Mano a Mano International Partners' Blog

Our Blog Has Moved

2011-11-15T13:48:00.001-08:00

Our blog is now part of our main website, and we will no longer be posting blogs here. Follow this link to go to our new blog page.

Keeping the Community Involved

2011-10-25T08:57:00.000-07:00

One of our major projects currently is a large-scale water reservoir being constructed in Sancayani, Bolivia, which when complete will provide water to nearly 4,000 Bolivian farm families. These infrastructure projects are hard work; for much of the tubing and channels we have to literally cut through mountains, and often just to transport our heavy machinery onsite we have to build roads first. Each day there are around a dozen community members volunteering to help on the project, doing tasks such as clearing the road of rocks and large debris for the heavy machinery:

Community residents contributed more than 32,000 hours on our last water reservoir project

In addition to the work that goes into the project itself, at the same time Mano a Mano emphasizes keeping the community engaged and informed throughout the process. For the Sancayani water reservoir project, Mano a Mano has held more than 25 meetings in the last 2 months alone. These meetings will include community members, local authorities, community associations, and residents from neighboring communities that may be affected by the project. We ensure that everyone's roles and responsibilities are clear, talk about how the construction is progressing, and address peoples' questions and concerns. Last week we held a meeting with the new leaders that were elected 8 days earlier, with more than 300 people in attendance.

We are very committed to ensuring the success of each of our projects, which starts with our collaborative model; there is a lot more that goes into these projects than the construction.

Community Maintenance Projects

2011-10-24T09:15:00.000-07:00

To ensure that the road and water projects that we build continue to be maintained and in good condition, Mano a Mano has implemented 'jornadas de trabajo' (work days) for everyone involved in the project - Mano a Mano, local authorities, and the community itself - to spend a day or two, 3-4 times a year, on improving or maintaining their projects. This past weekend more than 400 residents of Laguna Sulti participated in this jornada, showing up with their own tools to help get their reservoir (built with Mano a Mano) ready in preparation for the upcoming rainy season.

Mano a Mano was there to work as well, arriving with our grader and a truck to help with the heavy lifting.

These community maintenance work days are very important to ensure the long-term sustainability of our projects, and we were very pleased with the hard work and participation of everyone.

Segundo Velasquez on "Why I Started my NGO"

2011-10-13T07:57:00.000-07:00

Yesterday Mano a Mano co-founder Segundo Velasquez was part of a panel discussion at the Humphrey Institute of Public Affairs featuring local Minnesota organizations that work internationally. They discussed how and why they started their respective NGOs.

One part of the discussion focused on what makes a nonprofit successful; Velasquez responded that "It’s all about the human connection that brings it all together, working side by side to make a difference." You can read more about the panel here.

New Road in El Palmar Halfway Complete

2011-10-05T11:58:00.000-07:00

Last week staff from Mano a Mano did a site inspection of our road project in El Palmar, Bolivia. Twenty-two of the 56 total kilometers are now finished, and when complete the road will connect the communities of Canon Verde and El Palmar in the department of Chuquisaca, Bolivia and provide access to the larger markets of Tarija and Santa Cruz. We hope to complete the road later this year.

Aerial view of completed section of the road

Finished section of road

Constructing these roads is a very difficult process. The road is being built through mountainsides and dense jungle, and staff have to live on-site for weeks at a time without seeing their families. Many of the areas are so isolated that they are only accessible by horse or on foot.

Mano a Mano staff on-site

Meeting with local leaders. The generator providing lighting is the only one in the region.

During the inspection we met with local leaders about the project, who are very excited about the road and happy with the current progress; roads are crucial in improving the lives of isolated rural communities in Bolivia. The municipality and community are actively involved in the project and are paying for a substantial portion of the costs themselves. Earlier this year Caterpillar, Inc. made a video highlighting their collaborative partnership with Mano a Mano and explaining why road projects such as this one in El Palmar are so important in Bolivia:

Co-Founder Segundo Velasquez Recognized by Metro State

2011-09-30T09:26:00.000-07:00

Mano a Mano co-founder Segundo Velasquez was recently recognized by Metropolitan State University as one of "40 Alumni Who've Made a Difference!"

"Segundo Velasquez ('92) founded Mano a Mano International Partners in 1994 to improve health care in his native Bolivia and has led the organization on a pro bono basis since that time. From "kitchen table" beginnings, Mano a Mano has grown into an organization that makes health care available to more than 700,000 rural Bolivians, builds water reservoirs and roads to increase economic well-being, and provides emergency air transport to remote regions"

Congratulations Segundo!

Mano a Mano's 123rd Health Clinic in Kumara, Bolivia

2011-09-29T09:21:00.000-07:00

On September 10, 2011 we dedicated our 123rd health clinic in the community of Kumara, Bolivia. Our staff at Mano a Mano Bolivia put together a video of the entire process from start to finish:

You can learn more about our community health clinic model here.

We have a new plane!

2011-09-22T14:00:00.000-07:00

This week, after a long search, Mano a Mano has purchased a twin-engine airplane for our aviation program in Bolivia. This is a huge step forward for us and will greatly enhance our capabilities.

Mano a Mano's new plane!

To this point, Mano a Mano has flown two Cessna 206 planes for our emergency air rescue, jornada, and commercial flights. Both of these planes are single-engine planes, and while they will continue to be utilized in our program, having a twin-engine plane has numerous benefits. First, a twin-engine plane is safer. Because of the improved safety, we are now able to provide flights to organizations and businesses whose insurance plans only permit them to fly in twin-engine planes, which will provide a new source of revenue. Second, a twin-engine plane can fly further and faster, increasing our range to include other countries that border Bolivia and also decrease travel time on all flights. Third, the new plane is much larger, with 10 seats. Not only does this provide more passenger space, it also allows us to have more comfortable transport for passengers on emergency flights; we can now transport patients on a gurney rather than force them into a regular seat.

We are very excited to what this new plane will mean for all of Mano a Mano. Our aviation program is an integral part of our whole program: Bolivian medical professionals use the Mano a Mano plane to get to weekend health clinics in distant rural areas, shortening travel time to allow more time with patients; heavy equipment operators will now be able to purchase new parts and have them flown to construction sites in a matter of hours rather than days by car; and travelers to Bolivia will have a safer and more convenient mode of transport to see more of Bolivia.

We especially want to thank the donors and foundations who dedicated their time and resources to make this dream of ours become a reality!

Accomplishments

2011-09-14T09:48:00.000-07:00

As we celebrate our 17th year this weekend, we continue to be amazed at what a small group of dedicated people in the US and Bolivia can accomplish! Here are just a few of our acheivements since we started in 1994:

120,272 - volunteer hours in the US since 1994

2,180,061 - pounds of surplus medical supplies shipped to Bolivia

$10.1 million - value of this surplus

123 - number of clinics built in Bolivia. 115 of these clinics are financially independent and do not rely on any funding from Mano a Mano. (All clinics receive continuing health education and medical supplies on an ongoing basis.)

