausea or vomiting, fatigue or weakness, dizziness or light-headedness, and difficulty sleeping.  The best treatment of acute high altitude sickness is rest, fluids, and mild analgesics such as acetominophen or ibuprofen.  Symptoms will usually resolve in 1-2 days.In consideration of the effects of high altitude, please remember to take it easy, rest, and drink plenty of fluids.  It will be difficult to exercise at this altitude until you acclimate.  Normal physiologic changes in every one who goes to high altitude are hyperventilation, shortness of breath during exertion, changed breathing pattern at night, awakening frequently at night, and increased urination.  Avoid alcohol and sleeping pills (Diamox can be used as a sleeping pill, take upon arrival).Medication Options:   Diamox (acetazolamide)- Altitude sickness, Avoid alcohol and sleeping pills (Diamox can be used as a sleeping pill, take upon arrival). Coca tea or leaves: It is said that the drink helps reduce symptoms of high altitude illness.  However, please remember coca leaves are also used to make cocaine.  Ibuprofen –anti-inflammatory: Ibuprofen can be used to help reduce swelling of mucus membranes due to the altitude change.  In plane terms, it can help you regain your appetite and reduce any sinus pressure you may feel upon arrival.
  2. Food borne Illness and PrecautionsThere are many bacterial and parasitic food borne illnesses in Peru.  Please be very careful what and where you eat and drink.  DO NOT DRINK WATER FROM THE FAUCET OR SHOWER.  ONLY DRINK WATER FROM A SEALED BOTTLE OF PURIFIED/TREATED WATER.  Do not eat ice cubes.  Take precaution when brushing your teeth to not drink tap water.  The Peruvian tap water is not purified.  Keep your mouth closed when you take a shower.   Only eat food that has been cooked or boiled.  Do not eat food prepared on the street.  Also avoid vegetable and fruit salads and cold vegetables as they may have been washed in the local water.  Fruit that can be peeled is safe to eat.  Be extremely careful when eating at buffet type restaurants.  Do not eat raw seafood such as ceviche.Medications: Ciproflaxacin 500mg (#14) In case of acute gastroenteritis (fever, vomiting and diarrhea), you may want to bring a 7 day supply of Ciprofloxacin 500mg tablets #14, 1 tab orally twice daily) with you.
  3. Attire:Cusco is in the mountains and the average temperature during the daytime is 60° F and 40° F during the nighttime.  You can check www.weather.com for an idea of Cusco temperatures before leaving. We suggest that you bring a warm jacket or sweater for the evening.  A raincoat may be a good idea, particularly if you are there during the rainy season (November-March). If you will travel to Machu Picchu, consider bringing a short sleeve shirt and shorts or jeans.  The temperature will be warmer than Cusco with considerable humidity.   Because this region is known for warm alpaca clothes, you may want to purchase these items while in Peru.Hiking in Peru is amazing, but good quality hiking boots/clothes are a bit harder to come by if you are looking for normal US prices.  If you enjoy hiking, make sure you bring sturdy shoes and a few very warm layers in your pack along with you.
  4. Pickpockets:Although Cusco is a relatively safe part of Peru, common sense and awareness always helps keep you safe.  Be particularly cautious for theft of money, cell phones, laptops, cameras and documents.  Do not wear expensive jewelry or watches.  Be especially cautious if visiting local markets or downtown Lima.  A hidden money belt or pouch worn beneath your shirt may help prevent theft, and be sure to keep all zippers on bags securely closed, especially in crowded streets. Pickpockets: Walking around the tourist areas are rather safe during both day and night.  However, always be aware of pickpockets, especially during festivals.  Keep your bags/purses zipped up and if in crowds, in front of you so somebody cannot reach in and remove any of your valuables.San Blas: funky little artsy part of Cusco that is well worth a trip.  However, this area can get rather quiet and is known to be a bit more notorious for muggings and pickpockets.  Don’t walk around this area at night solo, and just be aware of your surroundings.
