The 2 million inhabitants of La Paz, high in the Andes mountains, carpet a crater with housing; it seems that all its streets are on a slope; El Alto, at more than 13,000 feet above sea level, sits high above on a plateau, the altiplano, where it’s 1 million mostly impoverished inhabitants spread across a flat plane. From the ridge where the two cities meet, houses cascade over the edge, sometimes literally, and down the mountainside. 
Traffic in both cities can be chaotic – with few rules, a game of chicken takes place in each intersection. Pedestrians dart across the street between moving vehicles. Six years ago, to deal with gridlock on the ground, the government opened a new transit system, the Teleferico; 10 interconnected lines of aerial cable cars sew the two cities together. Passengers soar above the traffic, like a condor. It’s breathtaking. As you fly over El Alto, it’s hard to miss their obsession with Transformers. Most buildings are square red brick with identical square windows, and they lend themselves to the geometry of transformers. Many, like Iron Man, have heads although most just reference the shapes.
The Teleferica is for pedestrians only and on this day, we had goods to deliver; we braved the streets with our local contact Vierca at the wheel. She drove at least 2 kilometres up the semi vertical winding maze of streets; I swear she spent more than half the time in first gear.
We drove up to the municipality of Parcopata in El Alto to visit a small hospital. Housed in a 6-room building, constructed 10 years ago as a school, the facility lacks basic equipment. Staffed part-time by a doctor, a trainee doctor, a dentist, and a natural medicine practitioner, paid by the government, with an ambulance supplied by the nearest hospital. We were greeted by the local mayor, who has pushed to get the facility to its present state because it’s such a long walk to that hospital for the 40 families that this small hospital aims to serve.
Most of the equipment in the outpost hospital has been supplied by one of our overseas donors, and we visited there on his behalf. But, with only two rooms in use, the need is clear; the dentist was examining a local man as he sat in a wheelchair – he told us he needed a dentist’s chair and a table for his tools. Many of the windows are still broken, courtesy of last year’s anti-indigenous election riots.
Before we left, we were served hot, sweet tea, a chicken sandwich, and speeches of thanks. We all signed their guest register.
I noticed an effigy of a man hanging from a lamppost at the side of the building and I asked our interpreter, Ingrid, why it was there. This is a high crime area, she said, and this serves as a warning that there will be consequences. We saw these figures throughout El Alto it reminded me of the ‘penny for the guy’ effigies we’d made, when I was a child, using our dad’s old clothes.
As they hugged us all goodbye, the mayor said: “Please, don’t forget us…”
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