Health & Safety

Staying Healthy

Contact the International Association for Medical Assistance to Travelers (IAMAT; tel. 716/754-4883 or, in Canada, 416/652-0137; www.iamat.org) for tips on travel and health concerns, and for lists of local, English-speaking doctors. The United States Centers for Disease Control and Prevention (tel. 800/311-3435; www.cdc.gov) provides up-to-date information on health hazards by region or country and offers tips on food safety. The website www.tripprep.com, sponsored by a consortium of travel medicine practitioners, may also offer helpful advice on traveling abroad. You can find listings of reliable clinics overseas at the International Society of Travel Medicine (www.istm.org).

No vaccinations are officially required of travelers to Peru, but you are wise to take certain precautions, especially if you are planning to travel to jungle regions.

A yellow-fever vaccine is strongly recommended for trips to the Amazon. Peruvian authorities confirmed an outbreak of yellow fever in the northeastern Department of Amazona in December 2005. The Pan American Health Organization reported an outbreak and 52 total cases of yellow fever in Peru during the first 6 months of 2004, with slightly more than half of those resulting in death. (However, just two of those occurred in areas covered in this guide, Loreto and Madre de Dios.)

The Centers for Disease Control and Prevention (tel. 800/311-3435; www.cdc.gov) warn that there is a risk of malaria and yellow fever in all areas except Arequipa, Moquegua, Puno, and Tacna, although Lima and the highland tourist areas (Cusco, Machu Picchu, and Lake Titicaca) are not at risk.

In the airport at Puerto Maldonado, in the southern jungle, public nurses are usually on hand to administer yellow-fever shots to travelers who have not received the vaccination. Carry your vaccination records with you if you are traveling to the jungle. The Centers for Disease Control and Prevention also recommend taking antimalarial drugs at least 1 week before arriving in the jungle, during your stay there, and for at least 4 weeks afterward.

The CDC also recommends vaccines for hepatitis A and B and typhoid, as well as booster doses for tetanus, diphtheria, and measles, although you might want to weigh your potential exposure before getting all these shots. For additional information on travel to tropical South America, including World Health Organization news of disease outbreaks in particular areas, see the CDC website at www.cdc.gov/travel/tropsam.htm. Also of interest is the WHO's informational page on Peru, www.who.int/countries/per/en.

Medical Attention

Prescriptions can be filled at farmacias and boticas; it's best to know the generic name of your drug. For most health matters that are not serious, a pharmacist will be able to help and prescribe something. In the case of more serious health issues, contact your hotel, the tourist information office, or, in the most extreme case, your consulate or embassy for a doctor referral.

It's wise to get all vaccinations and obtain malarial pills before arriving in Peru, but if you decide at the last minute to go to the jungle and need to get a vaccine in the country, you can go to the following Oficinas de Vacunación in Lima: Av. del Ejército 1756, San Isidro (tel. 01/264-6889); Jorge Chávez International Airport, second floor; and the International Vaccination Center, Dos de Mayo National Hospital, Av. Grau, block 13.

Common Ailments

As a tropical South American country, Peru presents certain health risks and concerns, but major concerns are limited to those traveling outside urban areas and to the Amazon jungle. The most common ailments for visitors to Peru are common traveler's diarrhea and altitude sickness, or acute mountain sickness (AMS), called soroche locally.

Altitude Sickness -- Cusco sits at an elevation of about 3,400m (11,000 ft.), and Lake Titicaca sits at 3,830m (12,566 ft.). At these altitudes, shortness of breath and heart pounding are normal, given the paucity of oxygen. Some people experience intense headaches, loss of appetite, extreme fatigue, and nausea. Most symptoms develop the first day at high altitude, although occasionally travelers have delayed reactions. The best advice is to rest on your first day in the highlands. Drink plenty of liquids, including the local remedy mate de coca, or coca-leaf tea. (Coca, as opposed to cocaine, is a mild sedative, and it's perfectly legal to consume coca tea or chew coca leaves in Peru, though it's not legal to bring back coca leaves.) Avoid alcohol and heavy food intake. Give yourself at least a day or two to acclimatize before launching into strenuous activities. Many hotels in Cusco offer oxygen for those severely affected with headaches and shortness of breath. If symptoms persist or become more severe, seek medical attention. People with heart or lung problems and persons with the sickle cell trait could develop serious health complications at high altitudes, or even die from medical conditions exacerbated by high altitude.

