Like last year, 2021 has been another challenging year, but we are grateful to you for helping Mano a Mano continue to partner with Bolivian communities – on projects they request & ultimately own – to improve their lives. Mano a Mano’s biggest strength is our community-based partnership model – bringing many people together to accomplish things that none of us could do on our own. Every activity, every project new or old, every event, depends on the dedication & effort of many people. As we look back at what we were able to do in 2021, we want to thank you:

• the communities & municipal governments in Bolivia;
• the people, schools, churches, community organizations, and foundations in the US;
• the people from many other countries that support Mano a Mano;
• the core Mano a Mano staff & volunteers at all 5 of our counterpart organizations in Bolivia and the US.

Without you – every person working together and doing their part – none of this would be possible. Thank you!

Annual Reports from Previous Years: 2018-2020

Check out our previous Annual Reports from the past 3 years (all financial statements, 990s, and previous year’s annual reports are available HERE):

• 2020
• 2019
• 2018

Together, We Help Hundreds of Thousands of People in Bolivia

Hundreds of thousands of people in Bolivia benefit from Mano a Mano’s health, education, water, road, aviation, food & farming, and medical surplus distribution programs!

• 2021 in Pictures
• Our Favorite Videos of 2021
• 5 Most Popular Posts of 2021

Reports on Each Major Mano a Mano Program in 2021

• Distributing Medical Supplies and Equipment in the Twin Cities and to Organizations Working Around the World
• Mano a Mano Clinics: 1,107,024 Patient Visits in 2021
• “Water is Life” – Mano a Mano 2021 Water Projects
• Providing Emergency Flights and Weekend Health Clinics: Mano a Mano’s Aviation Program in 2021
• 2021 Summary of Medical Distributions in Bolivia
• Moving Another Step Forward in Mano a Mano’s Long-Term Sustainability
• Training Farmers and Building Greenhouses: Mano a Mano’s Center for Ecological Agriculture in 2021
• Candita Walks Again, Thanks to New Prosthetic Leg
• Overhauling An Engine

Shipped 180,180 Pounds of Supplies From Minnesota to Bolivia

Despite some shipping costs increasing by 150% and other new shipping challenges due to COVID, Mano a Mano shipped 7 containers with 180,180 pounds of medical supplies and equipment from Minnesota to Bolivia in 2021. (We averaged 187,951 pounds shipped over the previous 4 years.) In addition, we also distributed tens of thousands of pounds of supplies to other nonprofits and to people in need locally in the Twin Cities. All of these supplies would have ended up in local landfills; instead they are helping people in Bolivia, Minnesota, and other countries.

• Mano a Mano provided larger amounts of medical supplies and equipment to hospitals in the Cochabamba area: Hospital del Norte, COMBASE, and Hospital Manuel Ascencio Villarroel in Punata in September.
• Traditionally, tribal families have carved boats from felled trees. But frequent accidents, some with tragic consequences, occur when naturally downed trees strike wooden boats. After a teacher and three students drowned when their canoe broke apart as they crossed a 100-foot-wide river on their way to school, several communities asked Mano a Mano to help them acquire aluminum canoes and boats. In September of 2020 we shipped three canoes and one jon boat in response to this request. Now located in the tropics, each watercraft will belong to an entire community, not an individual. It will be parked in full view on selected spots on either side of the river, available for shared transport to whoever needs it.
• Our counterpart organization Mano a Mano Internacional was in Tarija on October 26th, 2021 to distribute medical supplies and mobility equipment for 7 health centers in Tarija as well as San Antonio – a 2nd level hospital. Thanks to El Gobierno Autónomo Municipal de Tarija and the Secretaría de Desarrollo Humano y Gestión Social Municipal for partnering with Mano a Mano to make this donation possible. Supplies included instruments, hospital linens, catheters, wheelchairs, walkers, crutches, and other items.
• Mano a Mano staff and volunteers loaded 7.2 tons of medical supplies into 4 large trucks at our Cochabamba warehouse in late October to send to Potosi, where 24 health centers in and around the city will receive supplies (including 20 1st level (or primary care) health centers and 4 2nd level institutions).
• Pascuala is a member of the Tsimane community in the department of Beni, located in the Bolivian Amazon. She has been unable to walk for the past 12 years due to a tumor in her spine. She lives with her 6 children. She uses a wheelbarrow to get around. The wheelbarrow is much less stable than a wheelchair, and she occasionally falls out. She depends on her family to push the wheelbarrow. It’s difficult. Mano a Mano selected a wheelchair for Pascuala and brought it to the Mano a Mano Aviation hangar at the Cochabamba airport. It was flown from Cochabamba to Trinidad, then from Trinidad to San Borja, then by car from San Borja to the jungle, then volunteers went on foot from the jungle to Pascuala’s community of Yucomo (an hour and a half walk).