14,065 deliveries with 0 maternal deaths and 0.5% infant mortality rate (average infant mortality rate in rural Bolivia is 8%)

Schools, teacher housing, and community sanitation projects in 42 communities

Built 3 large water reservoirs and 153 atajados (small water ponds)

Constructed or improved over 1,400 kilometers of roads

962 emergency flights

Thanks to everyone that has been a part of Mano a Mano!

Weekend Health Clinics

2011-09-09T12:07:00.000-07:00

As part of our integrated approach to improving health, Mano a Mano provides jornadas, or weekend health clinics, in rural areas of Bolivia that have no access to health services. Doctors, nurses, dentists, and other medical professionals from Bolivia volunteer hundreds of hours of their time with Mano a Mano Bolivia traveling on weekends to some of the most remote areas of the country to provide free basic healthcare. They also give educational workshops on treatment and prevention of prevalent diseases in the area, such as malaria, dengue fever, chagas, leishmaniasis, and tuberculosis. Mano a Mano Bolivia volunteers usually fly to the jornada sites on the Mano a Mano plane; the trip can often be 15-20 hours each way on treacherous mountain roads, whereas flying reduces travel time to an hour or two, allowing more time to be spent with patients.

Jornada volunteers

Mano a Mano volunteer Nemecio evaluating a baby

Between 2006-2010, Mano a Mano provided 79 jornadas and had 15,200 patient visits. We have another 29 scheduled for 2011, such as a recent jornada to San Pablo de Isiboro in late July, an isolated community in the Amazon jungle in the Beni department (photos below). In a typical jornada our volunteers will see around 200 patients.

Mano a Mano Bolivia doctor with a patient

People in San Pablo de Isiboro waiting to be seen

Reading and Games with Sancayani Children

2011-08-11T08:57:00.000-07:00

Yesterday was our second Saturday of books and games with the kids of Sancayani. Along with big bags full of mandarinas, bananas and bread, we loaded a few heavy boxes full of books into the back of the car and drove up to 14,000 feet to meet them in their schoolyard. As we bumped along the road at about 10:30, we came into sight of the school and the ten or fifteen kids waiting for us leapt up and ran towards us. A few pretended to hide behind the whitewashed pillars and in the door frames in shyness, but peeked out, smiling, as we hopped out of the car. It was sunny but the wind was cold, and so strong that it kept blowing our hats off of our heads. At Blanca's (Blanca works in the Mano a Mano Internacional office in Bolivia) bidding, the kids led us behind the building to where the wind was less bitter. Perched on logs, rocks and concrete ledges, we gave the older students pencils and word-finds that Tracy (a volunteer from Europe) had put together while Blanca helped the younger kids glue together foam cutouts to make churches and bells.

Throughout the morning kids kept trickling in, arriving by bike or walking with a little sibling strapped to their back. By noon about thirty had found us. Generally the kids were fairly quiet and reserved, though more than a few were outwardly enthusiastic: the two little boys in my group of ten huddled together and whispered quietly to each other, looking around at everyone else and only vaguely trying to complete the word-find at hand; the girl at my side tapped my shoulder and proudly announced every word she found, and raced to finish first.

After word games and foam cutouts were mostly completed Blanca and I retrieved the books from the trunk, spread them out on a blanket, and invited the kids to each pick one to read. At first they approached the blanket shyly in twos and threes; after a few minutes nearly all of the kids ages eight and over clutched a book or were crouched over the pile, shuffling around for a suitable story to read. Rachel (a volunteer from the US), Ivo (Mano a Mano Apoyo Aereo pilot) and I sat with them, listened to them, and helped them read aloud. I read with Ronald, a 12-year-old boy wearing a red sweater and homemade slingshot slung over his shoulder. He read hesitantly, following the words with his index finger, carefully sounding out each sound and neglecting the spaces in between the words. Although I'm sure he knew most of the words he was reading, I doubt he understood them as he occupied himself with differentiating the sounds of b versus d and putting syllables together. His earnest attempts at what was obviously a difficult task were immediately interrupted if anyone, particularly a girl, looked over or walked by us: his eyes would nervously glance up at her and his voice would get suddenly soft.

Ronald

The ten-year-old word-find enthusiast, Maribel, was reading aloud to herself at our feet with a confident, consistent voice, exclaiming at pictures and funny phrases. Ronald sometimes paused and listen shyly to her reading, and then stumbled on his way. I was half sure he was scared of me, but I got a few genuine smiles out of him as we read and talked about the words. We got through one page in about twenty minutes, but his voluntary persistence really impressed me. None of the kids was required to be there, and could leave at any time. There was only one mom present, who came with a baby and her young son, and who quietly sat and observed the morning activities.

I joined a seventh-grade girl named Flácida who was devouring a story about two kids and a homemade jam competition, and she willingly read to me for the remaining fifteen pages of her book. Her voice was low and consistent and she read with little expression, though she rarely struggled with the words and sounded out the tough ones systematically. I asked her from time to time what was going on in the book, and she would briefly – and accurately – explain what had just happened, in a quiet voice with her eyes cast downward, though her quiet enthusiasm was obvious. She took the act of reading very seriously, and was not distracted for a moment by the kids wandering around, holding books and talking. She had walked an hour up from her town with her little brother to do this.

Blanca maintained a group of toddlers and young grade-schoolers by reading aloud and talking about reading with them. They sat in a group at her feet, wearing knit hats and shawls for the wind, squinting up at her and shouting out answers to her questions. Though a few unnamed members of our group suffered while wearing scarves, hats, and multiple sweatshirts, none of the kids mentioned the cold. After over an hour of reading time, we handed out food and little stapled booklets of stories to everyone and began packing up our materials. As some hopped on their bikes and headed down the hill towards home, a few students followed us around as we packed up, munching on bread and eagerly asking when we would be back. Blanca's idea is that Mano a Mano will make this sort of reading and activity day a weekly routine, which can eventually be passed on to the teachers and students to self-sustain, and which will spark the students' interest in books and reading. When the new six-room school is finished, Mano a Mano plans to donate boxes of books to make a small library of books for the students to take out and read at their leisure.

Libby Arnosti, Mano a Mano Volunteer

Agriculture Fair in El Palmar, Bolivia

2011-08-10T11:37:00.000-07:00

Yesterday local residents in El Palmar held an Agriculture Fair to show off their crops. The Fair was a huge event; the governor of the department was in attendance, as well as a number of local mayors. There were horse races and other games, and judges were there to select the best crops.