Sun Exposure -- Limit your exposure to the sun, especially during the first few days of your trip and at high altitudes, from 11am to 2pm. Even though it can be chilly or cold in the Andes, the sun is a killer (the higher the altitude and thinner the air, the more dangerous the sun's harmful rays are). Along Peru's desert coast, the sun is also extremely potent and likely to burn visitors who don't take adequate precautions. Wear a hat and use a sunscreen with a high protection factor (SPF 30 or higher), and apply it liberally. Remember that children require more protection than do adults. Heat exhaustion and heat stroke are serious maladies and are not difficult to get if you don't take proper precautions in Peru.

Dietary Distress -- Visitors should drink only bottled water, which is widely available. Do not drink tap water, even in major hotels, and try to avoid drinks with ice. If you're trekking in the mountains or visiting remote rural areas where bottled water is not available, boil water to purify it or use water-purification tablets. Carry bottled water with you at all times (especially on long bus or train rides); the heat of the desert and the high altitudes of the Andes will dehydrate you very quickly.

You're safer eating fruits that you can peel or salads and fruits washed with purified water, as well as foods that have been thoroughly cooked. Shellfish should be avoided by most; although ceviche is one of Peru's classic dishes, travelers should at least know that the fish and shellfish in it are not cooked, but marinated. That said, many, if not most, travelers eat it with few or no problems. (Your best bet is to eat ceviche only at clean, upscale places.) Vegetarian restaurants can be found in most cities (look for branches of the chain Govinda in the largest cities). If no vegetarian restaurant is available, most others will be able to accommodate you with salads, fruits, and vegetables such as papas (potatoes) and palta (avocado), although palta rellena is usually stuffed with chicken or tuna.

What To Do If You Get Sick Away From Home

Any foreign consulate can provide a list of area doctors who speak English. If you get sick, consider asking your hotel concierge to recommend a local doctor -- even his or her own. You can also try the emergency room at a local hospital. Many hospitals also have walk-in clinics for emergency cases that are not life-threatening; you may not get immediate attention, but you won't pay the high price of an emergency room visit.

If you suffer from a chronic illness, consult your doctor before your departure. Pack prescription medications in your carry-on luggage, and carry prescription medications in their original containers, with pharmacy labels -- otherwise they won't make it through airport security. Also carry copies of your prescriptions in case you lose your pills or run out. Don't forget an extra pair of contact lenses or prescription glasses. Carry the generic name of prescription medicines, in case a local pharmacist is unfamiliar with the brand name.

For travel abroad, you may have to pay all medical costs upfront and be reimbursed later.

Staying Safe

Peru has not earned a great reputation for safety among travelers, although the situation is no longer as dangerous as during the violent crime wave and terrorist threats of the late 1980s and early 1990s. Personal safety is an issue to be taken extremely seriously in most large Peruvian cities, especially Lima, Cusco, Arequipa, and Huaraz. Simple theft and pickpocketing are fairly common; most thieves look for moments when travelers, laden with bags and struggling with maps, are distracted. Assaults and robbery are rarer, but have been reported in many cities. In most heavily touristed places in Peru, a heightened police presence is noticeable, however.

