What else is a North London housewife just back from Peru going to cook?
Cauliflower, steamed until tender then finely chopped, combines beautifully with quinoa and cumin. Millet would also work though you could go the whole tradition and use pasta.
2tablespoons extra virgin olive oil
½medium onion, finely chopped with garlic if liked
1 ¼cups water
Salt to taste
1pound cauliflower (1/2 medium head), broken into florets
1cup low-fat cottage cheese
1scant teaspoon cumin seeds, lightly toasted and crushed
Freshly ground pepper
Heat 1 tablespoon of the olive oil in a medium saucepan and add the onion. Cook, stirring, until just about tender, 3 to 5 minutes, and add the quinoa. Cook, stirring, for another 2 to 3 minutes, until the quinoa begins to smell toasty and the onion is tender. Add the water and salt to taste and bring to a boil. Cover, reduce the heat and simmer 15 to 20 minutes, until the quinoa is tender and the grains display a threadlike spiral. If any water remains in the pot, drain the quinoa through a strainer, then return to the pot. Place a dish towel over the pot, then return the lid and let sit undisturbed for 10 to 15 minutes
Meanwhile, steam the cauliflower over 1 inch of boiling water for 10 minutes, or until tender. Remove from the heat
Preheat the oven to 375 degrees and oil a 2-quart baking dish or gratin
Finely chop the steamed cauliflower, either with a chef’s knife or using a food processor fitted with the steel blade. Place in a large mixing bowl. In a food processor fitted with the steel blade, purée the cottage cheese until smooth. Add the eggs and process until the mixture is smooth. Add salt (I suggest about 1/2 teaspoon), pepper and the cumin seeds and mix together. Scrape into the bowl with the cauliflower. Add the quinoa and stir everything together. Scrape into the oiled baking dish. Drizzle the remaining oil over the top and place in the oven
Bake 35 to 40 minutes, until the top is lightly browned. Remove from the oven and allow to cool for at least 15 minutes before serving. Serve warm or at room temperature, cut into squares or wedges
Cusco is the historic capital of the Inca Empire from the 13th until the 16th-century Spanish conquest. It has become a major tourist destination, hosting nearly 2 million visitors a year and most of them seemed to be there when we were visiting.
Between the tourists and the people trying to make money from the tourists, it’s a busy kind of place and high at around 3,400m with a population of about 434,000 people.
The first cathedral built in Cusco is the Iglesia del Triunfo, built in 1539 on the foundations of the Palace of Viracocha Inca. Today, this church is an auxiliary chapel of the Cathedral.
The main basilica cathedral of the city was built between 1560 and 1664. The main material used was stone, which was extracted from nearby quarries, although some blocks of red granite were taken from the fortress of Saksaywaman.
This great cathedral presents late-Gothic, Baroque and plateresque interiors and has one of the most outstanding examples of colonial goldwork. Its carved wooden altars are also important.
The city developed a distinctive style of painting known as the “Cuzco School” and the cathedral houses a major collection of local artists of the time. The cathedral is known for a Cusco School painting of the Last Supper depicting Jesus and the twelve apostles feasting on guinea pig, a traditional Andean delicacy.
As always, one of the best places to wander around is the local market, in this case a covered market called San Pedro
From the locals grabbing a snack to the more intrepid tourists drinking the fruit juices.
For vegetarians there is always a kind of horrified fascination with the meat aisles.
The endless fruit and vegetables are always cheery.
Including just a few of the three thousand varieties of potatoes we kept being told about.
And some of the combinations were a bit tricky to fathom. Is this a cupboard for medicines or condiments? Arnica and vinegar?
Many many varieties of quinoa, and even more types of tea.
Mostly the stable holders were just going about their business. In general I ask if someone minds f I take their photo and occasionally people object – no one was worried about pictures of the stall though.
The flower aisle was beautiful of course. the wooden spoon stall slightly less so.
All in all it was a really good way to get a grip on the place as people live in it now, as compared to the museum of Museo de Arte Precolombino (Peru) which gave lie to the Inca suggestion that before them the country had only had hordes of savages.
