The world’s most important doctor to millions in the war-torn and remote villages of Sudan | Tom Catena, M.D. (#40 rebroadcast)
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Hey everyone, welcome to The Drive Podcast. I'm your host, Peter Attia. This podcast, my website, and my weekly newsletter all focus on the goal of translating the science of longevity into something accessible for everyone. Our goal is to provide the best content in health and wellness, and we've established a great team of analysts to make this happen.

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If you want to learn more about the benefits of our premium membership, head over to peteratiamd.com forward slash subscribe. Welcome to a special episode of The Drive. For this week's episode, we're going to be rebroadcasting my conversation with Dr. Tom Katena, which was originally released in February of 2019. Prior to interviewing Tom, I had known about him for three years, but this interview was the first time I met Tom in person.

And it's actually the first time in my life that I was ever nervous prior to meeting another human being. Now, of course, this is incredibly ironic because when you meet Tom, and this, of course, will come across in the episode, he is quite simply the most humble person you can imagine. But I see in Tom what I consider to be the greatest of any qualities or characteristics in a person. And it really humbled me to meet him that day and to continue to get to know him better and better over the years since that time.

Since about the year 2000, Tom has been a missionary physician in Africa, initially working in Kenya. And then in about 2008, he moved to a region of South Sudan called the Nuba Hills or the Nuba Mountains, where he continues to take care of about three quarters of a million to a million people. At the time, he was the only physician in the area, and there's a single hospital there. It's hard to describe how few resources he has to run it. This is something he'll explain in the podcast. It's really nothing short of a miracle.

As an update to Tom's work, after several years of relative calm, Sudan is again besieged with conflict. This time, there is fighting between factions of the government. This civil war has inflicted widespread damage across the Sudanese health system. However, even with all of this, Tom's hospital is still functioning and caring for the wounded. Not only that, but the hospital now has its own clinical training school, which has 19 physician assistant students and 30 midwife students.

In 2008, when the hospital was founded, there were 15 staff members, including Tom and a few expatriate Catholic nuns. And the local Nuba were not formally trained at the time. As of today, there are 270 staff and over 50 formally trained Nuba health workers, including nurses, pharmacists, laboratory technicians, and anesthetists. And the first woman doctor from the besieged area of the Nuba Mountains is now also working with Tom.

In my conversation with Tom, we talk about a lot of things. We cover some of the unimaginable suffering that he sees and how he himself copes with death and copes with being in a situation that I certainly don't think I could be in, and I suspect many of you listening would relate to that. We talk about a crisis of purpose. I think it's easy to look at what Tom does and feel sorry for him or feel sorry for the people that he serves, but I must admit I came away from this interview actually feeling more sorry for us in a way.

And Tom so eloquently, without judgment, explains some of the differences between people with all the privilege in the world, like most of us listening to this, and the people that he serves. We also talk about the sense of community that exists in Nuba. And what you start to realize is that the way we die in this country and the way that we live in this country is so different from the way that people live and die in other parts of the world. It's not surprising that people there don't die from complications of type 2 diabetes, but instead they die from infectious diseases and trauma.

There's also a more subtle point here, which is that we are in many ways prisoners of our own world and our own mind and our own possessions. Tom's work is so important to me that I want to be sure anybody listening to this can get access to all the notes that we're going to put together on this topic. And as such, for this episode, the show notes will be free and available to everyone, including those who are not subscribers.

Lastly, and perhaps most importantly, if anyone is curious about how to support Tom and his amazing work, we will have a link at the top of the page of the show notes where you can give directly to the work Tom does.

My wife and I have been giving to Tom for about six years now, and I can say that it is unquestionably the highest ROI money that we contribute to any cause. In other words, for every dollar we give, we really have a sense of how it's being used and how it is changing lives. So without further delay, please enjoy or potentially re-enjoy my conversation with Dr. Tom Katena.

Hey, Tom. Thank you so much for making the time to come over here today. Sure, Peter. My pleasure. Glad to be here. Yeah, there are a few people that would be giving up more that they deem important work than you. So I know your time is tight. How often do you come to the U.S.? Well, this is my first time out in more than three years. So last time I was in the U.S. was November 2015. I was here for about five days. I was in my hometown of Amsterdam, New York.

And it wasn't much of a trip. I was, you asked about malaria. I was sick as a dog with malaria. So I was like in bed with malaria the whole time. The last day I felt a bit better just in time to go back to Africa. So it's been, it's been a long time since I've been back. You grew up in upstate New York. Yep.

Your pedigree is like the star, right? You went to Brown, you played football, you went to Duke Medical School. At what point did you realize you wanted to do something a little different vis-a-vis working outside of the US, for example? This desire to do this kind of work really was planted when I was in college, when I was at Brown.

And I always wanted to do some kind of mission work. And that term has several connotations, but I wanted to be a missionary, whatever that meant. I wasn't quite sure what it meant at the time, but I just had this idea. I wanted to work in other cultures, in other society, do mission work. But I was, as you, a mechanical engineering major, and that didn't really fit with doing mission work. This was in the 1980s, and most of the jobs then were in the defense industry. They were good jobs, but I didn't really want to do that kind of work.

So I graduated college and kind of floating around for a while, I was offered a job by GE. Working with their kind of nuclear submarine program, it would have been a really good job, but I just wasn't interested in that kind of work. I remember one day, it was kind of odd, I was coming back from my great aunt's funeral. I was with my brother Felix and an idea just kind of popped in my head, I should go into medicine because I could, if I do that, then I could do mission work and, you know, I like the sciences, I could stay in the sciences, do mission work, help people. Just kind of that general idea.

And ended up going to medical school and kind of kept that desire to do mission work. And that kind of evolved into wanting to work in Africa, work with people that don't have a lot of options for health care. You know, 15 years later, I ended up in Sudan. So you started out in Kenya, is that right? Right. So when I finished medical school, then I did five years in the U.S. Navy. I did a Navy scholarship for medical school. So I had to pay that time back. Then went to my residency. I did family practice in Terre Haute, Indiana.

now it was time to kind of be free and do what I want. So I thought, well, let me just go ahead and let me do this thing that's been kind of an itch for so many years. So I teamed up with the Catholic Medical Mission Board and they said, okay, we have an opening in Kenya at this mission hospital. Maybe go there. I said, okay, I'll go for one year. I'll see how it goes. If I like it, maybe I'll stay longer. Otherwise, maybe I'll just come back and start a practice.

and went down the canyon and fell in love with the place and decided to stay. What was the first thing that you remember when you got there as far as how different this was from the way you had trained? Because you did your residency in the United States, right? Right. I did my residency in the US and I did family practice. And the program I went to was kind of geared towards rural health.

So I thought, okay, if I want to do admission medicine, I've got to be doing more than just kind of outpatient office stuff. I need to do something with a little more meat to it. So, you know, a little bit of obstetrics. We did a bit of surgery, mostly just C-sections. So when I first got there, I think what struck me was just the volume of patients. I mean, I was a resident and, you know, in clinic days, we'd see like five or six patients, you know, and get all every little detail down in each one. And now, I mean, in this rural hospital in Kenya, it's

And I mean, just seeing 50, 60 patients, you know, huge numbers. The clinic, the wards are full. You go do a ward round. I was in charge of the adult ward. And there were, you know, at the time I thought it was a huge number, like 30, 40 patients there. And I was responsible for all them. It's just this year volume of patients you had to go through every day in the variety of diseases. So not only the tropical stuff, which I...

I didn't know much about it. I mean, here's malaria, TB, Leishmaniasis, all this kind of stuff I had no idea about. I had to learn about when I was there, you know, learned to thank God some couple more senior doctors there that I could learn from, but just a volume of patients and the variety of diseases you've had to face.

So what year did you get to Kenya? I arrived in Kenya, uh, January 17th, 2000. That's so interesting. I, I arrived at NIH when I was in medical school on January 17th, 2000. No way. Yeah. Yeah. That was, uh, which was NIH being at NIH while I was in medical school was one of the

Sort of more formative parts of my experience. So how long before you went to Sudan and what led to that transition? I'm trying to think of my geography, right? Kenya is south of Sudan, correct? Sort of south east of Sudan? Right, south and a bit east, exactly. Okay. And much more stable, right? I mean, Kenya is a relatively safe place to be. Right.

But Sudan is not, right? It's divided into these provinces. And the one that got all the attention was Darfur, which is the furthest west. Correct. Exactly. And that basically was a war zone. Right. I mean, a killing field, right? So Bashar was basically killing his own people there, wasn't he? Right. So to go from Kenya to Sudan, what were you thinking? I think maybe the modus operandi of my life was always looking for

What's the opposite of greener pastures? I'm looking for browner pastures. When I was there in Kenya, this was, as I said, I got there in January 2000. The civil war in Sudan was really raging at that time. And I was in Kenya learning a ton of stuff, really enjoyed the work. And I kept hearing about Sudan, the civil war in Sudan and how it's so terrible. And the conditions there were terrible. And there's such a lack of any kind of health services. I thought, man, I'd really like to get involved in that

in that struggle just to go and work with the, help the people there just because it was so, health facilities were so limited. I thought that's kind of the place I want to go to. So I had this general thought. This is 2001, 2002. Now, this was in June of 2002. I left my first posting, which was in a rural place called Motomo. I was there for two and a half years. I went up to Northern Kenya, a place called Turkana. I was at the Kakuma Mission Hospital, which is up in the Turkana Desert near the refugee camp. A woman named Deidre Burns. So Didi was there, I think her first time up in Turkana.

And I was talking to her. She's an American. She was doing a kind of short-term mission there. She's a surgeon and a family practice doctor. She did both, but was doing primarily surgery. And she said, look, there's a bishop I know. It was Bishop Macrom Gassis who was building a hospital in Sudan. I think he might be interested in going there. And I said, whoa, that's exactly what I've been thinking about doing, you know, for the past couple of years. It's back in 2002. So she said, look, he's got an office in Nairobi. He's living there in exile. Maybe you can make contact with his office because I was due to go to Nairobi and start working there. Anyway, to make a long story short, I ended up working in Nairobi.

linked up with his office and we started kind of making plans for the hospital and how would it run, the staff we would need, all that kind of stuff. And then it took six years, but six years later. Who funded the hospital? It was all funded through the Catholic Diocese. I see. So it was the Catholic Diocese of Elebate. Bishop Gassis was the bishop of the Elebate Diocese.

And he and his office were able to get funding through the church mechanism to fund the hospital. So now it's 08, 09, and that's when you go. Right. So I went to Nuba Mountains, arrived there March 10th, 2008 was the day I landed there in Nuba Mountains. Tell the listener a little bit about where Nuba is. I mean, I know it's in the southern part of Sudan. It's to the east of Darfur. Right. But it's pretty rugged country, isn't it? Right. So...

The Nuba Mountains is probably one of the most remote places in the world. It's a region which for many years in Sudan was kind of kept off limits. Before when Sudan was kind of a colony, it was under the Anglo-Egyptian condominium, partly kind of administered by UK and by Britain and by Egypt. They decided to kind of keep the Nuba separate. They said, look, these people have a unique culture and are unique people. They didn't really allow a lot of open tourism or people to go in there. It was kind of a closed area.

So they really kind of have maintained this separateness and this isolation over centuries. It's difficult to reach. It's semi-arid. It's got this thing, rainy season. It's got a dry season, but more hills. They aren't real high mountains, but sort of 3,000-foot hills, that kind of range. My history is not great, but I sort of remember that

Basically, Sudan was granted sort of, I forget the term, but when you're given your independence, for lack of a better word, that would have been in the 50s, right? Right, 56. Okay. And then what was the religious sort of map of Sudan? And did that figure into how it was divided? And was that partly why Nuba was, was it religiously diverse? Was it mostly Muslim, mostly Christian? Yeah, you know, Sudan is a very interesting place. It was one country up until 2011 when they divided the North and South.

Now, the religious makeup is in the north, so north of Nuba Mountains. It's primarily Muslim, almost all Muslim in the north. The south is primarily Christian. Nuba is right in the middle. And interesting enough, Nuba is a mix. It's about, let's say, half Christian, half Muslim. And everybody's an animist, but half are Christian, half are Muslim. And the Nuba are unique. I think a unique tribe in the world.

Where you have families which are mixed, you have Nuba Muslims and Nuba Christians, and there's no conflict amongst them. For instance, my wife is a Nuba. Her father, both her parents, when they were born, they just followed the traditional religions. The Christianity and Islam had not been introduced yet to the area. Now, as they got older, her father became Muslim, mother became Christian, they married.

Her father's a polygamist, so two wives, both wives are Christian. Their oldest son is a Muslim. The rest of the children are Christian, and nobody's really bothered by this. That's in Nuba. Now, the country itself, this difference between Muslim and Christian was really a big issue in the previous civil war. You know, we had sort of the southern African people that were mostly Christian against the northern Arab people that were all Muslim fighting each other, and there was very much a religious context to that previous civil war.

And also in the mountains, the people join the southerners. They're all African and new, but they join the southerners fighting the northern sort of Arab Muslim people in the north. And in the 1990s, there was a jihad against the people. So there was a real genocide in the 1990s against the who issued this jihad. The ideologue behind this is a guy who just died last year. His name is Hassan al-Turabi. And Turabi was a

a member of the Muslim Brotherhood, very bright guy, went to Sorbonne in Paris and was kind of intellectual, but really kind of an evil genius, if I can use that word. He was a real ideologue in the Muslim Brotherhood, and he managed to convince some of the imams in the north

to sign off a fatwa to allow jihad against Anuba. And many imams rejected it. They said, well, you can't do that. Even though he'd be killing Muslims with Anuba. Right, exactly. His response to this was, okay, you can have a jihad because the Christians are fair game in the jihad, and then the Muslims are apostates from the religion because they associate with Christians. Some of them eat pork. Some of them drink local beer. They're not real Muslims. Like this thing with...

The Nubar very much communal and to have Muslims and Christians together at functions, it was nothing but to him. The fact we could have Christians and Muslims in the same family was a huge scandal to him. He just couldn't tolerate that kind of stuff. So he said, no, these guys are also fair game because they're not real Muslims. So what year was that fatwa issued? That was in the, I think in the early nineties, it would have been 93, 94. So Bashir was already in power, right? His coup was like late eighties, right? He took power in 89. Okay. And this guy Tarabi, uh,

helped him win this coup. He was kind of the brains behind the coup and

And Tarabi, I mean, he was kind of a power-hungry guy. He said, okay, he figured if he helped Bashir get into power, Bashir was a military guy. And he thought, okay, if I help Bashir get into power, I'm much more intelligent than Bashir. I'll just kind of find a way to get rid of him and I'll take over. And Bashir said, look, I'm the one in power. You're not taking over. So he kind of always kept Tarabi at a distance. And he was always throwing Tarabi in prison afterwards because Tarabi started speaking out against him. So he put him in a quote-unquote prison. He'd be living in some luxury apartment in Khartoum.

But they kind of were at odds with each other. But Tarabi was the ideologue behind a lot of this movement. He's the one that invited Osama bin Laden to Sudan in the early 90s. So bin Laden lived in... When bin Laden was exiled from Saudi Arabia, which was in the early 2000s. Right. Well, that was before then he invited, what's his name? He invited bin Laden to Khartoum. So he lived in Sudan for a while. And a lot of, you know, Al-Qaeda had a lot of training camps in the desert in the north of Sudan. I had totally forgotten that fact. That's the chapter of Al-Qaeda that I'd sort of forgotten.

So you basically have a bunch of incredibly evil people who are deciding to kill their own citizens effectively. Right. You got there in 08, you said, or 09? 08. So we arrived March 2008. So historically that was the interim peace period. So since they got independence in 1956, Sudan has been at civil war, various parts of it have been at civil war for almost the entire history. That's 60, that's how many years? 62, 63 years.

Most of the history, they've been at civil war. So this was one of the brief periods. Actually, it wasn't even pre-Soviet because Darfur started in 2003. Darfur rebels started their fighting against the government in 2003. So this wasn't, the whole country was not at peace at the time. But the big war between the South and the North, the peace agreement was signed in 2005. So when we arrived in 2008, the peace agreement was still in effect and there was no active fighting. And then we were kind of waiting for this referendum to take place. The referendum, the way the peace agreement was signed up was Southerners, so South Sudan, would have...

the choice for self-determination. And that will be done by referendum. So the people actually have a vote, straight up vote. The majority vote to secede, they secede. The majority vote to stay and stay as one country, they stay. Now, 2011, they have the vote and like 99.99% vote to secede from the North.

