Tom Catena has dedicated the last 20 years of his life working as a medical missionary in Africa.
Nine of them he spent amid almost ceaseless civil conflict in war-torn Sudan, and for almost all 20, he’s lacked the resources and infrastructure that most Western physicians take for granted.
“Dr. Tom,” as he’s known among the locals, heads up a staff of some 200 at Mother of Mercy Hospital in Gidel. Most are non-medical personnel, and Catena is the only doctor among them. A majority train on the job; some who help maintain the grounds do so as charity. Occasionally, Catena has support from visiting physicians performing mission work, but even so, the amount of effort required of him is constant. That’s consistent with the way of life in a region where the general populace comprises subsistence farmers who grow sorghum and peanuts just to survive.
“We are extremely remote,” Catena said. “People here don’t live much differently than they did a few hundred or even a thousand years ago. Some schools are up and going, and people are keen on education, but it’s been held back by years of conflict.”
Mother of Mercy is the only hospital for some 300 miles in an area of the Nuba Mountains that is home to some 1.3 million people. What in March 2008 was conceived as an 80-bed, rural operation quickly expanded into a 430-bed campus that’s the first, last and only option for people there.
“Whatever hits the door, we have to find a solution for,” Catena said. “We’ve not been able to refer patients for many, many years. We have to do what we can with each patient.”
Such was the case during Catena’s first three years there. But when military violence reignited in June 2011, the “standard mission hospital” he operated “changed into a M.A.S.H. unit” almost overnight, he said.
“It was a stark contrast,” Catena said.
“We’d be sitting there and see 50 to 100 wounded at our gate,” he said. “We had to triage and see who needs to go to operation now and who can wait. We treated scores and scores of wounded with bombardment, shrapnel and bullet wounds to every part of the body.”
The team transitioned quickly from handling a variety of common ailments to caring for large numbers of people. But to grow capacity at the facility up to that increased operational standard, Mother of Mercy needs more physicians. Catena expects the first of them this spring.
“We’ve managed to keep things going with a dedicated staff and by the grace of God,” Catena said. “I spend quite a bit of time on the job teaching my medical assistants, [and] we’re getting our first Nuba doctor here in May or June. I’m really looking forward to teaching him as much as I can.”
Behind the newcomer are three or four others, Catena said. With his help, they’ll hopefully achieve a level of proficiency that will allow them to provide health care in the mountains “for generations to come,” he said.
“The next goal for me is to continue passing this on to the next generation of Nuba,” Catena said. “We’re slowly getting to that.”
It’s not dissimilar to Catena’s own on-the-ground instruction, which came almost as an afterthought to his interest in missionary work. Before he became a physician, the Amsterdam, New York native studied engineering at Brown University. Then came medical school at Duke University, five years in the U.S. Navy, and two-and-a-half years in residency. Catena trained as a family practitioner at Union Hospital in Terre Haute, Indiana, and came to Kenya in January 2000.
Initially, he worked in clinics and hospital wards, but quickly discovered he’d need to pick up surgical techniques to increase his effectiveness on the ground. After seven years “under the watchful eyes of mission doctors and Kenyan doctors,” Catena learned how to perform a variety of procedures, “but very low-tech in every field,” before moving to Sudan.
“We’re working in a specific environment,” he said. “This is rural African medicine. I’ve not done much else over 20 years.”
Even with the relief coming in the form of additional physicians over the next few years, Catena believes the institution is still probably about a decade away from operating without his daily, intense labor.
“I would like to gradually pull back a bit and get out of the day-to-day, seeing-every-single-patient mode, and start handing off some of these responsibilities to the Nuba doctors once they start coming,” he said. “[But] I plan to stay for the near future.”
Catena comes from a big family that’s “scattered around the Northeast,” but doesn’t believe he’ll be heading home to the U.S. to visit them any time soon. His younger brother, a priest, visited in 2016, and married Catena to Nasima, a Nuba woman he met there. Even were he not so specifically connected with the land and its people, Catena views his work in Sudan as an extension of his faith and the obligations that it demands of him.
“I see my role as showing the love of Christ to other people, and I do that through medical work,” Catena said. “My overarching goal is to be able to create a health care institution which will be top-notch.”
For that region of the country, which Catena described as having been marginalized historically, the opportunity to rise above its traditional station is showing itself in the influx of northerners who visit there for health care.
“I would love to see this area having a high-class, well-functioning, very efficient, rigorous health institution that can provide top-quality care to people all over Sudan,” Catena said. “It’s pretty hard for these guys coming from the north to look down on you if you take care of them. I think that goes a long way to helping the cause of the Nuba.
“This is a much better approach than the constant war,” he said. “In the long run, you have to have an alternative. Perhaps that can be through education and establishing high-quality institutions. We hope that would be a reality someday.”