The Incas were superlative masons and excellent working with silver and gold as the displays showed.
Their decorations included necklaces and similar made from shells from the coast.
But any walk through the displays quickly shows the superlative work of cultures alive and well long before the Incas came to power.
And what strikes a modern viewer is how fresh, how modern and often how comical some of the work turns out to be.
It would be difficult not to enjoy the stylised animal forms of some of the pottery and sculptures.
And outside on the streets of Cuzco, the everyday mix of traditional and modern continues.
This is an Ottolenghi recipe, though there are plenty out there. It makes two pizzas, to serve two as a main course with a salad, or four as a snack, though after the recent trip to Peru I tired it with purple potatoes, less “white” but aside from that perfectly lovely. He used anchovies in place of the artichokes, but I’d consider swapping in some dried tomatoes also – the white really just means no tomato sauce.
For the dough 200g strong white bread flour, plus a little extra for dusting 1 tsp fast-action dried yeast 1 tbsp olive oil, plus extra for greasing Salt and black pepper 120ml lukewarm water
For the topping 180g new potatoes, finely sliced (unpeeled) on a mandolin 3 tbsp olive oil 200g mascarpone 40g pecorino, finely shaved 4 artichoke heads, finely chopped 8 sage leaves, finely chopped Finely grated zest of 2 lemons (you need 2 tsp worth) 50g spring onions, trimmed and sliced thinly at an angle
Put the flour and yeast in a large bowl with a tablespoon of oil and half a teaspoon of salt. Stir to combine, then pour in the water and use a spatula to bring the mixture together until combined.
Transfer the dough to a lightly oiled worktop and, with lightly oiled hands, knead for five minutes, until soft and elastic. (You may need to add a little more oil if the dough starts to stick to the surface.) Divide the dough in half and transfer both pieces to a large oven tray lined with greaseproof paper, spaced well apart. Cover with a clean and slightly damp tea towel, then leave to rise in a warm place for 40 minutes. The dough should almost double in size.
Heat the oven to its highest setting, 250C or thereabouts: you want it red hot.
While the dough is rising, get on with the topping. In a small bowl, toss the potato slices with a tablespoon of oil, an eighth of a teaspoon of salt and a good grind of pepper. Transfer the potatoes to a large oven tray lined with greaseproof paper – the tray needs to be big enough for the slices to lie flat and spaced apart – then roast for seven minutes, until golden brown. Remove from the oven and set aside.
In a small bowl, mix the mascarpone, pecorino, artichokes, sage and lemon zest with a good grind of pepper.
Grease two large oven trays with olive oil, and lightly flour a work surface. Working with one piece of dough at a time, roll the dough into two 30cm x 20cm rectangles, then carefully transfer to each of the trays.
Spread the mascarpone mix evenly over both pizza bases, leaving a 2cm border around the edges. Sprinkle the spring onions on top, then add a layer of potatoes. Drizzle a tablespoon of oil over each pizza and bake for nine minutes (switch the pizzas around halfway through, so they both get a turn at the top of the oven), until the edges are crisp and golden. Scatter with a generous grind of pepper and serve warm with a green salad.
There is an excellent article published by the LSE which looks at the UK economy.
As the UK negotiates to leave the EU, the UK government has made much of the strength of our economy and our competitive advantage & it’s true that our growth and employment rates do not appear to have been damaged by the vote to leave the EU. Many businesses have been quick to identify potential opportunities associated with an independent approach to global trade.
But despite strong growth rates in 2016, the UK is not expected to experience GDP growth as strong as that anticipated in Europe and the US over the next several years. Our predicted growth rates of 1.6% in 2017 and 1% in 2018 are dwarfed by an anticipated 2.1-2.4% for the US and 2% in Germany. Part of this can be put down to the uncertainties of Brexit.
But slowing growth rates are also partly driven by long-standing structural issues in the UK economy.
The government likes to boast that the UK has recently achieved record levels of employment. But this has been accompanied by the growing insecurity of the labour market.
