Some of the highest peaks in the world cut jagged chunks out of the horizon, soaring higher than the mere 23,000-foot (seven thousand meter) high points that neighbor them. The vista inspires awe. Humanity is dwarfed by the rocky, moon like landscape and towering mountains. The air is thin, never seeming to fill your lungs, and crisp.

Even the name, the North Western Frontier Province of Pakistan, suggests a resignation, a humble, polite declining to assign a proper name to an area so vast, so high and so culturally diverse.

Throughout the mountainous region, isolated pockets of villages and settlements sprout up unexpected from the daunting landscape.

When Chinese builders came into the Northern Region of Pakistan two decades ago to build the Karakoram Highway, they found villages only miles apart that had no knowledge of each other, according to development workers from around Karimabad. People of Mongolian descent live across a valley from a community that stayed hundreds of years after their ancestors left the Caucasus, but they have never intermarried. Thousands of languages make communication difficult, even now, between neighboring towns.

Before the highway was built, the towns and people had little if any contact with the rest of Pakistan. The social and economic hierarchy here was still feudal. To this day, 90 percent of the people here are subsistence farmers, growing food only for immediate consumption, and have very little contact with the rest of the country, according to official census reports.

"The areas of the Northern Regions were still divided into kingdoms in the 1970s," said Essa Khan, a program manager with the Aga Khan Development Network, a nongovernmental organization that has been working in the Northern regions to provide health care and basic education since the 1940s. "Even today," he said, "people identify themselves with their immediate communities, not with the nation or region. The government doesn't have the funds needed to build bridges and roads or run electric or telephone lines. Development organizations and humanitarian groups are actually doing most of the work up here," he added.

"One of the first things that we really had to face," he continued, "was the way that the communities had ordered themselves. People were limited by birth and grew up in caste-like stratas. But, these tightly organized communities have also been of help because we've grafted a more democratic system over the traditional organization of the town."

The highway brought development and infrastructure, whether or not the communities were ready or even willing to accept them. Inevitably, the towns closest to the land where the highway was plotted saw the most immediate effects of trade and transport. After only a few years, towns like Karimabad, Gilgit and Ghulkin, close to the road, have developed small industries and export goods and produce to other parts of Pakistan and to China as well. Towns farther off, though, in provinces like Baltistan and Chitral, have seen little change in their standard of living.

Some towns rejected development models and programs despite their proximity to the road. Karimabad, a town of just over 5,000 people, exports embroidered bags and local produce. Even a few satellite dishes can be seen atop several hotels, an indication of the tourist industry, which is still in a stage of infancy but increasing annually. Though the town of Hoper is only a few miles away on the other side of the highway, a visit to it requires a long walk through a rocky valley and up a muddy plateau. Although women and men in Karimabad intermingle on the streets and there are schools for both, in Hoper women duck back into their homes in the presence of strangers, and men are still reluctant to send their daughters to school.

"Initially, the people in Hoper rejected our programs because, coming from an Ismaeli organization, they felt that it would be a betrayal to their Shiite heritage," said Safiullah Baig, a program officer with the Aga Khan Development Program. "In Karamibad and Ghulkin, towns that are Ismaeli, when the Aga Khan network suggests any sort of program, they take it immediately. They recognize the Aga Khan as their prophet and us as the arm of his work. But, even though the work here is nonsectarian, people hesitate to take money from a foundation not associated with their sect. Now, people in Hoper are seeing the success of villages like Karimabad and are anxious to start working with us and implement the changes we're offering. But it will take time."

Development, both as a theory and as a practice, seems tentative and fragile in the Northern areas. Sometimes one success almost necessarily means another's failure. Towns near the highway, which got on board the development wagon years ago, were ready for the access and facility the road offered, and they quickly prospered and cornered the market on the production and sale of certain goods, leaving little room for other newcomers to flourish. Those towns further away, with less enthusiasm for new infrastructure and schools, are still in the midst of what persistently feels like another century.

Development workers in this region say that the need to confront inequities and vastly different cultural beliefs has been one of their biggest obstacles. Some voiced their concern that they may be adding fuel to the fire unintentionally.

"This is certainly something that concerns us and something that we have to think about in our future work," said Stephen Rasmussen, chief operating officer of the AKDN in Pakistan's Northern areas. "At the same time, though, we also have to recognize that we're trying to do the most amount of good for the most amount of people. We cannot and will not force anyone or any community into accepting our work, and we've made it clear that though we operate with money garnered through the Aga Khan Foundation, we are a development agency, not a religious advocate."

Reaching out beyond the immediate interests of the Ismaeli community has meant that in some cases the Aga Khan network has channeled money through other organizations, but, most often, after initial reluctance, Shiite and Sunni communities approach them, having learned of the possibilities through word of mouth.

It still is not easy to reach Hoper. The town is centuries old, built upon a rock plateau so that none of the surrounding arable land was "wasted" on housing. Walking there means traversing a steep muddy valley, then hiking up through the stony incline. Along the muddy path, men bow under heavy bags loaded with firewood or produce.

"Not so much has changed here," said one man. "If there is an accident, the victim still usually dies en route to a medical center. Pregnant women with complications have to be carted down in a wheelbarrow and often don't make it the whole trip. We still have problems with sanitation and the basics that people are accustomed to in Karimabad. But one change that has become very real is the social one. My parents were like serfs and my father's voice was never heard among the community organizations. Now, if I have something to say, I say it. My bloodline doesn't determine my worth. It may not seem like a lot, but in one generation it feels like a revolution."