The Peter Attia Drive - #40 - Tom Catena, M.D.: The world’s most important doctor – to nearly a million patients – saving countless lives in the war-torn and remote villages of Sudan

Episode Date: February 11, 2019

In this episode, Tom Catena, a missionary physician who runs Mother of Mercy Hospital in the Nuba Mountains in Sudan, describes some of his extraordinary work as the only doctor in a remote, war-torn region of Africa. In terms of individual lives saved, you could argue that there is no other person on the front lines doing more than Tom. Additionally, we explore the manner in which the Nuba people die, which is in striking contrast the ubiquity of chronic disease and self-harm in the west, despite the extreme poverty and unimaginable suffering experienced by the Nuba people. Lastly, we discuss the lessons to be gleaned from the Nuba people, who despite their suffering, live so harmoniously, happily, and resiliently. To support Tom’s mission please visit www.amhf.us. We discuss: Background, medical training, and early days of missionary work in Africa [9:00]; Tom arrives at Mother of Mercy Hospital in the Nuba Mountains of Sudan, civil war breaks out, and his staff evacuates [15:45]; Learning surgery on the job and earning the trust of the community [40:45]; The amazing people of Nuba, and why Nuba feels like home to Tom [51:30]; NY Times article about Tom’s work, and Tom’s new venture on the board of Aurora Prize Foundation bringing awareness and funding to other missionaries doing great work [1:03:30]; Tom’s mind-blowing ability to deal with chaos while seeing hundreds of patients per day [1:15:45]; The most afraid Tom has ever been, and how he copes with the emotional trauma of his daily experiences [1:23:30]; The basic tools, technologies, and medicines that Tom is lacking that could save many lives [1:33:30]; The logistical challenge of helping Tom’s hospital, and what Tom really needs [1:39:15]; Diseases in the adult population [1:42:30]; Living without possessions, finding meaning, and being a missionary [1:59:30]; Sense of purpose, happiness, and suicide: Contrasting the US with Nuba [2:11:00]; Other than donations, is there a way people can help Tom and other similar causes? [2:19:15]; The food in Nuba [2:22:30]; Tom’s annual bout of malaria [2:27:30]; Patients that Tom will never forget [2:29:45]; Resources for people wanting to get involved in helping Tom’s work [2:34:45]; Peter tells a story that defines Tom [2:36:00]; and More. Learn more at www.PeterAttiaMD.com Connect with Peter on Facebook | Twitter | Instagram.

Hey everyone, welcome to the Peter Atia Drive. I'm your host, Peter Atia. The drive is a result of my hunger for optimizing performance, health, longevity, critical thinking, along with a few other obsessions along the way. I've spent the last several years working with some of the most successful top performing individuals in the world, and this podcast is my attempt to synthesize what I've learned along the way to help you live a higher quality, more fulfilling life. If you enjoy this podcast, you can find more information

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I want to thank you for taking a moment to listen to this. If you learn from and find value in the content I produce, please consider supporting us directly by signing up for a monthly subscription. My guess this week is Dr. Tom Ketayner. Now, I want to preface this by saying something that, you know, on the one hand is a little bit embarrassing to admit, but I think it also speaks to sort of the significance of Tom. I've been very privileged over my life to have met many quote unquote important people, people who are very rich or people who are very famous

or people who have accomplished great things athletically or otherwise. For whatever reason, I've never been nervous going into the first meeting with somebody who is quote unquote special. Not sure why, maybe just deep down kind of get that we're all kind of the same and just because one person smarter or runs faster or, you know, made more money, you know, and the end doesn't really matter that much. And we're all the same. But I got

to say I've known about Tom for about three years. We've exchanged emails in the past, but this interview was the first time I met Tom in person. And I only know how to say this just bluntly. It's the first time in my life I've ever been nervous to meet a human being, which of course is ironic when you meet Tom. And this will come across in this episode because he is quite simply the most humble human being you could ever meet. But I suppose I see in Tom what I consider to be the greatest of any qualities or characteristics of any human being. And so it humbled me and intimidated me to meet him.

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 Nuba Mountains, where he continues to take care of about three-quarters of a million people. He's the only physician in the area and there's a single hospital there that he runs with a... it's hard to describe how few resources he has to run it and I don't want to get into that because the episode will cover that in detail. But like you can only say that it is nothing short of a miracle what he and his very limited staff are able to do. His accolades are so numerous that I don't even think it's worth getting into them. I will say he is the recipient of the Aurora Prize

for Awakening Humanity. This is a prize that awards $1 million to the charities of Tom's choice. And needless to say that is about as high an honor as anybody could receive for the type of work that he does. He's been described by one Muslim man as Jesus Christ, which I think also speaks to the impact that he has had on the community that he serves. In this episode, we talk about a lot lot of things and obviously talking about kind of the unimaginable suffering that he sees and how he himself copes with death and how he himself copes with being in a situation that I don't think any of us can understand and certainly no physician can understand because

none of us really practice medicine alone and yet in many ways that's what Tom is doing. We talk about a crisis of purpose. So it's easy, I think, to look at what Tom does and feel sorry for him or feel sorry for the people he serves. But I must admit, I came away from this interview actually feeling more sorry for us. 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, and talk about the sense of community that exists in Nuba. And what you start to realize is that the way that 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 that part of the world. And it's not just on the obvious things. It's not surprising that people there don't die from complications of type 2 diabetes, but they die from infectious diseases and trauma. But there's a more subtle point here, which is we in many ways are prisoners of our own world, our own minds, our own possessions, these things. And to see the way Tom describes the freedom from that, it gives me hope that if someone like me can realign the way I think about these things that in many ways enslave me, perhaps I could even capture a fraction of the satisfaction, the happiness, the purpose that someone like

Tom has. Tom's work is so important to me, and I want to be sure that anybody listening to this can get access to all of the notes we're going to put together on this. And so normally our show notes are only available to subscribers. But for this episode, they're available to everyone. I don't want anyone to not be able to see this under any circumstance. So I really do recommend that everybody take a moment

and look at some of the videos that we link to if you don't make time for that But you are still sort of interested. I can't recommend enough that you watch the documentary the heart of Nuba Which is based on the work that Tom does there. I think you'll come away from this episode Understanding why I could feel so nervous meeting Tom for the first time and so without further delay Please enjoy my conversation with Dr. Tom Koutainer. Hey Tom, thank you so much for making the time to come over here today. It's your pleasure. 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 US? Well, this is my first time out in more than three years. So last time I was in the US 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 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, it's been back. You grew up in upstate New York. Yep. Your pedigree is like this star, right? You went to Brown, you played football, you went to Duke Medical School. Right.