Surveys suggest that as much as 8% of the workforce is now under-employed – that is, wanting to work more hours than they do. The number of people on zero hours contracts has increased more than five-fold since 2007, to more than 900,000. Self-employment has increased from 13% of the workforce in 2008 to 15% today, yet self-employed people earn less on average than they did 20 years ago.
This insecurity is linked to the ‘flexibility’ of our labour market, which is ranked 8th of 140 in the World Economic Forum’s rankings, achieving the same score as the United States.
Normally, economists would expect high levels of employment to lead to increases in average real wages. But the reverse has happened. Indeed, the decline in UK real wages since the financial crisis has been the largest of all developed countries apart from Greece, Mexico, and Portugal.
Between 2007 and 2016, annual real wages grew 10.8% in Germany, 9.5% in France and 6.4% on average across the countries of the OECD. In the UK, however, they fell by 2.6%. If inflation continues to erode nominal wages for the next four years, as projected by Office for Budget Responsibility, the period since 2007 will rank as the longest period of earnings stagnation since the 1860s.
The low-pay, insecure labour market that exists in the UK is partly responsible for our poor performance on productivity. Measured by output per hour, productivity in the UK is 13% below the G7 average, and productivity growth has more or less completely stalled in the last decade. The disparity between the UK’s productivity and those of our major competitors is sometimes expressed in the form ‘it takes the average British worker five days to produce what a worker in Germany, France, or the US produces in four’.
But of course this is nothing to do with how hard people work: it arises from the much lower levels of investment in physical and human capital in the UK. Public and private investment is around 17% of GDP in the UK, more than 5% below the OECD average.
Corporate investment in the UK is much lower than in most of our major competitors. Corporate investment in fixed assets (not including construction) fell from 11% of GDP in 1997 to just 8% in 2014, compared with (for example) 12% in the USA. This is much lower than the rate of depreciation, meaning that the stock of capital in the UK is actually declining. This disparity is partly accounted for by the lower share of manufacturing in the UK economy, but is still lower even when this is taken into account. And it is especially reflected in the lower share of research and development investment, which is of particular concern given the importance of innovation in driving future growth.
The sectoral make-up of the UK’s economy has also led to the emergence of a large current account deficit: our trade deficit has exceeded 2% of GDP for 15 of the last 16 years. This is at least partly due to the decline of our manufacturing base, which, though familiar to most of the developed world, has been far more acute in the UK than in competitors such as Germany and France.
The depreciation of the pound which followed the EU referendum has helped to raise exports somewhat – but not by as much as might have been expected, because the UK is particularly reliant on a small number of exporting sectors (of which financial services is much the largest) and many exports are made up of imported components. The UK’s trade performance is a consistent indicator of the weakness of UK productivity and competitiveness.
As such, it is hard to accept the government’s view that the UK economy is in a strong position to cope with the challenges of Brexit. Underneath the headline figures it is actually much weaker than most of our major European competitors. And Brexit will make many of these weaknesses more difficult to address. That is why the IPPR Commission on Economic Justice is calling for a fundamental rethink of economic policy in the UK.
The first step is to acknowledge that we have a problem.
The Sacred Valley of the Incas or the Urubamba Valley is a valley in the Andes of Peru, 20 kilometres (12 mi) at its closest north of the Inca capital of Cusco.
The valley, runs generally west to east, is understood to include everything along the Urubamba River between the town and Inca ruins at Pisaq westward to Machu Piccu, 100 kilometres (62 mi) distant. The Sacred Valley floor has elevations above sea level along the river ranging from 3,000 metres (9,800 ft) at Pisac to 2,050 metres (6,730 ft) at the Urubamba River below the citadel of Macchu Piccu.
So most tourists start their trip to Peru in the valley or even straight to Macchu Pichu which is relatively low in terms of altitude sickness.