El Palmar

Many residents said that these crops that they are now growing are because of the road that Mano a Mano built here 6 years ago. With the road, they said, they could now grow crops in addition to what they grew for their own consumption because they knew they could transport the produce to market before it rotted.

We are currently improving their access further, building a 56-kilometer road that will connect them to the larger markets in Tarija and Santa Cruz. This new road is 33% complete and should be done later this year. You can find more pictures from the Agriculture Fair here.

Interview with Mano a Mano Traveler Monica Geocaris

2011-08-10T09:34:00.000-07:00

Next week a group of travelers will be going to Bolivia with Mano a Mano, including Monica Geocaris and her family. Monica took a few minutes last week to talk about why she chose to go the trip. You can listen to the interview here.

Interview with Alberto Salazar, Sancayani Resident

2011-08-08T11:20:00.000-07:00

Last week Mano a Mano volunteer Libby Arnosti visited Sancayani, Bolivia with local Mano Mano staff, where we are currently constructing a major water reservoir project. Libby is a 20-year-old college student from Minnesota who is spending the summer collecting stories of people touched by the work of Mano a Mano. The purpose of her project is to get to know more personally the people we work with, hear their reactions to Mano a Mano projects, listen to their thoughts and ideas about the future, and gauge the need for more community improvements. While in Sancayani, a local community leader mentioned to Libby that a resident was interested in doing an interview with her.

Alberto Salazar

Below is the transcript of the interview with Alberto from Libby:

What is it like to live here? "Life is hard. There are a lot of responsibilities, starting with getting food to survive. In agriculture, even though it's a hard job – brutal – when you grow a lot, there is that much more income. In the city you have to buy everything! Everything. Meanwhile in the campo at least you have potato, beans, wheat, oca, chuño [peeled and freeze-dried potato], something. Which you don't have to buy. So in a big way that alleviates the economic situation in the family."

Why the water project with Mano a Mano is important: "Well, I think Mano a Mano is giving us [the associates of the project] a great opportunity. Because before in the highlands there was a lot of rain, a lot of water. But these last five or ten years, the water has dropped a lot. So now there isn’t enough to water our crops. We have spring waters higher up, but before a lot came down and now there is only a little. We don’t know why the spring waters are drying up, but this is also why this type of project benefits us so much. The reservoirs, during the rainy season, will fill up, and in these times [the dry season] we will have enough to water the crops, to plant, to produce. So what Mano a Mano is doing is going to at least somewhat alleviate that problem. So at least we will be able to produce potato, wheat, soybeans."

On hopes for the future: "In the campo, though, money is still important. If there is no money, there can be no studying. So you have to produce first. We sell our crops at the market and with that money the kids can study, we can buy clothes, food. Looking to the future I think that you always have to look out for the kids, no? My kids are the happiness of my family. My children, I think that their future is primarily through education. As their dad I would like them to study. Study - because here in the campo there is a lot of need. If there was a professional here who understood agronomy well, for example, that person could make a lot of money. Because in the campo we don't have the same possibilities as in the cities. In the city there is everything, but in the campo, we make do with what we have."

On future projects: "Maybe from here looking to the future, doing more projects with Mano a Mano, no? And I would think that not just here. Here we still have spring water. In other places they don't even have water to drink. So they have more need. This is what I hope, that [Mano a Mano] continues, and that it keeps supporting like that – directly – the community members. Because when help comes from the state it sometimes arrives very late or doesn't even arrive at all. So it suits us that help arrives directly to the communities. And this benefits us in a big way. This is the only thing I would ask; if they could do other reservoirs for Sank'ayani, even better, no? [laughs]"

More comments: "I have finished high school. Few people, maybe ten percent finish high school, of the people in Sank'ayani. My older brother was working as a carpenter, he was working in Punata. And so he brought me so I could help him during my summer vacation. And I stayed there, to work and to study. I worked by day and studied at night, for six years. Working eight hours a day Monday through Friday – and only until noon on Saturday – and studying from 6pm until 10:30.

After high school I went to Chile, to Concepción. I was looking for more opportunity. But there, as a stranger it is not easy either. And so I came back too and when I came back I dedicated myself more to agriculture. But you always bring something from other places.

There are some people – like me for example, no? – study, finish high school, but sometimes forget about their communities, and they go somewhere else, to the city, or somewhere else, foreign countries. But they forget. And when they come back, they come back then like strangers, no? And it's not the same. So, we always want to retain those roots, of where we came from, where we were born – we want to retain that, not lose it. Because, if it is lost, I don't know, then there wouldn't be this community – there would be no organization, and so everyone would think of their own family and no more. And we wouldn't achieve any type of project – like we always say, 'unity makes force'. So this worries us a little sometimes, that when our children leave here and sometimes forget.

Of course, older people, with the time they have lived, have more experience than we do. And that is a good thing. So they have more experience but this person maybe has not had even one day of classes. They haven't gone [to school]. They don't know how to read, they don't know how to write. But they have more experience than we do. We always share their experiences and our thoughts – we who have finished high school – and so we strengthen ourselves between the two. And so any type of problem that comes up we can solve quickly. So, this is the good thing. Between their knowledge, and those of us who have learned a little in school, in high school, so we between the two make our living so that any type of work that has to be done, we do it easily. And this – and this, I think, is our wealth."

Libby Arnosti and Alberto talking in Sancayani

Sancayani Students Participating in Water Reservoir Project

2011-07-29T09:28:00.000-07:00

Mano a Mano is currently working on a large water reservoir in Sancayani, Bolivia, which is being done in close collaboration with the entire community, as all of our projects are. In order to involve the younger children, recently 60 students and 5 local moms participated in an art class where they drew cutouts of the Caterpillar machinery that is being used to construct the reservoir. The Caterpillar Foundation has been a huge supporter of this project, and we are happy to have a way for the children to show their thanks. More pictures of the childrens' class are here.

Shipping 75,000 pounds of supplies to Bolivia

2011-07-27T12:58:00.000-07:00

Over the weekend Mano a Mano volunteers helped load 2 containers with nearly 75,000 pounds of medical supplies and construction equipment. The containers will be shipped to Bolivia, where the medical supplies will be distributed to our network of 120 health clinics throughout Bolivia. We also shipped bridge-making supplies and equipment in collaboration with Bridges to Prosperity, a nonprofit whose mission is to provide isolated communities with access to essential healthcare, education, and economic opportunities by building footbridges over impossible rivers. They are opening an office in Bolivia, and we shipped a number of large spools of used wire rope that will be used in the construction of footbridges.

Loading 2 spools of wire rope

Thanks to our great volunteers who helped out this weekend, despite temperatures in the 90s and a lot of heavy lifting; we really appreciate it!

