#40–Tom Catena, M.D.: The world’s most important doctor in the war-torn and remote villages of Sudan

KEYPOINTS

• 01

  Catena is the lone doctor for roughly 750,000 to a million people in the Nuba Mountains

  Catena grew up in upstate New York, played football at Brown, studied medicine at Duke and served five years in the US Navy. He then joined the Catholic Medical Mission Board for what he planned as one year in Kenya. He stayed about seven and a half years, then arrived at Mother of Mercy Hospital in Sudan's Nuba Mountains on March 10, 2008. He says its catchment area covers 750,000 to a million people across a region about the size of Austria. He describes his life's rule as seeking 'browner pastures.'

• 02

  When civil war broke out, he stayed while most of the staff left

  After South Sudan's 2011 vote to secede (he cites 99.99%), a disputed governor's election and forced disarmament in Nuba led to fighting on June 6, 2011. Ten days later the diocese sent a plane, arranged under a code name because of spies and the risk of bombing, to evacuate expatriates. Catena, two religious sisters and a priest stayed. He reasoned that without the hospital, women needing C-sections and the wounded would 'just die a miserable death.' He said those who left would not be judged.

• 03

  Most of the trauma he treats is to arms and legs, because those patients survive the journey

  Antonov planes dropped barrel bombs that threw shrapnel weighing up to 10 pounds; he keeps pieces. Early patients included a girl who needed a shoulder disarticulation and her cousin, whose hand had been blown off. Patients with chest wounds usually bleed out in the field, while abdominal injuries can arrive three or four days later.

• 04

  He learned surgery on the job, the way residents do

  Catena trained in family practice. In Kenya he did roughly 1,000–1,200 supervised cases, with mentors such as a Kenyan surgeon he calls 'a magician' walking him through operations, adding one new skill at a time. He admits to complications, including a hemopneumothorax on his 500th central line. His threshold for operating is 'first do no harm': if he can't improve a patient's health, he declines.

• 05

  The hospital itself was bombed

  The government portrayed it as an American Christian hospital treating rebels. Catena describes lying flat as an Antonov circled, learning that the whirring pitch was the sound of a falling bomb, through six to eight drops. He says he felt 'like a hunted animal' and feared losing a limb more than dying. Afterward they dug foxholes across the grounds.

• 06

  He has had to work with very few diagnostic tools

  They had ultrasound from the start. They waited eight years for an X-ray machine and got a lightweight Bluetooth unit about a year before this conversation, now operated by operating-room staff he trained. Lab testing is limited to urine, stool and hemoglobin, so rugged cartridge analyzers would help. Supply drops are impossible because fighters would destroy them, so logistics matter as much as money.

• 07

  The adult disease pattern looks nothing like America's

  Catena says that in ten and a half years he couldn't point to a single heart attack. Obesity is virtually nonexistent and type 2 diabetes appears occasionally in people in their 40s and 50s. But untreated hypertension is common, with pressures as high as 250/180. Tuberculosis is very common and HIV is well under 1%. He sees hepatitis B–related liver cancer and wants HPV vaccination and cervical screening.

• 08

  Fewer possessions make life simpler, he argues

  Catena says the more possessions people have, the more complicated their lives become, and meaning isn't found in material things. He cites the Gospel story of the man who 'went away sad, for he had many possessions,' while stressing he doesn't mean it judgmentally. He draws on his faith daily and attends church every day.

• 09

  He sees suicide as tragic as the war wounds

  Catena knows of only one suicide in Nuba, the husband of a staff member. Peter notes that in the US suicide ranks among the top 10 causes of death in every age group above 10, before even counting 'slow suicide' through alcohol and drugs. Catena suggests that a hard communal life makes people less inward-looking, and he finds the grief suicide leaves behind heartbreaking.