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 A Simple Bathroom Makes a World of Difference
El Alto's streets are unpaved, uneven, dusty. The flat terrain and mostly one-story homes allow a majestic, unobstructed view of mountains in the distance, and a blue sky that appears close enough to touch. It might be that this view inspires the people who live here, in deplorable conditions, to persevere despite the cold and stark environment.
 Seņora Maxima Alejo de Ticona lives here, in the slums of El Alto, in a small two-room house with her husband and seven children. Only 33 herself, she has children from two-and-a-half years old to 13. Three of her children clung to her skirt as she walked in front of her house.
"CARE helped us with the building of our bathroom," she smiles proudly, swinging open a door to a small outbuilding in front of her house. Inside, a toilet, sink and primitive shower were scrubbed clean. "I have never had my own washroom or toilet. No one in my family, or my husband's, ever has. We are so grateful for it."
 "And look here," she said, excitedly rushing outside. "There is a basin here too - for washing!"
Project manager Victor Rico explained, "In this neighborhood, CARE filled in the blanks, so to speak. The municipal government said they would provide the water if other agencies would provide the other infrastructure. The World Bank funded the laying of the pipe for individual water connections. CARE, little by little, is working with families to help them build their own bathrooms, like this family. A bathroom like this, though it only costs about $500 to build, can mean so much. I know that many people would be surprised to see what an impact something like a very simple bathroom might have on a family here."
 Seņora Maxima spoke again. "I used to have to walk every day to get water, with my husband after he came home from work. I cannot say exactly how long it took, but it was a lot of time that I now have back. We could only bring a little water back at a time. I need it for so many things with all of my children, for food, washing, bathing.
"Now I can make more of my time. I am a bit less worried about how I will take care of things. I don't have to worry about taking my children to a public toilet. These may seem like little things but it is a lot to us."
Basic Health Care - Beyond Basic
Dr. Jorge "Coco" Machicao is a physician who works in a reproductive health clinic in the slums of El Alto, Bolivia. A primitive building houses a surprisingly modern office, where women and men receive care and information previously unavailable in the area. The clinic offers a variety of reproductive health care services, including routine pap smears, STD screenings, maternal health care, child health care and survival programs.
CARE began the project four years ago, partnering with C…I…E…S… (CIES), a local nongovernmental organization (NGO). Dr. Marchicao, one of the project doctors, explained what motivates him. "What motivates me to do this work is that I can help improve people's lives. I live in La Paz, but I work in El Alto. Working here, I have a greater impact than I might in La Paz. Though it's only minutes from here, in La Paz I would have far more sophisticated equipment, and a larger staff. But it wouldn't be the same.
"Here, I work among a community of people, and watch the people grow. Let me give you an example. A few years ago, I received a call from a patient saying that her sister had been in labor for four days. Four days, you understand? She did not know whether the mother or the child would make it.
"I cannot explain the joy of saving both lives." He paused, "Nor can I explain the joy of being the child's godfather," he said.
 The story Dr. Marchicao shared reflects a happy ending to what is a stark reality in this area. Maternal and infant mortality are extremely high. "They are so high, in fact, that it is common for parents to leave infants unnamed for the first year of life," Dr. Marchicao explained. "They do not expect the child will live."
Through the CIES project, CARE also works with communities in child health and disease prevention. "Chronic diarrhea is alarmingly common here," Dr. Marchicao said. "With this program, CARE not only works with parents before a baby is born, but also with the family to improve its health as it grows."
"We train members of the community to implement the lessons regarding primary health care. They arrange community meetings where people can learn the causes of diarrhea and other illness and their prevention and treatment in a comfortable and convenient setting. Simple solutions like boiling water or using oral rehydration solutions make such a difference in the health of their children. Among their friends and neighbors, they feel comfortable asking questions. And what they come away with is an important and sometimes life-saving lessons."
I wanted to see what they spoke of in action. We drove to join in on a community meeting where families met to learn how to manage and treat diarrhea. Five of us packed into a small jeep, with the CIES logo emblazoned on its side. "CARE donated this vehicle for making house calls, transporting community volunteers and staff around El Alto," the driver proudly said.
The jeep slowed to a stop outside a nondescript house. A toddler opened the gate and let us in. We were met by a crowd of mothers and children sitting in a courtyard in a semi-circle atop benches, piles of stones and on the ground. Children - from school age to infants - sat near their mothers who looked at us quickly, and then looked away. Few children wore shoes. None wore socks. It was 45 degrees in the shade, 50 in bright sunlight.
Velia, a CIES volunteer, stood up. "Please welcome our guests and we will then get started." Answering her cue, several women held out their hands for shaking. "Buenas tardes, Senorita," they said, shyly. "Buenas tardes," I echoed.
It was time to begin. Velia and another volunteer named Delicia were the facilitators for this lesson. It was an interactive lesson where illustrations led the discussion. "What do you see here?" Delicia said, pointing to a picture of a baby whose diapers were badly soiled. "He has diarrhea. He is sick, no?"
These were illustrations that did not show an annoying bout of illness, but a chronic and rampant health problem here. Messages were reiterated throughout the lesson. Keep food covered, wash hands with soap and water, use a skin pinch test to check for dehydration, keep breastfeeding. The most important lesson of all, though, dealt with water preparation.
At this altitude, simply bringing water to a boil is not enough to kill waterborne bacteria that is often the cause of diarrhea. Water must be boiled for at least 15 minutes to make it safe for drinking or cooking. "Cooking gas is expensive," Jane explained. "And with so many demands on their time, mothers often forego the 15-minute rule in order to accomplish all that needs to be done in a day. Remember, most mothers have five children, no household water connection, no electricity and no heat. It's hard, hard work."
Though at first shy and quiet, by the end of the lesson the women and even some of the children were actively participating in the discussion. "That's salt! That's salt!" said a little boy, jumping in the center of the circle. He pointed as the facilitators showed women how a simple solution of water, salt and sugar can effectively stave off dehydration from diarrhea.
"It tastes bad," Delicia said, "but your kids will take it. And it works very rapidly, and costs very little."
As the class ended, people were encouraged to come to the front of the circle and practice making the oral rehydration solution, and handed a free packet of pre-packaged salts. Delicia raised her voice to be heard as the gathering of people began to disperse. "If you ever need help or have questions, you can find us at the CIES clinic."
We thanked Delicia for allowing us to watch her work. "I am glad you came. I am always glad to show the work that CIES and CARE do together. You see, they care about women. They go where the women are. And through volunteering, I get to wake up the minds of my neighbors."
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