So South Sudan separates. In the peace agreement... I'm sorry, is Nuba considered south or north in this cessation? Right. This is part of the problem because in the peace agreement, Nuba was separate. Okay. And what they said was, okay, South Sudan will have a referendum. The Nuba Mountains was not included as part of South Sudan. Nuba and Blue Nile were separate regions. And they said in these two regions, they're called the two areas, they will have what's called a popular consultation, which was a very vague...

system where there'd be committees set up, they would go and they would talk to people in the villages and kind of get their opinions on things and see what they wanted to do. If they wanted to separate, stay. It was very vague. And I think it was purposely vague because the government knew it was kind of a bargaining chip for the North to allow South Sudan to have this referendum. They said, okay. Because they knew in the end they would keep the Mammons because this thing was too vague. They would be able to manipulate it enough. They would keep the Mammons on their side. So South Sudan separates the

There are elections in Nuba Mountains in 2011 in May. The candidate for Bashir's party, of course, wins the governorship in the parliament. Just as a side note, before that election, the guy's name is Ahmed Haroun, who was running against the guy named Abdulaziz. Anyway, Ahmed Haroun was the candidate for Bashir's party, National Congress Party. And before the election, Bashir said, Ahmed Haroun is our candidate and he will win this election, whether by the ballot or by the bullet.

So going into it, it doesn't look like it's going to be a free and fair election. Right. And Bashir at this point, does he already have basically a warrant out for his arrest? Right. So he's got the warrant for his arrest. That was, I think, 2009, I think.

Ahmed Haroun also is indicted by the ICC for war crimes. He was one of the architects of the genocide in Darfur. So Ahmed Haroun, who is our governor, is indicted by the ICC. Bashir is indicted by the ICC. He also was a defense minister, was indicted by the ICC. So Ahmed Haroun wins. They go and say, okay, now our party is there in South Kordofan State in the mountains. There are still SPLA soldiers, like southern soldiers, living in this region. The Northern Army came and said, you know, did a forced disarmament.

of these SPLA soldiers and that's when violence broke out. So June 2011, June 6, 2011, Civil War breaks out in Nuba Mountains against the government. Now I've heard you speak about this in the past. It was overnight that most of the staff in your hospital left. So prior to that, leading up to that, the referendum and the breakout of war,

You've got this three-year period where you're in the hospital, you're working there. As far as NUBA can be tranquil, this is the greatest tranquility you've seen. The staff is what? It's you, it's what else? Right. So at this time, we started the hospital, March 2008. We went there with about eight expatriates, including myself. So I was the only doctor. We had a few nurses, an esthetist, a lab person. We had those eight expatriates. They were mostly from, they're all from Kenya or Uganda.

Those eight expatriates, myself, we had 15 local staff, NUBA. And the NUBA, I think the most educated person had finished primary school. They were not nurses. They were just kind of local people that could read and write a bit of English and could speak English. So they had to be taught everything. When we first started, they couldn't weigh a patient. They couldn't take a temperature, let alone give an injection or start an IV. Anyway, with time, we got these guys trained up a bit. So they had some pretty good skills. Most of that was done by these expatriate nurses.

Now we still kept expatriates, but over time we added more and more on-the-job trained people. We kept adding more primary school graduates, or eventually we got a few secondary school people, started training them on the job. We didn't have any trained NUBA nurses by the time the war started in 2011. So now war starts June 6, 2011. By June 16th, this is 10 days into the fighting, things are getting pretty hairy. There was a lot of fighting within NUBA, air bombardments all the time, and the

the diocese. And this is all from the North, the North and the North, right? Fighting within Nuba mountains. The resistance is posed by whom? Is it former Southern who have not seceded or are trying to basically, are the North and the South now fighting for Nuba? Right. So what happens is the South Sudan is totally separate. Okay. So within Nuba mountains,

You've got a lot of soldiers that were Southern soldiers, SPLA soldiers, a lot of whom were Nuba. Most of them were Nuba, but you also had other Southern tribes in the mountains kind of left over from the previous conflict. And they were there in the barracks. So all those kind of trapped SPLA soldiers are fighting the Sudan army.

Now they call themselves, instead of SPLA, they're called SPLA North. Okay. So from that point forward, these guys are called SPLA North. They have kind of a new identity as a separate military force from the SPLA, which is in South Sudan. So fighting is going on, aerial bombardments. June 16th, the Diocese says, look, we're sending a plane in and this plane is going to come in.

to evacuate anybody who wants to get out of there. Okay. And the plane was going to go to Uganda or to Sudan? The plane was flying into Nuba Mountains to pick up whoever wanted to get out and they would get out and leave. Now, this was a bit dicey because at this time, there were a few flights coming into Nuba Mountains, mostly getting people out, but they have to change the airstrip.

There are a few airstrips around, but they would give the location of the airstrip at the last moment, and they would have a code name for it because there were a lot of spies around. And if the North found out, they would come with their bombers and come and bomb the airstrip. They would try to bomb the plane on the ground or bomb the people that were trying to get in the plane to escape. So all this stuff was top secret. A plane comes in.

And they said, look, if we come in, we land, and we're taking off in 10 minutes. You better be at the airstrip waiting. Get your butts on the airplane. We have to be out by in 10 minutes or else these guys will come and bomb. And they do this at night, I'm assuming. No, they did it early, early in the morning. Okay. Because you can't, you know, there's no lights or anything for the planes to land. So it's all just by sight. So they would come early in the morning, land, and they would get out. So, you know, all of our expats that were there with us, they had all the knowledge. I mean, our anesthetist, our lab person, pharmacist, the nurses that were awarding charges, everything.

the ones that were doing most of the work and doing the leadership, they all decided to leave. Now, did you all sit down together and have this sort of heart to heart, which is each of you had to make a very difficult decision, which is you feel committed to this work you're doing, but now your life is at exponentially greater danger. Right. So yeah, we met with everybody. We had a group talk and we met individually and said, look,

This plane is coming in. This is the last plane that the diocese can send in. This is it. Once this plane comes and once it leaves, you might never get out of here because you have no idea what's going to happen the next day. You don't know if the Sudan army is going to overrun us. And this is the last chance. How did you think about that? I mean, was there a moment when you thought,

Maybe I should leave and go back to Kenya or go to Uganda or go somewhere else. I mean, what was that thought process like? Right. So, you know, I was encouraged to leave by some different people. I said, look, why don't you come out? You stay in Kenya for a while. Then when things blow over, then you can go back when it's safer. I thought, and I thought, geez, you know, first, I mean, you have no idea. This is just total chaos. You have no idea what's going to happen. What I did know is that we were getting people wounded or injured.

bowel destruction was ever coming in all the time, you know? So I knew if I leave, it's not like they can go somewhere else. There were no other hospital with surgical capability. Okay. There wasn't a single one. There was another small hospital nearby run by a German group that could do some inpatient stuff and outpatient and some minor stuff.

But really, if somebody needed a C-section or something more serious, they would just die. And that says nothing of the casualties that are going to start coming in as a result of this attack. Right. So all these people that came in that were wounded would just die a miserable death. And I knew that.

So for me, it was a very easy decision. I thought, you know, there's no way I can in good conscience leave this place and go out. It was a very, very stark reality. And to be honest with you, it was not a difficult decision. I think the sisters that were there, the two Camboni sisters that stayed, the priest that stayed, we all were of the same mind. We all thought the same thing. Let's just stick it out. We're here as missionaries. Let's do what we're supposed to do and take care of the people the best we can and come what may. We have faith in God. We'll see what happens.

And it wasn't, you know, we didn't feel like it was some big thing. It was just like, well, no, we can't go. You know, we got, we got stuff to do here. And, and the, you know, the other expats said, look, I've got a family. I've got this, I've got that. And we said, look, we are, we're not going to hold anything against anybody. This has to be very individual decision. If you guys want to go, we'll find a way to keep going. Don't worry about it. So we want to give them full latitude and,

to leave in peace and not feel they were abandoning people there. So I think everybody's pretty much at peace with the decision. The expats left. And I mean, sure enough, they left June 16th, the morning of June 16th. They left around six in the morning. They had to get out there early because they had to get the, you know, get this plan and just get out of the place. And we had to keep everything secret.

So all of our staff didn't know these guys were leaving. We had to keep it a secret from everybody. And they up and left. And then the staff came to work at 730. And so you had an anesthesiologist that was one of the people that left. Right.

So talk to me about 10 o'clock on that morning, the first time or whenever the first surgical case comes in, who's running anesthesia? That was the biggest problem. So these guys leave around six, eight o'clock casualties start rolling in. People that were, there was a bombing from one of the Sudan Air Force planes called an Antonov that has barrel bombs. They bombed in a location near us, maybe an hour, a couple hours away.

We hear these in the film, The Heart of Nuba, which we'll talk about in a few minutes. Right. So like two hours later, all these mangled bodies start coming. Describe what this, I mean, so I did my training in Baltimore. In many ways, trauma was a feature of the training program because if you're training in surgery, you know, one of my mentors said, you know, to be able to train at a place like Hopkins is a great honor because you really get to understand surgical anatomy in trauma.

And it's penetrating trauma in the United States is mostly gunshot wound and stab wounds. But I have no idea what you were seeing. So what, explain to me what things you actually saw, what types of injuries are you seeing? Right. So this was very start because when Antonov bombs, there are huge shards of metal. I mean, weighing, you know, 10 pounds, I've got a bunch of the scraps. I have them as a souvenir back in Nuba.

So imagine a scrap of metal weighs 10 pounds, red hot, just going through your body. So it slices off legs, slices up arms, cuts through people with just massive tissue loss and massive trauma. So I remember one young lady, she was 16. Her name was Urshalim, which means Jerusalem in the Arabic. And her arm was just totally mangled. I mean, just shattered. She came in, her cousin came in, his hand was, his whole hand was blown off by the Antonov shrapnel.

So these guys both need amputations. The girl, we did a disarticulation on the shoulders. So we had a couple of our on-the-job trained nurses there, and they had done some, they'd been taught how to do spinal anesthetic by the anesthetist. So they couldn't do GA. For the listener, GA, general anesthetic, meaning they couldn't intubate and put the patient fully to sleep. And I had never intubated a patient before. I remember when I was in the military, we intubated, had intubate goats for as part of our ATLS training, I think if I remember, but I'd never done it either.

It's like, what the heck? So I'm, you know, I was so afraid. I'm like, God, what do I do with these people? You know? So I remember reading the book. We have a book there, kind of basic anesthesia book. So I bring you through the protocols. Okay. First, give some ketamine. You knock them out with that. They go to sleep. Give it labatropine. You give it succinylcholine to paralyze them. Intubate. Then you give pancuronium. You have a halothanesthesia. Put the tube in. Blah, blah. Decide to intubate. I'm like, okay. Okay. Let's, let's do it. So we took some of these guys back and, you know, I would go and

give the drug. I had a nurse there, kind of on child, it's okay, give the ketamine. He would push it in, push the succinylcholine out, intubate. And I guess I should explain for the person listening to this because we use these terms so commonly. So intubation is a very important step where if you screw this up, you're going to kill a person. Literally, you will kill them. But you have to put a breathing tube into the endotracheal space. So this is now to allow a machine to breathe for someone while they're under anesthesia. And

We do these things in medical school. We did them in residency. A lot of our critical care training required that. But I have to tell you, and I was not trained as an anesthesiologist, I never intubated somebody without being incredibly nervous because it's so easy to put that tube accidentally into the esophagus and you think you're doing it right. And all of a sudden you, you know, you get the tube in, you hook it up to the ventilator, you think everything's going well and

And by the time you realize you're providing oxygen to their stomach instead of their lungs, it can be too late. Right. And then of course the panic that ensues is often what kills the patient. Right. Cause you're, you're getting, you're getting nervous and then you can't do it. You're starting to shake. You know, the problem is my, like I said before, my training was family practice. I did an internal medicine internship, you know, they family practice. I never intimated to somebody. I never did anesthesia rotation in medical school. That was not part of our training at all.

So I was very green with this. Anyway, by the grace of God, managed to get the patient intubated, connected the health. We have a really primitive structure called an OMV, Oxford Miniature Ventilator. It's got a set of bellows. It's like turn of the century kind of stuff. Turn of the 20th century.

So, you know, intubating. So we have to, you have to manual ventilation for the patient. Throughout the whole surgery? Yeah. Throughout the whole surgery. As long as they're paralyzed, you've got to, you've got to ventilate manually. Usually with the helithing, after you manually ventilate for about 20 minutes, they can breathe on their own. And it's a bit of an art to try to keep them under enough

where they can breathe on their own, but they're not in pain. So it was a big art to this kind of work, but it's all manual. I just have to go off on a tangent for a moment, which perhaps only the people listening to this who have medical training will appreciate what you're saying. I'm guessing you don't have blood gases. No. Okay. So you can't measure a patient's PaO2 or PaCO2.

And yet your anesthetist has to figure out how to ventilate, which again means how much oxygen the person needs and how much CO2 you take off. And if you screw either of those two up, you will kill someone. And if you told me to walk into Mass General or NYU or pick your favorite hospital and said, Peter, we're going to do everything for you. We're going to intubate the patient. We're going to do this. All you have to do is be the guy that manually ventilates them. Yeah.

I wouldn't be able to do that. Like I would, I would overdo it or underdo it. There's no way you'd hit that sweet spot. Yeah. You'd cause an alkalosis, acid, you would just, and then to be able to not have the laboratory tools to know when you're off the rails. Right. Yeah. In those days we didn't have a pulse ox. Now we have a pulse oximeter, which can measure the percent oxygen saturation of blood. That time we had no pulse ox.

Some of this stuff, maybe ignorance is bliss because you can't measure it. So you just hope and pray that things are going okay. But man, I just got the guy intubated. I mean, you couldn't do veterinary medicine like this in the United States. Right. Yeah.

You know, it was pretty hairy. We managed to get through and this went out. We eventually got an anesthetist to come. This was after about a month or two. Well, and in that month or two, what types of casualties did you see? Oh, I mean, everything, abdominal trauma, lots of leg trauma. We did a number of general anesthetics during that time. We had a baby that came in with interception. This was the worst case. It was a nine month old baby.

who came in who had an interception which is kind of an intestinal obstruction. Yeah, explain what that looks like, the telescoping part. Right, so interception is when the intestine telescopes on itself and basically causes a blockage of the intestine and then the longer you delay, that intestine can die and the person will die, the baby will die from infection. And we made the diagnosis and I'm just like, oh God, what are we supposed to do with this kid? So anyway, we take the baby to the operating room and said, we got to try something.

So, I mean, intubating an adult is hard. A baby is really, really hard. And we managed to get the kid intubated. So I did intubate the baby, started on the ventilated Pelothane, went out, scrubbed for the case, came back. We opened the baby up, did a bowel resection, put it back together, closed the baby up. And he did great. How old is the baby now? He's a white baby. He's eight years old now, eight, nine years old. So he's cruising.

But that's kind of one of the many miracles we've seen. And when these bits of shrapnel are going through people, I mean, you're seeing liver lacerations, you're seeing bowel injuries, hemonymothoraces, head trauma. I mean, give me a sense of the mortality. There are some cases that obviously just can't be saved. Right. Well, you know, I'll tell you, Peter, I think what happens, sometimes people say, why do you have so many extremity traumas?

Because they're the ones that make it in. They're the ones that survive. So, you know, the ones that get a really terrible trap in the chest, they bleed out in the field. Because we're, you know, we're six hours. Sometimes these patients come a day. We've had people with penetrating abdominal trauma with multiple holes in their intestines come three, four days afterwards and survive. So imagine that. You're leaking feces into the abdomen for three or four days. So imagine how strong these people are.

And they come and it's just a mess. And you open them up and some of them pull through. You know, anemic, dehydrated, they haven't eaten in several days. And these guys can survive. So some of it is the people are just tough as nails. But we get a lot of penetrating. I mean, kidneys get torn to shreds, liver lacks, massive kidney trauma, liver trauma. I remember one guy had, we counted, he had 23 holes in his intestines.

that we had to resect here, resect there, stitch this one. It just took forever. How did you learn surgery? Right. So I trained in family practice. And when I went to Kenya, we were doing a lot of tons of tropical medicine, a lot of obstetrical care, did a lot of C-sections. But I realized a lot of the disease burden in Africa was surgically related, a lot of it. I mean, a lot of it, of course, is tropical medicine. Okay, do all those things. And I said, well,

A good, it seemed like half of what we were seeing was surgically related, either just wound care, miscarriages, laparotomies, amputations, kind of the run-of-the-mill kind of surgical stuff. There's a lot of it. So I thought, I really need to learn how to do this stuff if I'm going to stay here long-term. So luckily, where I've been, both rural Kenya and Nairobi,

I met up with people that were willing to teach me things. So really it was like doing another residency. I mean, I would, I was in Nairobi, I had a whole day in the operating room and we would do tons of cases. And there was an American missionary doctor there named Mike Johnson. So Mike would just sit there and teach me stuff. You know, I would, I would do the, just like he did in residency. I would do the case. He would assist me and just kind of walk me through it. There was a Kenyan surgeon there. Dr. Rucho was a fantastic, he was like a magician. He was not so hands-on.