At what point did you realize you wanted to do something a little different to VZV 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 meant the time, but I just had this idea. I wanted to work in other cultures, in the 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 you know, they're good jobs, but I didn't really want to do that kind of work

So I graduated college and kind of floating around for while I was offered a job by GE Working with they were kind of nuclear submarine program. We've been a really good job But I just wasn't interested in that kind of work and submarine program. It would have been a really good job, but I just wasn't interested in that kind of work. And number one day it was kind of odd. It was coming back from my great aunts funeral. I was with my brother Felix. And I, I, the 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'd like the sciences, I could stay in the sciences, do mission work, help people. Just kind of that general idea. And it ended up going to medical school, and kind of kept that desire to mission work, and that kind of evolved into wanting to work in Africa, to work with people that don't have a lot of options for healthcare, you know, 15 years later,

ended up in Sudan. So you started out in Kenya, is that right? Right, so we don't want to finish medical school, then I did five years in the US Navy, I didn't even scholarship for medical school, I did five years in the US Navy, I didn't even scholarship for medical school so I'd have to pay that time back. Then we did my residency, I did family practice in Tarot, 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 Catholic Medical Mission Board and I said, okay, we have not opening in Kenya at this mission hospital Maybe go there. It's okay. I'll go for one year. I'll see what goes if I like it Maybe I'll stay longer otherwise me. 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 residence in the United States, right? Right, do my residency in the US

and I do family practice. And the program I went to was it kind of geared towards rural health. So I thought, okay, if I want to do admission medicine, I'd be doing more than just kind of outpatient office stuff. I need to do something with a little more me to it. So, you know, a little bit of obstetrics,

we did a bit of surgery, mostly just these sections. So when I first got there, I think what struck me was just the volume of patients. I mean, it 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, you know, I mean, in this rural hospital in Kenya, and I mean, you're seeing 50, 60 patients, you know, huge numbers. The clinic, the wards are fully, you go to the ward round, I was in charge of the adult ward, and there were, you know, at the time I thought I was a huge, I mean, like 30, 40 patients there, and I was responsible for all of 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 didn't know much about. I mean, here's malaria, TB, lychemoniasis, all this kind of stuff I had no idea about. I had to learn about when I was there. Learned to thank God some, a couple more senior doctors there that I could learn from. But just a volume of patients and the variety of diseases you've had a face. So what year did you get to Kenya?

I arrived in Kenya, January 17thth 2000. That's so interesting. I arrived at NIH when I was in medical school on January 17th 2000. No way. Yeah. That was 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 southeast of Sudan, right? South of the bit east, exactly. Okay. And much more stable, right? I mean, Kenya is a relatively safe place to be, right? Sudan is not, right? It's divided into these provinces and my, 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 in 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 the, you know, it's such a lack of any kind of health services. I thought, man, I'd really like to get involved in that struggle just to go and work with the help of 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 2000, that's in 2002. Now, this was in June of 2002. I left my first posting, which was in a real place called Motomo, it was there for two and a half years. I went up to Northern Kenya, a place called Turkana. It was at the Kakama Mission Hospital, which is up in the Turkana Desert near the refugee camp. A woman named Diedra Burns. So, Didi was, I think her first time up in Turkana. And I was talking to her.

She's an American. She was in a kind of short term mission there. She's a surgeon and a family practice doctor. She didana, and I was talking to her. She's an American. She was in a short term mission there. She's a surgeon and a family practice doctor. She did both, but she was doing primarily surgery. And she said, look, there's a bishop I know. He was a bishop in that CIS, who was building a hospital in Sudan. I think he might be interested in going there. And that said, whoa, that's exactly what I've been thinking about doing for the past couple

of years. It's back to 2002. So she said, look, he's got an office in Nairobi. He's living there in exile. Maybe he 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 ended up working in Nairobi linked up with his office and We started kind of making plans for the hospital and how it runs staff He would need all that kind of stuff and then took six years but six years later who funded the hospital

It's all funded through the Catholic diocese. So as a Catholic diocese of El Abed, Bishop Gassiz was the Bishop of the El Abed diocese, and he and his office were able to get funding through the church mechanism to fund the hospital. So now it's O809, and that's when you go. Right, so I went to New Mountains, arrived there March 10th, 2008, was there, landed there in the 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, but it's pretty rugged country, isn't it? So the Mammalans is probably one of the most remote places in the world. It's a region which for many years, and Sudan was kind of kept off limits before when Sudan was kind of a colony, was under the, called the Anglo-Egyptian condominium,

partly kind of administered by UK and by Britain and by Egypt. They decided to kind of keep the new besiever. They select these people have a unique culture and are new 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 in rainy season. It's got a dry season. But more hills, they aren't real high mountains, but sort of, you know, 3000-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 giving 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 it religiously diverse? Was it mostly Muslim, mostly Christian? Yeah, you know Sudan is a very interesting place. So you've got it was one country up until 2011 when they divided the North and South. Now they will just make it 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 interestingly enough, Nuba is a mix. It's about let's say half Christian, half Muslim and everybody's an animist but half our Christian, half our 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 they there's no conflict amongst them For instance my wife is is a Nuba

Her father both her parents when they were born they were just followed the traditional legends the the Christianity in 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 pligumist so two eyes both wise a Christian They're all oldest son is 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 Christian was was really a big issue in the previous civil war You know, we had sort of the southern African people that are mostly Christian against the northern Arab people we had sort of the southern African people that were mostly Christian against the northern and 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 Mammothins, the Mammothins of the Mammoth people joined the southerners. They're all African and new, but they joined the southerners fighting the northern and sort of Arab Muslim people in the north. And in the 1990s, there was a jihad against the new people. So there was a real genocide in the 1990s against the new people. Who issued this jihad? The ideologue behind this is a guy who just died last year.