“We feel very happy and moved to work together, we want to be a bridge and a helping hand that is willing to reach out to any hand in the world. Let us have an attitude of solidarity, as a municipality let us help with our good will to also reach out to other smaller municipalities in the department that need help.” – El Gobierno Autónomo Municipal de Tarija and the Secretaría de Desarrollo Humano y Gestión Social Municipal

Celebrated the Initiation of the “Punata Regional Complex”

Mano a Mano celebrated the initiation of the “Punata Regional Complex” – a comprehensive project in the Cochabamba Valley’s Punata region over the next three years that includes a 3rd expansion of the Laguna Sulti agricultural water reservoir (complete); a new public school (50% complete); a deep well for potable water (complete); a three-mile road; infrastructure needed for moving our aviation program from the Cochabamba airport; and preparation for a rural Center for Ecological Agriculture (CEA).

Banner honoring Epifanio Velasquez at Laguna Sulti. This is part of the Punata Regional Complex project.

Served Over One Million Patients in our Clinic Network

Mano a Mano’s network of 176 clinics will have nearly one million patient visits this year. We currently have 4 clinic projects under construction. As a part of the Bolivian health care system, Mano a Mano’s network of 176 clinic projects provide monthly reports to the Bolivian Ministry of Health. Our clinic program’s approach is that health outcomes can be dramatically improved with simple yet effective interventions, beginning with the basic ability to consistently access quality services in their own communities. While COVID-19 has been (rightfully) the dominant current health issue, primary health care is needed now more than ever; our network of clinics serve a vital role in providing access to primary health care for communities in rural Bolivia.

• Our counterpart organization Mano a Mano Bolivia picked up a truckload of medical supplies and equipment from Mano a Mano Internacional in late February 2021, for distribution to Mano a Mano’s network of clinics and other organizations that Mano a Mano Bolivia partners with. Mano a Mano Bolivia made 661 distributions in 2020; recipients of medical supply donations included: 46 2nd & 3rd Level hospitals; 51 public health clinics; 326 Mano a Mano clinics; 197 donations to individuals in need; and 41 to various other organizations (such as jails, police & firefighter units, and long-term care facilities).
• Construction of Mano a Mano’s school project in Chirusi, Bolivia is coming along very well. Workers are currently constructing the second floor. The community is excited to see the progress on this school building – the school where their children will attend. This project is scheduled to be completed in February 2022, in time for the next school year.
• Over the first half of 2021, Mano a Mano’s network of clinics had 466,822 patient visits. Mano a Mano also provides continuing health education programs, and has a number of new clinic projects currently under construction – all with the goal of improving access to quality healthcare for communities throughout Bolivia.
• Construction of a clinic in Guadalupe was started in August – one of four clinic projects currently underway.

“When we visited Mano a Mano Bolivia in Cochabamba, we were very surprised when we found out how the financing was obtained [by US donors] to make the project affordable. Now they give us an equipped health center, which was built in a very short time. All this gives us lots of joy.” – Ariel Siles Cespedes, Municipal Mayor of Tarabuco (Sarafuya is a town of 1,702 in the municipality of Tarabuco, department of Chuquisaca)

Built Deep Water Wells and Expanded a Large Water Reservoir Project

Mano a Mano’s 500+ water reservoirs, water ponds, and wells provide consistent access to water for 65,000+ people in rural Bolivia. We currently have multiple deep water wells underway, and recently completed a water reservoir expansion.