But if he was always, he was there in the operating room. So he would say, go ahead and start the case. After he had a little bit of experience, he'd say, start the case. If you have any problems, call me. So I'd start, open up, look around a bit. Say, okay, I'm stuck. What do I do? He'd come in, look around, say, I'll do this, do that. I do this and that. And things would go ahead.

before you know it, you're doing thyroids and laparotomies and resecting bowel and stitching liver and taking kidneys out and doing amputations. And I mean, you know how it is. You just kind of, once you learn a few, you have a few skills, you can add the next case, the next one, the next one. And I mean, it took, I was there for seven and a half years in Kenya. It was like doing another residency. I mean, at some point though, you have to be making mistakes that are harming patients because even in

are, and I say that not being critical, right? But just saying like, that's the nature of medicine. I mean, I, I think of every time I hurt somebody, even, you know, I, I remember once causing a hemonymer thorax in a patient when I put a central line in them, it was my 500th central line. So at this point you'd think I could do it blindfolded. And yet to cause that complication, which in my case, I'm lucky enough to have an x-ray to see that I've caused this complication.

you don't even, I mean, you're missing so many of the basic tools that could act as sort of a safety net. So what was that process like? I think what I wanted to make sure of when I was in Kenya, I think those whole seven and a half years I was in Kenya, I always had either somebody assisting me in the case or somebody in the room or in the next room over. So I think I was pretty well covered during that time. And by the time I was finished seven and a half years, I felt pretty confident I could go out on my own and do

and do surgery. I think it's this concept, you know, better than I do about 10,000 hours, you know, and I think in residency, you have to like a thousand cases, it's supposed to like a thousand cases at least, like that's like a minimum. Yeah. Maybe 1200 or something. Yeah. So I did, you know, by the time I finished my time in Kenya, I'd done. But for you, it's harder because you're doing a breadth of cases that like, even if you took something as broad as general surgery, you're

I mean, you were still doing basically orthopedic surgery as well. And obstetrics. Right, tons of obstetrics, a lot of urology. There was a mix. And I think maybe the trade-off is the surgery in Africa is much broader but less depth. Like we don't have any laparoscopic stuff. Of course, we have many of these da Vinci things and all that and all this high-tech stuff. You trade off kind of depth of surgery for breadth.

I felt after doing around 2,000 C-sections and over 1,000 other major cases, I felt, okay, I think I can do whatever we're doing in Nairobi. I can do that, I think, safely in Sudan. I mean, obviously, you know, we have complications and other problems. And there are a lot of limitations in terms of going into the case. So you tend to do more laparotomies because you don't have a diagnosis. You don't have a CT scanner. Right, no CT scanner. You don't know exactly what's going on.

To get a tissue diagnosis might take you six months. So you say, go, hey, let's do laparotomy and see what that thing is. That's your CT scan in the end. But that's about the best you can do. So I think what I always, what I try to do when I approach a case is, you know, the primum no known cherry, first do no harm. So if you think you'll make the patient worse by doing this, like, okay, I'm not an expert at doing this case.

And sometimes I say, I'm not going to do it. You know, I won't, I won't do it. If I think I really cannot improve this patient's health, I think, okay, this is too much of a risk. Sometimes I look, I just, I'm not really comfortable doing this, but usually I'll feel, I say, okay, I think it's better if we try to do this operation. I think we can, the patient can improve and we'll go ahead and it works. I mean, normally works out pretty well. I was talking with my wife and my daughter a couple of days ago and about how we were going to be speaking today. And they had so many questions about,

You know, we all watched the heart of new, but together. And, um, one of the questions my wife had was how do you deal with exactly that type of situation you described, which is what we would consider quote unquote end of life here in the United States or palliative care.

What do you do in a situation where somebody comes in and your judgment says this person is not an operative candidate, but also by not operating, they need to be palliated. I mean, they're not going to, they're not, it's not like, you know, they're going to walk home. How do you deal with that? And more importantly, I guess, than medically, how you deal with that, it's emotionally and how is that communicated to the community? Because you're still a foreigner, right? Right. Right. I'm still a foreigner and will always be one. So I would say when we first started,

10 years ago, people did not trust us. And it was incredibly nerve wracking. Something we just got here. People did kind of have this because they've been, these people have been traumatized and oppressed for so many years. They're not going to trust some foreigner showing up saying he's there to help them. So you got to prove yourself something. Well, you know, I got them doing these operations. What if we have bad outcomes? You know what happens? So it was really nerve wracking for all of us. And, you know, thank God things went pretty well. We went ahead. So the issue with palliative care is,

You know, we try to just talk to the family, talk to the patients, say, look, I think we can't do much for you. And as we go home, we'll take care of the pain and other things we can do. One good thing there is the people, their expectations are extremely are low. And I'm not saying that in a negative way, I'm saying in a positive way. They don't expect, they don't really expect miracles. They want to be treated as a human. They want that human touch. They want to talk to us and talk to you and say, okay, what can we do? If you tell them, look, we can't do much.

They're not very demanding, saying, no, you've got to get somebody to Nairobi for a second opinion. They're very accepting. I think that's just because their lives are very hard. They're not used to good outcomes. So I think, first off, they're very accepting. So when you tell them, look, I think there's not much we can do, we often will talk to the relatives. Culturally, usually the relatives will say, well, they don't like telling the patient, which is very different from here in the U.S.,

So we just talk with relatives and they're usually very accepting. They say, okay, we, you know, we see a dumb chicken. We'll take them home and make them comfortable there. They have some of their local traditional things they might try with the person at home, but they're usually very accepting of, of,

negative outcomes or bad news. When you're kind of at the edge of survival all the time, when you get this kind of bad news, it's not so shocking to you. It's like, well, that's what happens. People die. When people have bad outcomes, bad things happen to you. So it's not so unusual for them. In the US, we're kind of anesthetized that everything has to be perfect and we're not supposed to die. We're supposed to have this kind of outlook on life.

It's a very different way of doing things. So they're fairly easy in that respect. They understand this stuff. Most people have some level of faith, whether Christian or Muslim, they can accept this stuff in a theological sense also. It's not so difficult. When you showed up, how primitive was the extent to which people were receiving? I don't know how to describe the type of care, but there must have been local traditions and shaman and stuff like that, right? Right. And at some point you're showing up and you're

Coming from a place of science as sort of simple as you describe your work in medicine It is still grounded in the fundamental principles of Western medicine and you use antibiotics. For example, you wash your hands before you operate what was the Landscape like as far as the other types of medicine being practiced and are they still being practiced now? Yeah, they're still being practiced so their scope of medicine is

You have kind of the local level in the home. And what they'll do is almost any febrile illness. So some kids got a fever, someone's got a fever, they burn the person so that everybody there, my wife included, they have burn marks. They look like cigarette burns. They're not cigarettes, but they take a round thing, it's put in the fire and they burn on the back of the wrist.

back of the neck and the elbows. There are certain points where they burn the person to try to release the whatever it is. The spirit. The spirit of evil humors that are causing the problem. When they see that kind of smoke and they see the fat underneath the skin burning, they feel relieved. Okay, the thing is gone. Now I'm better. So they burn, they cut. A lot of people have cut marks on their arms or in the abdomens where they think that'll also release things. They cut down to cause some blood loss. That'll release some of the problem.

And that's usually done in the home, usually by the father or the mother or the grandparents will do that kind of thing. That's kind of the local treatment. That is still practiced, less so than when we came, I would say. I mean, everybody, all of our staff have burn marks from when they were kids. Now, we still see patients come with the burn marks. Sometimes it comes with a simple malaria. They've been at home four days and they've been roasting the kid. It's like, why, you know, just give us a chance. Anyway, so burning, cutting, that's one level.

They do have some herbal remedies that don't seem that prevalent. They were there, I think, traditionally. Some people still use those. And I don't know, you know, some, they still swear by it. If you use the neem tree or this Kayla, this plant that they use for malaria, they still swear that that thing works for that. A lot of kind of local fruits and vegetables they use for GI problems or other things. And those seem to work okay. And the third level is what's called the kujur. Kujur is kind of like a shaman.

And the Cajor is like the priest for the village. The traditional legend there is ancestor, kind of ancestor worship. It's communion with the ancestors. So if you're sick, if you have a problem, whether it's physical, psychological, whatever, you go to the Cajor, you have a little ceremony with the family, you all get together. Cajor will talk with your ancestors and

and then kind of give your report back saying, well, your kid is sick because you, your goats wandered on this guy's land and ate his crops. So you need to make up with this guy. You need to go and give him something. And then you pay the Couture something. And then this thing is kind of lifted. Child should get better. Those three things were kind of traditional treatment. The Couture is still very, very prevalent in the society and they still often go to the Couture and they still will often delay treatment when they go to the Couture. So how many people does your hospital serve?

Ketchum area is roughly a million, anywhere from 75,000 to a million people is in our catchment area. And the physical region is around the size of Austria, somewhere in that, in that, uh, range. The people there, I, for example, how many of the people that you serve would understand what you meant if you were going to New York? Like how big is their world?

Well, it's interesting you ask that. I mean, even the ones that have finished secondary school wouldn't have an idea. Like if they ended up here or, I mean, it would blow their mind. Maybe I'll give an example. My mother-in-law is probably in her 70s. So we went to talk to my wife. I was talking about writing a book. Actually, she started writing her book. And we went to my mother-in-law and we said, let's go and interview your mother as part of your book. You know, I can write about her life and my family.

My wife didn't actually know a lot of facts about her mother. They don't have that, you know, mothers and daughters there are not like buddy, buddy. You know, the girls are, you know, once they, once they get weaned from the breast, they start working, carrying water and firewood and everything else and cooking for the family. So we went to talk to her mom and my wife asked her mother, uh, her mother only speaks the tribal language. She doesn't speak Arabic or English or anything else. So we talked to, she's talking on the tribal language saying, do you know where Tom is from? And she said, she thought for a minute, she says, he's from Kenya.

And she said that. That's the furthest place she can imagine. Right, because she's heard of Kenya. So in her mind, anybody who's not from Nuba Mountains must be from Kenya. It doesn't matter who you are. So that's the outside world. And we said, well, no, he's from America. Have you ever heard of America? No, she'd never heard of it, had no concept of America. You know what an ocean is? No concept of an ocean, no concept of a lake.

No concept of Africa. She didn't know she was in Africa. So what she knew was her local area, just a few of the villages there. She'd been to Khartoum once. My wife's mother has leprosy. We've treated her for leprosy and have amputated, I think, all of her fingers at one point or another. She's really quite disabled. She'd gone to Khartoum some years previously to get treatment there and ended up not getting treated. But besides that brief trip to Khartoum, she'd never been out of that local area. A lot of my wife's siblings...

I've never been out of this 15 square mile radius. You can't imagine the worldview. Presumably your wife also hadn't experienced things outside of that until she met you. And what was the first time she left or traveled with you or given especially that you don't travel much? Right. So the first time we traveled was after we married. It was just this past June. We went to Armenia. So that was really her first time out of rural Africa. She went to nursing school, but that was in South Sudan in a while, which is

I mean, for South Sudanese, they call it a city, but it's a village, you know, it's a big village. So imagine we went from Eda refugee camp down to Juba, which is the capital. I mean, Juba's more or less a city, but it's really not very nice. Then we fly from Juba to Dubai and we were in the Dubai airport.

Which I was just there a month ago. Even for someone who's from the United States, the Dubai airport is an overwhelming. Yeah. I mean, it's terrifyingly huge. It's a city. I mean, it's a major city. So we get there and her eyes are the size of saucers.

Has she seen that much electricity in one place? No. I mean, not even close. Not even close. Has she seen fresh water to that extent? No. I mean, I'm trying to think if she'd ever seen a tap. No, we had taps in the hospital. We have a pump that pumps water up and we have some taps in the hospital. But, you know, flush toilets were, she'd never seen before all this stuff. Elevators. Elevators. So that was one of the things we get in there.

We're at the airport. We get in this, you know, push a button. This door opens. We get this thing and press on the button. Then the thing goes up and we get off. She's like, what was that? So no concept of an elevator. We got in the escalator and she's like falling over the place. We go to get off the escalator. She's like, what is the house? How's this thing moving? I think when she was in there since going, wow, I think they had one set of stairs. There might've been a second floor, but just the concept of walking upstairs is something strange. Little moving staircase.

So all these things were very new to her. Now we get to Armenia and I mean, just being in a city, I mean, the Air Van is a capital of Armenia, not like New York, but very different experience for her. Now she came to the U S for the first time just this past October. And I mean, she was in Times Square. I mean, saw the ocean for the first time. She went to my brother lives in near Boston on North shore of Boston. So that was the first place she went. So first place she went to, went to Boston and our hospital, uh,

was getting an award by a group called Medicines for Humanity, which supports us. And they were giving us an award for the work that our outreach team is doing. So nobody could make it. I couldn't go. Other staff couldn't go. So my wife went to accept the award on behalf of the staff. So she lands in Boston. And the first thing she does is goes to the Harvard Club to get this award. It's a very opulent place. Goes to my brother's place. He's up in Rockport, Massachusetts and sees the ocean for the first time. Sees a train for the first time.

goes to malls, to Walmart, you know, she loved the dollar store. And, you know, my family just went crazy with her. They had so much fun being with her, you know, seeing all these things for the first time through her eyes.

And I mean, she's very has a very common infectious joy to her. And they really kind of tapped into that. And it was really. And the flip side of that is we can sit here and have this discussion. And of course, most of us would be thinking how amazing at all the things that they don't have. But I'll share with you a story that I suspect will resonate and you will understand it.

this past Christmas my daughter's school each grade picks something they're going to do and that grade decided that they were going to buy Christmas presents for all of the kids at the Sudanese Community Center in San Diego and so they're basically all refugees and this was very interesting because we had already watched the heart of Nuba which is

Was her first time even she didn't know what sudan was and she certainly didn't understand Why there would be refugees leaving this place? so On the day that we take all the presents there and the kids have done an amazing job, right? They've bought like four or five presents for each and every kid there and we spend the whole day there So we go it's my whole family. So it's me my wife three kids and our youngest is like a year and a half old

So there's another little kid there a Sudanese girl who's also about the same age So the two of them are playing together But you know you feel like you got to sort of keep an eye on them because they can fall off the stairs or hurt themselves So there's a woman that's holding the Sudanese girl and she's sort of keeping an eye on our son as well and so that gives us time to go and do these other things and see the other kids and do all the other stuff and About four or five hours later when we're leaving my wife goes over to the woman who's has been holding this little Sudanese girl the whole time and says

"What's your daughter's name?" And she says, "Oh, I don't know. This is not my daughter. I don't even know whose kid this is basically."

And we couldn't stop talking about that, right? Which was talk about a different sense of community. Yeah. Right? There was nothing odd to this woman who was probably 20 to just say, hey, there's like this little 18-month-old running around. I'm going to take care of her. And by the way, she's taking care of our kid too. And so for as many things as they lack, they have something we don't have. Right. That taps into Peter. Something...

You always hear about the negative side of a place like Sudan. People think of Sudan, what are the images? War, poverty, disease, starving kids. The positive side is not shown. And some things always stick in my mind. One is we'll have patients that will come to us that it's a seven or eight day walk to reach us. And on the way, like they'll start their journey and start walking. Now, nighttime comes.

In the society there, you can stop in somebody's hut and just kind of knock on the whatever or just show up and say, look, I've got a long journey. Would you mind if I kind of spend the night with you? So that family would take this person and total stranger, give him a place to sleep, give him food, get some water for them to wash, take care of him that night. The next day he'll continue on his journey. Next day, stop at another total stranger's place.

That stranger will take this person in, give them some food, hang out. This next day, same thing until they reach the hospital. And this is the normal way of doing things there. The concept of community and what stuff belongs to you, what is a stranger, totally different than our outlook here. So when you're there, like, well, geez, who's really, really has it all? And who's doing the right thing? Which society is on the right track? You know, it's really, it's really mind blowing. Well, especially for you because you,

I guess it's one thing to know nothing that, but you've seen both worlds. And I've read enough about you to know, I've seen enough interviews to know. I mean, correct me if I'm wrong, but you've described being more at home there than anywhere else. Right. Which I have to admit, you know, Tom, when I watch the videos of that, the first thought that comes to my mind is not, I wish I was there. I realize that probably just speaks to me being sort of a vapid, shallow person, but...