His name is Hassan Al-Torabi. And Torabi was a member of the Muslim Brotherhood. Very bright guy went to Sorbonne in Paris and was Kevin 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 fonto to allow Jihad against the Nuba.

And many imams rejected it. They say, well, you can't do that. It's, you know, the Nuba. Even though he'd be killing Muslims within Nuba. Right, exactly. His response to this was, okay, you can have a jihad because the Christians are our fair game in the jihad. And then the Muslims are apostates from the religion because they associate with

Christians. Some of them he pork, some of them drink local beer, they're not real Muslims. Like this thing with the new bar very much communal and to have Muslims and Christians together at functions, it was an 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, now 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 90s. So we've been 93. So Bashir was already in power, right? His coup was like late 80s, right?

He took power in 89. Okay. And this guy, Trabi, helped him in this coup. He was kind of the brains behind the coup. And Trabi, I mean, he was, you know, he was kind of a power hungry guy. He said, okay, he figured if he helped Bashir, getting the power, but she was a military guy. And he thought, okay, if I help Bashir, getting the 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 by share said, look, I'm the one of power. You're not taking over. So he kind of always kept Trabi at a distance. And there always these, he was always throwing Trabi in prison afterwards because Trabi started speaking out against him. So he put him in a quote-unquote prison and we'd be, you know, libling some luxury apartment in Cartoon. But they kind of wore out with each other. But Trabi was the the ideologue behind a lot of this moment. He's the one that invited Osama bin Laden to Sudan in the early 90s.

So bin Laden lived in the early. When bin Laden was exiled from Saudi Arabia, which is yeah, in the early 2000s. Right. Well, that was before then he invited, what's his name? He invited bin Laden to Cartoum. So he lived in Sudan for a while

and a lot of, you know, a kind of a lot of training camps in the desert in the north of Sudan I had totally forgotten that fact that the chapter of Valkyrie that I'd prefer gotten So you basically have a bunch of incredibly evil people who are deciding to kill their own citizens effectively, right? You got there in oh eight you said her you said it on 9. Oh, wait, so he arrived March 2008. So historically, that was the interim peace period. So since they got independence in 1956, Sudan's been a civil war.

There is parts of a bit of civil war for almost the entire history. That's, it has 60, that's how many years, 62, 63 years. Most of the history they've been a civil war. So this was one of the brief periods. Actually, it wasn't even priest that because their four started 2003. Their four-year rebels started their fighting as the government doesn't. So this wasn't, the whole country was not a piece of the time, but the big war between the South and North, the peace agreement signed 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 way 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 way the peace agreement was signed up was southern, so South Sudan would have the choice for a self-determination, and that would be done by referendum. So the people actually have a vote. Straight up vote. The majority vote to succeed, they say, the majority vote to stay and stay as one country they stay. Now, 2011, they have the vote and like 99.99 percent 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 it for our friend them. The Nuba Mountains was not included as part of South Sudan. Nuba and Blue Nile were separate regions. And they said, these two regions, they're called the two areas. They'll have what's called a popular consultation, which was a very vague system where there'd be committee set up. They would go and they would talk to the people in the villages and kind of get their opinions on things and see what they want to do.

If they want to separate stay 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 to allow the South Sudan to have this referendum It's okay, and that because they knew in the end they will keep the mommons because this thing was too vague You know, they would be able to manipulate it enough. They will keep the new one their side. So South Sudan separates know, they would be able to manipulate it enough. They will keep the new one their side. So South Sudan separates. There are elections in new mountains in 2011 and may the candidate for Bashir's party of course wins the governorship in the parliament. This is a side note. Before that election, the guy's name is Ahmed Haroon who was running against the guy named Abdul

Aziz. Anyway, Ahmed Haroon was the candidate for Bashir's party, that's one Congress party. And before the election, Bixir said Amit Haroon 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 Bixir at this point, is 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 I'm at Haroon also is indicted by the ICC for crimes. He was one of the the architects of the genocide and so I'm at Haroon who's our governor as under is indicted by the ICC by she isn't that it by the ICC. It also was the defense minister wasn't that it by the ICC. So I'm gonna her to wins. They go and say, okay, now our party is there

in South Kortafant State in the mountains. There were still SPLA soldiers like southern soldiers living in this region. The Northern Army came and said, you know, did a forest disarmament of these SPLA soldiers. And that's when violence broke out. So June 2011, June 6th 2011, Civil War breaks out in new mountains against the government. Now, I've heard you speak about this in the past. It was overnight that most most of the staff in your hospital left. So prior to that leading up to

that the referendum and that the breakout of war. You've got this three year period where you're in the hospital. You're working there as far as new but 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 and esotist, the lab person. We had those eight expatriates, they were most seen from, they're often Kenya or Uganda. Those eight ex-patriates myself and 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 in right a bit of English and could speak English. So they had to be taught everything. 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. A lot, most of that was done by these ex-pagiot nurses. Now we still kept ex-pagiotists, but over time we added more and more on the job trained people. We kept adding more primary school graduates graduates or eventually we got a few secondary

