La Paz sits in a bowl carved into the Andes, ringed by peaks over 5000 meters, making it the highest seat of government on earth. This episode of the Extreme Cities series follows residents who navigate steep, oxygen-thin streets on foot, by minibus, and by cable car, the last of which now functions as public transit stitching the city to its poorer, even higher neighbor El Alto. Doctors and locals describe what thin air does to the human body over years of exposure, from altered lung capacity to the coca-leaf chewing that has become a practical adaptation rather than a tradition. Markets, construction sites, and informal settlements climbing the hillsides show a city still expanding upward despite the terrain working against it. Interviews with vendors, transit workers, and engineers explain how infrastructure gets built on slopes that would stop most cities cold. The film treats altitude not as a scenic backdrop but as the central force shaping how people work, move, and survive in La Paz every day.