If I'm going to be brutally honest, right? I don't look at that and think I want to be there. Right. I think I would never want to give up my family. I would never want to give up my comfort, my safety, my whatever. Right.

you couldn't fake it. I mean, so it's obviously so genuine for you and any, you know, the other people like John who are serving as missionaries there. I know that on some level, you'll say the answer is faith, but there must be more to it than simply your faith. Well, you know, some of it, Peter, I think is just, I think everybody is kind of geared a bit differently. So, you know, we grew up in a big family and

You know, my brothers could never, could never be there, but at the same time I could not do what they're doing. So I think, I think all of us are really, we're kind of wired a bit differently, even people in the same family. So I think I'm very comfortable there, but I couldn't maybe fit working in New York, you know, but I think the good thing is I don't attach a value to all this. Everybody has something to contribute. I really, I really believe that it's not just kind of blowing smoke. My thing is, is being there to the mountains. You know, it's a, it's part of the puzzle. Somebody else might be in New York, but

But you're doing a podcast. You're helping us in Nuba tremendously by helping get the message out. If you're in Sudan doing the same work I'm doing, we don't have this. So I think everybody has something to offer. And if we try to get in this thinking like, gosh, I'm not doing what he's doing. I should be doing what he's doing. I think we missed the point. We miss out on our shared abilities. You've got unbelievable talents and a brain twice the size of mine and you're using it.

in an area that you are comfortable with that is probably maximizing your abilities. I think it's good to be aware of what's going on in the world and everybody should think about their brothers and sisters elsewhere and contribute and do something to help other people. At the same time, don't spend too much time

stressing that you're not doing enough, you're not doing anything, do something. But it shouldn't be something which is agonizingly painful. You know, I think just the way I'm geared, that kind of life is a pretty comfortable fit for me, you know? So I don't see it. Yeah, it's a sacrifice. It is. And I miss the family like crazy. And I'm missing a lot and not being with my, it's been more than three years since I've come here. I'm missing my parents, my nieces and nephews, my brothers, my sister. I do. I miss all that stuff.

But I'm pretty comfortable in that weird remote setting in the mountains.

So I learned about you through my really dear friend, Rick Gerson, his brother, Mark Gerson, and ultimately met John. And I think they learned about you through a piece that Nick Kristof wrote in the New York Times in 2015. How did Nick come to find you? Because that story, we're going to link to that story. The story is amazing, right? It leads off with about a 10 minute video that

I watched over and over and over again. And I came home and I made my family watch it. And I sent it to my family back home. And there's a part in it that just says everything about it. I mean, first of all, I think Christoph did an amazing job framing the story.

And he was there, which is in and of itself, I want to actually understand how someone actually gets there because that strikes me as quite a challenge logistically. But he ends the article with a story of a Muslim man who proclaims that you are Jesus Christ. And I always, that's the title of the article, if I'm not mistaken. He's Jesus Christ, which coming from a Muslim man also speaks to the religious harmony that you've described. And for people like me who aren't especially religious,

It makes you think, well, I guess that's what religion should be about, right? It shouldn't be about most of what we think of religion as religion has its taboos here. But I think the point Christoph makes and makes it beautifully is,

If you want to be critical of all of the religious hypocrisy, by all means do so. But you can't then fail to acknowledge the times when in the name of religion, people are doing these incredible things in the name of all religions, by the way, it's not just your religion. I mean, as you know, it's, it's people of all faiths that are doing these things.

But in many ways, I think that story brought amazing attention to your work that it breaks my heart to think, are there other Toms out there whose stories are not being told? So how did Christophe find you or how did you guys find each other? He has an interest in Sudan. I think he's had it for a number of years. And I think for him,

He saw this, what Bashir was doing as such an egregious affront to humanity that he felt obligated to go and see firsthand what was happening. So he made a couple of trips into the mountains. You can fly into Juba. Then he got a flight up to the refugee camp in Ida and then managed to come into the mountains. You know, you don't come in with official permission of the Sudan government. So you're sneaking into the country. Right, basically sneaking in. You get a permit from the rebel government and they allow you to come in.

And I think he just has an interest in that part of the world and really wanted to do something that shed light on the situation there against Bashir. And he'd been to Tenuba, I think, one previous time and heard about the hospital and wanted to come and see us there and see what kind of work we were doing to see for himself and was there for a few days. I mean, he's a really intrepid traveler and incredible journalist. I mean, he's unbelievable. And what I respect about him the most is

is he can disagree with you, like, you know, whatever, religiously, politically, not agree with your beliefs, but he can realize what you're doing has benefit. He can look at it objectively and say, okay, you know, I don't believe in this religion, but I see what these guys are doing and highlight that. You know, not many people are willing to do that. I thought it was very elegant how he framed that in that piece in the New York Times. And that video, though, it's only about 10 minutes.

That was really my first introduction to you. God, it's about three and a half years ago now. So the world's a better place. Certainly the Nuba Mountains are a better place because of Nicholas's work. Right. And he tends to highlight people that are kind of not well known. And there are others that are out there. And that's actually part of what we're trying to do now with Aurora. Aurora's focus is on highlighting what they say is unsung heroes, but people that are kind of operating in the weeds that nobody knows about. So shine a bit of spotlight on them.

Not so much for publicity, but to help them both in their work and to raise, by raising their profile, you raise the issues that they're involved with. So tell people a little bit about what the Aurora Prize is and what it means for you to now be

you're the 2018 recipient. Is that right? 2017. 2017 recipient. So what is the Aurora Prize? I know it's based on, I know a few things about it, so I'll fill in the little bits that I know. It's a prize that has a finite life, correct? It was began in 2015 or 16, and it will run until about 2022, 23. And that duration, if I recall, is meant to commemorate the length of the Armenian genocide in 1911-ish, 1915. Well, it's a hundred years on

word. The genocide went on for about eight years, 1915 to 1923. So this is a hundred years henceforth. Those eight years, that's the, those eight years of the Aurora prize will be given out. Yes. And it's a, it's a substantial prize. You were selected. And my understanding is that

First of all, it takes an act of Congress to get you out of NUBA to be doing this other work. But it speaks to, I think, your understanding of how valuable this will be to the broader mission that you're serving. Right. What I saw was I'm very comfortable being in NUBA and doing the everyday medical work.

And I definitely want to go back to that environment longer term and get involved more with teaching the local people. And when these guys, once these guys come back from medical school that we have out there, really working with them to get their skills up. But I thought maybe using Aurora as a vehicle, it was time to come out to kind of see what was out there with Aurora to try to expand the model that we have in the mountains and

So find a way to bridge the gap between, say, big donors or people that have resources and small organizations, small people on the ground that are kind of doing a lot of the grassroots work and doing it very efficiently. Because I think there are a lot of other people that are doing the work nobody knows about. And there should be a way to try to connect them to resources. So through Aurora, that's one of my main goals. I wanted to come out and try to expand what we're doing. I felt that was...

We're in Nuba doing our thing, but maybe a little bit pigeonholed. How do we expand that and get outside of Nuba, get into South Sudan, to Central African Republic, to Chad, to Niger, other places which are really neglected parts of the world, hopefully into some conflict zones. That was my main thinking coming out. And my time now, I've got three months out of Nuba Mountains. I'm traveling all over the place, speaking on behalf of Aurora, kind of doing some, basically some promotion for them, but also meeting a lot of people and trying to formulate ideas

which direction we need to go in Aurora. So I'll be physically out for these three months. It'll be three months later in the year from September through November.

Besides those two or three month periods, I'll be back into the mountains, do my usual work at the hospital. What does more money solve in this problem? I remember recently Mark sent us an update about sort of where the dollars were going and it was sort of hard to believe that so much could be done with so little. And I don't think the stats are, I think they're so overwhelming that it's almost hard to put it in context, but it's worth trying.

For about a million dollars as an annual budget, what have you been able to do in the past year? A million dollars is pretty generous. That's probably more than we'd need for the basic work. But let's say if it's a million dollars, we can see about 130,000 outpatients. 130,000? 130,000 outpatients. Do close to 2,000 operations. See maybe 5,000, 6,000 inpatients. I mean, vaccinate tens of thousands of children.

I'm not sure what numbers of maternity antenatal clinic patients, but a lot, several thousand maternity patients.

for that. A lot of that million dollars, I mean, most of that would, gosh, I think it's, I mean, the number that comes that I use is about 750,000, but somewhere between 750,000 and a million, if I'm being conservative. If someone gave us a million bucks, we could easily run the hospital for a year and probably expand quite a bit of what we're already doing. That'd be a very generous amount of money for us for one year. Which is very interesting. Anyone listening to this who has some understanding of the economics of the US healthcare system,

Would find everything you just said to be sort of comical because of just the costs here are so artificial and so inflated and so ridiculous now

When you think about where those dollars go, I mean, how do you get these supplies? How, I mean, where do these things come from? I remember once asking, I knew somebody who was, I think, on the board of Doctors Without Borders. And I said, hey, how come you guys aren't in Sudan? You know, because I remember once reading, you guys couldn't even get certain vaccines and antibiotics. You just physically couldn't get the supplies. Right.

So you're really doing the work that nobody else can do here. Yeah, it's tricky. I mean, our number one problem, when people say, what's your biggest problem there? I always say logistics. It's the hardest thing because- You don't have infrastructure. Infrastructure is not there. And if we want anything, you want chemotherapy drugs, you want antibiotics, you want a roll of gauze, you've got to buy that in Nairobi. Nairobi is two countries away. It's South Sudan and Kenya. So it's got to come from Nairobi.

Like this past shipment of drugs came from there. It would be by truck up to actually through Uganda, up to the border with South Sudan, where they just harassed the heck out of the, out of the drivers and all kinds of, you have to bribe the guards. You've got to bribe the guards and they give you a hard time and they won't, they don't want you going through. And they say, no, it's always, they're always changing the rules. You know, so you don't know there's a duty. You've got to have all this paperwork. I mean, just reams of paperwork to get this stuff through. So we've got some people that are,

in Juba that don't actually work for us, but work for the church that help us through all this process to get this truck through. Now from there, there are, I don't know, 30 or 40 checkpoints from the border of Uganda and South Sudan up to the refugee camp in Ida. And it takes a few weeks. It takes about three weeks to get up there just because of the checkpoints and the delays and everything else. It can take three weeks to get up to this refugee camp in Ida.

Then from there, it's offloaded. We've got to go and pick it up. We've got to find a way to get it from EDA up to our place. Wait, not you personally? No, not me personally. But we've got to get some trucks or something to go down there and pick it up or find someone that can carry it for us. And that's about six...

That's about six hours. It's not really a road. It's a dirt track. I mean, there are roads there. These terrible dirt tracks you get from Edep to where we are. That's about six hours on the best day, just during the dry season. So rainy season, which runs from about June through October, you can't go with the trucks. You can't really even go with a, like a land cruiser.

Usually we don't move at all. If you really had to get in or out at that time, you've got to go with a quad bike. That can usually get you in or out. But sometimes even then, if it's a flash, if it's a heavy rainfall and you have a flash flooding, these dry riverbeds, if that fills up with water, you've got to wait. Maybe you have to wait a day, a few hours. So in the hospital...

on any given day, how much do you have in terms of IV fluids, gauze, antibiotics, soap? Right. I mean, things that we just, we can't even imagine not taking for granted in an American hospital. Right. I mean, if we have, if this truck makes it through, because we make our order and we make a fairly generous order just because we know it's so difficult to get stuff out there. If that stuff makes it all through, we're in pretty good shape. For how long? For a year. So we try to make it one full year on that supply that gets sent in. And, and,

The problem comes because sometimes you order stuff in Nairobi and it's not in stock. And you just can't order one-off things. There's no system to get stuff up to us. So it's really hard if you can't load everything on that truck for this one go, we're a bit stuck. And we've got to really be creative trying to get these other smaller things up. Is there like a chief logistics officer that is in charge of the ordering and the procurement and the management of this product? Because that sounds like a

I mean, that's a, that's a bottleneck, right? Yeah. It's a, it's a terrible job. So John Fielder through F commission healthcare has a woman who's in his, he's got an office, small office in Nairobi. They got a few staff. So she did all of our procurement. So we sent her the list of things we needed. I mean, it's, it's, it's a lot of items, a lot. So she has to go out and source all this stuff and get it in Nairobi from a few different vendors, get the trucks or less stuff, get it through, um,

Uh, we've got a couple of people in Juba that help us with logistics that are not employees of ours, but they're just kind of, they're helping us out, just kind of random people and they can help shepherd that stuff through. But it's, it's, it's really, really difficult. It's a lot of work for those people. What does the pattern of mortality look like in Nuba? My guess is

Infant mortality must still be quite high. Right. How much of that is due to challenges with prenatal care versus the actual deliveries and postnatal care? I think a lot of the neonatal deaths are just from difficult deliveries. You know, their baby gets asphyxiated, baby's born and dies. Is it stillborn or dies soon after birth? And there are very few

delivery is done. I mean, 99% of women there still deliver at home. To deliver in a clinic with maybe a traditional birth attendant is rare, let alone in a hospital. So I think a lot of it is just due to, you know, most of those people probably would end up with a C-section if they were at a hospital in the US or even in Kenya. If they had access to care or they would have the C-section. You know, we have one place doing C-sections. There are actually two now that do C-sections. How many babies do you deliver in a typical year? I think there are maybe three or 400 in our hospital, somewhere around there.

It came with the exact number. So it's, you know, it's really, it's not, it's a very small number compared to the number of deliveries. So the vast majority of women still deliver at home. But you're doing presumably more of the high risk ones. I mean, if a child is breached, is there, can you deliver a breached baby at home? That's, the risk would be enormous, right? Some make it out, but a lot of those babies are going to die because they just get, they get stuck, they get asphyxiated and the baby dies. So,

I mean, when we do our antenatal clinic, you know, these women will come and the midwife there fills the cart out for them.

So, okay, they've had 10 deliveries and four living children. You know, this one died at birth. This one died at birth. This one died from diarrhea. This one died from fever. You know, this kind of thing. So it's a lot of... And what about the mothers? What is the maternal mortality like? I don't know. And that's something I really wish I could have a grip on. Because you hear occasionally, you know, we don't, it's not that often we hear about it. But once I hear, oh yeah, this woman died from, she bled to death, you know, after giving birth to the baby at some remote village.

There's not really, it's so remote and people are so spread out. There's not really a system to collect that kind of information. So I don't really know. It's got to be, it's got to happen because, you know, we have a lot of women that we ended up doing C-sections on that would have died without that. You know, they've, you know, how many times a baby is stuck and,

Well, it's already septic and we have to do a C-section or something. And this says nothing of preeclampsia and all of the other things that would just show up even under the most normal circumstance. Right. And getting women with eclampsia is not uncommon. So if you get eclampsia at home, especially young, most of them are primates that are very young, they're not going to survive when they start convulsing. And to get to us is a chore. I mean, it's really hard to reach us

What are the patterns of diseases like there? I mean, when we're watching, and again, I keep mentioning this because it's just such an important film, The Heart of Nuba. You see these things that you're doing, Tom, that just, I mean, they blow my mind. And maybe because I know enough about medicine that I can watch what you're doing and appreciate, you know, the partial nephrectomies you're doing on kids with, you know, tumors in their kidneys. And like, how did you even learn to do that operation? Yeah.

Even within the realm of surgery, that's not a trivial operation to do on a child that size. Yeah, I'd done some nephrectomies before, total nephrectomies for tumors or for trauma or for whatever. So meaning remove the whole kidney. Remove the whole kidney. So I wasn't so worried about that, but I was worried about was the other kidney. It's harder to take part of the kidney out because you have to be able to preserve the blood flow to the part that remains. Right, and they can bleed to that. So if it was just, say a tumor was partially involved in the kidney and say you're doing the operation and you can't stop the bleeding,

your backup is just to take the whole thing out, but you couldn't do that in this case. - 'Cause this child had one kidney that had to fully come out and then there was a partial, so you basically, this kid would die if you couldn't save half of the remaining kidney. - Right, exactly. So it was a lower, the tumor was in the lower pole of the kidney, so we had to take out half the kidney.

So there was a visiting, actually a visiting, it was a friend of mine who was visiting. He's a family practice doctor. Corey Chapman was there and we were talking about this case and going back and forth. And he said, let's look on YouTube if there's something. Because I read, I've been reading about it and everything I was reading was talking about all these fancy things. You know, there's some kind of a slush, like an ice slush that you have to bathe the kidney in to get the metabolism way down so you can do the operation. Just different things we didn't have.

So we looked on YouTube and I'm just, when I think about it now, I wonder how we did it because normally we can't watch YouTube there because we have internet. We have a satellite dish internet, but the speed is very, very slow. So normally we can't watch any videos cause it's just too, it's just too slow. But for some reason we were able to see this video and it was this group of Polish surgeons that were doing the partial nephrectomy and with a fairly low tech approach. So we watched that and said, okay, I think, I think I can do it following what these guys are advising. Um,

We kind of followed their system, managed to put these sort of buttresses on the lower part of the kidney to kind of staunch the bleeding and it worked. And the child did very well. That was helped by YouTube. I think that really helped us out in that case. Like the Khan Academy of Surgery. That's right.