school people, started training them on the job. We didn't have any trained numer nurses, Nuba nurses by the time the worst started 2011. So now, Worcesters June 6th to 11th, by June 16th, there's 10 days into the fighting. Things are getting pretty hairy. There's a lot of fighting within Nuba, Arab bombardments all the time and the diocese. And this is all from the north. The north is. 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. Got it. So within Nuba Mountains, you've got a lot of soldiers that were southern soldiers, S.P.L.A. soldiers,

a lot of whom were Nuba. Most of them were Nuba, but you also had other southern tribes and their mommons kind of left over from the previous conflict and they were there in the barracks. So all those kind of trapped S.P.L.A. soldiers are fighting the Sudan army. Now they call themselves instead of S.P.L.A. North. Okay. So from that point forward, these guys are called S.P.L.A. North. They have kind of a new identity as a separate military force from the S.P.L.A. which is a cell Sudan. So fighting is going on, air of embarrasments. June 16th, the Diasis says, look, we're having, we're setting 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 New Memountains 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 New Memountains, mostly getting people out, but they have to change the airstrip. There were a few airstrips around, but they would give the location of the air strip the last moment, and they would have a code name for it, because if there were a lot of spies around, and if

the North found out, they would come with their bombers and come and bomb the air strip. They would try to bomb the plane on the ground, the ground, the people that were trying to get in the plane to escape. So all of a sudden, it was top secret. A plane comes in, and this look we come in, we land, and we're taking off in 10 minutes. You better be at the air strip waiting. Get your butts on the air blinning. We have to be out by 10 minutes, where all these guys will come and bomb.

And they do this at night, I'm assuming. Now they did it early in the morning, because you can't, there's no lights or anything for the planes to land. So it's all just by it by sight. So they would come in the morning, land, and they would get out. So all of our expats that were there with us, they had all the knowledge. I mean, our nested test, our lab person, pharmacist, the nurses that were warden charges.

That was our doing most of the work and do 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. You know, once this plane comes and once it leaves, you might never get out of here. You know, because you have no idea what's gonna happen the next day. You don't know if the city of Armin is gonna overrun us. 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, it was encouraged to leave by some different people. It's like, look, why don't you come out, you stay in Kenya for a while

than 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 gonna happen. What I did know is that we were getting people wounded or well, the destruction was they ever coming in all the time, you know? So I knew if I leave, And what I did know is that we were getting people wounded or bowel destruction, as I ever

coming in all the time, you know. So I knew if I leave, it's not like they can go somewhere else. They were no other hospital surgical capability, okay. There wasn't a single one. There was a small hospital nearby, ran by a German group. Like I do some inpatient stuff and outpatient and some minor stuff. But really if somebody need a C-section or something more serious, they would just die, Okay. 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, it was not a difficult decision. I think the sisters, that were there, the two Cumboni sisters, that stayed the priestess day. 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, we didn't feel like it was some big thing. It was just like, well, no, we can't go. You know, we got to be out stuff to do here. And, 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're not going to hold anything. It's anybody. This has to be a 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 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 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 X-Pats 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 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. It was one of the people that left. So talked to me about 10 o'clock on that morning the 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. At a clock, casualty 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, but... Right, so like two hours later, all these mangled bodies start coming in.

Yeah, describe what this... 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, one of my mentors said, you know, to be able to train in 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 explained to me what things you actually saw, what types of injuries are you seeing?

Right. So this was very start because when I turnna of 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, Megan Nuba. So imagine a scrap of metal weighs 10 pounds, red hot, just going through your body. So it slices off legs, slices of arms, cuts through people with just massive tissue loss and massive trauma. So I'm here, 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 blown off by the Antonov Shrapnel. So these guys, both the interpretations, the girl, we did a dysorteculation on the shoulders.

So we had a couple of our, on the job train nurses there, and they had done some, they've been taught how to do spinal anesthetic by the anesthetist. So they've been told they couldn't do GA. For the listener, GA general anesthetics, 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 and intubate goats put the patient fully to sleep. Right. 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 I remember. I never done it either. It's like, what the heck? So I was so afraid. I'm like, what am I doing 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 protocol. It's okay. First, give some ketamine. You knock them out with that. They go to sleep. Give it a little batch of pain. You give a succinylcholine, to paralyzum,

intubate, and you give panchironium. We have a hellethane esthesia, put the two veins in the body, decide intubate. Like, okay, okay, 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 the child. It's okay, give the ketamine, you would push it in, push the sexual colon out into bait. 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 gonna 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 get the tube in, you hook it up to the ventilator, you think everything's going well. And by the time you realize you're providing oxygen to their stomach instead of their lungs, it can be too late. And then of course, the panic that ensues is often what kills the patient, right? Because you're getting nervous and then you can't do it.

You're starting to shake. You know, the problem is my, as I said before, my training was family practice. I did an internal medicine internship, you know, they had family practice. I never intimidated somebody. I never did an 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 get the patient, integrated connected to the help we have a really primitive structure

called an OMV, Oxford miniature ventilator. It's got a set of bellows. It's like turn of this injury kind of stuff, turn of the 20th century. So, you know, intubating, so we have to, you have to manual ventilation for the patient. We're throughout the whole surgery. Yeah, for the whole surgery. As long as I paralyzed, you've got to ventilate manually. Usually, with the hella thing, after you manually ventilate for about 20 minutes, they can breathe in their own. And it's a bit of an arc to try to keep them under enough, where they can breathe in their own, but they're not in pain.

So it's a big arc 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. Right.

