Did You Know There’s An Imperial City in Peru?

And it’s not Machu Picchu!

Cusco, Peru sitting at 3400 meters above sea level

Cusco: The Imperial City!
Peru, the South American country geographically resembling the state of California, has essentially become synonymous with the architectural wonder of Machu Picchu. However, many may be unaware that in order to get to Machu Picchu, one must first travel to the Imperial City of Cusco (sometimes spelled Cuzco to honor the native Quechuan language). Much less a mandate and more of a pleasant surprise, Cusco immediately captivated my senses with its rich Inca culture, delicious food, and majestic architecture. What didn’t steal my heart? The altitude sickness. Let’s start there.

Myself and a Cusquenan pan-flute musician. This was shortly before my altitude sickness set in. Photo credit: Kesley Howard.

Cusco Will Take Your Breath Away…Literally and Figuratively
From the 13th to 16th century, Cusco, Peru was the capital of the Inca empire; forever cementing it as Peru’s Imperial City. The city itself is shaped like a puma — an animal in the Inca culture with great religious significance and thought to embody earth and power. Cusco sits at an elevation of 3400 m above sea level; that’s 11,200 ft for us non-metric using Americans! Elevations this high are notorious for causing altitude sickness — a syndrome that occurs at high elevations due to decreased amounts of oxygen in the air. The body essentially goes into panic mode due to the decreased oxygen supply. Symptoms of nausea, headache, shortness of breath, dizziness, and fatigue are telltale signs you’re experiencing altitude sickness. The symptoms are almost immediate as you land and exit your plane.

Arriving in Cusco 1–2 days before any planned activity is recommended to acclimate to the altitude sickness. Acetazolamide, a medication often used for the prevention and treatment of altitude sickness, is also recommended. Initiation of therapy is usually recommended 24–36 hours prior to arriving at high altitude. Copious water and sugar consumption are also touted as remedies for altitude sickness. The most interesting of remedies for altitude sickness is coca. Coca (not cocoa) tea, a hot beverage made from tea leaves that contain the raw product ultimately responsible for the drug cocaine, are a natural remedy for altitude sickness. The leaves’ analgesic, anti-thirst, and energizing effects are thought to both ease and treat the uncomfortable symptoms of altitude sickness. In Cusco, coca is ubiquitous and comes in many forms — candy, leaves for chewing or stuffing in your cheek like tobacco, or the tea form.

Therapies for altitude sickness. Left: Coca tea. Right: Acetazolamide.

Fun fact: The wildly popular and addictive beverage, Coca Cola, was initially created as an alternative to morphine and is derived from the Coca leaf! It also once contained very small amounts of cocaine! The coca leaves currently used to make Coca Cola are “decocainized”!

Even with strict adherence to every precaution and recommendation, I was no match for Cusco’s high elevation. My battle with altitude sickness commenced almost immediately. As I exited the airport, I felt light on my feet and had a tingling sensation in my fingers and toes (also possibly a side effect of acetazolamide). Then there was the Airbnb rented by myself and my travel companions. It was draped with an almost never-ending flight of stairs. A feat that would take seconds at regular altitudes now rendered me a panting and breathless rendition of my former self. Resting every 8–10 steps was all but mandatory for fear of passing out. By the end of the night, nausea, body aches, and a headache to battle even my worst migraine, were undeniable realities that confirmed I was experiencing altitude sickness. I drank another cup of coca tea, took my evening dose of acetazolamide, some migraine medication, naproxen, and Zofran and called it a night! (Don’t judge me! What can I say? I’m a doctor and I don’t travel without a full pharmacy!)

By morning, due in part to a good night’s rest and my arsenal of medications, my altitude sickness resolved — and not a moment too soon! It was time to see Cusco in all its glory!

Read on to see how I spent my first day in Cusco, Peru!

It’s all smiles on the streets of Cusco! Take that altitude sickness!

Shopping in San Pedro Market
If you’ve been following me on Medium or any of my social media platforms, you know that visiting the market is by far one of my favorite things to do in a new country. Cusco was no different! There was so much to see! Fruits, vegetables, textiles, smoothies, nuts, dried fruits, and potatoes! Sooooo many potatoes! As the capital of the Inca Empire, Cusco played a significant role in the empire’s agriculture. The native people of Cusco are believed to have cultivated over 3,000 species of potatoes! Coca, in every form imaginable, was wildly abundant at the market! Coca leaves, coca candies, coca tea, coca chocolate — it was all there for the taking. Food stalls were also present where one could partake in many of the areas traditional Andean cuisines (Andean refers to the Andes mountain region). I purchased my beloved llama sweater from the market and it remains one of my favorite souvenirs from my time in Peru.

Treats and goodies at the San Pedro Market

Marveling at the Architecture
Given the wonder that is Machu Picchu, it’s obvious that the Inca are no strangers to architecture. At every corner, the cathedrals, statues and home dwellings of the city of Cusco underscore this fact. Plaza de Armas, Cusco’s main square and the historical gathering spot of the Inca Empire, and Plaza de San Francisco are perhaps the most popular examples of the Inca and ultimately, Spanish colonial architecture. I literally stood in the middle of these plazas and slowly turned in a circle in an effort to somehow appreciate and internalize the magnificence around me.

Basking in the sunshine in Cusco’s Plaza de Armas

Fun fact: Jose Gabriel Tupac Amaru, the rebel leader who lead an uprising against Spanish rule and serves as a Peruvian symbol of the struggle for independence, is honored with a statue in the center of Plaza de Armas. It’s also believed that he was the inspiration behind the renaming of iconic rapper, Tupac Shakur.

Free Walking Tour
Did someone say “free”? Count me in! Just kidding…kind of! What can I say? I love a bargain and the walking tour with Free Walking Tours Peru, LLC was just that. Our tour guide, Cesar, was so informative and truly made me fall in love with this beautiful city. We walked the entire central area of Cusco while simultaneously learning about history, cuisine, and architecture. Three of the most memorable things I learned were:

1. You can always identify a Cusquenan man because he is usually short in stature, has beautiful caramel-colored skin, a broad chest (an evolutionary adaptation to assist with high elevations), and is clean-shaven!

2. Most Cusquenan homes will have two ceramic bulls perched on the roof. The Bulls of Pucara, a tradition that dates back to the Inca culture, are thought to bring protection and good fortune to those who reside in the home.

Bulls of Pucara atop a Cusquenan home. They’re thought to bring good fortune and protection.

3. At the time of their death, Cusquenan families would bury their loved ones in the floor of the home!

Skeleton of a deceased Cusquenan family member buried in the floor of the home.

In the shadow of its ever-popular neighbor, Machu Picchu, Cusco doesn’t always get the notoriety it deserves. But trust me! This beautiful Peruvian town is vibrant and full of history, cuisine, and culture. I’m so glad the high elevation didn’t get the best of me or I wouldn’t have been able to explore it! If you’re visiting Peru, be sure to allow 1–2 days to enjoy and experience all Cusco has to offer. If you’ve been to colorful Cusco, what was your favorite part?

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World Traveler. Peds Rheumie doc. Lover of life & its lessons. I write to inspire, entertain, and educate! Follow on IG: @docwash11

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