The first part of the tour from Rio to La Paz's accommodations were not clean especially the campsite in Paraty and Salta. Salta had the worst sanitation - the bathroom and toilets particularly were horrible. The whole group did the upgrade and stayed in the lodge because of the cold weather. Anyway, inside each lodge (casita) there was hardly any hot water. Basically most of us did not shower. The hotels in Peru were good, Uyuni, Bolivia's hotel without heat or consistent shower was painful. After all it was South America. The tour itinerary was top class. Wouldn't change it at all.