HEALTH & SAFETY ISSUES ON SIERRARIOS TRIPS

There are several aspects of health and safety to consider on a whitewater river expeditions. 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 both your and responsibility. Risks fall into various categories:


HEALTH ISSUES

Overview:
There is a chance you get sick during an 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, there will be at least one guide 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 the destination country and visit a doctor well before the trip. Consider requesting prescriptions for acetazolamide (to prevent altitude sickness if going to high elevations), ciprofloxacin (to treat traveler's diarrhea), and scheduling appointments to get immunizations.

Immunizations/Malaria:
It is often recommended by the CDC that folks traveling to less developed countries be vaccinated against Hepatitis A, Typhoid and Tetanus.  If you're entering tropical areas, you might also consider getting Yellow Fever and Rabies immunizations and taking anti-Malaria medicine (depending on the risk).  Look at the threat from Malaria where you will be traveling and take appropriate precautions. Anyone doing a trip in sub-Saharan Africa (such as on the Blue Nile) should take anti-malaria medication, as without it, the risk is very high that you will contract this disease. [see this Malaria MAP from the CDC].  

Traveler's diarrhea:
One of the most common ailments among tourists in less developed countries is traveler's diarrhea (gastrointestinal problems).  You should try to minimize chances of getting it by avoiding potentially contaminated 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, invariably many foreigners still get traveler's diarrhea on a river trip. It almost never afflicts local people or folks who spend a lot of time there and are accostumed to the microbes. If you suffer from traveller's diarrhea, the symptoms are usually upset stomach, diarrhea, nausea, lack of appetite, fever, general fatigue and/or vomiting. It usually lasts 1-3 days but sometimes lasts longer (especially the loose stools). You can treat some symptoms with Pepto bismol, Tums, 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 usually have some courses of ciprofloxacin on the trips, but it might not be enough. If you can get some to bring along, please do so (and let the trip leader know). Also, do note that antibiotics will only treat the problem if it is due to bacteria (whereas up to half of all traveller's diarhhea cases are due to viruses or protozoa).

Altitude Sickness:
In some countries we will be driving or going to high altitude (such as on the Upper Grand Canyon section of the Marañón in Peru). If you will be going to high altitude possibly from drives over passes at >4000 m (13000 ft), you may suffer from altitude sickness - also called soroche in the Andes. 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. [Note that acetazolamide is 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 trips is usually 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),
- note: epi pens are not generally not provided; although sometimes we do have epinephrine ampules with injection means, if you are allergic to bees or other things and may suffer anaphylactic shock, you should bring your own prescription epi pen

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SAFETY ISSUES

Rapids:
There are significant risks in whitewater rapids that you must be aware of. General SierraRios trips have competent trained guides in charge of rafts who can take passengers safely through the section of river to be navigated. Such passengers must follow the instructions of the guide, which at times means walking around class V rapids. We also allow competent participants to be in charge of their own kayak, IK, or raft. If you are in charge of a boat, 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 first and then running rafts one at a time so that two rafts are not overturned or stuck at the same time - which could overwhelm the safety crew below. 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. In some cases, a rapid must be run as portaging would be very difficult or involve a long detour (such as at Shapalmonte rapid on Río Marañeon (on the UpperGC section) and Mayas rapid (in the InnerGorge). This should be considered before deciding to join a trip. Note that our rating of a class V rapid may be different than what you are used to. We consider rapids like Hance and Lava Falls in the Grand Canyon of the Colorado only class IV. In general, class V means there is excessive risk for flipping, injury or death. We generally do not take passengers or clients through any class V, and if so, it is only with a lot of safety in place. SierraRios LLC assumes no responsibility if there is damage, loss, or death due to accidents occuring on or off the river

Camp/Hikes:
Accidents or problems can occur not only on the water, but also 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). SierraRios LLC assumes no responsibility if there is damage, loss, or death due to accidents occuring on or off the river

Shuttles:
We cannot guarantee against accidents in shuttle vehicles. We employ local shuttle vehicles to and from the river and select newer buses with seasoned licensed drivers that minimize the chance of an accident. However, accidents can always occur, and we are not responsible for damage, injury, loss or death if so. 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 who might be able to make changes or alternate arrangements. We generally provide or strongly recommend options like flights that minimize risks from long drives on winding mountain roads in possibly dangerous conditions. SierraRios LLC assumes no responsibility if there is damage, loss, or death due to accidents during transport

People:
It is possible to encounter unfriendly people at any point on a trip and we cannot control for this. However, on many sections of river where the threats are known, we employ precautions to keep our groups safe. This may involve hiring local guides to accompany our group (e.g., Jungle Marañón) and/or paying armed security to join the group on the rafts (e.g., Blue Nile) or nearby in a motorboat (e.g., Usumacinta). Each river has its unique character and threats. We always seek to keep our groups safe from all negative encounters or assaults. SierraRios LLC assumes no responsibility if there is damage, loss, or death due to unfriendly human interactions

Special note on Peru trips: While there is generally no threat from the Sendero Luminoso terrorist group anymore, assault and robbery can happen anywhere in Peru. 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 guides on rafts. However, in some places, and particularly in the jungle with the Awajún, we can still encounter unfriendly people who do not know the history of our interactions with village leaders and their approval of our passage. In the jungle section, we always employ Awajún guides who join us 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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Special note on Ethiopia trips: Long ago the Blue NiIe canyon was one of the most notorious for assaults on river runners, but in the past 10-20 years with more stability in the country and the virtual disappearance of the shifta, assaults do not occur. On some trips, we have employed armed militia to accompany our groups on the Blue Nile and other rivers, though we have found all residents we encounter friendly and with the bilingual guide who we always have with us, there is no need for armed security. We always take great precautions to ensure the safety of our groups, but depending on the current situation and threats, you may or may not have armed security on your trip.
Special note on Myanmar trips: All whitewater rivers in Myanmar are located in "restricted areas" and require special permits from the government to access. These areas are in the surrounding border states where the majority of residents are non-Burmese ethnic minorities such as Kachin, Shan, Wa, Pa-o, Tai, Karin, Karenni, and Chin. For decades the minorities have sought independence and/or more autonomy to control their own regions and people, with most maintaining standing militias/armies. These ethnic armies sometimes come into conflict with the central Burmese army (Tatmadaw) leading to many issues reported on periodically. Permits for foreigners are not granted to areas where there is more unrest or perceived danger. Nevertheless, there are still risks to entering the restricted areas, with possible detainment by ethnic armies and/or encounters with armed militia. In general, even during such encounters, we as foreign tourists with bilingual Burmese guides along who have communicated with the relevant ethnic minority leader, are generally well-treated and allowed to pass in peace, though there can be delays/detainment until permissions are verified.


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 or Garmin InReach device and a local cell phone for communication during 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 Garmin or SPOT device, OK messages with position will generally be sent out from camps where anyone can view the current status of the trip.

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 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 most rivers that we run. In the event of critical life-threatening injuries, we will use the satellite phone to call and arrange a helicopter evacuation. [In Peru, "Apache" is our contact - a pilot and former army general who knows all other helicopter pilots in the country. 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.


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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!