David and Sally Monahan began their volunteer medical trips to the Brazilian Amazon basin in 1979.They would spend Thanksgiving working at the Medical Clinic, The Diabetes Program, The Child Malnutrition Treatment Center in the city of Santarem 500 miles up the Amazon. In addition they went on many trips up the Amazon to remote villages on the boat Esperanca and in 2002 began yearly trips to Quilombo villages on the Trombetos Tributary to the Amazon. Their participation ended in 2010 when the American NonProfit Organization gave the control over the clinic to their Brazilian counterpart Fundacao Esperanca.
Dr. Monahan was on the Board of Directors of the Amazon-African Aid Organization (3AO) a 501(c)(3) nonprofit support organization. In addition, to donating their time and paying their way the Monahan’s were involved in financially supporting the Brazilian medical activities. They also work to recruit physicians, dentists, and surgery teams to serve.
Quilombo – A Little History
Quilombo is an African word that means “run away slave village”. The Portuguese enslaved 3.5 million Africans between the mid 1500’s and 1888. That is seven times the number brought into the United States. Although these African-Brazilians were spread throughout Brazil, most were in the northeast area where they labored on the vast sugar plantations.
Of the Quilombo, assemblages of runaway slaves, the most famous was the Republic of Palmares. A virtual state reviving African traditions, creating social order and a highly civilized community. Palmares resisted attacks from colonial authorities for over 100 years from 1580 to 1694 lead by their great resistance leader Zumbi. Finally in 1695 the Portuguese transported large cannons across miles of trackless jungle, killed Zumbi and destroyed the 20,000 men, women and children of the settlement.
Amazon Health Care Article taken from Prep Times, St. John’s Prep, Danvers, MA Spring 2003 Issue
Last fall, David Monahan, M.D. ’62 traveled 24 hours by boat, deep into the Brazilian rain forest, to bring medical care to the descendants of runaway slaves living in hidden villages called Quilombos. There is no way in or out of the villages except by boat and “there is no health care in these places at all—zero,” said Monahan.
Monahan spends most of his time running a busy, full-time medical practice in Southern California. But since 1979, he has traveled frequently to the central Amazon River valley to volunteer for Fundacao Esperanca, a humanitairan organization that operates the Quilombos boat.
Once a month, the medical boat makes the journey from the port city Santarem—itself about 500 miles from the mouth of the Amazon—to three Quilombos villages. There are 27 villages, all located in a biological reserve on an isolated stretch of the Rio Trombetas, a large tributary of the Amazon. The villages were settled in the 1830’s by slaves escaping from vast rubber and sugar plantations. At that time, there were 3.5 million African slaves living in Brazil, more than seven times the number of slaves in the United States.
“Eight staff members, the volunteer physician and our captain leave Santarem at 8:00 a.m. Thursday morning. We cross the Tapajos, continue upstream in the Amazon (40 miles across at points) and turn north on the Trombetas to arrive at the village of Moura in time to see patients at 7:00 a.m. Friday. Our 24-hours boat trip certainly pales in comparison to that of the runaway slaves who founded this village 170 years ago in 1832,” said Monahan, describing day one of a five-day trip.
There is no electricity in the villages, so Monahan and his colleagues use the boat’s generator to provide power for the equipment they bring in with them. Typically, they see patients in the village school. The recently built school is constructed of wood and sits on stilts 10 feet above ground with a high, thatched roof, woven palm leaf walls and hard-packed dirt floors to insulate against the oppressive heat.
The medical team immunizes villagers, provides prenatal care, and treats a wide variety of ailments. They see everything from parasitic infections and diabetes to malaria, leprosy and crocodile bites. They also teach nutrition, sanitation, and preventive care. “We are appreciatively welcomed as our monthly excursions are their only contact with western medical care. Before the vaccines we bring were introduced, 50 percent of the children perished before age five,” said Monahan.
The team keeps charts and records on the villagers to provide for continuing care. Doctors can monitor patient’s progress by communicating with physicians who volunteer on subsequent river trips. Last year, Dr. Monahan treated a 12-year old boy suffering from his third attack of malaria. “He was extremely ill, but somehow our drug regimen saved his life. I didn’t learn of this happy ending until our volunteer team returned in January.”
On his most recent trip, Monahan saw 100 patients in three days. The nurse who traveled with his crew saw another 100 people. At the end of the long day, the team retires to the boat to update medical charts and sleep in hammocks in the intense jungle heat.
Village life revolves around the river. Looking out from the back of the 100-foot boat, Monahan sees mothers scrubbing their children, villagers fishing and children cleaning their catch. “That’s where all the crocodile bites come from,” Monahan commented simply. It’s a subsistence living and the local diet consists mainly of fish, rice, fruit, and manioc roots.
Headquarters for Fundacao Esperanca and the home base for the Quilombos boat, is a well-equipped primary care clinic in Santarem, a city of more than 350,000 originally settled in 1661. Santarem sits on the Rio Tapajos where it flows into the Amazon. Since the clinic was founded in 1975, it has grown into a compound that includes a children’s center, women’s health program, a diabetes clinic, a dental clinic, and a general medical clinic with a laboratory and pharmacy.
The clinic employs a full-time Brazilian doctor and staff, but it depends on volunteer physicians for plastic surgery, orthopedics, opthalmology and other specialties. The doctors who volunteer come mainly from the United States. They pay their own way and stay for three weeks at a time.”It’s really edifying for doctors because you treat things here that you train for but don’t often see at home,” observed Monahan.
On their arrival in Santarem, the volunteer doctors work at the medical clinic, the diabetes center and the children’s center. The highlight is the Quilombos boat trip which takes place on the third weekend. Monahan recruits and screens physicians as project volunteers. “The villagers asked us to come in and that gives you a nice feeling as a physician,” said Monahan. “You’re saving lives.”
Monahan, who is self-effacing about his humanitarian work, is deeply committed to improving the quality of life in the Quilombos villages. He is a member of the board of the Amazon-African Aid Organization, and currently is raising funds and recruiting doctors to bring the boat to the other Quilombos. Without health care in the villages, he said, “if you get something you die. It’s a fatalistic approach, but that’s the third world.”
The boat is partially underwritten by a bauxite mining company located not far from Moura. “We have worked to keep our administrative costs at less than six percent of our cost of providing patient care, and because all donated funds go directly to medical delivery services, virtually all of our donations are used to pay for medications and supplies,” said Monahan. “We’re filling a gap, and the advantage we have here is our administration ongoing set-up in Santarem. The clinic has sustained itself for 30 years and that is very unusual in the third world.”
The need for medical care is not the only thing that brings Monahan to Brazil. He loves the spectacular beauty and tremendous power of the Amazon. An astonishing 200-foot rain forest canopy reaches the river’s edge near the Quilombos. During the rainy season, the river rises 40 feet. “The phenomenon of the Amazon is that because it is so difficult to reach, there are many species that haven’t even been discovered yet,” marveled Monahan. The Amazon provides one-fifth of the world’s water supply, emptying 8 trillion gallons a day into the sea. Ten Amazon tributary rivers are themselves twice the size of the Mississippi River.
Quilombo team ferrying supplies up to School House/
Two Quilombo children
A grass hut that is
The Esperanca Quilombo Team