mlgb

I don't automatically assume that the commercial travel clinics giving consults are going to assign a physician for that task. Most likely it will be a "Travel Nurse", NP, etc..

Because yellow fever is not endemic to the US, not "medically necessary" few places actually have it. In California most people get punted to the commercial clinics (Passport Health). They use NURSES who just read off of the CDC website. That's it. And they want you to bring your own list of inoculations and medical history, they only have what you give them and don't have access to your medical record. A few Public Health Departments and Universities provide travel vaccines, but often just for residents and students. Even fewer will have yellow fever. It's worth checking as the cost will be less than the commercial clinics. I'm also not assuming that you will see anyone but a nurse there, not a "physician".

kja

Thanks for that information, mlgb. Thank goodness I don't live in California! I hope other parts of the US offer travel clinic experiences more like mine in DC.

crellston

Hi KJA.

I based my comments not by assuming anything but on two factors. Firstly significant experience of getting vaccination and travel medical advice from GPs and travel clinics in many different parts of the world and, secondly upon discussions with my son who, after training here in London, is is a consultant and director of training in a major hospital in Australia.

If you actually got to see a "an infectious disease specialist" then I suspect you are in a very tiny minority, The vast majority of people wont have access to such a facility. The vast majority of people looking to receive medical advice and vaccinations will access such advice through nurse practitioners in travel clinics or GP surgeries. Going to you own physician has the benefit that they will have access to your medical history whereas at a travel clinic the patient will be expected to provide that. Either way those individuals providing the care on the front line will rely on data and information from a CDC or NHS or similar website.

Not disputing that you got to see an infectious disease specialist but I would have thought the vast majority of these will be busy working in hospitals or primary research centres rather than in travel clinics.

kja

I had no idea how fortunate I've been!

As mentioned above, I go to the Travel Medicine Clinic at Georgetown University Medical Center in DC. A part of the Infectious Diseases division of that university's / hospital's Department of Medicine, several physicians provide travel medicine services through that clinic. The physician I see (an M.D. with board certification in both internal medicine and infectious disease and an M.S. in clinical epidemiology) focuses on tropical disease and is actively involved in research, education, and treatment. She even did part of her advanced training in Peru. I've seen her several times and have always been impressed by her command of both individual and locality based risks and her ability to help me think through the risks and benefits of various possible interventions. She typically uses the CDC website as a "teaching tool" while providing substantially more -- and more specific -- information than is available on that website.

BTW, she mentioned that the number of residents training in travel medicine or tropical diseases has been relatively low in recent years -- not surprisingly, those who have specialized in infectious diseases have been a bit busy with COVID in the last few years. I have no idea how many physicians with advanced, specialized training provide travel medicine services in the US., but if it's hard to find an expert infectious disease physician for travel consultations now, I can only imagine that it will be harder in the next few years.

crellston

Fortunate indeed kja! Of course the vast majority of travellers will have no real need for that level of expertise. Indeed, I don't imagine it will be too long before such matters are all handled by Artificial Intelligence ......

tom_mn

Here's hopefully the final itinerary:

Lima 2 nights (yellow fever vax, meds, currency)
Ollantaytambo 3 nights (arrive via taxi tour)
Machu Picchu 1 night (arrive via train)
Cusco 5 nights (arrive via train then shuttle)
Puno 2 nights (arrive via Inka Express tour bus)
Colca Canyon 2 nights (arrive via shuttle arranged by lodge)
Arequipa 3 nights (arrive via shuttle arranged by lodge)
Nasca 1 night (arrive via day bus CdS)
Lima 1 night (arrive via day bus CdS, to get into position for morning flight the next day)
Iquitos 1 night (arrive via flight late morning, to be sure to be in position for boat to lodge which is not refundable, cheap insurance, tour the fixed up Amazon boat)
Amazon Lodge 3 nights (transport to/from Iquitos by the lodge)
Lima 3 nights

crellston

Looks good to me! A nice reasonably paced trip. So many people try to rush through these places.