And if you told me to walk into mass general or NYU or pick your favorite hospital and said, Peter, we're gonna do everything for you. We're gonna intubate the patient. We're gonna do this. All you have to do is be the guy that manually ventilates them. I wouldn't be able to do that. Like I would overdo it or underdo it. There's no way you'd hit that sweet spot. You'd cause an alkylosis acid, and then to be able to not have the laboratory tools

to know when you're off the rails. In those days, we didn't have a pulse ox. Now we have a pulse ox, similar to which you can measure the percylogs. Oxygen saturation. Oxygen saturation. That's a lot. That's how we know 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 managers got the guy into it. I mean, you couldn't do veterinary medicine like this in the United States.

Right. Yeah. Yeah, it was pretty hairy. We managed to get through and this one, eventually we got an anesthetist to come. This was after about a month or two. And in that month or two, what types of casualties did you see? Oh, I mean, everything.

Abdominal trauma, lots of lectrum. We did a number of general anesthetics during that time. We had a baby that came in with interception. This was the worst case. This was a nimonthole baby who came in and had an interception, which is kind of an intestinal obstruction. Yeah, I explained what that looks like, the telescope being part of it. Right. So interception is when the intestine and telescopes on itself, and basically it causes a blockage

of the intestine, and then when the longer you delay, that intestine can die, and the person will die, the baby will die from infection. And we made the diagnosis that I'm just like, oh God, you know, we supposed to do with this kid. Anyway, we take the baby to the upper room and say, we got to try something. So I'm intubating an adult, his heart, baby is really, really hard. And we managed to get the kid intubated. So I didn't pay the baby, started on the ventilated bowel thing. When I 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'd be great.

He's, how old is the baby now? He's, like, 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. And when he's in bits of shrapnel are going through people. I mean, you're seeing liver lacerations, you're seeing ball injuries, hemonymothoruses, 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, well, I think what happens sometimes people say, why do you have so many extremity traumas? Because there's the ones that make it in. That one's survived. Yeah.

So, you know, the ones that get a really terrible trauma of 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 and some of them pull through You know anemic dehydrated they have an eaten in several days and these guys can survive So some of 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'm here one guy had I'm a liver trauma. I'm a one guy who had, we counted,

he had 23 holes in his intestines that we had a, you know, persect here, respect there, stitch this one, just look forever. How did you learn surgery? Right, so yeah, I trained in family practice and when I went to Kenya, we're doing a lot of, you know,

tons of tropical medicine, a lot of obstetrical care, 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 courses tropical medicine, like you do all those things and say, well, a good, similar half of what we were seeing was surgically related, either just wound care,

miscarriages, laparotomy, imputations, kind of the, one of the milk kind of surgical stuff, there's a lot of it. So I thought I really need to learn how to do this stuff. I'm gonna 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 There was no way I had a whole day in the operating room

And we would do tons of cases and there was an American missionary doctor there and they might Johnson So like we just sit there and teach me stuff You know, I would do it just like you 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 a little bit of experience. We start the case. They have a problems call me So I'd start open up, look around a bit. So, okay, I'm stuck on my new week. Come in, look around. I'll do

this to that. I'll do this and that and things will go ahead. Before you know what, you're doing thyroid and laparotomy and reciting bowel and stitching liver and taking kidneys out and doing imputations. I mean, you know what, 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, 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 our, 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 remember once causing a hemonymothorax 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 what I was in Kenya, I think those whole seven-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 go, well, I'm my own 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 look a thousand cases,

it's supposed like a thousand cases at least, like that's like a minimum, maybe 1200 or something. Yeah. So I did, you know, but time I finished my time in Kenya, I've done it. 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, I mean, you're still doing basically orthopedic

surgery as well. And obstetrics. And obstetrics. Yes. 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 divinci, you know, all that and all this high tech stuff. You trade off kind of depth of surgery for breadth. I felt after doing around 2000 C-sections and over a thousand 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 laparotomy because you don't have a diagnosis. You don't have a CT scanner. Right, no CT scanner. You don't 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 exactly what's going on. To get a tissue diagnosis might take you six months. So you say, go, hey, let's do lap, or how do I mean to 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, the premium known known chair 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 gonna to do it. You know, I won't do it. I think I really cannot improve this patient's health. I think, okay, this is too much of a risk. Sometimes it looks, 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 this operation, I think we can be patient and improve and we'll go ahead and it works, I mean, it only 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. You know, we all watched the heart of New but together. And 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, you know, they're going to walk home. How do you deal with that? And more importantly, I guess, then 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 was still a foreigner and it will always be one so I would say we first started 10 years ago people did not trust us and

It was incredibly nerve-wracking something we just got here People to 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, is there a help them? So you've got to prove yourself. It's something, you know, it comes with these operations. What if we have bad outcomes? You know, what happens?

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, you know, we try to just talk to the family, talk to the patients, they look, we think we can't do much for you. And if you go home, we'll take care of the pain or the things we can do. One good thing there is the people, the expectations are extremely are low. And I must say that negative, I'm saying 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 saying, they're not like demanding, saying, no, you've got to forget something in Nairobi for a second opinion. They're very accepting. I think that's just because

of 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, just, you know, they don't like telling the patient, which is very different from here in the US. So we just talk with relatives, and they're usually very accepting. They say, okay, we see you've done what you can, well, then we'll take them home, and we come 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 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, yeah, that's what happens people die You know and people have bad outcomes bad things happen to you So it's not so unusual for them

You know 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 you know have this kind of outlook on life It's it's a very different way of doing things So they're fairly easy in that respect they understand this stuff You know most people have some level of faith with a Christian 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. 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. 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 they're scope of medicine. You have kind of the local level in the home and what they'll do is almost any ephaberal 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, just put in the fire and they burn on the back of the wrist, the 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 or the spirit of evil humors that are causing the problem.

