This was a bit of a bitter sweet day. It was the last day of clinic for us and we felt sad that this phase of our trip was over. We had enjoyed the experience and hopefully made a small difference in the lives of some people. We had made great friends and learned a lot about the Sacred Valley and its people. The medical students had been impressive in their energy, planning, zeal, adaptability and collegiality. Sangita was a bit concerned that there was no ophthalmologist following her after we left but also quite confident in the skills of the many students that had worked with her the previous 5 days.
At the same time we were looking forward to Machu Picchu and hoping it would live up to all our expectations. The plan was to go to clinic and then around 3.00 PM have a cab pick us up, take us back to the hotel, pick up our bags and leave for Ollantaytambo where we would catch a train for Aquas Callientes. A few points regarding logistics to help future visitors to this area:
- The train has limited space for carry on bags. This is particularly true of the Vistadome trains. We did not see anyone being stopped but if you do have huge bags it might be a problem. Also, if your hotel in Aquas Callientes is not close to the station, you will have a lot of hard work to do. So you want to take only the minimum amount of stuff with you. Most people leave their larger bags at their hotels and just take a back pack.
- We were going to not come back to our hotel in Urubamba, instead going straight to Cusco. Senor Edwin the hotel owner/manager suggested we send the larger bags via cab to our hotel in Cusco. He guaranteed that they would arrive safely there and be waiting for us when we got there. This was excellent advice and much appreciated.
- There are several types of trains – with the Expedition and the Vistadome being popular options. Vistadome’s claim to fame is the better view of the surrounding landscape for a slightly higher price. Before you splurge on this, check the times for sunset/sunrise. In June, it gets dark by 6.00 PM in the valley and you won’t be able to see much. Also the Vistadome has less luggage space as noted above.
- If you have a relatively inflexible schedule, you want to buy your train tickets online ahead of time. The major barrier is the problem with the web site accepting credit cards. If your card does not work, you can contact them via phone/email and email a scanned copy of your passport and credit card to get confirmed tickets.
We took a public bus to Lamay Clinic which is where the Peru program started. It thus holds a very special place in the history of the Peru Health Outreach Project.
The clinic is very nice and clean with a small garden in the courtyard. We saw a lot of more complex medical problems here. We did still have quite a few patients speaking Quechua only even though this was not quite as rural.
The medical director of the clinic was able to help us with some translations but one of the most helpful people was a patient. He was way back in line but volunteered his services to help other patients. We would call him in to help and then he would go back to his place at the back of the line. Even other patients in the room pitched in to help and HIPAA seemed to an issue from another planet.
I will not forget one of the patients we saw. She spoke only a bit of Spanish but we did not realize this right away as she started responding to our questions in Spanish. It seemed she had stomach pains and wanted pain medications. We were unable to determine the cause of this by history or exam. It did not seem to be dyspepsia or a gall stone or other common problem. She also seemed to have a sadness about her that was hard to pin down. We thought she might be depressed and called in the medical director to find out about options for possibly treating and following up on this. The director picked up that she was more comfortable in Quechua and elicited that she had been told she has incurable stomach cancer and she just wanted to get some pain relief. Apparently she did not know enough Spanish to tell us all this and we had lost something in translation. One of the first questions we asked in triage was regarding language and need for translators but she apparently felt she would be able to communicate adequately in Spanish. Another lesson learned – instead of asking patients if they spoke Spanish, maybe ask them if they would prefer to use Quechua! Medical diagnosis is heavily reliant on history taking and this case again highlighted the need for open and excellent patient – physician communication.
Overall both the students and faculty members were getting more comfortable with the workflow and more efficient. At times I would be working with 3 students simultaneously – one taking history, one doing an examination and one doing counseling and education. Sabrina when she was not helping in ophthalmology would come over to help with the history taking in medicine.
She told me, “Medicine is so cool! It is like a mystery you are trying to solve by talking to the patient.” I am glad she was able to get this insight so early before being dazzled and brainwashed by hi-tech and low-talk specialties.
Soon it was time to leave. Luckily all patients were seen by the time we left and so we did not feel guilty about leaving a bunch of work for the others. Greta, one of our colleagues was going to accompany us on the same train so along with her we did our goodbyes and hugs and left in our cab.
The cab driver spoke only Spanish but between Greta and Sabrina we got a lot of information from him about the sacred valley. He showed us a town with a Puma statue in the center. The town is named after a Puma because the mountain next to it is shaped like one!
We picked up our back packs from the La Quinta Eco Lodge, said goodbyes and thanks to Edwin and the staff there and then drove on to Ollantaytambo. Ollantaytambo is a beautiful town and if your schedule permits, allow some time to explore it.
Also for some strange reason, the handicraft shops next to the train stations have some of the best prices compared even to the ones in the Pisac Mercado. There is a decent waiting room inside the train station but it can get very full at times. Instead if you need a place to sit, there is a great cafe just outside the train station gates which serves good coffee and also has pizzas made in wood-fired ovens.
The trains work very much on schedule and are very nice and comfortable. Most of the people taking these are tourists and thus you have opportunity to meet and strike up conversations with people from around the world.
We had one brief scary moment. We were lined up to enter our coach when another train came in. There is no raised platform so the only thing separating from being crushed to death was a yellow line in on the ground. The train did come in very slowly and the officials made sure everyone stayed behind the line. Still a pretty scary moment!
The train ride itself was quite uneventful. It was dark and there was not much to see. Next to me was a couple visiting from Australia whose daughter lives in Peru.
So we had a great conversation about Sydney and Peru and US and India and time passed quickly. At the train station a person from our hotel was waiting for us with a sign.
It was dark and getting cold. We followed him on a brisk uphill walk to the hotel glad that we did not have large bags to carry. We were tired and wanted a good nights rest before getting up early for a bus ride to the top, to get there in time to see the sunrise from Machu Picchu. Aquas Callientes has many many places to eat and food is thus not a problem. We were staying at Hotel Green Nature which has been recently refurbished. There is WiFi but with poor reception in the rooms. The bathroom is excellent with hot showers and they serve breakfast starting at 4.30 AM for those trying to make it to the first bus. The owner speaks English and is able to provide information regarding bus and Machu Picchu tickets if you need. Being a worry wart, I had called the hotel from the US to confirm our reservation and he gave me a 10% discount just for doing that!
There are two reasons to get up early for the first few buses. One is to see the sunrise over Machu Picchu. In June, this occurs right around 6.00 which means you want to be on one of the first 3-4 buses. These first bus leaves at 5.00 AM and the subsequent ones as soon as they are full and take about 30 minutes. The other reason is to be one of the first 400 people to reserve a spot to climb to the top of Huyana Picchu. Either way you want to be at the bus station close to 4.45 AM or even sooner. There are a number of people who come to Machu Picchu by morning train and leave that same day. Getting up early can help you beat these madding crowds! This will also allow you to most likely see Machu Picchu’s mystic side, shrouded by fog and clouds. On the flip side it starts getting warm at around 10.00 AM and if you get there after that, you can avoid carrying an extra layer of clothing.