• Transporting Heavy Equipment in Bolivia Takes Hard Work (and Many Repairs)
• After months of COVID-related construction and project delays, the Toro Toro runway is open for business! Local residents and Mano a Mano personnel marked the completion of this exceptionally challenging project on May 21, 2021.
• Mano a Mano’s expansion of the Laguna Sulti water reservoir is now complete! The rain recently arrived and filled the reservoir. One rain and the reservoir is about to overflow by the large overflow opening.
• Mano a Mano plans to construct several projects in the Cochabamba Valley’s Punata region over the next three years. We celebrated the initiation of these projects in May 2021.
• We have been building water reservoirs to improve community’s access to water since 2006, and over the past few years we have also acquired the heavy machinery and equipment necessary to drill deep wells – another means to improve access to water for communities in need.

Mano a Mano’s expansion of the Laguna Sulti water reservoir is now complete! The rain recently arrived and filled the reservoir. One rain and the reservoir is about to overflow by the large overflow opening.

Provided Emergency Flights for 308 People

For nearly 15 years Mano a Mano’s aviation program has focused on 2 programs for Bolivian communities that have minimal access to health care (at no cost): emergency rescue of ill and injured individuals, transporting them to urban hospitals for life-saving treatment; and weekend clinics for which we transport volunteer health care professionals into remote areas to provide primary medical & dental care. From January-October 2021, we have: made 498 flights, with a total of 545 flight hours. The Cessna Caravan aircraft, which Mano a Mano purchased in 2018, flew 51% of these flights; airlifted 254 patients, primarily individuals suffering from severe COVID-19, to specialized care in urban hospitals; and transported 215,600 pounds of cargo, including PPE and oxygen concentrators, to healthcare providers located throughout Bolivia. Aviation program staff make every effort to maximize each flight, by including cargo on flights made for other purposes.

• On July 13, 2018 – 3 years ago – Mano a Mano staff, board members, and volunteers went to Fleming Field in South St. Paul to check out the Cessna Caravan before it started its journey to Bolivia. Since arriving in Bolivia, this plane has increased the capacity of Mano a Mano’s Aviation program to transport more people & more cargo, more efficiently.
• Thanks to Devised TV for sharing the story of Mano a Mano’s aviation program in Bolivia. From their trailer about the one-hour documentary (available on Amazon Prime Video): “Ivo Daniel Martinez is an anonymous hero. At the controls of his plane (sometimes a tiny Cessna, sometimes a twin-engine Piper), he defies the quite extraordinary flying conditions of Bolivia to come to the assistance of the most remote communities in the country.” To watch the documentary on Amazon Prime Video: search for “On the Wing”; go to Season 2, Episode 1 – “Pilot of Hope.”
• Learn more about what our emergency flights look like for a typical month in May 2021. At the time, Many of these flights were for transporting COVID patients. COVID-19 infections in Bolivia were currently at their peak and rising, with 2,798 new infections reported each day. There were new quarantines, vaccinations were slowly becoming available but not being widely distributed, and the healthcare system was heavily strained trying to meet the needs (much of which is still true).
• Mano a Mano recruits medical professionals to spend a weekend providing healthcare in rural areas with limited access to healthcare. Three to eight volunteers, along with a pilot, fly to a prearranged airstrip location on an early Saturday morning, and return home the next day.In November 2021, we provided dental care to 309 people in 2 communities in the department of Beni through 2 weekend health clinics.
• Our plane transports medical cargo throughout Bolivia. Here is one such flight: on Friday, April 23rd, Mano a Mano transported medical supplies and equipment to the municipality of Baures in the department of Beni.

A weekend health clinic in November 2021.

Center for Ecological Agriculture in Cochabamba, Bolivia

Mano a Mano’s Center for Ecological Agriculture (CEA) provides training & tools for rural Bolivian farmers to improve food security & nutrition in their communities.

• It’s exciting to see the greenhouses that Mano a Mano has been building with the community of Corani Pampa being put to use!
• At any given time, Mano a Mano and our 5 counterpart organizations have dozens of projects in the works: clinics, schools, water wells and reservoirs, roads, training programs, medical supply distributions, emergency flights and transport, and more. All of these projects are done in partnership with Bolivian communities (and none of these projects are easy). Some projects take place on a daily basis, some are currently underway and will be completed in the weeks and months to come, and some are in the planning stages for this year and beyond. Just to give one example, here is the schedule at our Center for Ecological Agriculture (CEA) in Cochabamba, Bolivia over a few weeks in August (the CEA is part of the work of our counterpart organization Mano a Mano Internacional)
• Mano a Mano’s counterpart organizations Nuevo Mundo (started in 2005) and Internacional (2012) (we are 5 counterpart organizations in total) have lived rent-free in their Bolivian founders’ homes since they were created. Each organization began with a singular purpose and depended heavily on volunteers. From these humble beginnings, they have grown in size and scope, with highly skilled staff who take on complex projects. Soon, both organizations will have office space of their own in a shared building. Construction began in early 2020 but was delayed by the pandemic; it has been moving forward throughout 2021.