Volunteers stuffing the empty space with walkers; we never waste space!

Emergency Flight in the Beni

2011-07-19T08:21:00.000-07:00

After writing about recent Mano a Mano flights in Bolivia, we received an update on another emergency flight yesterday in the Beni region of Bolivia. A 20 year old woman with congestive heart and kidney failure was unable to receive sufficient treatment at the nearby hospital in San Lorenzo, so they called Mano a Mano asking if we could fly her to Cochabamba to receive care. Our pilot Ivo Daniel Martinez Velasquez flew to the Beni yesterday morning and picked up the patient, along with her doctor Emilio Guzman to accompany her on the flight. Upon landing in Cochabamba, medical staff was waiting to take her to the hospital; they are hoping she will be able to return to the Beni by Wednesday.

Mano a Mano pilot Ivo Martinez Velasquez helping the patient into our plane

Mano a Mano Flights in Bolivia in July

2011-07-18T08:56:00.000-07:00

Mano a Mano Apoyo Aereo pilot Ivo Daniel Martinez sent our US office an update about his recent flights during the past week:

Friday, July 8

We received a call asking for a flight to transport two patients from the community of San Lorenzo de Moxos. One had appendicitis and the other is waiting for test results to make a diagnosis.

Saturday, July 9

We transported four physicians to the community of Monte Cruz. They completed a weekend health clinic. A quick exam of two patients showed that they had to be transported immediately to Cochabamba in order to receive specialized attention so the aircraft returned to Cochabamba.

Sunday, July 10

We went to pick up the physicians from Monte Cruz. We combined this flight with a private pay flight which helps us generate funds. This way we don’t have an unpaid leg on the flight.

Monday, July 11

We received a call from the mayor of Culpina, asking for an emergency flight for the daughter of one of the council members who had worked very closely with Mano a Mano Nuevo Mundo. This seven year old girl had been operated on during the previous month; it was a major operation which included changing heart valves. She had been recuperating normally but, inexplicably, the situation became seriously complicated. The child was unconscious and couldn’t move. Her parents took her to the city of Tarija where they hoped for help from a specialist but none were available. They saw the need to transport her to Cochabamba (where she received the operation). It was not possible to consider transporting her by land, given that the bus trip is 20 hours and the girl needed IV fluids and oxygen as soon as possible. The parents asked that the commercial airline transport her but it refused because of the girl’s complicated situation. Mano a Mano responded and flew her to Cochabamba; now the girl is doing well and is recovering normally.

Transporting her to Cochabamba in the Mano a Mano plane

Tuesday, July 12

We completed a private pay flight to the community of San Lorenzo, generating funds for Mano a Mano. In the afternoon, we completed another private flight to the city of La Paz with an overnight stay.

Wednesday, July 13

We returned from La Paz.

Thursday, July 14

We received a call asking for an emergency flight. Some Chilean tourists suffered an accident, a collision of two vehicles on the Salt beds of Uyuni that left eight wounded and two dead. The wounded could have been moved to a hospital in Potosi, but the urgency was to transport the two who had died to the city of Calama in Chile. Sadly, we had to turn down this flight because our small aircraft would only have been able to carry one of the coffins. Two coffins cannot enter the aircraft and the distance to Calama is great. Finally the Chilean Air Force sent a version of the C – 130 to Potosi to pick up all of the wounded and the dead.

Saturday, July 16 and Sunday, July 17

We are providing air support to a weekend health clinic in the community of San Pablo in the Beni province (organized with Mano a Mano Bolivia).

Thanks for all your support. Without your help this would be impossible.

Ivo Daniel Martinez Velasquez

We Are Shipping Two Containers of Donated Medical Supplies to Bolivia

2011-07-15T13:46:00.000-07:00

Mano a Mano is shipping 2 containers with more than 40,000 pounds of medical supplies from the US to Bolivia, where they will be distributed to our network of 120 clinics, as well as other organizations throughout Bolivia. You can learn more about the project here, and if you're interested you can make a donation below:

Donate online to Distribute Donated Medical Supplies to Bolivia and Save Lives at Razoo

Videos made by Supreme Master TV

2011-07-15T08:46:00.000-07:00

Last year Supreme Master TV, a nonprofit channel airing constructive news and programs that foster peace and promote healthy, green living, aired two videos showcasing Mano a Mano's programs as part of its "Good People, Good Works" feature. Part one highlighted our health and education programs:

Part two focused on our road and water projects:

Thanks Supreme Master TV for making these videos!

Pictures of Dedication of our 119th Clinic in Santa Rosa, Bolivia

2011-07-13T08:43:00.000-07:00

With every clinic that Mano a Mano builds, the community always celebrates its completion with a dedication ceremony. It is a huge event, and nearly everyone attends. Local leaders and politicians make speeches giving thanks, the children perform dances and play music, and often donors who contributed to the project in the US travel to Bolivia to attend as well.

Before the dedication takes place, volunteers make the final preparations to get the clinic ready for use - cleaning floors, making beds, and moving in the furniture, supplies, and equipment needed.

More pictures of this dedication are available here.

Happy Birthday to a Very Special Volunteer!

2011-06-28T09:40:00.000-07:00

On July 4, 2011, we celebrate Gloria MacRae's 85^th birthday. Gloria is one of Mano a Mano's most dedicated volunteers and has been with us since the beginning; she made a $25 donation to Mano a Mano during our first year in 1994 and then, she says, it took over her life. Over the years Gloria has recruited many volunteers and donors, always carries a Mano a Mano brochure in her purse, talks with everyone she knows about our work, requests donations of medical surplus, and the list goes on.

We even have her to thank for helping get our clinic program off the ground. When we celebrated Gloria’s 70^th birthday in 1996, we kept secret that more than 100 of her friends were raising funds to build the first Mano a Mano clinic in her name, “Clinica Gloria”. Imagine her surprise when we presented the gift: enough seed funding to build two clinics, Clinica Gloria I and Clinica Gloria II. And the rest, as they say, is history.

For her 75th birthday we had a new challenge. Northwest Airlines had donated 8,000 crystal glasses to Mano a Mano, which we planned to sell as a fundraiser. Gloria was our best salesperson; she even began carrying glasses in her purse to sell for $2 each to everyone she knew, and we raised over $16,000!

Gloria was born in Empress, Alberta, Canada on July 4, 1926. She emigrated to the U.S. to attend the University of Texas, became a medical technologist, and worked for a pharmaceutical company until age 35. Beginning to feel restless in her lab-focused job, she decided to seek another career and chose social work through the University of Minnesota’s masters program. She worked as social worker at Gillette Hospital, Ramsey County, and Anoka State Hospital until she retired. Not one to stop at that point, she went on to teach English to spouses of foreign students, became the volunteer social worker for Macalester Plymouth United Church, served on the review board for the St. Peter Security Hospital, and adopted Mano a Mano.