How long do you just spend rounding? I mean, how many inpatient beds do you have in this hospital? Yeah, it's 435 beds. And what's your typical capacity? I mean, your typical utilization, how many patients are in there? I mean, it's, it's about a hundred percent occupancy. It's, it's a bit less now than it was saying the peak of the fighting and the peak of the fighting. It was crazy to be five, 500 people there, 550. So there were several children's ward, several to a bed. We have wounded all over the place. I mean, not even in beds, just

wherever we could, we could fit them. It looks like when you see movies in war zones and you see the tents that are serving as, you know, hospitals and you just see amputation, nose completely missing, you know, sort of the most gruesome things. That's what it looks like you're in. I mean, you are literally in a war zone. I'm thinking back to residency and

If we had to round on 20 patients in the morning, we were moaning and groaning like it was going to be the end of the, oh my God, I'm not going to have time for breakfast today before the OR. I've got to round on 24 patients. Yeah. So you're rounding on 300 patients? I mean, I don't even know how you do that. Now probably 300. In those days it was more. I mean, I remember one time we had this measles epidemic and just on Children's Ward, we had 225 patients.

So 100 normal cases, malaria, bowel obstructions, hernias. You don't have vaccines, I'm guessing. Is that the reason the kids all get the measles? Well, with the first three years of the fighting, we didn't have them. So the usual provider stopped providing them. The usual big organization that provides them stopped providing the vaccines. Why? Just logistically couldn't get them in? Logistically. And we were in rebel-held territory. And a lot of these people, these big organizations don't

want to violate the sovereignty of the host government by providing something as simple as vaccines. This is just how it is, which really shocked me. The sovereignty of a government that kills its own people needs to be respected? It's the theater of the absurd. It's crazy.

So, yeah, I mean, rounds were just, they would take hours. I mean, it started at 7.30 in the morning and 2 o'clock I'd be finishing up and just try to get through all those people. But then you're, aren't you being interrupted every hour by some trauma that comes in? Because... Right. There's stuff coming in. There's stuff, there's other emergencies. I mean, the other stuff was still coming. I mean, somebody comes in, a woman comes in who's having a miscarriage, is bleeding. We have to break into a C-section on somebody who can't deliver. So all this stuff was still going on. It was, it was pretty crazy. I mean, it was...

You really had to just go as fast as you could. It was a lot of just putting out fires. We weren't able to spend a lot of time with these patients, obviously. It was really, had to go pretty rapid fire through all those cases. It was exhausting. Psychologically, it was rough. One of the other questions my daughter wanted me to ask you is,

What's the most afraid you've ever been there? You know, she was sort of taken aback and we told her before the movie, I said, look, Olivia, this is, uh, this isn't a Disney movie. You're going to see people getting killed. You're going to see bombs dropping on innocent people and it's not a movie. It's real. Right. So are there times when you are just

afraid for your own safety? Yeah. I think every time they bombed the hospital twice and they bombed our local region kind of within a half kilometer several times. So the first time the area was bombed, we were at church and the church was just outdoors. It's not really a church. It's kind of an outdoors thing. And we were finishing up and the catechist was up there talking to people. And we heard the airplane overhead and

We were used to it because every day the airplane came overhead, but we'd never been, our immediate vicinity had never been bombed. So we just got, oh, the airplane's overhead, it's going to bomb somewhere. And is that because you had this belief that said even these people, as wicked as they are, wouldn't actually bomb a hospital? Right. Is there some sort of view of we'll respect at least one sanctity of life? Yeah. So that was the bit in the back of our minds. And we hadn't been bombed yet. This was a couple years into it.

We had them in bomb directly. There weren't commercial flights. So anytime you heard an airplane, it was going to bomb somewhere. And then we hear the airplane. Then invariably a few hours later, wounded would show up. They bombed somewhere and people were wounded and the wounded show up. This day was a bit different. We heard the airplane overhead and the mass was over. We're kind of standing there. All of a sudden somebody says, everybody get down.

So we just dive on the ground. It was lying flat. And I heard the airplane drone overhead, this Antonov sound. Then I heard the pitch change. It was high pitched, like a whirring sound, almost like a jet engine noise. And then boom, this incredibly loud explosion. It felt like it was two feet away. I mean, it was like half a kilometer away. It wasn't right. But it was so loud. And boom.

it circled again then I realized that what that whirring sound was was a sound of the bomb falling through the air so then I now so now I know what that sounds like then this happened six bombs six times you kept hearing this thing comes around again bombs and you're lying there terrified thinking you just you feel like you want to burrow yourself into the ground and disappear you know just lying flat exposed thinking what you know what happens and the thinking is

not even so much being killed, but what if, what if my, you know, what if my leg is blown off or my arm gets blown off? You have no control over this. You're totally at the, at the mercy of these people. And you feel like you're, you feel like you're just in like a hunted animal. That's the, that's what I felt like. I felt like I'm, I'm a hunted animal. And at that time, since we hadn't been bombed, we didn't have the foxholes dug around. So immediately after that,

we went and we dug foxholes all over the hospital grounds. And that's what you see in the film. There's actually one point when you're being interviewed and the bombs start coming and you guys have to jump into these foxholes. Right, right. And then another time we were bombed, I was in the hospital and just down on the floor of the hospital, you know, and you're thinking, well, you know, you're just thinking this might be it. This thing might, because you can't tell where it's going to fall. You hear that whirring sound.

And we hear that whirring sound. You don't know if that's going to fall on top of you, if it's going to fall right next to you and just then shatter your body. You have no idea. So it's really terrifying. I mean, there's no other way to describe it. And I mean, you know, when you see this stuff that's happened in Syria, people living in these cities, I mean, you can imagine what that is like. And the kids that were in that situation, that's something that will never outgrow that fear and that feeling of being bombed. You really, you feel like you're a hunted animal. I think it's the closest thing I can imagine.

Not that I've ever been hunted or I'm an animal, but you just feel like it. I remember thinking to myself, we were down, this is after, this is a few bombings later, we're down in the foxhole and there was a Sukhoi 24 jet going overhead. A Sukhoi 24 is a supersonic jet bomber, you know, bombing villages, you know, huts. I'm thinking, what are these people doing? I remember thinking to these guys, I said, how can they bomb us? Don't they know there are people down here? That's what I felt.

You know, like it was some exercise where they made a mistake. And of course they knew exactly there are people down there. That's why they're bombing, you know? But I, I really hope someday I will meet these pilots. Not that I don't even feel any animosity towards them. The feeling is never as strange. You don't feel anger. You don't feel animosity towards these people. Just kind of wonderment. Like, what are they doing? Like, why are they doing this?

So I would love to meet these guys someday and say, what were you thinking? What did they tell you before you did your mission? I was a flight surgeon in the Navy. So I know you have a briefing before the pilots fly out. They discuss the mission. Today we're going to fly here. We're going to bomb this target. This is our objective. What were you told in the briefing room? And they say, okay, today you guys are going to bomb a hospital. There are a bunch of civilians there. I mean, presumably if you're trying to put your psychology hat on, you have to believe that they are being told something

that the people that they are bombing are somehow a threat to them or their sovereignty or supporting rebels. I mean, you'd have to concoct a story that's so orthogonal to the truth. Right. Maybe that might be it because, I mean, after one of the times the hospital was bombed, one of our staff heard a radio broadcast from El Abed, which is a city in the north. And the way they portrayed it on this radio was they admitted they bombed a hospital. They said, we bombed an American church hospital

in Cowda, which is the capital of the rebel-held territory, hospital taking care of the rebel soldiers. That's how it's portrayed. So you're an American hospital, and America, of course, is a great enemy. It's a Christian hospital. Therefore, they're no good. And they're taking care of rebels. Taking care of rebels. So you're justified in this act. And my guess would be that's what these guys were fed. Who knows if the pilots were true believers? I know I worked with a lot of pilots in the U.S. military, and they would

They would not go along with the mission that they said, you're going to the hospital with civilians. They wouldn't do it. We say, look, man, we're not doing this. I know these guys, they were not, uh, these guys, they love to fly and they love the country, but they were not interested in killing civilians. And, uh, I still hope someday I can meet these guys and just have a talk with them. And, uh, just to know what they were thinking and what, what went on in their brains, like whether they know this, how they feel about it. I'm just interested in what they would, what they would say.

How do you cope with what I could only imagine is stress and anxiety aren't the right words, but just sort of the gravity of it. Like when you describe a day in your life, you know, getting up at 530 in the morning, making rounds at seven, operating. If you said, Peter, you got to go do this for a month.

I mean, first of all, I could provide no assistance to you. That's the unfortunate reality of it, right? Despite my medical training, I would, I mean, I could, you know, put IVs in patients and that's about, I mean, I don't think I could provide any benefit, but let's assume I could even magically provide benefit. I can't imagine how physically, but more so emotionally exhausted I would be at the end of 30 days. Right. Even thinking back to my training where, you know, you'd have

every other night call, but on one of the nights in between you didn't get to go home. And so you've been in the hospital for three and a half days and it's been one trauma after another. Like even that feeling is just as physically tired as you are, there's something different going on, which is just an emotional depletion. Right. So to imagine that you're now eight, no more, you're coming up to 11 years into this and this is just in Sudan. Right.

I don't understand how you can do that. I think you hit the nail on the head. I think probably the emotional trauma and upset is probably worse than the physical degradation your body takes by just always being on call. And just even when you're not called at night, it's hard to sleep. You know, there's a lot of kind of fear and worry about things. But there's always that less so now because they're not bombing. But there's always that sense of worry about being in physical danger. But even when you're out of that

when the physical, the risk of physical danger is not there. It's just the, the psychological thought of always being responsible for the, for the patients and not having a psychological rest. Like I can't refer these people somewhere. There are other colleagues we can talk to or get an advice on or have somebody else see these patients. It is very draining. And, um,

I don't know. I just, you know, a couple of things is one, of course, is I do draw on my faith all the time. And I think that does help me keep centered a lot. You know, I go to church every day and that's, I think helps put things in a bit of perspective. That's just how it is. And besides that, I think you see the people there, they see the strength and resilience of the people. You say, well, okay, if they can put up with this environment and keep functioning, keep going ahead, let me just try to keep taking care of them as best I can.

So I definitely get a lot of strength from the people there and their attitudes. They've been in this for their whole lives and they're not giving up. They're pushing ahead with things. So let me see if I can also just keep going. It's not easy by any stretch, both physically and mentally and emotionally. It's very, very draining. But I don't know. It's weird. I mean, you get up in the morning and you...

you know, I had this huge number of patients to get through and you kind of say, man, I'm sure if I can, so I'm tired already. You kind of see the first few and then you've, before you know it, you're finished with the children's ward, take a deep breath. Okay. I got through all the children. Now we go to the female ward. You get through there, you pick up pace a bit. You get to the male ward, you go through them, see the maternity patients. Now it's one o'clock. You're okay. I finished the rounds. We go to clinic, go to clinic. And there's a big line of people. How many patients would you see in clinic typically? Uh, maybe 40, 50. Yeah.

Again, I don't even know what that means. I mean, I think most US physicians would have a hard time seeing that many patients in a week in clinic. Do you have any blood tests you can do? Can you do CBCs or UAs even? I mean, what's the extent to your diagnostic toolkit? So until recently you had nothing. I mean, now you have an ultrasound. Right. We've had the ultrasound from the beginning. Okay. So we've had that the whole time. That's been hugely helpful. You don't have an x-ray machine. X-ray we do now. Okay. So we just got that about a year ago.

- So you can do a chest x-ray at least if you want some assistance with, does this person have pneumonia or pneumothorax or something like that. - Right, so prior to a year ago we didn't have the x-ray, now we do. It's been a help. Lab has been difficult. We can do a urine, we can check a stool, we can do a hemoglobin. Sometimes we can do a CBC, but the machine always seems to be broken. You know, we'll get in the machine, work it for a while, then it just stops working. Can't do a CBC. Chemistry tests, we can sometimes do a creatinine, but then that machine breaks.

And, you know, you can't do a creatinine. Sometimes you can do ALT, ST, machine breaks, can't do anything. But would those things matter? In other words, if someone's listening to this and says, well, gosh, if it's $50,000 to buy a new lab, piece of laboratory equipment, can we have one of those, you know, brought in with next year's supplies? Would that make life easier for the care you guys provide? Yeah.

It would help. And, you know, like there's a, just saw this chemistry analyzer. It's called a Piccolo, which is supposed to be kind of built for these remote locations. It's pretty doctor proof. I mean, you kind of have this thing that's pretty hardy. You slip in a disc, you put a drop of blood on it and it gives you a result. So our guys in the lab could do that. Not our lives. Our guys in the lab can do the other tests, but the machines are just very sensitive. It's less about the human. It's more about the, you need a robust machine. You need a very robust machine. So this is kind of a thing and that's about 14 grand. Yeah.

If we had one of those and some of the discs, which have the reagents kind of embedded in them. So if you had a year's supply of test strips or reagent discs and then the machine, you could do a CBC and a Chem 7 or a metabolic panel of some sort? Right. Yeah, that would definitely help.

We're pretty limited. We can do a peripheral blood film. So taking blood, you know, guys can do the film. We can look at that. So you're a pathologist now too. Yeah. And a very bad one. You're a hematologist. I'm terrible at it, but I can pick up like a chronic leukemia, chronic myelitis, chronic lymphocytic or an acute leukemia. Those are, if it's pretty obvious, we can pick those up. But a lot of blood films, I'm baffled by. And when you have a child that has leukemia, I assume you send them to Kenya? It's impossible. Why? It's too far. It's too expensive. It's too difficult. Like just the administrative stuff to get them there.

And the chance in Kenya of them being, I mean, maybe at a higher ed hospital, they could get decent care, but we just can't do it. So what do you, can you treat with chemotherapy a child? Not with leukemia. If a child has leukemia, we often will give steroids to try to, you know, palliate them a bit. Palliative care. Yeah, for leukemias. For chronic leukemias, these are, again, are usually adults. If it's a chronic leucocytic leukemia, we'll treat them with cyclophosphamide. We don't have tablets, but we'll give periodic injections and that can kind of whittle them a bit.

CML, chronic myelocytical leukemia, we don't have treatment for. I would like to have at least some hydroxyurea, which is kind of an older drug for it. You know this drug Gleevec? Yeah, I was just about to say Gleevec would cure most cases of CML. I mean, it's a very expensive drug in the United States, of course. That's the problem. So with Gleevec, I was so excited like a month or two ago. I'm reading that Gleevec is now in generic. Oh my God, maybe we can buy Gleevec because we get a few a year. We don't get a huge number of CML patients. We get a few.

I think, man, we wouldn't need a huge amount. So I look it up and it's okay, Glee Max gone on generic. So the price went from 8,000 a month to 7,000 a month. Yeah, this is another one of these ridiculous systems, problems, which is a lot of times when drugs go from being branded to generic, there's virtually no change in price. Right. We just can't do that. There are a lot of things that are just beyond our scope of being able to pay for it. That's something that to me is...

It's really difficult to consider. I mean, if you know, we can be as critical as we want of the US healthcare system for all of its buffoonery.

But in large part, it's because we can be buffoons. Right. It's because we have infinite resources, though we don't. Right. But in the short term, we have infinite resources. And so we never have to ask the question of what are we optimizing for and how do we triage expenses? On the other hand, you're faced with that decision every single day. Right. So you would look at a patient with CML and say,

We're not going to spend $80,000 a year to save this person's life because as much as we believe every life is equal, we sort of know that $80,000 can save a hundred lives in another way. And are you the one that has to make that decision by yourself? Yeah, it's agonizing. It's absolutely agonizing. That's, that's, that's just one example of many. I've got a woman that comes all the time with CML and she's got a huge spleen that hurts. She's anemic and she's got a bunch of kids.

I got to talk to her in clinic and try to figure something out with her. And she walks, I don't know how long, how far she walks to reach us. I mean, it's absolutely agonizing. I cannot send her anywhere. There's just, it's totally impossible. Just can't do it. So,

If we had, we wouldn't need mountains of Glee vac. I mean, a small amount would be enough to at least get her through a year. There are few people that have CML. It's a few, it's not a huge number. If someone's listening to this and they say, I'm going to tell you a story in a moment called the starfish story, but I want to save one starfish. That's that's, I'll tell you the story. Logistically, would it even be possible for someone to provide one year's worth of Glee vac to a patient in your hospital? Is that something that they could do through the American, the African mission? How would someone even logistically go about providing

providing specific or project-based funding to your mission. - If they could get the drug, say they had access to the physical drug here in the US, maybe if they sent it to say, the Catholic Medical Mission Board, which is my sponsoring lay sending agency, and they also help us a lot with logistics and with the overall managing the hospital, they might be able to find a way to get it down to us, at least get it to Juba, and then we could figure out a way to get it up to us, if they could get the physical drug.

there was a program when I was in Armenia the time before last. We met some guys and there's supposedly some Gleeback program that you can register, like the patient can register and they can get drugs at either low cost or no cost. So we went through all this thing, contacted the person and she said, okay, all you have to do is fill out these forms, have the patient go to Khartoum and get the drugs. That's absolutely impossible. We can't get to Khartoum. That's on the other side of the enemy lines and you just can't reach there. Which gets back to your point of providing the

the money is half the battle, but the logistics of actually getting it in there. And I mean, just spitballing, you can't have these things airdropped or airlifted in because the enemy fighters will obliterate anything that's trying to, it's not like you can fly the Cessna in there to get this stuff in there. There's been no non-bombing aircraft in our airspace for, it's been since November, 2011. So-

So even foundations like the Gates Foundations, which do a ton of great stuff in Africa, I mean, Sudan's basically off limits. You know, say they were able to provide money for a bunch of Gleevec. One of the problems, and one of the problems I've decided to go with Aurora is a lot of these funds are kind of unassailable. If you're

I'm an individual or even a small organization that's trying to apply to one of these big organizations to just get through that application process to get funds and then to account for it and do monitoring evaluation and follow-up. It's a very daunting task. You need people who are trained in this area of writing proposals and monitoring evaluation, all this sort of stuff, to really follow through with all this.