And when they see that kind of smoke and they see the fat and they do 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 in their arms when they have them in, where they think that'll also release things, they cut down to have cause of blood loss, that'll relieve some of the problem. And that's what you've 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 practice less so than when we came, I would say. I mean, everybody, all of our staff have burn marks when they were kids. Now, we still see patients come with the burn marks. When it comes with a simple malaria,

they've been at home four days, they've been roasting the kids. 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 thing works for that. A lot of kind of local fruits and vegetables they use for GI problems are the things. Those seem to work okay. The third level is what's called the Kujur, Kujur is like a Kankakashaman.

The Kujur is like the priest for the village. The traditional legend there is 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 kujur, you have a little ceremony with the family, I'll get together. Kujur will talk with your ancestors and then kind of give you a report back saying, well, your kid is sick because your goats wandered on this guy's land and ate his crops. So you need to make up with this guy, you're gonna go and give him something and then you pay the cajur or something and then this thing

is kind of lifted. Child should get better. Those three things were kind of traditional treatment. The cajur is still very very prevalent in this society and they still often go to the cajur and they still will often delay treatment when they go to the cajure. So how many people does your hospital serve? Catchment area is roughly a million, anywhere from 70,000 to a million people. Is it in our catchment area? And the physical region is around the size of Austria, somewhere in that 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've asked 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 give an example my mother-in-law is probably in her 70s So we went to talk to my wife 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 on about her life. My wife didn't actually know a lot of facts about her mother because 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 wean 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 her mother only space 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 you know where Tom is from and she said she thought from it She says he's from Kenya And she said that for thought from it, she says, he's from Kenya. And she said that for this place, she can imagine. Right, because she's heard of Kenya. So in her mind, anybody who's not from Newham mountains must be from Kenya. It doesn't matter who you are. You know, so that's the outside world. And we say, well, now he's from America. Have you ever heard of America? No, she never heard of it. Had no concept of America. If you're 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 is just a few of the villages there. She's been in cartoon one. She's My wife's mother has leprosy. We've treated her for leprosy and they've been potatoed. I think all of her fingers at one point or She's really quite disabled. She got on the cartoon some years previously to get treatment there and not getting treated. But besides that brief trip to cartoon, she'd never been out of that local area. A lot of my wife's siblings have never been out of this 15-square mile radius.

You can't imagine the world view. 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 the first time given especially that you don't travel much? Right, so the first time we traveled was after we married was just this past June We went to Armenia. So that was really her first time out of rural Africa She been to you on nursing school, but that't South Sudan, and 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, we went from either of G 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.

And I mean, 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 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've tried to give she'd never seen a tap. No, we had taps in the hospital. We have a pump that pumps water up. We have some taps in the hospital.

But, you know, flush toilets were, she never seen before but 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, pressure button, this door opens, we get this thing in the press of 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, how's this thing moving? I think when she was in nursing school and, wow, I think they had one set of stairs. There might have 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 Irván is a capital Armenia, not like New York, but very different experience for her. Now she came to the US for the first time just this past October and I mean she wasn't Times Square. I mean saw the ocean for the first time. She went to my brother lives in near Boston and North Shore Boston. So that was the first place she went to. So first place she went to Boston and our hospital was getting an award by a group called Medicines for Humanity which supports us and they were given some work for the work that our outreach team is doing. So nobody can make it.

I couldn't go. My 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 was a very opulent place. Right. It was my brother's place.

He's up in Rockport, Massachusetts. He's the ocean for the first time. He's a train for the first time. Goes to malls, to Walmart. She loved the dollar store. And 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 hard. 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 was her first time even. I should have known what Sudan was. And this was very interesting because we had already watched the heart of Nuba,

which was her first time even, I should have 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 presence 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 how much 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, I don't even know whose kid this is basically. And, and we couldn't stop talking about that, right? Which was talk about a different sense of community, 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, like 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 types of the Peter something. You always hear about the negative side of place like so that people think of sitting over the images or of place like Sudan. People think of Sudan, what are the images? War, poverty, disease, starving kids. The positive side is not shown. And something that 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. And the society there, you can stop in somebody's hut. And kind of knock on the whatever or just show up and say, look, I'm going, you know, I've got a long journey. Would you want to buy a kind of spend the night with you in a rest day? So that family would take this person in total stranger, give him place to sleep, give him food, get some water for them to wash, take care of that night. The next day he'll continue on as journey. Next day, stop 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 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 realized 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. I think I would never want to give up my family. I would never want to give up my comfort, my

safety, my whatever. You couldn't fake it. I mean, so it's obviously so genuine for you and any, 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, some of it Peter, I think, is just I think everybody is kind of geared a bit differently.

So we grew up in a big family and 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, but differently even people in the same family. So, I think, I'm very comfortable there, but I couldn't maybe fit working in the York, you know. But I think the good thing is, I don't attach a value to all of this, because everybody has something to contribute. I really believe that.

It's not just kind of blowing smoke. My thing is being able to amount. You know, it's part of the puzzle. Somebody else might be in New York, but you're doing a podcast. You're helping us in New York tremendously by helping get the message out. If you're in Sudan doing the same work I'm doing, we don't have this, you know? 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 must have 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 for 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 man. I've spent more than three years that come here. 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 any of 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 Christoff 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 Christophe 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 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, at 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. Right. 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 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 tombs out there whose stories are not being told. So how did Christa 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 Bashi was doing as such an egregious affront to humanity that he felt obligated to go and see firsthand was happening. So he made a couple of trips into the mountains. You can fly into Juba, then you got to fly up to the refugee camp in Ida,

then manage to come into the mountains. You know, you don't come in with official permission to the Sudan government. So you're sneaking into, right? He's 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, in that part of the world and, and really wanted to do something that shed light in the situation there against Bashir.

And he'd been it to Nuba, I think, one previous time. And I heard about the hospital when they 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. He's a really intrepid traveler and incredible journalist. I mean, he's unbelievable. And what I respect about him the most 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.

It 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.

