Bolivia's Childhood Death Rate

On the road to Huayllamarka, Bolivia Photo by Joe Palca

April 2, 2001 -- In Bolivia, for every 1,000 children born, 87 die by age 5. That's the highest childhood death rate in South America, four times more than Argentina next door -- and 10 times more than the United States.

Poor sanitation, lack of clean water and poverty are obvious culprits. So is inadequate health care. But as NPR's Joe Palca found on a recent visit, even when health care is available, it can be hard to get the services to the people, and the people to the services.

Community Activist Libertad Navia Photo by Joe Palca

In the city of El Alto just north of La Paz, community activist Libertad Navia goes block by block, encouraging people to go to the clinic for prenatal care, nutrition counseling and vaccines for their children. But Navia says many people in El Alto, especially members of Bolivia's native Indian tribes, are relucant to go to government-run clinics where they may face unfamiliar Western medical practices, disdainful doctors and discriminatory treatment.

Apart from the Bolivians who won't seek medical help are the Bolivians who are often beyond medicine's reach. Palca rode with Ned Olney, executive director of Save the Children in Bolivia, to a village 120 miles south of La Paz to check on a promising childhood nutrition program. Flooding and mudslides often complicate Olney's rounds; this year, heavy rains have made some routes nearly impassable.

When Olney's driver tried to guide the 4-wheel drive vehicle around a washed-out stretch of road, the car plunged halfway over a ledge and began to fill with water. Olney, Palca and the driver scrambled out unhurt and locals dragged the car from the water -- but the travelers never got to the village. The episode, Palca says, drove home that "building better roads, along with creating a sanitation system and providing a steady supply of clean water, are all things the Bolivian government could do to lower childhood deaths. That hasn't happened."

 Listen to Joe Palca's report as aired on All Things Considered.