Though as a Cuzcena pointed out, setting the Cuzco airport at right angles to the valley means every international tourist is obliged to fly into Lima and catch a second smaller plane to Cuzco, where most of them want to be. It was said with a degree of bitterness that’s hard to dispute. Given a choice, we wouldn’t have bothered with Lima, and it’s difficult to imagine any other tourist having a different view.
On both sides of the river, the mountains rise much higher, especially to the south where two prominent mountains overlook the valley: Sahuasiray, 5,818 metres (19,088 ft) and Veronica , 5,680 metres (18,640 ft) in elevation.
The glaciers of these mountains provide water for crops and for the supply of towns throughout the Valley, though as the world heats up, the glaciers seem to be on the retreat. The intensely cultivated valley floor is about 1 kilometre (0.62 mi) wide on average. Side valleys and agricultural terraces expand the cultivatable area, though many of the terraces are unused, either because they’re protected as part of a historic site, or because after the Spaniards the irrigation system broke down and can’t be reconstructed.
The Sacred Valley was the most important area for maize production in the heartland of the Inca Empire and access through the valley to tropical areas facilitated the import of products such as coca leaf and chile peppers to Cuzco.
The climate breaks into two seasons, wet (October – April) and dry and monthly average temperatures range between 15.4 °C (59.7 °F) in November, the warmest month, to 12.2 °C (54.0 °F) in July, the coldest month. At this time of year, the sun rises at around 6am and sets around 6.30pm though it’s position at the equator means there’s probably only half an hour difference whatever the time of year. The difference in temperature between night and day is much more extreme. Waking early before sunrise and the temperatures outside were below zero. As soon as the sun came out (which was very quickly) the temperature rose to around 20C. So having been warned to take Winter clothes, we actually enjoyed a British Summer time (yes, it really is mostly 20-25C at the height of Summer here).
Our first trip from our hotel in the Valley was to the site at Ollantaytambo, mainly because as the furthest day trip from Cuzco, numbers are a lot lower in the morning.
Ollantaytambo is a town and an Inca archaeological site in southern Peru partway down the Sacred Valley, northwest of the city of Cusco.
Most importantly as a visitor from sea level, it is at an altitude of around 2,792 metres (9,160 ft) above sea level. During the Inca Empire, Ollantaytambo was the royal estate of Emperor Pacahuti who conquered the region, and comes up a lot in conversation with guides travelling the country. He built the town and a ceremonial center.
At the time of the Spanish Conquest, it served as a stronghold for Manco Inca Yupanqui, leader of the Inca resistance.
Nowadays, it is an important tourist attraction on account of its Inca ruins and its location en route to one of the most common starting points for the four-day, three-night hike known as the Inca Trail. It’s where you’ll catch the train to Machu Pichu, if starting in the Valley.
The main settlement at Ollantaytambo has an orthogonal layout with four longitudinal streets crossed by seven parallel streets. At the center of this grid, the Incas built a large plaza that may have been up to four blocks large; it was open to the east and surrounded by halls and other town blocks on its other three sides. All blocks on the southern half of the town were built to the same design; each comprised two kancha, walled compounds with four one-room buildings around a central courtyard.
Ollantaytambo dates from the late 15th century and has some of the oldest continuously occupied dwellings in South America. Its layout and buildings have been altered to different degrees by later constructions, for instance, on the southern edge of the town an Inca esplanade with the original entrance to the town was rebuilt as a Plaza de Armas surrounded by colonial and republican buildings. The plaza at the center of the town also disappeared as several buildings were built over it in colonial times.
‘Araqhama is a western part of the main settlement, across the Patakancha River; it features a large plaza, called Manyaraki, surrounded by constructions made out of adobe and semi-cut stones.
And as a tourist town there are people willing to open up their courtyards and allow you total a look inside the walls. Each “house” consists of a single room with a mezzanine. Cooking is over an open fire with a hole in the roof to allow the smoke to escape.
And the minute someone rattles a bunch of barley grass the ever-present guinea pigs rush towards the food. They’re obviously hugely picturesque, even when the guide points at the largest and fattest as next week’s likely lunch.
