Bolivia 1999

baking in the altiplano

An Evaluation of PAHO’s Sanitary Models in Pasto Grande
By Amy Gottlieb

As a recipient of the Transcultural Award, I went to Oruro Department, Bolivia to evaluate the impacts of PAHO’s sanitary models on health. In doing so, I acted as project coordinator for the duration of my ten week stay. I assisted in bi-weekly diarrhea surveillance, collected and tested water quality, and developed a questionnaire to assess the construction, operation and use of PAHO’s sanitary models in Pasto Grande. Some of my preliminary findings are as follows:

Water Pump



After spending several weeks working in Pasto Grande and Jatita, I observed several key findings regarding PAHO’s sanitary models. Nineteen percent of the pumps are not functioning. However, the majority of these pumps are incomplete. In addition, members of the community have voiced their concern that little effort has been done to alleviate the problem.

Another key finding is that 85. 1 % of the population is using water from the pump as its primary source of drinking water; however, 42. 1 % are also utilizing other sources for water consumption. This could cause confounding problems when trying to evaluate the impact of the pumps on the health of children less than five years of age.

Community members are also experiencing problems with turbidity (58.5%). Hopefully, these problems will abate in time.

Another area of concern is the fact that 49. 1 % of the population do not know where to buy parts for their pump. This not only creates problems with sustainability, but it shows a lack in education in the beginning of the project. A larger emphasis needs to be placed on the maintenance and upkeep of the pumps.


The lavanderias in Pasto Grande are not being utilized. Seventy-five percent of the homes are not using their lavanderias for various reasons. They either do not function at all (26. 1 %), are lacking a hose to connect the lavanderia to the tank (I 7.0%), or the lavanderia leaks (70.2%). 1 strongly recommend looking into a different type of material to construct the lavanderias, especially in the altiplano, where freezing cold temperatures cause the water to expand in the tanks, thus leading to cracks and leaks.

In addition, people are not accustomed to using the lavanderias. Most people wash their clothes while seated. One may try to revise the design of the lavanderia to make it more accommodating for everyday life.
Administering Rabies Vaccinations
(Rabies vaccinations for dogs)

Diarrhea Surveillance


I had the privilege of working with Ruth Luna and Elizabeth Encina every two weeks for the months of June and July. In addition to diarrhea surveillance, these nurses provide vital services to the community. For example, one Saturday morning, Elizabeth Encina and I helped vaccinate all the dogs in Pasto Grande for rabies. In addition, Elizabeth administered pap smears to women in the community. Often informative lessons accompany the diarrhea surveillance. Issues pertaining to reproductive health, nutrition, breast feeding and monitoring the growth of children are discussed in an informal setting. Both Elizabeth and Ruth have gained the trust of the community, and people feel comfortable confiding in them.

In addition, there are days where the women will congregate to bake bread or cake in the altiplano. This time together is not only an efficient way to gather diarrhea surveillance, but also provides an excellent opportunity for community development.

The results of the diarrhea surveillance are quite interesting. Surprisingly, Pasto Grande has a higher percentage of diarrhea than Jatita. This trend could be for various reasons. Trends in water quality are often slow and may take several months/years before clear trends can be seen. Since the majority of the population has only received their pumps two months ago, 48.0% (n–24), it may be too soon to see a difference between the control and intervention community. In addition, the overall incidence of diarrhea is quite low. This may be due to seasonality.

In time, definite trends may form. It’s important to determine where people are gathering their drinking water. If members of Pasto Grande continue to drink from their noria, comparing the incidence of diarrhea between Pasto Grande and Jatita may be misleading.

childs play

Project Relation to Career Goals

As a public health student specializing in international community health, this collaborative, community-based project provided valuable overseas experience. I was able to apply the skills and knowledge acquired from the RSPH in the field. In addition, I learned the proper procedures for diarrheal surveillance, water sampling, and how to develop and conduct a questionnaire.

Working in Bolivia also allowed me to enhance my Spanish skills and networking capabilities in Latin America, which is where I’d ultimately like to pursue my professional public health career.

This opportunity increased my knowledge in the field of water quality, sanitation and personal hygiene. With the increasing pervasiveness of water quality issues in the public health arena, the demand for public health practitioners who understand both the importance of the environment and its implications on health may be in high demand.



A preliminary report was delivered to PAHO prior to my departure. In addition, an on- going dialog exists between myself and the project coordinator in Bolivia. This open line of communication encourages feedback for both parties. In addition, I’ve already presented my Brown Bag, which has allowed me to disseminate information here at the Rollins School of Public Health.