The only slight change I would consider would be to get the train back to Ollantaytambo from AC and then take the taxi tour of the Sacred Valley on the way back to Cusco. The reason being that one of the stops at Chinchero involves an uphill walk from a car park to the plaza of some 20 mins at an altitude of some 3800m ( higher than Cusco) . Some people who have just arrived from sea level find it quite tough.

tom_mn

Understood about Chinchero, but here is what is going on. When MP used to have the am or pm ticketing, things cleared out in the late afternoon and people were able to get some peace at MP then, in addition to early morning. Now with hourly tickets admitting new people till 3pm, they say it's jammed until closing and the only peaceful time is early am, requiring a night's stay nearby. So early rise that day, then spending much of the day at MP and not rushing, and getting the train out late afternoon, therefore no time to sightsee on the journey to Cusco. That altitude is similar to Trail Ridge Road @ Rocky Mtn NP so I know what you mean about being winded, will have to make do. Another option is a day trip from Cusco to Chinchero and a walk down the Inca trail to Urquillos, if it is a pretty walk.

mlgb

Second leg, after Lima you will fly into Cusco, will you be doing the Diamox regime ahead of time? If not I would simply transfer directly to Ollantaytambo and not do anything requiring exertion at all. It really is best to just rest up on that first day to help acclimate. So just "arrive via taxi" and don't do any "touring". Maybe a later afternoon walk in Ollantaytambo around to the old Inca village streets? (Night 1 don't have a big dinner, something like a soup is good, helps with hydration). Next day possibly see the Ollantaytambo ruins. Night 2. There really isn't much else that is very close by to Ollantaytambo, the other sights are really closer to Cusco. Since you want to get into Machu Picchu early, might it be better to take an afternoon train INTO Aguas Calientes and spend Night 3 there? It's a scenic ride and nice to do during daylight.. (Aguas Calientes and Machu Picchu are BOTH lower in elevation than Ollantaytambo).

You can leave most of your luggage at your Ollantaytambo lodging, then spend the night AFTER Machu Picchu there. Then you will be able to do the half-day "taxi tour" on the way from Ollantaytambo to Cusco, stopping at the Moray Circles and Salineras, and Chinchero. (all three at higher elevations) on the way to Cusco and be deposited directly at your Cusco hotel (instead of the annoying and probably more expensive train/shuttle combo). You don't really need an English speaking tour for this, suggest you get a quote from taxidatum, alternatively your hotel can help arrange this on the spot. This also gives you another chance to see Ollantaytambo ruins if you didn't feel up to it early on or if there were some travel delays. Drop a night off of Cusco. You still have plenty of time to see Pisac as a day trip, the other nearby sites such as Sacsayhuaman and the city of Cusco.

tom_mn

I finally paid for MP train and admission tickets. IncaRail was cheaper so went with that, leaving Ollantaytambo at 6:40 am arriving MP Town supposedly at 8:01am. I got Inca Bridge tickets for 10-11am so I think that's plenty of cushion. And if everything goes well with the train/bus, with the bridge tickets we can access the citadel at 9am, an hour earlier, at least that is what I read online (the tickets don't actually say that any more if they ever did).

A tip for others: Don't try to buy MP tickets at work, the security systems in place may not allow the "joinus" app to function. Was able to do it at home.

As you can see, deleted the night in MP town, it just seemed a lot more running around than it was worth. I got a late train back to Olla, 8:20 pm, so plenty of time to eat and check things out in the town, and a cushion if weather holds us up at the citadel for an hour or 2, won't worry about having to make a train.

I think that that was the right decision, a single visit to MP on a day trip from Ollantaytambo, we'll see.

tom_mn

Also: Inquiring that it is true that the Machu Picchu tickets don't actually say "Machu Picchu" on them anywhere??? They say "Entry to Inka Bridge" with a time, name and passport number, and have the Culture Ministry and Joinus logos, and a square bar code on the left side.

tom_mn

I found a sample online, and no, the new tickets do not say "Machu Picchu" on them, just the name of the chosen route.

https://abexpeditions.com/machu-picchu-tickets/

tom_mn

Comment: For Americans, buying domestic tickets on LATAM is a bit fraught. They want you to use the latamairlines.com site, which charges $20-$50 more per ticket than the https://www.latamairlines.com/pe/es site does. Using a reddit for advice, the Latam NZ site offers the lower Peru site fares but navigates in English and charges in US dollars, https://www.latamairlines.com/nz/en Also following the reddit used a Mastercard, bought 2 of my 3 flights that way. Not sure if the card makes any difference. Noting that if one plans to check a bag might as well buy the full economy fare for about the same price and which also offers free seat selection and a refundable fare. Note also that on the Airbus 320, the first row of exit row seats (extra leg room but not reclineable) is selectable at no additional charge when flying full economy.