Safety/Health issues on SierraRios trips in Peru

SAFETY & HEALTH ISSUES ON SIERRARIOS TRIPS IN PERU

There are several aspects of safety to consider on a whitewater river expedition in Peru. Although we take measures to minimize the risk of something negative happening such as injury, sickness, or property loss, you need to realize what can occur and what your responsibility is. Risks fall into various categories:

SAFETY ISSUES

Rapids:
There are significant risks in whitewater rapids that you must be aware of. SierraRios trips generally allow competent participants to be in charge of their own kayak, IK, or raft. You must understand the risks associated with navigating your own craft, be honest about your ability level, and take precautions to minimize problems in rapids. Those in charge of boats must accept responsibility for what happens to them on the river, as well as for any damage to or loss of boats/oars/frames/etc. A certain level of freedom will be provided to those in charge of a boat, but each such person must abide by trip leader requests, which may mandate not paddling certain rapids. At bigger rapids we generally stop, scout and discuss a plan. The plan usually involves having safety kayakers in the water and running rafts one at a time so that two rafts are not overturned or stuck at the same time - which could overwhelm the safety kayakers and rafters. If you are not comfortable with the safety set-up, please discuss with the trip leader to make modifications to the plan. You generally will have the option to portage a tough rapid or have a guide run your boat through the rapid. Those who are passengers or paddlers on rafts also are responsible for making the decision to ride in a raft through rapids or walk around. On Río Marañón, exceptions exist at Shapalmonte rapid (on the UpperGC section) and Mayas rapid (in the InnerGorge), two class IV rapids that are difficult to walk around and generally must be passed in a boat. This should be considered before deciding to join the UpperGC or Inner Gorge sections of the trip.

Camp/Hikes:
Accidents or problems can occur off the water. For example, while loading/unloading rafts, in camp, and on hikes it is possible that you sustain an injury. What happens to you off the water is your responsibility. For example, you need to make the decision whether to attempt to climb past a waterfall in a side canyon (where you can fall and break a leg), whether to attempt to lift a heavy pail of water (that might strain your back), where you step in camp (objects can cause trips and falls), and how you handle hot or other potentially dangerous objects (boiling water can spill on you and burn you).

Shuttles:
We cannot guarantee against accidents in shuttle vehicles. We have employed shuttle vehicles to the put-in on newer buses with seasoned drivers that minimize the chance of an accident, and always try to select safe transport vehicles. As a participant you should consider the vehicle transport offered on the trip, and if you are not comfortable with the arrangement, discuss with the trip leader.

People:
It is possible to encounter unfriendly people at any point on the trip. While there is generally no threat from the Sendero Luminoso terrorist group anymore, assault and robbery can happen anywhere. Also, along the river, villagers in the Lower Grand Canyon section and in the Jungle Pongos may be suspicious and detain/rob/force-out river-running groups if they do not know or trust the group (e.g., see C&K article Mendán; C&K article Asháninka). This risk is now minimal on SierraRios trips since we've run groups numerous times through these areas, our guides know villages leaders, and we usually take along local folks on rafts. Note that in the jungle, the Awajún do not allow passage by their villages without approval. SierraRios has secured such permission for our trips and we expect to have such approval on all trips along with Awajún guides who will join us on parts of the jungle sections for safety and cultural interactions. These guides sometimes recommend against travel further downstream for various reasons. If a trip ends short of the intended destination due to this unforeseen safety threat, no refunds are provided. [You might be able to recover something from a travel insurance policy for cancelled trips or portions thereof that are out of our control]
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LIABILITY / COMMUNICATION / EVACUATION

Liability/Insurance:
All participants joining a trip will be required to sign a liability waiver/agreement. Please read it over and consider the implications before deciding to sign up for a trip. It is strongly recommended that all participants have medical insuance to cover hospital/medical costs as well as travel insurance to cover rapid evacuation and property loss. Travel insurance policies can be purchased online through Squaremouth, Tavelguard, or Travelsafe. You are responsible for personal equipment loss, missed flights, and/or evacuation/medical costs.

Communication:
SierraRios trips will generally have an Inmarsat satellite phone, cell phone, and sometimes a SPOT device on the trip. Participants can make calls from the satellite phone for $1.50/minute (from anywhere in the canyon) or from the cell phone ($1.00/minute; limited coverage available) to anywhere including the USA. If we have a SPOT device, OK messages with position will generally be sent out from camps where anyone can view the current status of the trip (at the SPOT link here).

Loss/damage deposit:
Any person in charge of a boat or gear on the trip is responsible for damage or loss to that equipment, whether it be to their own gear or to SierraRios gear. A damage deposit must be made above the cost of the trip that will cover damage or loss of SierraRios gear. If the loss exceeds the damage deposit amount, you may be required to compensate SierraRios LLC for the loss before you continue on the journey. You are responsible for replacement costs resulting from damage or loss of any equipment while under your control.

Evacuations:
In the event an evacuation is necessary, the general policy will be to raft the injured to the nearest point where easy evacuation can be made - generally a village or road - and then contract a vehicle to the nearest clinic/hospital. If one of these access points is too far away, a litter may be made and the person carried up and out of the canyon on a trail (perhaps with help from local residents). Trail access is available very frequently along the Marañón. In the event of critical life-threatening injuries, we will use the satellite phone to call Apache (our contact who is a pilot and former army general who knows all other helicopter pilots in the country) and arrange a helicopter evacuation. Apache's contact is written inside each satellite phone box. SierraRios LLC is not responsible for personal equipment loss, missed flights, and/or evacuation/medical costs.