Although most visitors travel freely throughout Peru without incident, warnings must be heeded seriously. In downtown Lima and the city's residential and hotel areas, the risk of street crime, including theft and muggings, remains high. Carjackings, assaults, and armed robberies are not unheard of in Lima. Occasional armed attacks at automatic teller machines occur. Be especially vigilant at Lima's international airport, where a number of robberies and attacks have been reported. Street crime is prevalent in Cusco, Arequipa, and Puno, and pickpockets are known to patrol public markets. In Cusco, "strangle" muggings (in which victims are choked unconscious and then relieved of all belongings) were reported in recent years, particularly on the streets leading off the Plaza de Armas, in the San Blas neighborhood, and near the train station. You should still not walk alone late at night on deserted streets. There were at least three reports of rape in Cusco in 2005, one by a gang. In rural areas outside Cusco, trekkers should travel in groups. A group of hikers along the Inca Trail was attacked and robbed as recently as November 2005.

In major cities, taxis hailed on the street can lead to assaults -- I highly recommend using telephone-dispatched radio taxis, especially at night. Ask your hotel or restaurant to call a cab, or call one yourself from the list of recommended taxi companies.

Travelers should exercise extreme caution on public city transportation, where pickpockets are rife, and on long-distance buses and trains (especially at night), where thieves employ any number of strategies to relieve passengers of their bags. You need to be supremely vigilant, even to the extreme of locking your backpack and suitcases to luggage racks. Be extremely careful in all train and bus stations. Several provincial and inter-city buses and combis traveling from cities to villages have also been attacked and passengers robbed.

In general, do not wear expensive jewelry, keep expensive camera equipment out of view as much as possible, and use a money belt inside your pants or shirt to safeguard cash, credit cards, and passport. Wear your daypack on your chest rather than your back when walking in crowded areas. The time to be most careful is when you have most of your belongings on your person -- for example, when going from airport or train or bus station to your hotel. At airports, it's best to spend a little more for official airport taxis; if in doubt, request the driver's official ID. Don't venture beyond airport grounds for a street taxi. Have your hotel call a taxi for your trip to the airport or bus station.

Report any criminal activity to the nearest police station or tourism police office.

In addition to safety and health concerns, travelers planning a trip to Peru should keep a close watch on current events. Although the large-scale terrorist activities of the local groups Sendero Luminoso and MRTA were largely stamped out in the early 1990s, the U.S. State Department reported a resurfacing of the long-dormant Maoist terrorist network Sendero Luminoso in remote parts of the central highlands in late 2001. In March 2002, a radical offshoot of the Sendero Luminoso was blamed for a car bomb attack that killed 10 near the U.S. embassy in Lima. Two more isolated attacks in 2003 were attributed to Sendero Luminoso. Neither group, however, is currently considered to be active in any of the areas covered in this guide. Peru's political situation remains a bit tenuous, especially after strikes by farmers and teachers in the last couple of years and possible instability related to the 2006 presidential election. However, at present, stability concerns should not deter anyone from traveling to the country. Before you depart, check for travel advisories for your home country.

Discrimination in Peru -- In Peru's larger cities, including Lima and Arequipa, Afro-Peruvians and Amerindian populations occupy the bottom rung of the economic ladder, and they are frequently blamed by the white population for much of the cities' crime. That perception can be consciously or subconsciously directed at travelers of color, who might experience some discrimination, most often expressed in less-than-welcoming receptions at hotels or restaurants. A number of nightclubs in Lima maintain unofficial discriminatory admissions policies.

Ecotourism

The International Ecotourism Society (TIES) defines ecotourism as "responsible travel to natural areas that conserves the environment and improves the well-being of local people." You can find eco-friendly travel tips, statistics, and touring companies and associations -- listed by destination under "Travel Choice" -- at the TIES website, www.ecotourism.org. Ecotravel.com is part online magazine and part ecodirectory that lets you search for touring companies in several categories (water-based, land-based, spiritually oriented, and so on). Also check out Conservation International (www.conservation.org) -- which, with National Geographic Traveler, annually presents World Legacy Awards (www.wlaward.org) to those travel tour operators, businesses, organizations, and places that have made a significant contribution to sustainable tourism.