One of Mano a Mano’s new greenhouses in Corani Pampa.

Thank You to Our Volunteers in Minnesota & Bolivia!

• Thanks to our Metro State Social Work Field Placement students that have spent 20 hours a week working at Mano a Mano’s office/warehouse in St. Paul this semester! We are grateful to be working with this great group of Fall 2021 students, and this Metropolitan State University Social Work program over the past few years.
• On July 4th, 2021, Gloria MacRae, one of Mano a Mano’s most dedicated volunteers, celebrated her 95th birthday! Gloria loves a party, but due to COVID-19 restrictions we weren’t able to celebrate in person with her the way she would like to. 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 made a $25 donation to Mano a Mano during our first year in 1994 and then, as she says, ‘it took over her life’. So this year we asked Gloria’s many friends & family to send birthday cards and happy birthday wishes by video.
• Carmen Duran is a dentist and a long-time volunteer with Mano a Mano in Cochabamba, Bolivia. For the past two decades, she has participated in Mano a Mano’s weekend “jornadas” — dental and medical blitzes in which volunteer health care providers fly in to remote jungle communities to offer much-needed dental and medical care.
• For the past 18 years, a creative and determined group led by Dianne Van Goor in Sioux Falls, SD, has made 400-500 layettes every year, a labor of love, focused on improving the survival rates of rural Bolivia’s babies and moms.
• When Mano a Mano has needed to repair or upgrade its computers, electronics technician and Mano a Mano volunteer, Larry Oberg, has been our “go-to guy”. But in 2020 Larry surprised us with a new project and a question: could we use repaired sewing machines in Bolivia? Our answer: Yes.

2021 in Pictures

Note From Mano a Mano Executive Director Nate Knatterud-Hubinger

Mano a Mano has completed many new projects in 2021, with many more projects underway and planned for the future across our five counterpart organizations. The hundreds of projects we have built over the past 27+ years continue to operate as intended, providing access to quality services – water, food, health care, transportation, education – that are basic human rights for rural Bolivian communities. But none of this is easy. Some of these projects are years in the making; our staff traveled to one community to meet with leaders dozens of times, before we ever reached the point of signing a partnership agreement and raising enough funds for the project (and raising funds – which kickstarts every Mano a Mano project – is a never-ending process).

Our projects are spread throughout Bolivia, so our staff regularly drives 8+ hours each way to visit sites, and with larger projects they may stay on site for weeks at a time. Our heavy equipment and vehicles break down regularly due to heavy use in difficult conditions. As one recent example, to replace 2 tires on our front end loader ($2,500 apiece!), they are so big they wouldn’t fit on our plane, so instead of a 30-minute flight it was a 25-hour trip by truck one way – from the worksite to one of the few cities in Bolivia that carries these supplies. (And they often don’t have the required items at all in Bolivia, which is why many items for repair & maintenance of our heavy equipment and aviation program are bought and shipped from the US.) Shipping costs have increased dramatically over the past 12-18 months; one container would cost ~$2,500 to purchase up until 2020; they are now ~$6,300 (+150%!), with shipping & Bolivian Customs costs having similar increases. We have still shipped 7 containers this year.

Of course, COVID has been the biggest added challenge. We have not traveled to Bolivia or hosted any events in nearly 2 years, and we have had to cut back on our volunteers in the office, who we depend on to collect and organize medical supplies to ship to Bolivia. Restrictions, quarantines, and stay-at-home orders have been regular occurrences in Bolivia, and have delayed and limited many of our projects and programs.

But thanks to you and many others, we are still able to get things done. Mano a Mano consists of only a couple of paid staff in the US, and we depend on you – our volunteers and donors – to be able to partner with Bolivian communities. We are extremely grateful for your support!

– Nate Knatterud-Hubinger, Executive Director, [email protected]

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