For every birthday since 1996, it's become a tradition for Gloria to encourage friends to make a donation to Mano a Mano in her honor. Gloria exemplifies the spirit of our organization, and we thank her for her tremendous support; Happy 85th Birthday Gloria!

New Video Highlighting Partnership with Caterpillar Inc.

2011-06-23T09:49:00.000-07:00

Mano a Mano International works on a model based on partnership; part of that process is seeking alliances with key corporate partners in the US. The Caterpillar Foundation has become one of those key alliances, and we have been working together for 3 years to help bring solutions to impoverished rural Bolivian communities. In 2007, Mano a Mano approached the Caterpillar Foundation to seek funding for two new roads. Caterpillar considers roads to be a priority in helping to open new markets that could spur an increase in economic development. Caterpillar indicated; “we were impressed by Mano a Mano’s commitment to assist rural communities [giving them] access to markets through the construction of roads and runways. Passable roads hold the key to economic well-being.”

Since 2007, Caterpillar has trusted their investment to Mano a Mano to continue to offer solutions in Bolivia. CAT has provided us with a matching grant - providing a dollar for dollar match up to $225,000 for any contributions from other businesses to support our proven efforts in improving health and economic opportunity for impoverished Bolivians. In addition, the Caterpillar Foundation wanted to capture the impact themselves and hired a team of professional photographers to travel to Bolivia and share the Mano a Mano story:

Clinic Program Update

2011-06-17T12:06:00.000-07:00

As part of our clinic program, Mano a Mano Bolivia keeps extremely detailed statistics for everything they do, from number of patient visits to vaccinations to outcomes in each of our 120 clinics in operation. To give you an idea of what our clinics do, here are some of the numbers for the first 3 months of 2011 (119 clinics reporting):

179,342 patient visits overall. The focus of our clinics is primary care, and particularly maternal & child health, and that is reflected in our visits.
49,051 general medicine visits, including 24,504 exams for children under 5

Child and mother waiting to be seen in the La Joya clinic in the department of Chuquisaca

36,430 dental visits, including 2,124 extractions and 8,186 fluoride applications. Dental work is in high demand, and we have dentists in 48 of our clinics.

21,515 OB/Gyn exams
9,164 prenatal exams and consults

9,585 vaccinations. This includes vaccinations for yellow fever, tetanus, and a series for children under the age of one.
392 deliveries, with 384 live births. Providing trained personnel to assist during deliveries is one of our primary services; having access to trained assistance significantly improves mortality rates, but is particularly lacking in rural areas. In rural Bolivia, only half of all deliveries are assisted by trained personnel, in contrast to 88% of births in urban Bolivia (Caruso, Stephenson & Leon, 2010; World Health Organization, 2009). Due to this gap in services and extreme poverty, in rural Bolivia up to 8% of infants die within a month of birth, and the maternal mortality rate is 524 per 100,000. In our clinics, we have attended 14,065 deliveries since 1999, with 13,984 live births; the infant mortality rate in our clinics is 0.58%, and no mothers have died during childbirth. This is a huge reduction; statistically one could expect 1,125 babies and 74 mothers to die.

1 new clinic built in Aramisi, Bolivia. The first quarter of the year is the rainy season in Bolivia, so most of our construction is done later. We are on track to build 8-12 clinics in 2011.
28,141 education hours for Mano a Mano staff and communities. Health education is a huge component of our clinic model; we train on average 10 health promoters in each community, and our medical staff attend at least one continuing education conference every two years. Mano a Mano Bolivia schedules ten continuing education conferences each year, including an annual collaboration with Regions Hospital.

Community Health Promoters Learning CPR

These are just a few of the many facets of our clinic program. We are proud of the results, and are very grateful to our staff and volunteers at Mano a Mano Bolivia, and the local communities and municipal governments who all work extremely hard to make these projects successful.

Mano a Mano Dedicates its 120th Clinic in Chunavi, Bolivia

2011-06-03T10:31:00.000-07:00

Paul Cormier, a mountain guide from New Hampshire, and his team just returned back to the US from their annual climbing expedition in Bolivia. Paul's trip was more than mountain climbing; two years ago, during one of his climbing trips in Bolivia, Paul heard about Mano a Mano's work and asked how he could help. Paul and his fellow travelers wanted to give something back to the community of Chunavi, where they had set up base camp during their climbing expeditions. Chunavi is a small village more than 13,000 feet above sea level in the Andes Mountains, located a few hours' drive from La Paz. Last year they began the Chunavi Fund, which was dedicated to raising enough money in the US to build a community health clinic in Chunavi. The clinic project would be built using our collaborative approach involving Mano a Mano, the community of Chunavi, the Municipal Government, and the Bolivian Health Ministry.

The Chunavi Fund was very successful, and now, one year later the project is done! The clinic is fully equipped with medical supplies and equipment, and has a full-time RN; soon a physician will also be hired by the local municipality. The entire community came out for the dedication ceremony last week to celebrate its completion, and Paul Cormier and his group traveled to Bolivia to attend the dedication. This is Mano a Mano's 120th clinic in Bolivia. The local community and municipality were heavily involved throughout the process, volunteering nearly 4,000 hours during construction. Thanks to everyone who made this project happen!

Chunavi volunteers mixing cement at the clinic construction site

Mano a Mano Bolivia Executive Director Jose Velasquez meeting with the community during the planning process

Under construction

Dedication Ceremony in May 2011

Paul Cormier and his group as the guests of honor for the dedication

Agriculture Fair in Omereque, Bolivia Showcases New Crops

2011-06-01T08:14:00.000-07:00

This past weekend the community of Omereque held an Agriculture Fair to showcase the new crops they have been able to grow this year. With water from the 148 atajados (farm ponds) Mano a Mano has built in the Omereque area, farmers planted vegetable and fruit crops that they have never planted before (tomatoes, celery, peppers, squash, carrots, beets, cabbage, lima beans, peas, lettuce, onions, radishes, achojcha, watermelon, and chirimoya). Usually these crops are only able to be grown at lower altitudes, but because there was sufficient water they were able to gorw these crops. This fall they will plant their usual staple crops of corn and more potatoes.

One of the 148 atajados built in Omereque; each pond provides water for 1-4 families

Some of the varied produce at the Agriculture Fair

Because they had such success with their new crops, the municipality decided to sponsor a fair to which farmers brought their produce to show to others who came from throughout the region. Agronomists judged the produce. Mano a Mano staff and volunteers traveled from Cochabamba to attend as well.