It's very difficult to access some of these big funds and big organizations. A lot of these bigger groups are set up to do that kind of work. And their administrative size has grown exponentially because in order to get this funding, you need a big administrative staff to apply for the funds and follow up and accountability and accounting and all that kind of stuff. Right. And you've got tons of extra time, I'm sure, to do that, right? I just can't do it. I just can't do it unless it can be made fairly simple.

Or someone's okay. If I got the drug, I'll send it to Catholic Medical Mission Board and then Catholic Medical Mission Board will send it down and we get the drug. You know, at least as far as Juba, then we can try to figure out a way to get it up. But it's just, it's really, there's a problem with access and just getting through the administrative things you have to do to get some of this stuff. So there are several kind of different levels of difficulty. So going back to the sort of state of diseases you see,

If a person makes it out of their sort of the young life, right? If a person's sort of your age or my age, what are they going to die from? Middle-aged people, we have a lot of cirrhosis, liver cancers, and that's, there's a huge- Is it hepatitis B? Hepatitis B, yeah, huge. Like we do, we screen all of our pregnant women for hep B. Do you guys have a hep B vaccination program? We do, we do. The reason we started screening the pregnant women is just to get an idea about the basic rate. And it's about close to 20%.

hepatitis B positive just in general populations or people who are not sick. They're pregnant with children. So what we're doing is we encourage the mother when the baby's born, we give the baby hepatitis B vaccine immediately after birth. And we hope with that, that we'll stop prevent this baby from getting hepatitis B as they get older and prevent all the complications from that.

We haven't really scaled up to the point where we have so many happy, positive people. And can you only vaccinate the women who are coming in for deliveries? Or are you able to get the vaccine into the community for the women who are still delivering at home?

No, we haven't reached that point yet. So you're only scratching the surface then because the majority of these births are outside of your hospital. Right, exactly. I mean, eventually we'd like to have kind of midwives these places and have the testing capability to test all these people for hepatitis B. Or if people delivered in these clinics, you say, look, we can't do the testing, but we'll just give the vaccine. We'll assume the kid has hepatitis B, give the vaccine. Because they have to get hep B anyway as part of the pentavalent series. So after that first shot, we continue with pentavalent.

which is DPT, diphtheria ptosis tetanus, hepatitis B, and MFOS influenza B. I've heard that kids actually can get diphtheria in Africa. Yeah. Has there been a case of diphtheria in the United States since the 40s? No, I think that, I think. I don't even know what diphtheria is. I mean, like, I mean, it sounds stupid to say that, but I remember learning about it in medical school and I know we all get the vaccine for it. What, what is the disease? What is, how does it manifest? We,

We've only had, from what I remember, one case, and I think she had diphtheria, it was in an adult, but it's a coronary bacterium diphtheriae, and it's a bacterial infection. It affects the throat, and it looks almost like a thick scab that forms in the throat.

They kind of die from airway problems. You know, this thing is thick and they can't really swallow. They can't really breathe well and they can die from airway problems. It's a horrible, really a terrible disease. And you mentioned your mother-in-law has leprosy. Right. Again, I've never seen that in my life. It's a bacteria as well. Is it in the tuberculosis family or something like that? Exactly. It's Mycobacterium leprae.

It's a mycobacterium and it's transmitted by respiratory droplets. Oh, it's not by touch. I thought leprosy was sort of contagious through touch. Yeah. Is that a wives' tale? Yeah. It's really transmitted by respiratory droplets and it should be prolonged close contact. So somewhat similar to TB. It's a very slow growing organism, but prolonged close contact, respiratory droplets, you can affect the nerves in the skin.

And by that nerve infection, people lose sensation. They get cuts or wounds. They don't take care of things. They burn themselves. They don't pay attention to what gets infected. Bone gets infected and you have to amputate the digit. Are these people prior to your arrival that were kind of outcast and they would be not touched or anything like that? Yeah, there was definitely discrimination against them. They didn't have like separate places where they would make them outcast, but people would kind of avoid them. Like my mother-in-law still, I think a lot of it was

The people themselves would kind of withdraw due to shame and due to the fear of us giving it to somebody else. Like my mother-in-law kind of withdrew. She stays by herself. She doesn't eat with the other family. They keep telling her, look, come and eat with us is okay, but she will not come and eat with other people. She always insists to kind of eat by herself. Hmm.

She does it herself. She's kind of a self-isolation from society. She's pulled herself out. So she'll talk to you in chat, interact with you. But then with eating and with more social interactions, she'll kind of pull back and eat by herself. And how prevalent is tuberculosis? Very, very prevalent. And for our place, our HIV rate is quite low. Which is what? It's less than, much less than 1%. Oh, wow. Point something.

maybe 0.1%. And is that an artifact of where you are geographically, or is that as part of the benefit of some of the aid relief that made its way in the early part of 2000s? Yeah, I think the main reason is our isolation. Is there drug use there? Prostitution? I mean, which I assume would be the two most dominant modes of transmission. No, prostitution is not really part of that society. IV drug use is unheard of. It's all through, like with most of Africa, it's through heterosexual transmission.

And I think just the, it's starting to get a little bit of a toehold in Nuba, but still our rate is very low. I'm worried that if peace comes and the place opens up and you've got more movement of people in and out, the rate's going to skyrocket. That's what happened in South Sudan. The Nidus is there because we have a lot of STDs. Gonorrhea is very common.

Do you see tertiary syphilis in really advanced cases? I don't think so, but maybe some of the stuff we're seeing is just undiagnosed tertiary syphilis. I don't know. I don't think we see it. What I see is syphilis is we do VDRL tests and we have a lot of VDRL positives, which are not a very accurate test. We have a lot of false positives. We have a lot of VDRL or RPR positive people. We do that screening. We're just screening now with the pregnant mothers for VDRL and we have a lot of positivity tests.

We don't see the Shanker's or the secondary syphilis. That's really, really rare. But the vitreo positives are very common. So we talked about liver cancer. Do you see heart disease? No. Heart failure.

So in the older population, we'll see a fair bit of heart failure. Somebody maybe in their 60s, 70s that's in heart failure. And it's like bacterial or I remember there was some bacteria like Chagas something or other that would weaken the heart muscle. Is it that type of a heart failure? Yeah. No, we don't have Chagas disease in our area. It's just old age. Do you think it's atherosclerotic in origin? I don't think so. I've never seen anybody that could say, I think this person had an MI. Just not a single one in 10 and a half years.

Some is hypertension, just kind of untreated hypertension. And we'll let people come in with blood pressure of 250 over 180. Really? Yeah. How prevalent is obesity, overweight, type 2 diabetes? Obesity about 0.0001%, almost non-existent.

An occasional person is a bit overweight, but really, really rare. And how often do you see type 2 diabetes? We'll see it. Not so prevalent, but it's definitely there. Somebody see older, you know, older people come in and just new diagnosis of diabetes. Maybe someone who's 40s or 50s. Do you ever see fatty liver? Like when you're operating on a patient, do you ever see that the liver is fatty? No. No.

No, I think no, never. I can't remember a single case when I've seen fatty liver. What kind of cancers, I mean, you do so much cancer surgery, especially in children, but they're cancers we don't see that much here. Right. What types of cancers do the people in NUBA get versus basically not get? I mean, in the United States, of course, you'd have lung, breast, colon, prostate are the lion's share of cancers followed by pancreas. So those are the big five.

How prevalent are those cancers in NUBA? Not so. I mean, like if we go to kids first, our Burkitt's lymphoma is fairly common. That's an EBV related, if I recall, right? Epstein-Barr virus is... Epstein-Barr virus. And you only, you really just see that in malaria holoendemic regions. So we're in that, it's called a Burkitt's zone. And that's a great cancer because it's curable with just cyclophosphamide. Six courses cyclophosphamide and you cure a cancer. It's great.

very satisfying, but it's rare to have a cancer you can cure, obviously. For adults, liver cancer is probably probably the most common, and that's hepatocellular carcinoma, and probably all related to hepatitis B positivity. They drink a fair bit. There's a local beer they make from sorghum, but the alcohol content is not very high. It's

We have a fair bit of cancer of the cervix. So for females, probably cancer of the cervix is the most common. And can you screen for HPV? You're the local gynecologist as well. Right. Can you do a pap smear? No.

Perhaps we would be a little bit impractical because we have to do the swab and get that sent off and do it high level, you know, get it off to a pathologist. Is there any way, I mean, again, if someone were listening to this and said, oh my God, like if I could have an impact on eradicating cervical cancer for these women, is that even feasible to have the equipment there to, after you do the swab, assess for HPV? No. For cancer cervix, two approaches are,

One would be this Gardasil, the HPV vaccine were made available either at very low cost or just giving us part of, I think it's, I actually just heard today as part of the WHO package. So they can be integrated into the system where HPV is given to young girls, even young boys. But then we're back to the logistics problem, right? Is how do you, even if the WHO or any of the foundations came along and said, we want to provide HPV vaccination on mass to Africa,

you're still somewhat excluded, right? We give other vaccines. If they can be lumped into your annual supplies. Right. And just do it to get stuff out there. But if you do it in one big push, get it out there. It's got to be all cold chain. It's really, it's really hard, but it's doable. Get this stuff out there. One big push that will make a huge difference. So start with that.

The treat cancer, the service treat earlier versions, they call it a see and treat technique. I've not done it, but it's not, there's probably a YouTube video on it. There probably is. I think, I think there has actually, you paint the cervix with something. I can't remember if it's iodine or some substance and you look for irregularities in the cervix.

And then you freeze it. You have the little nickel nitrogen cylinder with some probes, put that in the cervix and you freeze it, make a nice ball of the cervix. Then you, you, you kill those precancerous cells and hope that those people not go on to develop invasive cancer of the cervix. You would need some personnel for that because that would be,

Pretty labor intensive. That's more of a preventive medicine thing. We come in, examine them. Because you're not treating people with the cancers. You want to get the precancerous lesions. So you have to screen them, do a lot of these screening things. We paint the cervix with some substance. Look and see. You don't even need a colposcope. It's something even more simple than that. I know they're doing it in Uganda and they have this equipment. So that might be kind of an in-between thing before Gardasil becomes available. At least we do a screening of young women, check the cervix.

See what it looks like when you paint this stuff and then treat with liquid nitrogen. We don't have the equipment. None of that stuff is there, nor the knowledge to do it. What about breast cancer? How prevalent is that? It's definitely there.

The problem with breast cancer is by the time we diagnose it, we only diagnose it when you can feel a lump. - No one's getting a mammogram. - Right, no mammograms or we don't do other stuff to diagnose it, MRIs, whatever you have. - So women present with a palpable mass that they're feeling and they show up. - Right, so usually they come with a palpable mass and they already have a nose and an axilla.

- So in that situation you still do modified radical mastectomies? - We do, we usually do a modified radical mastectomy and then follow with adriamycin, sigafosamide chemo,

And do that sort of every month for about six cycles. And I mean, it's still, the results are pretty dismal. I mean, usually they get a couple of years, but two years on, two and a half years on, they come back and they've got another lump. They got a lump in the axilla. There's another tumor in the chest. So the chemotherapy almost assuredly isn't helping, is it? No, I really don't think it's doing much. So yeah.

It's really frustrating. Would getting a mammogram machine add value? I mean, of course, there's all the futility and the controversy around mammography per se, but I'm just sort of thinking of like, what are some finite resources that could be added to... I mean, you're serving a million people, basically, that...

live in a world we can't even imagine as far as even the simplest acts of prevention. Right. The problem with that to do the screening, the scale up to that level. Yeah. You need a whole new staff to get people through. Right. And the same thing with cancer service screening, it's maybe possible. So it's not just a matter of supplying the machine. You need the radio. You need someone who's dedicated to reading mammograms all day long. Or I mean, I guess the other option is

I mean, AI should actually make mammography. This is probably one of the most important applications of machine learning is actually reading x-rays. And you wouldn't even need a radiologist at some point. There will be a day when

You could run a million women through a mammogram in a year and there's a machine that's reading it and basically giving you the answer. And then now you still need the logistics of a person taking the patients through the machine and operating the machine. But anyway, we got to think big, Tom. We got to, we got to think of these other ideas. I think these are areas where technology and medicine and developing where there's not always a good marriage, but there are some areas where you have technological leaps. Like for instance, our x-ray machine,

Part of the reason we waited eight years to get one, first of all, they were expensive as heck. How much did it... I don't even know how much an x-ray machine would cost. This one cost $33,000. Which, of course, in the United States, that's the cost of getting your gallbladder removed. Literally, that's about the cost of a cholecystectomy. Yeah. For us, it was a big expense, but...

We do quite a few x-rays now. Our operating, the guys actually take in, our x-ray techs are the operating room guys. The guys in the operating room, my lab, my assistants in the operating room are the ones we taught how to take x-rays and they do a pretty good job. We waited that long because we wanted a model that,

that we could use. It was very small, lightweight, simple, where you didn't have to use the chemicals and developers and all that sort of stuff. And we just waited. And now we have a model where- Is it digital? It's digital. So it's a tiny little device mounted on this little thing. And gosh, it's like the size of a small, like a tiny box that has the x-ray tube in it. And it's a laptop.

and the screen operates by Bluetooth between the x-ray machine and the computer. Take the x-ray, that shows up on the computer screen and it's all there. And you can take that x-ray

and adjust it. You can darken it, lighten it. You can focus in on certain areas. I mean, it takes a beautiful x-ray and you can just play around with it. So you really get a nice picture. And there's very little variable cost at this point. It's all a fixed cost that you've covered. And now the more you use it, the better. You're getting more. Right. Absolutely. And the power is also the other thing was the power needed because we're 100% on solar. We've got a backup generator. It's 12 and a half kilowatts.

How long does 12 and a half kilowatts last the hospital if the panels were to go out? We could run things on it. The problem with the rate limiting factor there is the fuel. Like right now, I think we, I think we're left with maybe. Oh, so you, if you have enough fuel for the generator, you could run indefinitely off it if you needed to.

Yeah, but I mean, we'd have to give probably big breaks of time. It's a fairly concise thing. And the hospital is the only thing that has electricity? You don't have electricity in your home? No, there's no grid. So it's just the hospital has power. We run on the solar, I mean, pretty much 24-7. We really don't need, as long as the batteries are there and everything's functioning, we don't need the generator at all. And we try to

we try to find the time when these batteries are going to order a new set and new panels, whatever we need to re-up that. So we're, I think, three years into this set of batteries. What about colon cancer? Do you see that? Pretty rare. We've had, what, maybe two or three cases in 10 years. I mean, it's really, really rare. The folks who are the most elderly within the community live to what age? I mean, what is considered old? Nobody there knows their age. They don't have any birth records. Even my wife doesn't know her age. She's somewhere in her 30s probably.

So they don't really know their exact age, but I would guess they're probably, and the person there would probably be in the 70s, his or her 70s. I don't think they live much beyond that. And do you see cognitive impairment in that population? Really rare. You rarely get somebody to say, I think this person has Alzheimer's. Really, really rare to see that. I mean, I think they should die of something else before they reach that stage.

You just don't see it. The point you just made, that reminds me, there's a movie which you may have seen. I think it's called A Good Lie. Yes. It stars Reese Witherspoon. It's a beautiful story. Yes. After we saw The Heart of Nubo, we watched that because I wanted my daughter to sort of understand the history of...

the Sudanese refugees. And that's one of the points from the movie that I remember being very sort of moved by. They were all assigned the same birthday because nobody knew their birthday. Like even something like that that we would take for granted. Do they celebrate birthdays? No, nobody does. I mean, you know, my wife, we kind of invented a birthday or she invented one of November 21st. So when that day comes around, we'll usually do something. I mean, she's always surprised. Like what, what are you doing? Oh, okay.

So she doesn't give me a hard time for not buying flowers if we could buy flowers. So it's pretty, it's pretty easy to be married to a newbie lady. It's, you know, she doesn't, the expectations are very low. How has your life changed since you've been married? I mean, do you have a greater sense of obligation to not die, to put it bluntly? Yeah, I would say, yeah, definitely. So I'm like, you know, you can't be so cavalier with things because now I've got a wife and I wanted to kind of look after her and make sure she's okay. Yeah.

