'Dr Tom,' Only Surgeon for 1.3M People in Sudan Region, Wins Award

Marcia Frellick

February 03, 2020

On some days, American surgeon Tom Catena, MD, 55, may see 400 patients a day at Mother of Mercy Hospital and outpatient clinic in the Nuba Mountains of Sudan, one of the poorest regions on Earth.

The 1992 graduate of Duke University Medical School in Durham, North Carolina, is the only surgeon for 1.3 million people in the region, described as twice the size of Massachusetts.

For 8 of the 12 years he's been there, since he helped found the hospital, he was the only doctor as well. A pediatrician has since signed on and another physician is available a couple of hours away, Catena told Medscape Medical News.

Dr Tom Catena treats a woman with an infected arm at the Mother of Mercy Hospital in Sudan.

For his current and previous service in Nuba, he was recently awarded the $500,000 African Mission Healthcare (AMH) Gerson L'Chaim ("To Life") Prize for "outstanding Christian medical missionary service."

Catena delivers babies, performs major and minor surgeries, treats infectious disease, cancers, and wounds, rounds on wards, and doles out vaccinations over long days, 7 days a week.

Work in the early years meant dodging shrapnel.

Bombs Exploded Around Hospital

Bombings were steady from 2011 when South Sudan won independence from Sudan, until a ceasefire in recent years; during the fighting, the chaos regularly exploded near the 435-bed hospital in Gidel, Catena said.

Foxholes were dug for quick cover for patients and staff. The bombs have stopped for the time being, but for years, there was a steady stream of patients with war wounds. Catena, a Catholic missionary born in Amsterdam in upstate New York, said he knows the fighting could break out again.

"It's not an ideal way to do medicine," he said. "There's just no other option."

For the past 2 years, Catena said, the hospital has been completely dependent on individual donors for everything from batteries to gasoline for the vehicles to medicine and supplies. Twenty solar batteries provide electricity with a backup generator for emergencies and water is drawn from a well with a solar-powered pump.

Jewish businessman and philanthropist Mark Gerson and his wife, Rabbi Erica Gerson, founded AMH in 2010 and "Dr Tom," as patients and staff call him, is the fourth winner of the prize.

Gerson told Medscape Medical News they chose to center their efforts on Africa because "you have the biggest humanitarian problem in the world — that most people in Africa lack access to care."

Asked what he hoped the money would support, Gerson said recent numbers from the hospital show what's possible: Last year, from January through September, with a total budget of under $1 million (US), the work at Mother of Mercy included 68,455 clinical visits; 1894 operations (655 major operations); 381 deliveries (73 of them by cesarean delivery); 190 patients treated for tuberculosis and six for leprosy; and 5249 vaccinations for children under 5.

"So what do we want the money to do? More. More of that," he said.

The money will also help support a training center for medical professionals who will then train others. The goal is not just to help for now but to build a sustainable staff and financial infrastructure "so the people of the Nuba Mountains will have access to treatment for the long term," Gerson said.

Catena, named in Time's list of 100 Most Influential People in 2015, said the hospital is open for emergencies 24 hours a day, 7 days a week. When he isn't actively treating patients, he is on call.

Gerson said Catena receives about $350 (US) a month and only because an AMH donor insisted the doctor use the small sum for himself.

"He [Catena] tried to redirect it to the hospital," but the donor insisted as a condition of the gift, Gerson said.

"He wants to give it all to God, literally," Gerson said.

20 Years in Africa

The decision to become a missionary predated the decision to become a doctor, Catena said.

He had graduated from Brown University in Providence, Rhode Island, in 1986, where he majored in mechanical engineering and was a nose guard on the football team.

Medicine better matched his calling to help people, Catena said. He did his residency in family medicine in Terre Haute, Indiana, and then 5 years of service as a doctor in the Navy.

He became a part of the Catholic Missions Board, which had hospitals all over the world. But he saw the greatest need for his services in rural Africa.

Dr Tom Catena comforts a young child in the village of Gidel. He often sees as many as 400 patients in a day.

Catena said his surgical experience was limited to a single cesarean delivery in residency, so he spent 7 1/2 years in Kenya learning procedures from missionaries and local surgeons. He learned by reading volumes of books and by observing local doctors.

Surgical instruction is not always conventional, he acknowledged, and procedures have to be modified for use with the equipment and staff available.

When he moved to the Nuba Mountains to found the hospital in 2008, he was faced with a case of a 3-year-old girl with bilateral Wilms tumors. One kidney was riddled with cancer as was one third of the other.

He had only ever removed a single kidney. So he downloaded a YouTube video of Polish doctors performing the procedure and was able to mimic what they did to remove one full kidney and half of the other to save her life.

Civil War Since the 1950s

Catena notes that Sudan has been in civil war since 1955.

"There's only been about 10 years of peace since then," he said. As a result, access to the rural regions and development of a healthcare workforce is "way, way, way behind," he said.

Twelve years ago, "there was not a single high school graduate in the region," he said. The highest level of education was 8th grade, Catena said.

Since then, some people have been trained as clinical officers, similar to physician assistants, and lab technicians, and in pharmacy roles. And some have been able to obtain training in other African countries and return to Nuba.

His wife, Nasima, whom he married in 2016, is one of the local people who was able to get training elsewhere. She now works at the hospital as a registered nurse.

Most Westerners were evacuated when fighting escalated, but Catena and clergy members have refused to go. Catena said the decision for him has been easy.

"The truth is — and I don't want to sound arrogant — people would have no option. I was the only doctor left.  Lots of people would have died and I knew that. I never would have gotten over that — that sense of guilt of knowing that people would die if I left," he said.

Saddened by Burnout in the US

Catena retuned to the United States last September to attend the Catholic Medical Association conference in Nashville, Tennessee. He admits he had been out of touch with the medical environment in the US but was "horrified" by the stories of burnout.

He heard the stories of frustration with technology and disillusionment that the reality of medicine did not match the hopes. 

"Medicine has a very personal feel and you've got to have some connection with the patients," he said.

Catena said people ask how he could avoid burnout seeing so many patients, and he said seeing so many with such great need and with such a variety of injuries and illnesses perhaps prevents burnout instead of causing it.

"I get exhausted and frustrated because we don't have the optimal equipment or the drugs, but I don't feel a sense of burnout. I feel there's a tremendous satisfaction in the work," he said.

No Plans to Leave the Continent

As to his future, Catena said it was always the plan to stay at the hospital until he could turn over medical operations to the Nuba staff — and that goal is many years away.

A new physician is joining the staff this summer, he said.

When he can turn over the medical operation there, he plans to seek out the next place that needs him. But he and Nasima have no plans to leave Africa.

"I just feel the need is so great," he said.

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