One of the displays at the fair

The farmers and the municipal officials are very excited about the ponds. They held sufficient water to irrigate these varied crops. The vegetables and fruits grown this season are completely new to these farmers, and they are grateful to have this food for their families. Now that they have seen how well these crops grow in their area, they plan to plant more of them to sell in city markets next year. Mano a Mano has worked extensively with the community of Omereque; in addition to the 148 atajados, we have also constructed classrooms, teacher housing, a maternity ward, roads, and airstrips. They have worked very hard to improve their community, and we are very happy for them to see the fruits of their labor.

Update on Martha

2011-05-24T11:38:00.000-07:00

A few days ago we wrote about Martha, a 17 year-old girl from San Borja, Bolivia. Martha had a large tumor in her knee, and Mano a Mano provided an emergency air transport for her to Cochabamba.

Martha being transported to Cochabamba

Martha was taken to the Clinica Los Olivos, one of the best health care centers in Bolivia. We asked for an update from our staff in Bolivia about Martha's condition, and yesterday we received this note from Maria Blanca who went to visit her:

I was hoping to share good news with you, but it's not the case.

Yesterday, we spoke with Sister Adelina. She informed us that nothing could be done with the girl. They had done what they needed to so she could withstand the surgery, but they can't do anything for her. They're afraid that by amputating the leg, she'll lose too much blood and die. I imagine that there must be at least 3 liters of blood in the tumor on the knee, so it's hopeless.
Today I went to the hospital to visit both of them. The girl's name is Martha, the oldest of two sisters. I spoke with her, she told me that she's been sick for a year and a half. I fed her (it was dinner time), I gave her something to drink, and I gave her some money. I prayed for her. I said goodbye.

Tomorrow the Mano a Mano plane that brought her here with hope, will return her to San Borja to wait for the end in her little corner of life. Hopefully it can be God's will, that, in an act of mercy, He could choose a different ending.

What could we do for Martha? Nothing! Not even take her out of the country. She doesn't have a birth certificate, no I.D., let alone a passport, no money. It's like she's just a wild animal. The poverty in my country is huge.

I want to thank you all for your generosity. I know you all loved her and wanted to do something for her. Martha will be a memory in our lives. I want her to remind us of love more than pain. There are still many Marthas in the world. It's true that today you and Mano a Mano got there late, but we hope that tomorrow we arrive on time.
María Blanca

Sadly, not all of our stories can end happily. We are looking to do what we can to help Martha's family, and are collaborating with the NF Network to learn more about neurofibromatosis, a genetic disorder which causes tumors and which is the likely cause of Martha's tumor.

International Conference on Acute Care with Regions Hospital

2011-05-20T10:14:00.000-07:00

Last week Mano a Mano hosted 15 doctors, nurses, and health care professionals from Minnesota for a continuing health education conference with our medical staff in Bolivia. This was the fourth conference in the past 2 years that Regions Hospital staff has participated in; hundreds of Bolivian health care professionals attend each conference, including Mano a Mano staff and staff from other organizations throughout the country.

Conference attendees

These continuing education courses are a critical component of our clinic model; each year our staff at Mano a Mano Bolivia put together 10-12 three-day health education workshops for doctors, nurses, and dentists, and every medical staff member of the 375 (and counting) that work in our clinics has to attend at least one per year. In 2010 our staff provided 13,298 hours of continuing health education. Topics for these conferences focus on staff members' immediate concerns: traumatology, nutrition, bio-security, problem pregnancies, and family violence. These workshops are valuable learning experiences as well as an added incentive for our medical staff, most of whom work in distant rural areas and look forward to the chance to travel to Cochabamba and spend time with their colleagues.

With Regions' support we are able to cover more topics in which they have additional expertise; all of the topics selected are chosen based on the requests and primary concerns of our staff in Bolivia. Topics at this years' conference included burn management, nutrition, periodontal surgery, gastrointestinal hemorrhage, and renal failure, among many others.

We are very grateful to the Regions volunteers from Minnesota who travel to Bolivia, at their own expense, to take part in these conferences, and special thanks to all of our wonderful staff at Mano a Mano Bolivia who hosts the conference and handles all the logistics. This is a great collaboration for us, and we look forward to the next one!

Emergency Air Rescue in San Borja, Beni

2011-05-19T08:35:00.000-07:00

One of our most recent emergency air rescues occurred on May 5, 2011. We received a call from a small community that was 3 hours away on horseback from San Borja, Bolivia, in the department of Beni.

There were 5 people that needed assistance. Unfortunately, we only had space for 3 in our Cessna airplane because one of the women needed to lay down. This 17 year old young woman had a very large tumor on her knee - twice as big as her head - and was in extreme pain; she could barely move. She lived in a Chiman community (one of the indigenous groups of Bolivia) and didn't speak any Spanish, so she wasn't able to explain what had happened.

Tumor on her knee

Another of the women had tuberculosis on her spine and was essentially paralyzed. The 3 women were flown from San Borja to Cochabamba, where they would have access to the care they needed (the 2 other patients were not in as critical condition and took a bus to Cochabamba). The young woman's leg will have to be amputated; she most likely would have died if she had not been able to get to a hospital quickly. Special thanks to our Mano a Mano Aviation staff and our pilot Ivo Velasquez for making this flight!

Container of Surplus Supplies Arrives in Bolivia

2011-05-17T10:17:00.000-07:00

Our container of supplies recently arrived in Bolivia! In October of 2010, Mano a Mano US volunteers loaded 16,634 pounds of school supplies, wheelchairs, walkers, and other items. We have now shipped more than 3,000,000 pounds of supplies since 1994, valued conservatively at more than $10 million! These items were donated from hospitals, schools, and other institutions in the US and were destined for the landfill; while in Bolivia even the most basic items are not available. These supplies fill a critical need in insuring that the infrastructure projects that we build are well-equipped. Clinics without medical supplies and equipment are not functional; schools that do not have desks, chairs, and supplies do not last. While many of these items are bought or made in Bolivia - our staff at Mano a Mano Bolivia make the beds, desks, and chairs for our projects, and local Bolivian governments purchase items such as autoclaves, microscopes, and other equipment - we save money by being able to use donated supplies, freeing resources to be used in other areas.

Woman receiving walker from Mano a Mano Bolivia warehouse; we filled 691 requests for supplies in 2010

It is a long process to get through customs, but it was finally released in April and is now being distributed in Bolivia. We are currently planning our next shipment of 50,000+ pounds of supplies this summer.