Right. So the world's a better place. Certainly the newba mountains are a better place because of Nicholas's work. Right, and he tends to highlight people that are kind of not not well known. And there are others that are out there. And it's actually part of what we're trying to now with Aurora. Aurora's focus is on 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 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, it began in 2015 or 2016, and it will run till 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 onward. The genocide went on for about eight years, right?

Okay. 1915 and 1923. So this is a hundred years henceforth. Those eight years, those eight years that were or prize will be given out. Yes. And it's a substantial prize. You were selected. And my understanding is, first of all, it takes an active 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. What I saw was I'm very comfortable being a newbie 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 Aura as a vehicle, it was time to come out to kind of see what was out there with Aura to try to expand the model that we have in the mountains. 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 pigeon-holed. How do we expand that and get outside of Nuba? Get into South Sudan to Central from public to Chad to Newshier 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 the 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 trying to formulate which direction we need to go in Aurora. So we physically out for these three months, there'll be three months later in the year from September through November. Besides those two, three months periods, I'll be back into a month's, 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 is 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 it was a million dollars, we can see about 130,000 outpatients. 130,000 outpatients do close to 2,000 operations, see maybe 5,000, 6,000 inpatients, I mean vaccinate tens of thousands of children. See, I don't know, I'm not sure what numbers of maternity and tino-clinic patients, but a lot, several thousand maternity patients for that. A lot of that million dollars. I mean, most of that, gosh, I think it's, I mean, the number that comes that I use is about seven and fifty thousand, but somewhere between seven and fifty thousand 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, expand quite a bit of what we're already doing. That'd

be very, 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 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 in 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 the role of gau. 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 ship and a drug came from Nairobi by a truck up to actually through Uganda, up to the border with South Sudan, where they

just harassed the heck out of the drivers and all kinds of things. You have to bribe the guards. You've got to bribe the guards and they give you a hard time and they don't want you going through and they say, no, they're always changing the rules. See, I know there's a duty, you've got to have all this paperwork. I mean, just reams a paperwork to get this stuff through. So we've got some people that are in Cuba

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.

You can take three weeks to get up to this refugee camp in Ida. Then from there, it's all floated. We've got to go and pick it up. We've got to find a way to get it from ETA up to our place. 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 up, carry it for us. And that's about six hours. It's not really a road. It's a dirt track. I mean, there are roads there. There's these terrible dirt tracks. You get from ETA up to where we are. That's about six hours. It's not really a road. It's a dirt track. I mean, there are roads there. There's these terrible dirt tracks you get from heat up to where we are. That's about six hours in 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, 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 heavy rainfall, if a flash flooding, the dry river beds fells up with water, you gotta wait.

Maybe it's the way to 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, 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 the problem comes because sometimes you order stuff from 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. It doesn't really hard.

If you can't load everything on that truck for this one go, we're a bit stuck. And you've got to really be creative trying to get these other small 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 bottleneck, right? It's a terrible job. So John Fielder through F commission healthcare has a woman who's, and he's gotten off a small office and I wroterobi, 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 a lot of items, a lot. So she just go out and source all this stuff and get it in Nairobi a few different vendors get the trucks or less stuff, get it through. We've got a couple of people in jubo that help us with logistics and not employees of ours, but they're just kind of they're helping us us out just kind of random people and they can help shepherd that stuff through but 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 new but 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, they're maybe as it's fixated, maybe it's born and dies. There is a stillborn or dies soon after birth. And there are very few deliveries done. I mean, 99% of women there still live at home. The deliver in a clinic with maybe a triathlon birth attendant is rare, let alone in a hospital. So I think a lot of it is just due to, most of those people probably would end up in a

CSI section if they were at a hospital in the US or even in Kenya. If it access to care or they would end up in the CSI section, we have one place to in C-sections or actually two now. How many babies do you deliver in a typical year? I think there are maybe three or four hundred in our hospital. Somewhere on there. I became with the exact number. So it's really it's not, it's a very small number compared to a 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, 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 get stuck, they get fixated, and baby dies. So, I mean, we do our antenatal clinic, 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. 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. 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 what's on your head? This woman died from, she blooded death, you know, after you've been birthed 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 end up doing C-sections on that would have died without that. You know, you know, how many times a baby is stuck, well, it's already septic, and you know, we have to do C-section or something. And this has nothing if preeclampsia and all of the other things that would just show up even under the most normal, you know, circumstance. Right. And getting one with the clampy is not uncommon. So if you get a clampy at home, especially young, you know, 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. 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, the partial nephrectomy as you're doing on kids with tumors in their kidneys. How did you even learn to do that operation? Even within the realm of surgery, that's not a trivial operation to do on a child that size. Yeah, I'd done some of the fractures before. I told the fractures on for tumors or for trauma or for whatever.

So I'm meeting, removed the whole kidney. I mean, 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. 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 you know, the kidney completed that.

So if it was just say the 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 a lower pool of the kidney. So I had to take out half the kidney. So there's a visiting, actually a visiting as a friend of my was who was visiting. He's a family practice doctor, Cory Chapman was there and we're talking with this case and going back and forth. And he said, let's look on YouTube if there's something because I read, I read, 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 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 with a speed is very, very slow. So don't worry 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 because it's just too slow. But for some reason, we're able to see this video. And it was this group of Polish surgeons that were doing the partial infrectorate, and with a fairly low tech approach. So we watched that. So okay, I think I can do it following with these guys are advising. We kind of followed their system managed to put these sort of buttresses on the lower pole, the kidney, the kind of starched bleeding, and it worked. And the child did very well. That was held by YouTube. I think they really helped us out in that case. Like the Khan Academy of Surgery. How long do you just spend rounding? I mean, how many inpatient beds do you have in this hospital? It has 435 beds. And what's your typical capacity? I mean, your typical

utilization, how many patients are in there? I mean, it's about 100% occupancy. It's a bit less now than it was saying the peak of the fighting. The peak of the fighting, it was crazy. Be 500 people there, 550. So over, you know, several children were, several to a bed. We had wounded all over the place. I mean, not even in bed, just wherever we could fit them. It looks like when you see movies in war zones, and you see the tents that are serving as hospitals, and you just see amputation, nose completely missing, the 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.