Towns along the main road have endless restaurants with ladies standing at the side waving rotisserie guinea pigs looking very like roast rats, in an attempt to lure people in for lunch – not tempted. But the house also includes a lot of totems or charms which are a bit gruesome and sit somewhat uneasily with the catholicism we were expecting, including lama foetuses (apparently very expensive), skulls from dead relatives etc.
These buildings have a much larger area than their counterparts in the main settlement, they also have very tall walls and oversized doors. To the south there are other structures, but smaller and built out of fieldstones. ‘Araqhama has been continuously occupied since Inca times, as evidenced by the Roman Catholic church on the eastern side of the plaza.
And up on the hills above there are food stores where maize and dried potatoes would be put away in the good years for the expected years of fallow during el nino etc. The potatoes at least look like the most unappetising, stones but in times of hunger they would fill you up and keep a family going. The Incas storehouses or qullqas were built out of out of fieldstones on the hills surrounding Ollantaytambo. Their location at high altitudes, where there is more wind and lower temperatures, defended their contents against decay. To enhance this effect, the Ollantaytambo qullqas feature ventilation systems. It is believed that they were used to store the production of the agricultural terraces built around the site. Grain would be poured in the windows on the uphill side of each building, then emptied out through the downhill side window.
To the north of Manyaraki there are several sanctuaries with carved stones, sculpted rock faces, and elaborate waterworks, they include the Templo de Agua and the Baño de la Ñusta. ‘Araqhama is bordered to the west by Cerro Bandolista, a steep hill on which the Incas built a ceremonial center. The part of the hill facing the town is occupied by the terraces of Pumatallis, framed on both flanks by rock outcrops.
Due to impressive character of these terraces, the Temple Hill is commonly known as the Fortress, but the main functions of this site were always religious. The main access to the ceremonial center is a series of stairways that climb to the top of the terrace complex. At this point, the site is divided into three main areas: the Middle sector, directly in front of the terraces; the Temple sector, to the south; and the Funerary sector, to the north.
And it’s an excellent introduction to the incredible engineering and stonework of the Inca sites, with dry stone walls full of precision cut blocks and trapezoidal doorways (no arches). The Temple sector is built out of cut and fitted stones in contrast to the other two sectors of the Temple Hill which are made out of fieldstone. It is accessed via a stairway that ends on a terrace with a half finished gate and the Enclosure of the Ten Niches, a one-room building.
Behind them there is an open space which hosts the Platform of the Carved Seat and two unfinished monumental walls. The main structure of the whole sector is the Sun Temple, an uncompleted building which features the Wall of the Six Monoliths. The Middle and Funerary sectors have several rectangular buildings, some of them with two floors; there are also several fountains in the Middle sector.
The valleys of the Urubamba and Patakancha rivers along Ollantaytambo are covered by an extensive set of agricultural terraces or andenes which start at the bottom of the valleys and climb up the surrounding hills. The andenes permitted farming on otherwise unusable terrain; they also allowed the Incas to take advantage of the different ecological zones created by variations in altitude. Terraces at Ollantaytambo were built to a higher standard than common Inca agricultural terraces, for instance, they have higher walls made of cut stones instead of rough fieldstones. This type of high-prestige terracing is also found in other Inca royal estates such as Chinchero, Pisaq and Yucay
View across the terraces Ollantaytambo
A set of sunken terraces start south of Ollantaytambo’s Plaza de Armas, stretching all the way to the Urubamba River. They are about 700 meters long, 60 meters wide and up to 15 meters below the level of surrounding terraces; due to their shape they are called Callejón, the Spanish word for alley. Land inside Callejón is protected from the wind by lateral walls which also absorb solar radiation during the day and release it during the night; this creates a microclimate zone 2 to 3°C warmer than the ground above it. These conditions allowed the Incas to grow species of plants native to lower altitudes that otherwise could not have flourished at this site.