Orthopedic supplies being loaded at Mano a Mano warehouse in Cochabamba, Bolivia

Orthopedic supplies being dropped off at our Mano a Mano Bolivia warehouse, where they will be distributed to our network of clinics and to individuals who make a request at the office

Our medical surplus distribution program is an extremely important component of our clinic program; without sufficient supplies we cannot provide high-level care to patients in our network of clinics. It is also one of the major incentives for retaining doctors in rural clinics. As Dr. Carlos Moises Guevara Retarnazo, a doctor in one of our rural clinics told us:

I had heard from my friend that the clinics are clean and well equipped, that there is no problem in getting supplies to use in treating patients, that the personnel in the Cochabamba office are available by phone every day to help with difficult cases, and that doctors receive more training from Dr. Ortuño who is very supportive. In most clinics in Bolivia, you can’t get supplies, the building starts to fall apart and nobody responds; you are totally on your own. I have found everything that my friend said about Mano a Mano to be true and am very happy to be working in this clinic. I travel to Cochabamba to the office once each month and feel that I am part of a big family that is Mano a Mano.

Mano a Mano Aviation Program

2011-04-15T10:09:00.000-07:00

Our staff in Bolivia recently put together this great presentation highlighting our aviation program.

Last year we provided 384 emergency air rescues, and 962 since 2006! Check out the presentation for more information about the different programs.

World Water Day - "Water is Life"

2011-03-22T11:40:00.000-07:00

Today is World Water Day, an initiative that came out of the 1992 United Nations Conference on Environment and Development in Rio de Janeiro recognizing the critical role that water plays in peoples' lives.

Mano a Mano has been working in partnership with local Bolivian communities since 2005 on water projects. Water is critical; as the communities always tell us "water is life." One of our current water projects is constructing a large-scale agricultural water reservoir in Sancayani, Bolivia.

THE NEED
Over 3,000,000 of Bolivia’s 9,000,000 citizens live in rural areas. The vast majority of rural residents eke out a meager living as subsistence farmers, raising crops and a few domestic animals on one – two acre plots, and earning an average income of $200 - $300 yearly: less than $1.00 per day. The Cochabamba Valley essentially has two climatic seasons: a warm, rainy season during which rain falls nearly every day for three to four months, and a cooler dry season during the remaining months when moisture rarely falls. Lack of water during most of the year results in widespread failure of crops to mature and substantially reduces yields. In contrast, during seasons of heavy rains fields flood, washing away germinating seeds and spouting plants. Together, these problematic circumstances result in failure to meet the nutritional needs of the local farm families and make it nearly impossible for them to improve their standard of living.

Beginning in 1950, Sancayani farmers attempted to use their picks and shovels to dig a channel along the side of their mountain, hoping to direct spring water and snow melt to the land they cultivated, and thus increase their crop yields. Unfortunately, the area closest to them was filled with rock which they could not penetrate with hand tools. After numerous failures and a nearly disastrous landslide, they concluded that lack of engineering expertise and heavy machinery that could safely dig and stabilize the terrain would force them to abandon their dream of having sufficient water to raise crops to feed their families and sell produce in urban markets. Their Valle Alto neighbors told Mano a Mano staff that they had been trying for fifteen years to find a means to channel the abundant, high mountain spring water into the river so they could have water during the dry season. When these subsistence farmers heard that Mano a Mano had begun to build water reservoirs, they approached staff of Mano a Mano with a plea for help in constructing a reservoir. “Water is life”, they said. “Without water we cannot live”.

CONSTRUCTION
Sancayani is our largest reservoir project to date; when complete it will provide water for crops and livestock to 3,500-4,000 Bolivian families! This has been a very challenging project. The location is nearly 14,000 feet above sea level, with constant fog, mud, and sub-freezing temperatures. Our staff and 15-20 community members have been working for more than a year, with the reservoir scheduled for completion later this year.

Mano a Mano heavy equipment working on the channel to transport water to the reservoir

Sancayani residents working alongside heavy equipment on the channel

RESULTS
We have completed 3 large-scale agricultural water reservoirs and 160 atajados (mini-reservoirs) since 2005; these projects provide water to more than 13,000 people. Average family income has doubled or even tripled due to increased crop quantity and quality that access to water provides. In each project the community and municipal government are heavily involved throughout and have set up cooperatives and maintenance plans to ensure long-term sustainability. With our Choquechampi water reservoir project, community members dedicated more than 32,000 hours of labor during construction!

Community members passing rocks; completed reservoir

These water projects are essential to improving rural Bolivians' lives, and each of our projects has provided clear results by improving communities' food security and increasing crop yield, which allows them to sell crops in the market to increase incomes. Just as important, through our partnership agreements there is a clear plan for training, maintenance, and distribution of water to ensure that these projects last.

But the need is still great; there are many more communities that have asked for Mano a Mano to partner with them. As one woman told us:

We have good land but not enough water to keep crops alive. Our young men go to Spain to work because they cannot make enough money here to sustain their families. Now Spain doesn’t want Bolivians any more, so the men are coming home. But how will they feed their children? Our water runs away and the corn produces little or dies of thirst. We know that an atajada (water reservoir) would hold rain water to channel to fields as our ancestors did. Please help us again. You know we have ganas (motivation) and will work every day if you bring your machines and build with us. Then we could feed our children and sell the rest in the city.”

If you would like to support our efforts in partnering with Bolivian communities on water projects, consider making a donation today on World Water Day.

Chunavi Clinic

2011-03-17T11:38:00.000-07:00

Mano a Mano is currently constructing a clinic in Chunavi, a small community north of La Paz, nestled more than 13,000 above sea level in some of the tallest mountains in South America.

Site for the clinic; Andes mountains in the background

As with all of our projects, the community signs an agreement with Mano a Mano detailing everyone's roles and responsibilities. The model we have used has resulted in 119 completed health clinics throughout Bolivia, with 108 financially independent of Mano a Mano.

Mano a Mano Bolivia's Executive Director Jose Velasquez meeting with community leaders

In addition to Mano a Mano's master builders, two master builders from the community were hired and will work alongside our staff and local volunteers. A typical clinic project takes around 2-3 months to complete
and more than 4,000 hours of volunteer labor from the community. That's the equivalent of having 10 additional full-time workers!

Women from Chunavi mixing cement for the clinic

Construction is on schedule to be completed within the next month. A group of US donors who have been tremendous supporters of this project will be traveling to Bolivia for the opening dedication ceremony. The group traveled last year to Chunavi, when this clinic project really began (they also kept a blog about their experiences). Thanks to everyone involved; our model requires the hard work and dedicated effort from the local community, our staff and volunteers in Bolivia, and our staff, donors, and volunteers in the United States. We need everybody, working together, for these projects to be successful and sustainable.

New Road Project in Bolivia

2011-03-15T11:15:00.000-07:00

Mano a Mano is currently constructing a road that will connect the communities of Canon Verde and El Palmar in the department of Chuquisaca, Bolivia. Roads in Bolivia are either nonexistent or little more than flattened dirt paths, making travel difficult, slow, and often dangerous.