  5. Electricity:Because Peru uses 220 volts instead of 110 volts and a different electrical plug, an electrical adapter and voltage converter (transformer) will be required in Peru if you bring an electrical device from the US.  Some electrical devices, such as your laptop, have this built in and will not need an electrical adapter.
  6. Transportation:Taxis are relatively inexpensive in Cusco.  However, if traveling independently, always take secure taxis or call one if late at night.  Settle on a price to your destination before leaving or entering the taxi, most are slightly negotiable.  Locals generally are willing to tell you the appropriate price.  If taking a taxi from a hostel, ask the front desk owner to point out a secure taxi if it is late at night, and if possible, travel with a friend.  Carry bags with you instead of in the trunk if possible, a friend of mine had a taxi driver drive off before she was able to unload!If traveling to a more remote hostel/club/whatever at night, take a taxi in place of walking.  Don’t be a target for muggings, and if you talk to those that have lived in the area for a while, a traveler walking around in a quiet part of town at night is a great way to make yourself a target!Buses/collectivos: Vans and buses frequently make loops around the city.  Each one has a name on the top, and follows a set route.  Overall, they are pretty safe and cheap.  However, finding out the routes is sometimes a process of trial and error, or simply asking the locals.  Many are happy to help.If taking a bus or van to a near-by town, such as Pisac, try to find one in good repair, as these roads are rather full of twists and turns.  I often asked if I could sit in the front to avoid motion sickness and have the rare opportunity to buckle up for the journey.  However, I warn you that this is not the seat for the faint of heart- sometimes seeing the narrow mountain road can be rather, well, thrilling, by itself.  I recommend scheduling plenty of daylight on either end of the car journey to not only be safe on the road, but also allow you not to arrive in a strange new town or drop off location at night.
  7. Alcohol:Remember you are at altitude in a dry climate: this means not only will you become dehydrated quicker (think hangover), the alcohol will actually absorb faster into your bloodstream than at lower altitudes (think drunk faster).  If your choose to drink, which many do due to the wide array of nightlife offered here, go slower than you normally would at home and try to find purified water to sip in between beverages.Girls: some bars/bartenders, like in any location, are known to slip drugs in girls drinks out at clubs.  Try to always go out in groups, watch your drink being made, and never leave it unattended while you go off to dance or socialize.
  8. Drugs:Any street drugs such as cocaine and pot are offered fairly frequently on the streets of Cusco.  Remember that these drugs are illegal and penalties for foreigners can be harsh.  Use your head, and remember that staying in a foreign jail probably isn’t on the top of your to-do list.
  9. Money:You may exchange money in Peru, but it is easiest in larger cities like Lima and Cusco.  Bank ATM’s offer the best rates.  Hotels can exchange money, but the rates are generally not as good.  Credit cards can also be used in the major cities, but beware you may have to pay a fee or percentage for using the card abroad.  If traveling to rural settings, be sure to have some cash in local currency (nuevos soles).  Do not carry a large amount of cash.  Avoid changing money on the street, as there is a chance of receiving false currency.  Have CLEAN, NEW bills ($20s) for exchange only!!!!  Ripped or crumbled bills will not be accepted for exchange.
  10. Phone:Your cell phone may operate in Peru; however check with your service plan to assess charges.  Otherwise, calling cards or Skype (if you have internet) may used to call home.   Local cell phones can be purchased quite cheaply in most markets in Peru, and you simply purchase minutes, as you need them.  If staying in the country for a few weeks, this may be a great option not only for safety (sketch cab? Get lost? Dark sooner than expected? GREAT to have a phone at those moments), but also to keep in touch with friends along the way!

Last of all, have fun!  Staying safe while traveling mostly involves common sense, and building a few routines (extra document copies, making sure you have medical/evacuation insurance, keeping someone posted on your whereabouts, etc.) into your travel routine to keep you safe in case of the unexpected.