After our exhilarating and exhausting 12 hour walking tour of Lima, we left our hotel at 6.00 AM to get to the airport. The cab driver showed up on time and there was no traffic so we made good time. Since we left so early, we missed the hotel breakfast.
Check in went very smoothly. We had our bottles of water which thought we would have to empty prior to security. We asked the lady at the check in counter and she said, “Oh that is just for international flights. No problem for domestic flights.” She did emphasis that we should get to the gate as soon as possible, even though the flight was not till 8.15.
We went through security with our shoes on, and with our water bottles without a problem. The screener was not even looking at the monitor as our carry on bags went through the X-ray machine. Once we got on the other side we found only one place to eat with a very limited selection. So at 7.30 in the morning we ate pizza and a chocolate croissant! Looking back it would have been better to take our time to eat a decent breakfast before going through security as there is a big food plaza with McDonald’s Dunking Donuts, Subway, Starbucks etc. Important lesson learned for the return trip.
Our flight was on Star Peru which has its own private waiting lounge area with several gates on the first floor. It was great to see several of the medical students at the lounge as they were taking the same flight to Cusco. Just a bit after schedule our flight was called and we got on a bus to take us to the plane that was on the tarmac. When we got there, there was another bus parked at the plane and was unloading passengers onto our plane. This was a bit confusing till we found out that the other bus has stopped at the wrong plane! The passengers were asked to get off and we were able to board the plane! I wonder if anyone would have picked up the problem if we had not showed up!
The flight was remarkable for the amazing landscape unfolding below us. The plane had to gain height very quickly as it had to clear the Andes. The peaks at times seemed to be about to scrape the bottom of the fuselage. We saw the very dry highlands interrupted by an occasional snow covered peak or a lake. On the port side (North) were very tall snow covered peaks, with one particularly standing out from the rest. This was probably the Salcantay peak which is over 20,000 feet and the plane appeared to be flying almost level with it. Landing into Cusco was interesting as the plane had to find a low pass between the high mountains that surround the city and land and then dip down to land in the Cusco valley.
Cusco is at >11,000 feet altitude and I have to mention acute mountain sickness or Soroche as it is called here. It can happen to anyone and it is good to be prepared. Strangely the physiologic basis of acute high altitude sickness is still not fully understood. A good review article from the Annals of Internal Medicine is available here. At the elevation of Cusco, the barometeric pressure and the inspired oxygen are only about 70% that at sea level. A rapid ascent to this height as in a flight from Lima to Cusco can precipitate acute mountain sickness with headache, nausea and vomiting being prominent features.
It is a good idea to start acetazolamide (Diamox) under the direction of your doctor, 24 hours prior to getting to Cusco. This changes the pH in your blood towards the acidic side. The body reacts to this by breathing faster and deeper and thus blowing off carbon dioxide. This “hyperventillation” probably helps you get acclimated by starting early what you need to do at high altitude. Acetazolamide does have side-effects most noticeable of which is strange sensations in the hands and feet and a loss of taste. There are other options like high doses of steroids (with its own potential side effects) or local options like coca tea. Almost everyone – even the fittest person – will have some shortness of breath and will need to slow down.
Apparently Acute Mountain Sickness usually does not start till about 2-3 hours after going to high altitude and does not occur at less than 9000 feet and. Since we were planning to go down to the Sacred Valley (about 9000 feet) right away after landing in Cusco, we had not taken acetazolamide. This was mostly because I have have seen people have pretty horrible paresthesias with it in the past.
At the airport we met up with the medical students and our minivan cab. All the medical supplies and personal luggage meant we had tons of bags and it took a while to get all these loaded up on the roof. We also waited for a couple of other students to show up on a subsequent flight.
It was about 11.00 AM when we were all ready to go. We needed to be at our hotel in Urubamba at 5.00 PM for an address by Dr. Morales a local physician helping us coordinate the mission.
It seemed a shame not to explore a bit of Cusco since we were already here. The cab driver was willing to show us around and stand by the minivan to guard the bags while we explored.
We had a terrific time in Cusco as it was Sunday and a day of fiesta with a lot of dancers and watchers congregating on the big plaza. We drove up to the Inca Ruins and the statue of Christ on a mountain top (very similar to the one we saw in Lima). Sabrina got to pet and pose with an alpaca. We saw a Peruvian barbecue with families cooking in open fields with food being cooked underground with hot stones in a technique called Pachamanca – underground cooking. I know I keep drawing analogies with Gujarati food (Tacu Tacu and Vaghareli Kichidi) but the resemblance between Pacahmanca and a very traditional Gujarati recipe called Matla nu Undhiyu is uncanny. Both involve taking a mixture of green vegetables and tubers and roasting them with spices in a pot under the ground covered with fire. Take a look at the links to the 2 videos above if you have doubts.
So far it had been a terrific day but we had by now spent about 3 hours at high altitude (that we had not originally planned for) and both Sangita and I got symptoms of Acute Mountain Sickness. The features were typical with headache and nausea and we told the driver to start driving down to the valley which is 2000 feet lower.
On the way, he stopped at a very quaint “store” where they brewed coca tea for us and had Sangita inhale the scent of some fresh herbs and then put them on her head and covered it with a alpaca cap. While Sangita was being ministered to, we got a demonstration of how natural herbs are used to color alpaca wool.
Anyway, either the stuff worked or descending to a lower altitude did the charm for soon we felt better. But Sangita felt it was the herbs that helped and she kept them in her bag for the rest of the trip, just in case. We had to reluctantly throw these away when we got to Lima airport 8 days later so as not to get in trouble at US Customs!
Soon we were in a beautiful sacred valley and pulling up at the serene La Quinta Eco Lodge which would be our home for the next 6 days.
Senor Edwin Gonzalez runs a tight ship here and supervises a very caring and professional staff for whom our every wish is a command.
We got a gracious welcome from Dr. Morales and enjoyed a great 3 course meal. The amount of preparation that went into this trip was reflected in the fact that they did not need to be told about our vegetarian requirements. The WiFi was working, the showers had hot water and the bedroom was huge. We were all set to focus on our mission.