A Field Report, by Jon Fielder, MD
On our honeymoon in 2003, en route from the US to Kenya, my wife and I visited Italy. In St. Peter’s we circled Michelangelo’s Pieta, awestruck. What does it mean to chip this staggering image out of marble? And sometimes I wonder, “What is harder, to crack stone into a marvelous pattern, or to coax a place of healing from the midst of poverty, despair, and violence?” A great privilege of this job — if one is willing to look beyond the mud, or the barrenness, or the crumbling buildings — is to witness wonders surpassing even the dreams of Michelangelo. —
Dr. Tom Catena, spare and thin, is by far the tallest person around. He towers head and shoulders above the Sudanese staff and patients of Gidel Mother of Mercy Hospital. Located deep inside the Nuba Mountains, a contentious area along the new border between Sudan and South Sudan, Gidel Hospital has 80 beds but over 200 patients. “Dr. Tom,” the facility’s only full-time physician, rounds on every one of them, four days a week. Two other days he operates. Sometimes he even gets a day off.
Trained as a family physician, Tom’s skills harken back to a time when the generalist was king. The pediatric ward houses kids with malaria and malnutrition, and everything in between. A recent measles outbreak during the rainy season necessitated a separate tent for 220 patients. Tom cared for all of them, too. Of 1,400 measles cases, only 28 died — thought to be a fraction of the actual cases and deaths which never made it to a hospital. (Gidel is now running a mammoth vaccination program, reaching 30,000 children at risk whose immunization schedule had been interrupted due to years of conflict.)
On to the women’s ward, where patients fighting cancer receive chemotherapy and those with bowel obstruction are recovering after surgery. Patients crowd a narrow hallway — because the ward is a hallway. The maternity is actually the slowest clinical area. Most women deliver at home.
The transportation challenges are legion in the Nuba. The dirt roads are impassable much of the year. Few vehicles ply the byways often targeted by Antonov bombers from the north. “We only have a few cars, but we must have the highest accident-to-car ratio anywhere,” Tom laments, alluding to the reckless driving which results from no licensing authority, no traffic police, no lights, and no paved surfaces. In fact, overt signs of government are few and far between. These victims, too, become his patients.
In the male ward, it’s mostly battle trauma. Men in traction, others with tubes in their chests, a boy recovering from a shrapnel wound to his liver, incurred when he picked up an unexploded shell. Throughout the whole facility are the victims of war: burns, gun shots, flying hot metal. Without Gidel Hospital and Tom, they have nowhere else to go. It’s seven bumpy hours to the refugee camp, where the aid group Doctors Without Borders operates a clinic not equipped to handle major wounds. Elsewhere are small government dispensaries with two rooms and a handful of medicines.
Perhaps that’s why, during our approach to the hospital gate, upon seeing a large group of children walking, Dr. Catena’s colleague commented, “Maybe they are coming to sing to Tom.” The grateful, suffering community offering thanks from its youth in song — not the kind of reimbursement one usually gets in return for filling out insurance claim forms.
Trained at Duke and in the Navy, Tom left for the mission field after completing residency in Indiana. He knew from a young age that he wanted to be a missionary. For over twenty years he has served in Tanzania, Kenya, South Sudan and Sudan. He never worked in the US after residency, living a spartan existence on a small stipend from Catholic Medical Mission Board. I met him briefly during his time at St. Mary’s mission hospital in Nairobi, where he set a record for performing a dozen C-sections in one night.
Possessed of a deep well of energy and boundless enthusiasm, Tom is — and must be — efficient to complete all this work in the stultifying heat. He doesn’t waste words — he speaks both Arabic and the local language — or wear his heart on his sleeve. But I did see it on his wrist, a band inscribed “John 3:30.” The passage reads, “He must increase, I must decrease.” Faced with violence and uncertainty, Tom and his team embody another of those great pronouncements of Zosima in The Brothers Karamazov:
One may stand perplexed before some thought, especially seeing men’s sin, asking oneself: “Shall I take it by force or by humble love?” Always resolve to take it by humble love. If you so resolve once and for all, you will overcome the whole world.