The unfinished structures at the Temple Hill and the numerous stone blocks that litter the site indicate that it was still undergoing construction at the time of its abandonment. Some of the blocks show evidences of having been removed from finished walls, which provides evidence that a major remodeling effort was also underway. It is unknown which event halted construction at the Temple Hill, likely candidates include a war of succession, the Spanish Conquest of Peru and the retreat of Manco Inca from Ollantaytambo to Vilcabamba.
At almost the opposite end of the valley, much nearer to Cusco, lies the citadel of Pisaq which lies atop a hill at the entrance to the valley.
The ruins are separated along the ridge into four groups: P’isaqa, Inti Watana, Qalla Q’asa, and Kinchiraqay. Inti Watana group includes the Temple of the Sun, baths, altars, water fountains, a ceremonial platform, and an inti watana, a volcanic outcrop carved into a “hitching post for the Sun” (or Inti).
The angles of its base suggest that it served to define the changes of the seasons. Qalla Q’asa, which is built onto a natural spur and overlooks the valley, is known as the citadel.With military, religious, and agricultural structures, the site served at least a triple purpose. Researchers believe that Písac defended the southern entrance to the Sacred Valley, while Choquequirao defended the western entrance, and the fortress at Ollantaytambo the northern.
Inca Pisac controlled a route which connected the Inca Empire with the border of the rain forest. The Inca constructed agricultural terraces on the steep hillside, which are still in use today. They created the terraces by hauling richer topsoil by hand from the lower lands. The terraces enabled the production of surplus food, more than would normally be possible at altitudes as high as 11,000 fee
So we flew in, stayed overnight at the airport hotel (just across a zebra crossing from the airport terminal) and on the way back from la Paz, were left with just 6 hours to kill, too short a time for the more traditional tourist neighbourhood of Miraflores.
& that is how we arrived on a walking (and lunching) tour of Callao.
The port district of Callao was founded in 1537 by Spanish colonists and quickly became the principle port for Spanish commerce in the Pacific. At the height of the Spanish Viceroyalty, almost all goods from Peru, Argentina and Bolivia bound for Spain passed through Callao, and then on to Panama before the Atlantic crossing.It flourished in the 19th century, which saw the building of grand plazas and South America’s first railway. Its fortunes began to decline in the 20th century and historical monuments, such as the Real Felipe fortress, Plaza Grau and other architectural gems seemed destined for oblivion.
A sign on the streets of Callao reads, Del puñal al pincel (from dagger to paintbrush). A couple of years ago, few visitors to Peru would have set foot here.
More than just down-at-heel, this main port district of Lima was downright dangerous, notorious as a haunt of gangs smuggling cocaine worldwide.
From an era of economic boom and the affluence that comes with it, Callao had suffered progressive economic decline in the ensuing years. Basically the area became, and still shows more than a few signs of being a slum.
You would not choose to walk around it alone of a night. But projects like Callao Monumental are at least trying to bring regeneration and visitors to the area, so it’s a great time to visit the fresh and edgy district as part of any tailormade trip Peru.
Callao Monumental is an art project, showcasing some of the country’s best street art, contemporary galleries and artists. It showcases contemporary urban art, champions local artists and engages with the community through its outreach and regeneration work. The hero of the initiative is an Israeli. Roughly translating as shooting star, “Fugaz” is a private initiative by an Israeli businessman and art lover, which aims to restore Callao through art and culture, and offers locals an alternative to a life of theft and drug trafficking.
The transformation began with 18 artists, 15 walls and one fractured community. “We didn’t want the locals to feel like we were invading; we wanted them to join in. Especially as Callao is the only place in Lima where, when you die, a graffito of your face is painted on the grave,” Angie Pelosi from Fugaz told me.
The heart of the project is located in the historic Ronald Building, a covered market built by a British engineer, and renovated specifically for this project. It consists of six floors of independent restaurants, artesanal fabric boutiques, galleries and studio spaces for resident artists.
It provides a starting point, plus an opportunity for retail therapy, lunch or just a cup of coffee and sit down after a walk around the barrio.
On the ground floor, you walk through an impressive arcade of galleries and boutiques. The high vaulted stained glass roof allows light to pour in and reflect off the white marble floors. Wondering up through the maze of hidden staircases and corridors you discover exhibitions of paintings, photography and installation art.