There's been a little bit of a change in perspective with that. And I think if, and when we get children, I think that'll change another degree up for sure. Do you think you could do what you do if you had children? I think we could stay there and, uh,

If things get really hairy, we'd have to see how to proceed. But just in terms of, I mean, your wife is a nurse, so you have the luxury of working together. So as focused as you are on your work, she is there with you. Right. When you have children, they will not work with you for quite some time. I just wonder, would it be challenging to sort of

now be torn between two obligations that for many years will not overlap at all? It'll be difficult. You know, I think one thing, and one thing I remind my wife of is that, you know, I finish work late and I'm always, you know, often preoccupied with things and things with the hospital and all that sort of stuff. But at least I'm there every evening. The weekends, we have a little bit of time on a Sunday to be together. And I

even though the work is very much all-encompassing, there's no commute and there are no distractions. There's no TV, there's no radio. We don't have other things that kind of occupy our minds. So when we're together at home, we really can be present to each other. And I would hope that if we have children...

I'll be able to use that to really spend time with the kids and not be always in work. You know, if life continues like that in Nuba, there's not any travel involved. I'm just there. You know, it's funny when you say it that way, it's actually, you may actually spend more time with your kids than many of us do here because of our disabilities.

distractions and our travel and our this and our that. Yeah. Life here is, is much more hectic. I mean, it's, it seems almost ironic. You feel out of place here, even though you grew up here. I mean, when you walk down park Avenue or Madison Avenue, are you sort of like, what in the hell is this place? I do. I do feel a bit out of place in a sense. I do enjoy it. Like I've never, even when I was like grew up in upstate New York, I'd never spent time in New York city. So this is really kind of, it's, it's exciting. Um,

I like it, but I don't think I could stay long-term. I mean, a lot of people I'm sure say that about New York, but...

I do feel much more at home in the mountains where it's very quiet and kind of sedate and your time is your own when you're off. What possessions do you value? I mean, I know you have some textbooks and things, but I mean, your home is very modest, obviously. By the standards of someone living in the United States, it would not really, you wouldn't even really call it a home in the same way. Right. But you don't give the impression that you're wanting anything.

No, I really don't. I think that has been my character since I was a kid. I think I'm very much a minimalist since I was born. All these clothes you see me wearing, well, the socks, the trousers, both these shirts, I bought when I came out of Nuba last month. So I have scrubs. I had scrubs, I had one pair of trousers, I had a suit, a few t-shirts, and that was it. And they're like, hey, look, you've got to go and meet people.

You can't be wearing your scrubs around. So I had to buy all this crap when I came out. It was painful for me to buy clothes. Like, I don't, I just don't like it. When I go back, I said, look, when I go back to the mountains, all this is winter coats and this stuff. I'm not taking this stuff back with me. I'll keep it in Armenia. Let someone there use it. I don't know. I don't want it. My suit, I do have one suit that I wore to the ceremony in Armenia, the world prize ceremony. But I bought that suit in 1985. So I haven't...

I've had about one since then. Probably when you were interviewing for medical school or something. Well, I was interviewing for jobs, like for engineering jobs. That's the reason I bought it. So it was the same one I used for interviewing for medical school. And then I've used it when I come out for the Soura Prize ceremony. I'll take it out and wear that suit with a blue shirt and a tie.

But a ball of crap in 1985 and I know that you it's absolutely against your nature to sort of be critical of Anyone, but do you spend any time thinking about the way the world works here and how most of us are? somewhat attached to our possessions Yeah, and the more possessions we have the more complicated our lives get I mean you certainly hear people talk about minimalism few people can apply it to the extent that you can of course, but I mean I

What have you learned about this and how how could you speak to somebody like me who you know? Loves his possessions as much as the next person and can't imagine giving up these comforts I mean help me understand because you don't look like you're miserable And you look even happier in these videos in Nuba I'm sure that this is about the hardest thing you've had to do all year Yeah, it is schlep around New York and talk to idiots like me. No, I

You know, I'll tell you, Peter, I really do believe that the more detached you become, not like in this Buddhist kind of Nirvana sense, but the more detached you are from things, the easier life is. It just simplifies your life. I mean, for me, I look at a lot of possessions and things and attachments as just adding more complications. You know, life becomes so complicated. It's much harder here in the U.S. You know, I see my sister and how she's interacting with the kids here.

You know, there's a reason why advertisers are good at what they do. You know, what they want to do is convince you to buy something you really don't need. And they're very good at it. Why does medicine Avenue exist? Why is there a huge billings of medicine Avenue? These guys are very good with what they, what they do. They're convincing. They've managed to convince all of us to get things that really don't need and convince us that we'll be only happy and fulfilled and satisfied if we have those things. So you've got all this tsunami pushing against you.

For me, I think just because I'm in a place where you can't have anything that kind of realized, well, geez, I don't have any of this stuff. And I kind of like it. It's, it just makes things much easier for me. I've always been a bit of a minimalist even when I was, when I was younger, but I've come to kind of feel that that's really, I do feel better with less. And I think everybody is looking for some kind of meaning in life. You know, this book, this man's search for meaning, this Victor Frank, that was something that was one of my, is one of my favorite books.

and this idea of logotherapy, but we all really do need a sense of meaning in our lives. That's extremely important for our psychiatric makeup. Whatever that is, it's different for every age person, whether it's kids, whether it's your pets, whether it's your job, but to try to get something in your life that's meaningful. And if you're looking for it, this is me philosophizing, but certainly I think if you're looking for immaterial possessions, I don't think you'll find it there. So if I can make a bit of an aside,

Something I talked about earlier with a talk with the Catholic Medical Mission Board volunteers, my favorite Bible passage, I can't remember the book and the verses, but the basic story is there's a guy, the guy's a very wealthy young man, and he goes to Jesus, they try to justify himself and says, look, what do I have to do

to get eternal life. And Jesus says, well, follow the prophets. You've got all this stuff there. Follow the Ten Commandments, follow the laws of the prophets, and you'll be okay. And the guy says, well, I do all those things. What do I need to do to really become perfect? And Christ said, you know, sell everything you have, pick up your cross and follow me. And it says something very, which I think is very beautiful. It says, the man went away very sad because he had many possessions. He couldn't do it.

He couldn't, he wanted to, I think he wanted to justify himself. See, I'm doing, I'm good. I'm doing all the things I need to do. I should be okay. And Christ kind of turned that on his head and said, okay, if you want to be perfect, sell everything you have and come and follow me. And I think, I think what he's saying is, look, if you really want to be perfect, you really want to be happy, you know, get rid of, I mean, it's a bit of pie in the sky stuff in a way and not practical for, for people.

But in some way, get rid of your baggage and come and follow. Yeah, because it could be metaphorically get rid of your stuff, right? Exactly. I don't think it's necessarily literal, right? Right. It doesn't mean throw your couches out, but it can be. It means don't be wed to these things the way that I think we are. Exactly. And the theological meaning is exactly that. It's not that you can't have things, but what's your attachment to those things, you know? Is this thing where you put your values, you know, is your value in the car you drive and the

what kind of beer you drink or whatever, or is your value more in people and what you're doing and how you're helping people? There is a bit of values in that. And I think I'm sure some people can do it very well. They're very wealthy. They have a lot of stuff, but they do have a sense of detachment from that. I just think it's more difficult. You know, it talks about this passage about it's more difficult for a rich man to enter the kingdom of heaven than it is for a camel to go through the eye of the needle. That's kind of something you say, well, eye of the needle, it's supposed to be where the camels were and to keep them out of the city.

And I think it looked like an eye of an eagle and the camel couldn't go through there. It's not saying being rich is bad or rich people are bad people. That's totally, that's, I think it's missing the point. It's just very difficult because it's very difficult to be detached from things when you have a lot of possessions. You know, I'm trying to say that without coming across as being judgmental. I don't mean that, but certainly for me, I feel much better having less. I really, I really think that. Well, it's funny at the outset, you talked about this idea that

Even in college you were sort of struck by this idea if you wanted to be a missionary and you even said something to the effect of whatever that meant and it's sort of funny like if you say to me Peter picture a missionary and

I don't actually picture you. I picture someone going into a remote part of the world and hitting people with Bibles, right? Like that's sort of the image we have of a missionary. But in the reality of it, I think what you're doing is far more aligned with, in as much as one believes in sort of religious values, I guess, I think what people like you do that is

regardless of one's religious views, they can't help but respect it is you're not preaching it to anybody. You're not hitting anybody over the head with a Bible. You're just sort of saying, look, I'm here to serve you. And your example is what's actually doing the talking as opposed to your words. Whereas I think most of us, myself included, are far too quick to use our words to speak as opposed to our actions. Well, you're tapping into my favorite quote, which has been attributed to St. Francis. I don't know if St. Francis is like many people. He's my favorite saint.

Francis of Assisi, who lived in the early 1200s, he said, preach always and sometimes use words. And I think that's exactly what I think we try to do at Mission. Show the love of Christ by who you are and what you're doing, Colossus. And don't get too wrapped around the axle about how it's going to play out.

Remember, if you're there as a missionary, God is the one that changes hearts, not me. I'm not smart enough to do that. I'm not a guy that's going to have just the right thing to say and to school somebody on something. I can't do that. But I can do my best to show the love of Christ to these people. And that's what I feel comfortable with. If you ask me why I'm a Christian, I can talk to you about it. And my words might be a bit jumbled and goofy sometimes.

But preach always and sometimes use words. Are there any cases of suicide in Nuba? We had one guy who's the husband of one of our staff. And yeah, he shot himself. And that really shocked everybody. He seemed to have some kind of psychiatric problem. He was kind of acting a bit strange a few days. They didn't tell us, but he'd been in one of the refugee camps, was acting a bit odd there, came back to Nuba, and was acting a bit odd at home. And then the night he was acting a bit odd, he went and he shot himself.

It's the only case I know of. It's extremely rare, extremely rare. I mean, to me, there are so many amazing contrasts between Nuba and America, right? I mean, they're so obvious, they're not worth stating. It's these subtle ones that to me are interesting, right? There must be a different sense of fulfillment, contentment, happiness, happiness.

sense of purpose there versus here. I mean, as you know, I'm sure you're not paying close attention to statistics in the United States, but suicide is among the top 10 causes of death in every, I may be incorrect on this, but I'm not far off, in every age demographic except for zero to 10. So once you get above 10 to 20, 20 to 30, suicide is always in the top 10 as a cause of a disease. And that doesn't include

That's what we call fast suicide. Right. When you kill yourself immediately with a clear, but then you have all the slow suicide. So the alcohol related, you know, basically people that kill themselves with alcohol and drugs. Yeah. So when you include all of those, I've heard analyses that would suggest that self-harm would be sort of top five causes of death across the board. What does that say to you, given that you're, you live in a world that has, uh,

one one thousandth of the privilege and for all intents and purposes like shouldn't everybody be killing themselves in Nuba so to avoid being a you know ripped apart by shrapnel yeah it's very interesting and you know my initial thought that comes to me is the people are when you're really gripped in this struggle to survive so your your life is based on you know every day is you're just trying to survive when you have that sort of primal instinct of survival you're

You don't, your mind doesn't drift off to other things. You don't think about so much about your life is hard. Your life is this, your life is miserable. So I think you become less inward looking. Suicide is so inward looking, so focused on your own misery that you can't come out of it. I mean, it's such a miserable thing. I mean, it breaks my heart when I hear about these things. It really does. Because I think, man, it's,

To get to that point when you just, life is so miserable for you and you are so miserable, you kill yourself. It for me is heartbreaking. Does that break your heart more than the tragedy that you see every day? I mean, not to compare miseries, but like what you see breaks my heart. Maybe I'm numb. I mean, and it's not to say that I'm not heartbroken by anybody who hurts themselves, but I'm

what you see is so staggering. Do you see this as an even greater source of tragedy? For me, I would, I would equate that with the five-year-old girl who's got the shrapnel ripping her arm off. I would, I would see, I would feel the same sense of, of pain and heartbreak with that. Suicide is a similar effect where, you know, if a child dies from this kind of thing, the effect you have on the whole family is devastating. The grief, suicide, the grief you leave behind

I think that's really tough. And that really, really breaks my heart. Not only for the person who was so miserable that they decided to take their own life, but for the people behind it. Oh gosh. And that's terrible, man. I would just never wish that on anybody. And yet it's almost impossible in the United States to not have your life touched by suicide. I think it would be very rare that someone listening to this in America wouldn't know somebody first or second hand who hasn't taken their life either physically

clearly and deliberately or sort of slowly and maybe less deliberately. Yeah. I think it's wrapped up in that struggle for survival. There is a will, you know, a natural will to survive. And when you're in this kind of daily grip, even when there's, when there's not fighting just to survive there, the amount of work it takes to

to get up in the morning to, you know, make food, to cultivate crops, to keep the animals out of your garden. I mean, it's, it's a, it's a tremendous struggle. There's a book. I think the book is called tribe, Sebastian Younger. Have you heard of this? I've heard of it. Yeah. I can give you a copy. Actually, I have a copy here, so I'll give it to you as one more possession to have. Right. Um, but he writes about how post nine 11 suicide rates went down in New York. And he talks much more eloquently about this than I ever could. But

I guess it speaks to what you're saying, which is when there's a real struggle, when there's something and something that can bring people together in a common goal or something that unites people, it can presumably distract from some of that pain that can otherwise hurt us. Right. And it's interesting because I fairly recently was hearing about this PTSD and

And I mean, how many veterans have killed themselves? It's, it's, that's another heartbreaking thing. Somebody is fighting in Iraq or Afghanistan. They survive all that. They come back home, they get despondent, they kill themselves. It's,

What kept them alive during the fighting was a sense of camaraderie, togetherness, fighting for a common goal. I mean, no matter what you think about warfare and the horrible things that happen in warfare, at least they have some kind of a common bond. They come back home to the US and people are indifferent to them. Nobody pays attention to them. They've lost the common bond with their comrades.

and friends, and what ensues is despondency. And before you know it, we had this huge rate of suicide amongst veterans that come back, not so much from the trauma they had during the fighting. It wasn't like flashbacks to horrible things that happened there, but the sense of loss of any bonds, that human contact with other people, that sense of purpose is gone.

So I found that quite interesting, that thought. It just makes you wonder if there is a way to, you know, we have these dating apps here in the United States, right? You probably don't have a lot of them in Nuba. Well, dating is totally illegal there. The word dating doesn't even exist. How did you meet your wife? Well, we have what she calls secret love. That's not like in a scandalous sense for anybody, but...

you know, there you can't openly date somebody. You know, if, if somebody like I, I can never be alone with her somewhere, like just chatting out in the public, people would tell her brothers, Hey, this guy is talking to your sister. What are you gonna do about it? They come and they beat me up. They'll beat her up. And then this big scandal. And they say, Oh, you know, either you guys gonna get married or what's going on here? You just can't, you can't be doing this.

So you have to do it. We did it very quietly. You know, it's got the, it's, it's difficult. We got to know each other kind of on the side and our marriage is normally arranged. Is that why this dating process is unnecessary? Yeah. Traditionally they were arranged. Now they're not so much arranged, but the families will meet together. Somebody, you know, some might show interest in somebody else than they have to approach the family, but there's not really a dating. They can't go through a public dating thing. If you, if you're interested in marrying a girl, um,

you've got to go and approach the family right away and say, look, I want to marry this woman. Then they have to start negotiations with dowry and all that sort of stuff. You can't be seen together in the public sphere. It's just totally not allowed. So not so much a range. There's some attraction between the two, but they have to really make the move fairly early. So one of the problems is you don't really get to know the other person very well. It's really difficult. They're good and they're bad points because you –

You're not really allowed to go through that process of dating if they know somebody and all that sort of thing and they're the family. All right. So there's definitely no Nuba version of Tinder. So I think where I was going with that was in the same way that we have these dating apps, which are basically trying to pair people, right? With similar interests. At a meta level, it would be interesting if there would be a way to pair a void that exists here in this country and for much of the civilized world, right? Yeah.

void of purpose with a part of the world where purpose is not lacking but resources are lacking and in many ways I think that's what philanthropy sort of tries to do. But of course the question is it's more than just that right? I mean, I don't think it's just Giving I think there's more to it, right? I mean I and I was sort of thinking about this knowing we were gonna speak today that because my daughter asked me another question She said, you know, she said well, can you ask dr. Tom like what is

could a 10 year old girl in San Diego do to help a 10 year old girl in Nuba? And I thought, and I thought, and I thought, and I was like, I don't know. Cause it's not like you going there is going to, you know, be a practical solution and, or even provide value. I mean, even me, even if I decided, Tom, please, I'm going to come for a year and work at your side, I would slow you down. I mean, I would be a waste of like, you'd spend a year just teaching me how to get out of my own way. So

How can people help? I mean giving is of course the most obvious you've outlined so many clear tangible examples of where

Even modest resources by the standards of our healthcare system would have profound step function changes there. Is there something else people can do to help? Yeah. First of all, never underestimate the value of a donation to someone you trust or a group you trust or an organization you trust. The amount, the impact that has is tremendous. We can't do anything in our work without financial resources. Beyond that, I think one is just becoming aware of the situations and

Yeah.

be aware of the political situations there, advocate on behalf of some of these people that are oppressed or having difficult lives, whether it's working in issues of poverty or poor health, poor education. I think people have a voice to offer and people do have an influence over governments. So government policies, government funding is a reflection of the constituents. And I just came to realize this full well in this trip that

Because some of these people say, well, the government funding, a lot of these administrative requirements, these beneficiary organizations have become more stringent and more difficult because governments require these things because they're accountable to their constituents. Their constituents are saying, why are you sending so much money to Africa? They're wasting it or it's a waste of money. So to give the money out, the constituents are holding the money.

politicians' feet to the fire. If the constituents were a little more open and said, look, let's help out, let's be aware of what's going on and try to help some of these people get out of their misery so they can eventually help themselves through education, better health, all these sort of things, that would free the politicians up a bit more.

to allow more resources to go out and to more aid and other things, more benefit to give them. I mean, the goal in all this stuff is eventually let these people who are beneficiaries now stand on their own two feet, maybe in the next generation, next go around. This cycle of aid, I mean, everybody knows the cycle of aid and dependency is a bad thing. Great, but how do you get out of that?

