By Ana V. Diez Roux, MD, PhD, MPH

More than 30 years ago as a medical student, I traveled to a remote part of Argentina in the northern province of Salta. I traveled with three friends, one an agronomist, another an artist, a third a psychology student. Pablo (the agronomist, or perhaps almost agronomist as I am not quite sure if he had finished his degree) was the lead and main reason for the trip. He was working for a development nonprofit. His job was to work with the Wichi community (original native inhabitants of the region) and support their efforts to create a rural cooperative.

We traveled three days from Buenos Aires to Los Blancos, a small town in the middle of an arid and sparsely populated area called "El Chaco Salteño," a 24-hour train from Buenos Aires to Tucuman, a bus to Salta and then on to another small city called Tartagal. And finally, a cargo train that inched its way at snail's pace across a reddish desert, dotted with a few islands of green (this was the rainy summer season) to Los Blancos, almost on the border with the province of Chaco.

Los Blancos ("The Whites" in translation) was built on the two sides of the train tracks: on one side lived the white settlers in low brick and cement houses with electricity for a few hours only during the day, and on the other side lived the Wichi, in homes with adobe walls and wood or tin roofs scattered among the low bushes and a few spindly trees, no electricity, no running water, no paved streets. When you walked down the white part of town, you saw few people because it was always hot, stiflingly hot, so everyone sat inside with the shades drawn. But in the Wichi part of town scores of barefoot children followed you around smiling, waving and staring, weaving in and out of the bushes in front and behind you, goats trailing behind them, as their parents looked on from wooden benches under the trees.

I am sure we did not do much at all for the Wichi, despite our best intentions. I like to think Pablo could have had some impact perhaps through his efforts to support the development of the cooperative. Ignacio (the psychologist) and Carol (the artist) did activities with the children for which we had brought paper and colored pencils from Buenos Aires. The children loved to draw. They drew pictures of snakes, leopards and trees, and colorful pictures in red and blue and green.

I sat in on a clinic held by a lone nurse twice a week in a one-room health center in the white part of town (the only health care available at the time). Most of the patients were children, often the same ones I saw across the railroad tracks. They came in for respiratory infections, diarrhea, scabies, or skin infections they acquired while wading in standing water. The nurse did not have much to offer, just a few creams of dubious pharmacological value and a limited amount of oral antibiotics. But his main weapon were shots of penicillin, which were thick and painful and which he reserved for only the most severe of skin infections. When he prescribed, he would ask my opinion, half in earnest, half in jest, and I, feeling utterly useless despite my medical training, would usually just nod.

A few days ago I saw a story in the Argentinian newspapers, a story that made it to CNN, about deaths among Wichi children. They reported nine deaths from malnutrition so far this year and many more were hospitalized for infections and diarrhea, the typical story of contaminated water, no sanitation, poverty, and now compounded by even higher temperatures than usual.

My heart sank when I saw the photos again, the same images as 30 years ago. I wondered if some of the adults in the new photos were the children who had welcomed us, four white strangers, with so much generosity.

There is no easy solution for communities like the Wichi. Water is of course critical, but in a sad twist not even digging wells helps because much of the water is salty or contaminated with arsenic. Organizations are trying to promote the implementation of new systems that collect and purify rainwater, but the financing and sustainability of this is uncertain. The environment is deteriorated to the point where it is impossible for the Wichi to make any sort of living from the land they live on. They are poor and marginalized, do not own their lands, and are now increasingly the victims of climate change suffering from heat, drought and floods.

I read recently that as part of the recent crisis a health center in Los Blancos was occupied by residents protesting the lack of supplies, and especially the lack of water. Water is clearly the emergent problem today, but the absence of access to water is the tragic manifestation of much greater underlying structural problems. There is no better illustration of the social and economic causes of infant mortality and child deaths than this sad story of the Wichi: poverty, environmental degradation, discrimination, structural lack of opportunities and inequality. Sadly, their story is repeated in similar communities all over the world.

Many years ago, the semiarid region where the Wichi live today was a dense forest rich in wildlife. The Wichi capture the animals in that forest in tiny wooden figures carved in palo santo, an aromatic wood, and in vivid masks of birds, anteaters, and wildcats painted black, brown and grey. When I left Los Blancos, the children gave me several figures as gifts, and over the course of my life, perhaps nostalgic for the time I spent there, I have bought Wichi masks and figures in crafts stores in Buenos Aires. I see several masks hanging on my walls in my home here in Philadelphia, so far from Los Blancos, as I write.

The province of Salta has declared a socio-sanitary emergency, and aid groups are flowing in from all over the world to assess water quality and try to help the Wichi. It remains to be seen whether this new "crisis" will pave the way for a different kind of strategy, one that takes to heart the root causes of these deaths.