On a busy Friday we came across resident artists at work, setting up for a photography exhibition, chatting with them about their work.
All six floors of the crumbling Casa Ronald, built in the early 20th century by English-educated financier Guillermo Ronald, with cathedral-high ceilings and marble columns, has been restored by Fugaz and transformed into an arts hub.Elsewhere in Callao, independent galleries such as Evolución and Bufeo have opened, design stores including Lima Modern and Balkanica are moving in, and leading sculptor Victor Delfin has set up shop there.While artworks costing hundreds of dollars are aimed at the wealthy Limeños who are now discovering this formerly no-go barrio, the galleries all commit to working with the community and employing local people. Young chalacos work as guides and can attend creative workshops, life-coaching talks, Muay Thai classes for those that perform well at school and English lessons.
There is also a rooftop terrace, well worth a stop for the spectacular view of the surrounding area, including the harbour and the modern commercial port, the naval base and the historic Real Felipe fortress.At the weekends, when the community project tends to arrange more events, there’s a bar up there and sometimes live music – a great spot for a sun downer, taking in the view.
Murals by local and international street artists now grace the walls but that was only the beginning of the new face of Callao Monumental, the historic centre. Artists, businesspeople and chalacos, as Callao residents are called, have all got involved: they include grandmother Cristina, whose children are all in prison, and Luis, better known as El Padre, who takes in street children.
The change in Callao has been remarkable, with crime reported to have fallen dramatically. “I’ve noticed how people are coming together,” Pelosi says. “They’re starting to care about their community. Even the police have seen an improvement.”
Everyone warns you before travelling to Peru, sometimes a bit too enthusiastically, about altitude sickness. In fact our recent trip was quite well planned, skipping over Lima at sea level to the relatively low lying Machu Pichu (2430m) through the Sacred Valley around Ollantaytambo (2792m) to Cuzco (3399m) and the heights of La Paz (3640m) and Uyuni (3700m)
And once you arrive the advice is generally good and sensible stuff: take it easy, go slowly, drink lots of water, eat light foods only, don’t drink or smoke.
Even so, whilst walking along the flat becomes straightforward and downhill a breeze, even after two weeks anything more than a couple of steps up and we were all wiped out. Just rushing to get things ready in the morning could leave us panting for breath,
And they don’t warn you about the very basic impact of such dry air – your nose dries out making night time sleeping less pleasant than it could be. Your mouth and throat become very dry so you drink more and more. The UV light will burn easily and the bright light will persuade your brain that it should feel hot, whilst the wind actually keeps you quite cool. Vaseline on the nose and mouth isn’t a great look but was surprisingly practical.
But absolutely no one tells you about what it will feel like when you return to sea level, how wet the air will feel and how full of “stuff”
It was a good trip but I’m glad to be home, sleeping in my own bed. Mostly.
I had both of my babies at home, the first in a small two up two down terraced house, the second in the slightly larger house that we still live in, just a couple of streets away. Both are within 5 minutes drive of a major teaching hospital.
My girls were born safe and healthy, with no problems or complications. I was lucky.
In my first delivery, the midwife arrived early, which is to say, she set out after the second phone call because, she’d had a bad experience the night before (the cord caught around the baby’s neck as it was being pushed out, and she had struggled to keep the baby alive). Since it turns out that I’m the kind of woman who has 3 hour labours (the average is closer to 12 hours) if she’d left it much later she’d have arrived too late.
The second midwife (one attends for the mother, one attends for the baby) failed to arrive in time. Since she’s the one who brings the pain relief (air and gas) it was a short but painful birth, with a first degree tear (not stitched – should have been stitched, never rely on nature to fix a raggedy labial tear).
But in conversation about the Vicky Foxcroft article afterwords, I took exception with one commentator who suggested that planned home births were the reason for the high still birth rate in the UK. It’s just not factually correct.