So what are some creative ways we can do that? But you can't do anything without some help at this point, but geared towards getting these people to stand in their own two feet. Talk to me about food. I heard a funny story once that, is there a word for food in Huba? Like it's like it. So, you know, Huba has like 99 different languages, uh,

amongst the Nuba people. But does everybody speak Arabic? Pretty much. Most will speak Arabic. And you speak Arabic? Yeah, I speak, I mean. Shwaya. Yeah, shwaya, shwaya, shwaya. The dad of, my wife's language is Tira and this came from her. The local word for food is ngumo. And I would say, what did you have for supper last night? And she said, well, I had food. I said, what kind of food? She said, you know, food. What are you talking about? I had food. I said, what kind? She said, well, I had a sida, you know?

Aceta is the kind of the, it's like a cake made out of sorghum, kind of ground sorghum boiled. I mean, just totally tasteless. She loves it. You know, so I have to have my, my aceta. So for them, the word food and, and this aceta is synonymous. There's so little variety. So little variety of foods. So what do you eat? First of all, what did you weigh? Cause you were a nose guard in college. Right. I've seen pictures of you. You were huge. Yeah.

What did you weigh in college? In college, I was 230 and this was 1985. I weighed 230. And what did you weigh when you arrived in Kenya in 2000? Probably around 190, I would guess. And what did you weigh by the time you got to Nuba in 08? Then maybe 170. And I got down, I was down about 150 up until recently. Now when I've come out for the past month,

I think I've gained about 20 pounds. I was down to about 150. You've gained 20 pounds in the United States in a month. Yeah. So you were down to 150 pounds a month ago. Yeah. Talk to me about what you eat. Well, that's the thing. I, I, I eat, but my wife makes the food there. So is this food. This is the. What did you eat before you got married?

Then I was living on the hospital compound. So we'd have a lot of, they would send them food in from Kenya normally. Like once a year, they'd send food in. So usually rice, kidney beans, some kind of lentils. So we'd have that every day. Once a while, I'd have chicken. But usually it was just kind of rice and beans kind of stuff. So now when I got married and moved off the compound, my wife makes a sesita. And she has some sauce on top of it. So the main sauce is this okra.

Okra grows pretty well. They take okra, they dry it and they pulverize it in the powder. They mix that in with water and some other stuff. And it makes like a really slimy sauce that you pour over the sorghum paste and it tastes about as good as it sounds. I mean, it's really pretty bland. Where's the protein? You know, I think the sorghum actually has a high protein level. I think it's a grain. And I'm saying that because...

the people are pretty muscular. Like that's what they eat. They eat that and they'll have maybe some sorghum porridge in the morning. And that's pretty much it for the day. And I mean, a few peanuts, they have peanuts too, but not huge numbers of peanuts.

What about fruits or other vegetables? For fruits, there are seasonals. So you can get mangoes for maybe two or three months out of the year. You know, mango season is there. There are tons of mangoes. Then they, when they're gone, they're gone. You don't see a mango for several more months. Then there's two seasons for mangoes usually, but it varies quite a bit year to year. So mangoes are there periodically. Lemons you can get for fruits.

That's about it. Oranges are not there. You know, pineapples. Are there tomatoes? Tomatoes are there for a couple months, sort of towards the end of the rainy season. You can get tomatoes and you can get some greens. They grow a few kind of greens there and they'll put that on top of it. Like even the tomatoes will kind of cook up a bit and make the okra slime to it and put that over the aceta. That's not bad actually.

We'll have that quite a bit. Or the other thing we'll have during the rainy season is milk also. Milk is only there for a couple months. The cows will only give birth during the rainy season, and therefore they're only lactating during the rainy season. So they'll get milk sort of towards the end of the rainy season, those last couple months. And since there's no refrigeration, most times we'll have it sour, sour milk. So we'll get milk out, let it sit for a while, and it becomes sour. That'll also decontaminate it a bit. There's a lot of brucellosis there.

And you take the sour milk, which is kind of curdled. And, you know, I think people have had sour milk before. And you pour that over the aceta, over the sorghum paste. That just doesn't sound tasty. It's not very good. It's really, it's, you kind of eat it and you're like, oh man. You know, the problem is you eat it, you're kind of hungry a bit, but there's no way of going back for seconds. Like, okay, that was enough. Just kind of go to bed, you know, or go back to work. It's like, okay, I guess I'm finished. My wife really, she does a great job cooking with what limited resources we have, but she

It's pretty stark. Is there a food that you particularly looked forward to having when you knew you were coming to the United States? Yeah. Like you're Italian, right? Yeah. So pizza, eggplant Parmesan is my favorite food in the world. So my sister made that when I was down there. Hamburgers. I just crave cheeseburgers, like just a good sandwich, you know, with some chicken sandwich or something.

Is this really nice with a good bread? You know, this kind of stuff. You've been sick when you're there. I mean, how many times have you had malaria? Well, I've been there 10 and a half years. So I've gotten malaria every year except for 2018. How bad is malaria? It sounds awful. It's pretty bad. I mean, sometimes you're wishing somebody comes in and just shoots you and puts you out of your misery. You're pretty sick with it.

It's worse than influenza, right? Yeah. And influenza, anybody who's actually had the flu will attest that's 10 days of really bad living. Yeah. Larry's pretty miserable. I mean, real bad headache, nausea, vomiting, you can't sleep, just high fevers, body aches, terrible body aches. And sometimes you get a bit lucky. You take medicine, you're over it in a few days, but-

A lot of times it'll drag on for a month. But you don't take prophylaxis throughout the year or during the rainy season, which I'm assuming is when it's endemic? Right. I don't take prophylaxis. Just because of the cost? Yeah. I just don't want to take the drug. I just want to say, okay, let me just not take it. Take it once you get it. Right. Once I get it. Sometimes it'll drag on a bit longer. I mean, sometimes you get it just for a month. You take the medicine, you feel a bit better for a couple of days.

Then next evening you start feeling the chills and shaking and the headache comes again. And it's like, oh gosh, still with me. It can really drag on for a long time. So every year you've got it. Every year. That was in a coma a few years ago. Just, uh, God, it was a strange night or started feeling sick the night before. It was on a Tuesday night and started taking, I took some oral drugs. I think a coartum, which is a artemisinin derivative. Took that at night, went to bed, uh,

Just kind of had a kind of fitful sleep. And then I woke up the next morning and all these staff were in my room. I have an IV in my arm and I'm an IV quinine. Like what, what's going on here? The doctor needed treatment. That's right. But I was really out of it. That was like 11 o'clock when I woke up and I was really, you know, they tried to get me up in the morning. Some of the staff, cause I was in the operating room day on Wednesday and our guy that's our assistant there, uh,

I didn't show up. I was down there by 7.30, and I didn't show up, so he came up to the room. He tried to wake me up, and I couldn't get up. Like, I didn't respond to him. So he thought I was dead. He was like, hey, the doctor's dead. People came running in. Anyway, I didn't die, so I just was out of it for quite a while. But then I recovered pretty quickly. I can't even imagine. When you think back, Tom, about all of the people you've taken care of in the last 10 or 11 years, so even just limiting it to the time in Nuba,

Is there any one particular patient that just stays with you, that haunts you? One case, one story, one child, one adult? I mean, I have those stories. I've got one or two, probably three stories that have stayed with me from my training. Right. That if I even think about these patients, I'll tear up. I mean, just, you know, unfortunately, they're all bad outcomes. Right. But they're also...

They're not like the only bad outcomes I've seen, but there's just some, there was some emotional connection that happened. And then it's maybe it's sometimes you're projecting what's happening there onto your own life or something, but do you have those cases? Yeah. Probably like you, the ones you really remember are the ones that have been outcomes or ones that didn't go well. Gosh, we had one kid. I remember he, he came in on a Sunday morning and he had been

The Antonov bombed and the shrapnel went in his face and just tore his face to shreds. And he went to some clinic somewhere and they put a few stitches in it, like chromic stitches. And he came a couple of days after that and his face was just mangled. So we took the stitches out and it was all just pus and dirt coming out. I mean, just they didn't clean the wound out. So we took all these stitches out, cleaned the wound out well, put them on some antibiotics. A couple of days later,

We go in, he's got high fever and he can't swallow. I'm like, no crap. He's got, he's got tetanus. So he could get tetanus. I remember the day before that, I remember the Antonov came overhead. The Antonov is the airplane that bombs. And we saw the kid, he was like maybe 10 years old. He was standing against the wall, just shivering when he heard the airplane, just shaking. He was so traumatized. He was so traumatized. He was shaking like this.

Then like the next day, he gets a real high fever. He can't swallow. Put him in isolation, put NG tube down to feed him. And he just died from tetanus. Like overnight, he died from tetanus. And I remember this kid's face and how, and I said, what the heck? It was a 10 year old kid with this thing. We had another kid, there's a child who this is a few years ago. He was, he was bombed. He and his aunt. And it was an incendiary bomb from the Antonov. And I don't know what they had, napalm or whatever, but it bombed him. It just, he had, I don't know,

He had third degree burns on probably 60, 70% of his body. And he lived. Is that even survivable? No, he lived like two months with this and both he and his aunt were the same. And I mean, we tried everything with these kids, the amount of work the nurses did every day just to try to address him and the agony he went through before he died. I remember that, you know, his aunt would have these scabs and I remember there were, her eye was burned with this thing. And I remember there were maggots coming out of her eye, you know?

I think, what the heck are we doing? This is crazy. Who are these? These are civilians. Bernadette. There were six other kids that were in an area that was being shelled. So the Sudanese would shell their village all night, and then they would bomb during the day. So at nighttime, they would sleep in the foxholes for protection. So right next to them was a straw rakuba, kind of a straw little structure. So the artillery shell fired and hit the rakuba.

thing burst, it was just like a kind of lean-to with made of grass and wood. It set this thing on fire and it fell into the foxhole. And there were, I think, nine people in the foxhole all sleeping. Three were burned to death immediately. Six of them came to the hospital with varied degrees of burns. And a couple were just like 80% full thickness burns. I mean, just, they lived for quite a while before they died. Two of them, one girl started improving, then developed tetanus and died from the tetanus.

So these are the ones that really kind of stick out. Maybe one of the soldiers I remember best is a guy that, he was a guy that I told you before, he had 23 or 24 holes in his intestines. We opened him up and we just, I mean, hours we operated on this guy. Post-op, he was doing great. I mean, he was cruising. I started feeding him. He was sitting in bed. The next time I called down to see him, he's changed condition, as they say. And I went down there, he's already dead. He was a Darfuri who was fighting with the rebels. And I just remember thinking, you know what?

What would this like for his, like this guy's got a family, you know? He's fighting in this place. His family's somewhere in Darfur. What's happening? Do they have any idea what's happening here? So many terrible things, you know. There was one young kid. He was about 16. The Sudan army was encroaching on our area. So the rebels ran out there to kind of repulse them. And then people just kind of jumped on the vehicles to go out and fight, you know. So this kid just jumped on the vehicle. He didn't have a gun, no weapon, no anything. He was a civilian. He goes out there.

He gets shot in the head with, with, you know, machine gun or something. He comes in with, with, you know, part of his skull missing and his brain tissue kind of pulsating out. I mean, he survived for two or three weeks like that. You know, he had steroids and different things, antibiotics, try to count things down and ended up just kind of going south and dying. So these are all, all people I'll never forget. And there are many, many, many beyond that. If people want to get involved in any way, shape or form, where would you recommend they, they look to as a, as a resource?

I think like an African Mission Healthcare Foundation, there was something on their website about the hospital. That's one source to go to. And their website is? It's amhf.us, www.amhf.us. So that's a pretty good source to start. There's a group called Take Heart Foundation.

which was set up to kind of to harness the whatever support to be through the Heart of Nuba movie, which was made by my friend Ken Carlson. Which I recommend everybody watch it. I think it's a, I'm sure it was done on a shoestring budget, but it's so well done. Yeah. You know, it just sort of speaks for itself. So anything raised through them goes to African Mission Healthcare, which comes to us without anything taken out. Catholic Medical Mission Board is another good source for

That's my, they're my sponsoring organization. They're here in New York. They've been here for, I think over a hundred years and there's cmmb.org I think is their website. These are probably the main sources for our work at Nuba. You know, I'll close with a story, Tom, that I think in many ways kind of defines you. I remember when I decided I wanted to go to

medical school, I was applying for this scholarship and in the end I didn't get the scholarship. But I remember during the interview, this guy asked me a question. He said, you know, what do you want to be? And at the time when I went to medical school, I wanted to be a pediatric oncologist. And, uh,

I know what the guy was doing in retrospect. I mean, I think he was just trying to push me. And he basically said like, why would you want to do that? You can't possibly make a difference, you know, without dedicating your life to research, you're not going to have a difference saving one kid's life at a time, et cetera, et cetera. And, you know, I remember thinking of a story after, which in many ways exemplifies you to an extent that probably no one else, which is, you know, in medicine, you can do two things, right? You can

You can do something very scalable through research. You know, you can devote yourself to working on, you know, treatments for cancer or developing a new drug to treat this disease or that disease. Or you can be on the front lines trying to save one life at a time. So the story is there's these two guys walking down the beach and it's after a really high tide and the beach is covered in starfish. And the starfish are going to die pretty soon if they don't get back in the water, which means they're pretty much all going to die. The two guys are walking and

Every few steps, one of the guys bends down as he picks up a starfish and he throws it back in the water. Five steps later, he does it again and again and again. After like the 10th one, the one guy says to me, he goes, what are you doing? And he says, well, you know, if these starfish don't get back in the water, you know, they're going to die. And he goes,

Have you looked and seen how many of them there are here? You can't possibly make a difference. And he throws another one in the water and he says, well, it made a difference to that one. And I think for doctors that don't have the privilege of being able to affect the larger through research or policy changes, whatever, for people on the front lines, I don't think there's a human being on this planet who throws more starfish back in the water than you.

In the end, medicine is individual. It's the beauty of our profession. And it's a huge privilege to have the opportunity to affect one person. And in the end, you close the door and it's you and the patient, whether you're in Nuba Mountains, whether you're here in New York. And that's an incredible privilege. And I think if we keep that focus, just one person at a time, I think people can kind of relax a bit.

You can see that what you're doing for that one person. I think people look at Africa and say, what you're doing is a drop in the ocean. I really like that story because when you're there, you don't see a drop in the ocean. You see a person. You see a life. You see a life. And you see somebody that can laugh and can cry and can play and has aspirations and is a living, breathing human being. You think, man, we helped this one person. That's a huge thing. And I think that helps to stave off some of the burnout and the cynicism.

The fact that you are, this is a very individual thing. So one person is really a big deal. It's everything to that one person, that one person's family. And I think we really have to keep that in mind, especially with this growing realm of cynicism and sort of negativity that we see now. Tom, I have been wanting to meet you for three years. I didn't know that I'd ever get a chance to. So it's, it's sort of beyond a privilege to,

And I know that for you being outside of Nuba is the toughest thing imaginable, which is of course the irony sitting here in the plush New York city. And yet all you're doing is pining to go back to a place where your own life is in danger. But you know, I remember thinking, God, I really just, I'd love to be able to interview Tom. And I remember thinking there's no way he could justify making the time to do this when his time in the U S is so short. So I

When I asked Rick and Mark and John, and they said that Tom would be happy to sit down, I just, I couldn't believe it. And I might make the case that of all the interviews I've ever done or will do, this is the one I feel most privileged to. So thank you. Thank you so much. Yeah. Thanks, Peter. This has been a real privilege for me to be here with you. And thanks for giving us the platform to spread the word a bit. Thank you so much. Thank you for listening to this week's episode of The Drive. It's extremely important to me to provide all of this content without relying on paid ads.

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