HEALTH ISSUES

Overview:
There is a chance you get sick during the expedition. Common problems experienced are traveler's diarrhea, bug bites, altitude sickness, colds, cracked skin, foot fungus, and skin infections. Other injuries can occur such as dislocated shoulders, broken bones, sprains and lacerations. We will have a major first aid kit with pharmaceuticals. On SierraRios trips guides are trained to administer first aid (guides have completed courses in Wilderness First Aid or Wilderness First Responder - inquire about the guides on your trip to find out their level of training and most recent course completion dates). While we take precautions to minimize problems such as traveler's diarrhea (see below) and accidents, it is generally up to the participant to keep themselves in good health. Participants should consult the CDC website for information on traveling in Peru and visit a doctor well before the trip. Consider requesting prescriptions for acetazolamide (to prevent altitude sickness), ciprofloxacin (to treat traveler's diarrhea), and scheduling appointments to get immunizations. Additional information is below:

Immunizations/Malaria:
It is recommended by the CDC that folks traveling to Peru be vaccinated against Hepatitis A, Typhoid and Tetanus. If you're entering the jungle areas, you might also consider getting Yellow Fever and Rabies immunizations and taking anti-Malaria medicine. In general, the main Grand Canyon of the Amazon section down to near Bagua is in arid terrain with few mosquitos, where the CDC puts little risk of Malaria. This probably holds for Yellow Fever as well. [see this Malaria MAP from the CDC]. If you are planning to visit a doctor before the trip and get some immunizations, you should also request some additional prescriptions to treat/prevent traveler's diarrhea and/or altitude sickness (below).

Traveler's diarrhea:
One of the most common ailments among tourists in Peru is traveler's diarrhea (gastrointestinal problems), also referred to sometimes as Montezuma's Revenge. You should try to minimize chances of getting it by avoiding potentially dirty foods before the trip. During the trip we'll do what we can to prevent it by strictly adhering to NPS Sanitation Guidelines: basically minimizing the microbe exposure through liberal use of sanitizing solutions (bleach in water at about 100 ppm) for hand-washing, dish-washing, table-wiping, and cleaning veggies/fruits. There will be a hand-wash station at camp that you should always use after bathroom use and before handling food/plates. See the FOOD/WATER section for more details. Despite these measures, and perhaps because there is contact with river water and other microbe-containing surfaces, invariably many foreigners still get traveller's diarrhea on a river trip. It almost never afflicts Peruvians or folks who spend a lot of time there and are used to the microbes. When it strikes you, the symptoms are upset stomach, diarrhea, nausea, lack of appetite, general fatigue and sometimes vomiting. It usually lasts 1-3 days but sometimes lasts longer (especially the loose stools). You can treat some symptoms with immodium and anti-nausea pills, but if you want to eliminate the problem completely, you should start a course of antibiotic (ciprofloxacin) immediately and take for 3 days or until symptoms subside. We will have some ciprofloxacin on the trip, but it might not be enough. If you can get some to bring along, please do so (and let the trip leader know).

Altitude Sickness:
Folks who will be starting on the Upper GC section will base out of Huaraz, which is at 3000 m elevation (10000 ft). This high altitude, with associated drives over passes at >4400 m (14000 ft), and possibly some hikes before the trip, may lead to altitude sickness - also called soroche in Peru. Symptoms are light-headedness, headache, nausea, and fatigue. If you're acclimatized to the altitude for several days, it probably will not affect you. If you're not acclimatized, you might suffer. You can prevent altitude sickness with acetazolamide (also known by trade name Diamox), a prescription medicine that increases bicarbonate excretion in urine and therefore lowers the pH of your blood (higher blood pH is one of the primary causes of altitude sickness). Folks who take acetazolamide starting 1/2-1 day before getting to high elevation often can go up to above >16000 ft for several days without adverse effects. If you're going to the doctor to get immunizations and/or antibiotics, you might also mention that you'll also be at high altitude and request a dose of acetazolamide. It's surprisingly hard to find in Peru. The common "anti-soroche" pills they sell down there are simply aspirin or tylenol, which do little for most of the symptoms.

Major First Aid box:
The major first aid kit on Marañón trips is a large ammo can and will contain bandages, implements (scissors, safety pin, syringe and needle), tape, bandaids, a Sam splint, and some pharmaceuticals:

- analgesics (percocet, vicodin)
- anti-inflammatories (ibuprofen, tylenol, aspirin)
- anti-histamines (Claritin, diphenhydramine)
- GI treatmens (Pepto-bismol/Tums, immodium)
- anti-fungals (clotrimazol)
- topical antibiotics (neomycin, tri-ointment)
- anti-itch (ointment/creams)
- cold symptom relief (Halls, decongestants)
- vaseline/heel cracking lotion (Bag balm or similar),
- oral antibiotics (ciprofloxacin, amoxicillin/other (for respiratory or ear infections),
- epi pen (though this may not be up to date - if you are allergic to bees, you should bring your own epi pen]

SUMMARY
SierraRios expeditions are often some of the most memorable experiences in participant's lives. The information on this page is not meant to scare you from joining a trip, but rather to prepare you for some of the problems that might be encountered so that you act responsibly and get adequate insurance. So sign up for an expedition, be challenged with a new experience, enjoy it in a safe way, and help us protect some of these incredible river canyons!