Babies are classed as stillborn if they die at any point after 28 weeks of pregnancy, up to the birthing process itself which is when half occur. Over 98% of stillbirths happen in low and middle-income countries. Pakistan has a rate of 43.1 for every 1,000 children born – that’s one in every 23 mothers finding out their baby is dead.
But bad things happen everywhere.
For every 1,000 babies born in Britain, 2.9 are stillborn (based on at least 28 weeks of gestation) – more than twice the rate of 1.4 in Iceland. Britain is now 21 out of 35 of the world’s wealthy countries according to the Lancet Stillbirth Series (2016). Croatia, Poland and Czech Republic have better stillbirth rates than the UK.
Equally worrying is the UK’s annual rate of reduction, which is now just 1.4% – placing us 114th globally for progress on stillbirths.
So what aren’t we doing as well as we might?
The Netherlands, which has cut its rates by almost 7%, hasn’t just improved care during the birth, but focused on women’s health while they are pregnant and even before that too. In particular, it has had a huge programme to reduce maternal smoking, as well as structured investment in analysis and understanding of each stillbirth.
Here in the UK, underlying the overall rate of 2.9 per 1000, the survey found mothers in the most deprived areas were up to twice as likely to experience a stillbirth as the country’s most affluent mums – although that research only covered the years up to 2005. Poorer mothers are more likely to smoke and more likely to be either significantly overweight or underweight, all risk factors for stillbirth.
And this is why I think I was so offended by the references to home birth in the context of still birth. In order to reduce the rate of stillbirth in the UK, it’s important to understand the risks, where they arise and what can be done to mitigate them.
Both the UK and Iceland have tiny levels of home births, both around 2% of annual births. Stillbirth, like most birth, is a hospital phenomena in the main (98%) of cases. If we want to improve our rates of stillbirth, we need to tackle the real causes.
10 babies are stillborn every day in the UK.
In women with a BMI over 30, the risk rises to 1 in 100 (from 2.9 per thousand). An increasing BMI is associated with an increased incidence of pre-eclampsia, gestational hypertension, macrosomia, induction of labour and caesarean deliveries.
Underweight mothers also have an enhanced risk of stillbirth where being underweight (a BMI of < 19.9 kg / m2) has been shown to be associated with an increased risk of preterm deliveries, low birth weight and anaemia and a decreased risk of pre-eclampsia, gestational diabetes, obstetric intervention and post-partum haemorrhage
Women who smoke have an enhanced risk of stillbirth. In meta-analysis research carried out by BMC Public Health smoking during pregnancy was significantly associated with a 47% increase in the odds of stillbirth.
Around half of all stillbirths are linked to placental complications.
Other causes include bleeding before or during labour, placental abruption, pre-eclampsia, a problem with the umbilical cord, obstetric cholestasis, a genetic physical defect in the baby, pre-existing diabetes, and infection in the mother that also affects the baby.
Reduced fetal movement is a good indicator of stillbirth, with slowing down of movement noticed by the mother in two out of three stillbirths.
Still, Dr David Richmond, consultant gynaecologist and president of the Royal College of Obstetricians and Gynaecologists, describes the survey as a “wake-up call”.
In the UK, there is still much to be done to ensure our rate of progress is as good as the best in Europe.
Through the Each Baby Counts initiative, we are this year beginning to undertake a structured review of each and every stillbirth that occurs during labour in term pregnancies to help identify common risk factors, learn from what went wrong and apply the lessons in maternity units across the country.
One of the most striking observations is how often poor fetal growth corresponds with stillbirth, consistent with a recent Panorama programme that suggested regular scans could halve the UK rate of still birth by tracking growth and highlighting failure to thrive. The latter can often be addressed by inducing early births.
The four key recommendations are based on extending best practice around the country and include:
Reducing smoking in pregnancy
Risk assessment and surveillance for fetal growth restriction
Raising awareness of reduced fetal movement
Effective fetal monitoring during labour
None of these relate to home births. All of the recommendations require joined up, consistent maternal care with time to be spent monitoring, managing, helping women to manage their lives and their pregnancies.