Typical mountain road in Bolivia

Roads are vital in improving the lives of these communities,

creating a safe method of transportation and providing access to transport their produce to city markets, where they can get a better price. In many of these communities, having a road can shorten what before was a multiple-day journey into only a few hours. Building roads in these areas is a very difficult process. Mano a Mano uses its heavy equipment to clear out the dense vegetation and mountainous terrain; in many areas local volunteers are needed to manually move the large boulders and logs that slow progress.

Mano a Mano's heavy equipment clearing the path

Local volunteers clearing a boulder from the road

The project is 21% complete, with 12 kilometers of road finished; the final road will be 56 kilometers. To date, Mano a Mano has constructed or improved more than 1,000 kilometers of roads throughout Bolivia.

Dedication of new road in Riberalta, Bolivia

Emergency Air Rescues in 2010

2011-03-10T11:25:00.000-08:00

One of Mano a Mano's core programs in Bolivia is its aviation program. This is a critical component of our work due to the unique challenges of traveling in Bolivia. Bolivia has a very minimal road network. Only one two-lane roads connects the country’s capital to other major cities; tropical regions have almost no roads. Rivers connect some tropical settlements but their width, rapid current, and large amount of debris present danger to even the most experienced boaters. Small aircraft transport has become the mode of choice for reaching into these areas.

Goals of Mano a Mano aviation program:

Provide safe, efficient and reliable air transport to support Mano a Mano’s programs in rural Bolivia;
Increase aviation capacity in Bolivia by training pilots and technicians;
Create and operate an emergency response program;
Generate income to help cover operating costs by maintaining other aircraft, transporting cargo, and flying private individuals.

Using two Cessna 206 six passenger aircraft, Mano a Mano transports:

Medical professionals into remote tropical communities to conduct weekend clinics for tribal groups that have no other access to health care;
Ill and injured patients from isolated areas to urban hospitals for emergency medical care;
Staff and volunteers to distant communities that request the opportunity to partner with Mano a Mano on a project;
Emergency supplies of food, medicine and medical supplies and other desperately needed items to regions that have experienced a flood or other natural disaster.

In 2010, we provided emergency air rescue to 266 Bolivians! Each case is unique and presents different challenges; read about one of our recent flights where we airlifted a family in the tropical community of Ushbe whose house was crushed by a tree.

The Mano a Mano Model

2011-03-08T13:34:00.000-08:00

One of the main things that differentiates Mano a Mano is the model that we use. Here we'll briefly walk through the entire process for building a rural health clinic, although the model is very similar for all of our projects.

First, the community in Bolivia approaches us to request a project. This is a huge point; the local community is the driver of the process, Mano a Mano does not pick locations or projects itself. The community goes to our office in Cochabamba to request whatever project they have decided is most important, from a clinic to a school to community bathrooms, and are put on the waiting list until funds are available. When there is funding, Mano a Mano meets with the community and local leaders to sign an agreement detailing everyone's responsibilities:

Mano a Mano provides a portion of the funding, skilled labor (architect and contract construction workers), construction materials, most of the needed medical equipment and supplies and furnishings, and continuing health education for the staff and local community
the community provides a plot of land, any locally available materials, unskilled volunteer labor (this usually amounts to around 4,000 hours per clinic), and some funding
the local government agrees to pay the staff salaries of the doctor and the nurse and include these expenses as a permanent line item in their budgets, and to purchase specialized equipment (e.g. microscope, centrifuge)
as part of its national health program, the Bolivian Health Ministry provides vaccinations, some medications, and free services for expecting mothers and children up to 5 years old (including its newest program that pays mothers to attend pre and post-natal checkups during the pregnancy)

Community meeting at Mano a Mano Bolivia office to discuss a project; signing an agreement

In this way everyone fulfills a specific role, without which the project would not be possible. During the next phase of the process - construction - the community is involved extensively. Typically a schedule is set up and 4-8 local volunteers work at the construction site daily - laying brick, collecting and transporting materials, cooking food for the construction workers, and anything else that is needed.

Community residents working at Apillapama clinic

The partnership doesn't end after the clinic is built. Anyone who has traveled in the developing world has seen the deserted buildings that used to be clinics or schools, but are now empty due to a lack of long-term planning and support. With our model, Mano a Mano provides most of the furnishings needed at the start for the clinic through our medical surplus program - hospital beds, exam tables, dental chairs, and basic medical supplies. Providing supplies is also an ongoing service; without supplies it is almost impossible for clinics to provide the level of service needed.

In addition, Mano a Mano provides continuing education courses for the doctors and nurses on staff, as well as basic life support training to a group of community residents that become volunteer health promoters.

Community residents learning CPR

All of our clinics are connected by radio to our office in Cochabamba to talk with our staff about difficult cases or in emergencies. As part of the signed agreement, within 3 years administration of the clinic is turned over to the community, but the health education, medical supplies and equipment, and connection with the Cochabamba office are always an ongoing service.

Included in the clinic design is living quarters for the doctor and nurse. Almost all of our clinics are in rural areas, and without adequate housing it's very difficult to recruit and retain staff. We have had no problem in hiring and keeping doctors and nurses, and they often cite our model (consistent availability of supplies, continuing education courses, clean facilities, reliability of being paid their salary) for why they stay.

The critical component to the whole process is the community itself. We work based on the notion that the community is an able and willing partner in the process to improve their own lives. The fact that they request the project and then commit time and resources to complete it demonstrates their commitment to maintaining the project over the long term. As an example, below is a brief story from Jose Velasquez, Executive Director of Mano a Mano Bolivia, describing a situation that came up with one of our first clinic projects over 10 years ago:

“The mayor had signed a commitment to fund the clinic nurses’ salary but she didn’t receive it for a whole month. When she told us on the radio that she hadn’t been paid, I drove to the community and told the mayor that, if he didn’t pay her within a week that we would close the clinic – I knew he had the money from the health care fund. He didn’t pay her so I drove there again and met with community leaders to explain the situation and then locked the clinic door. About 50 villagers piled into an old truck, drove to the mayor’s office and set up a noisy demonstration in front of his door, demanding that he pay their nurse. The next day he paid the salary. I think everybody in Bolivia heard about it. We have never had a problem again with the government not following its commitments.”

Using our model, we have built 118 clinics, with 737,312 patient visits in 2010. 113 of these clinics are financially independent of Mano a Mano; 98.77% of the salaries for our 366 doctors, nurses, and dentists on staff are paid for by sources within Bolivia. We continue to move ahead and work with new communities, but the need is great. Currently there are 272 communities that have requested a clinic that are on the waiting list.

Bolivian families waiting in Mano a Mano clinic