Right. I'm thinking back to residency. 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 around on 24 patients. Yeah. So you're rounding on 300 patients.

I mean, how, how do you know how you do that? And now probably through and to those days 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 is both instructions. You don't have vaccines, I'm guessing, is that the reason they can't all get the measles? We, with the first three years of the fighting,

we didn't have them. So the usual provider stop providing them, the usual big organization that provides them, stop providing the vaccines. Why? Just logistically couldn't get them in. Logistically, and they, we were in rebel held territory, and a lot of these people, like, big organizations,

don't want to violate the sovereignty of the host government by providing as 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 yummy runs would just, they would take hours and we started 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 not 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 miscarriage bleeding, we have to break into a C-section on somebody who can't deliver. All this stuff was still going on. It was pretty crazy. I mean, it really had to just go as fast as you could. It was a lot of just putting out fire. We weren't able to spend a lot of time with these patient, obviously. It was really, I had to go pretty rapid fire through all those cases. It was exhausting. Sleika, logically, it was rough.

One of the other questions my daughter wanted me to ask you is, it was, 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, 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. 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, or we were at church and the church was just outdoors. It's not really a church, it's kind of outdoors thing. And we were finishing up and the couticus was up there talking to people and we heard They are playing overhead We were used to it because every day their plane came overhead

But we've never been or immediate vicinity never been and they've been bombed So we just got our brains overheads 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? There's 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 bombing. This was a couple years into it.

We had them in bomb directly. There weren't commercial flights. So anytime we heard an airplane it was going to bomb somewhere. And then we hear the airplane then invariably a few hours later when they would show up. They bombed somewhere and people were wounded

when they show up. This day it was a bit different. We heard the opponent overhead and the mask was over and kind of standing there. Also, and somebody says, everybody get down. So we just dive in the ground. There was lying flat and I heard their airplane drone overhead in the Santa Nostalgia. Then I heard the pitch change. It was high pitched like a worrying 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 in it, but it was so loud. And it circled again. And then I realized that what that worrying 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 it's happened six and bomb six times. It kept hearing this thing, comes around again, bombs. And you're lying there, terrified thinking, you just feel like you want to burrow yourself into the ground and disappear. You know, just lying flat exposed, thinking what happens? And the thinking is not even so much being killed, but what if my leg is blown off,

or my arm gets blown off, you have no control over this. You're totally at the mercy of these people. And you feel like you're just a hunted animal. That's what I felt like. I felt like 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 bomb start coming in, you guys have to jump into these foxholes. Right. Right. Then at other time, we were bombed. Those in the hospital and just down on the on the floor of the hospital, you know, 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 worrying sound. And we hear that worrying sound. You don't know if that's going to fall on top of you. If it's going to fall at 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 happening in Syria, people living

in these cities, I mean, you can imagine what that is like in the kids that are in that situation. That's something never, never I'll grow 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 not that I've ever been hunted or I'm an animal, but you just feel like 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. Sukhoi 24 is a supersonic jet bomber, bombing villages, you know, huts. And thinking, what are these people doing? I'm rethinking to these guys and say, 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 when they made a mistake. And of course, they knew exactly there are people down there. That's what they're bombing, you know? But I really hope someday I will meet these pilots.

Not that I really don't feel any animosity towards them. They're feeling it's never 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?

You know, what they tell you before you did your mission? You know, I was a flight surgeon in the Navy. So I know you have a briefing before the pilots fly out. They discussed the mission to everyone to fly here. We're in a bomb this target. This is our objective. What were you told in the briefing room? And they say, okay, today guys are going to buy my hospital.

There are a bunch of civilians there. I mean, presumably if you're if you're trying to put your psychology hat on, you have to believe that they are being told that the people that they are bombing are somehow a threat to them or their sovereignty and supporting rebel. 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's bombed, one of our staff heard a radio broadcast from elevators, which is a city in the North. And the way they portrayed it on this radio was they admitted they bombed the hospital. They said we bombed an American church hospital in Kauha, which is the kind of capital,

the rebel held territory, hospital taken care of the rebel soldiers. That's how it's portrayed. So your American hospital and America, of course, is a great enemy. It's a Christian hospital. Therefore, they're no good. And it's taking care of rebels. Take care of rebels. So you're, you're justified in this, in this act. And my guess to me, that's what these guys were fed. Who knows if the pilots were true believers? I know worked with a lot of pilots in the US military and they would not go along with the mission that they said you're going to the Bama Hospital with civilians. They wouldn't do it.

They would say, look man, we're not doing this. I know these guys, they loved the fly and they loved the country, but they were not interested in killing civilians. And I still hope someday I can meet these guys and just have a talk with them. And just to know what they were thinking, and what went on in their brains, like whether they know this, how do they feel about it?

I'm just interested in 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, you know, when you describe a day in your life, you know, getting up at 5.30 in the morning, making rounds at 7. 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. Despite my medical

training, I would, I mean, I could training, I could put IVs in patients. 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, even thinking back to my training where, 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, is 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 in the head. I think probably the emotional trauma and upset is probably worse in 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 you're being 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 patients and not having a psychological rest. I can't refer these people somewhere. There are other colleagues we can talk to or get a device on or have somebody else see these patients. It is very draining. I don't know, I just, 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 new people. You say, well, okay, if they can put up 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. And they've been in this for their whole lives. And they're not given 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 I can. So I'm tired already. I get feeling spending, kind of see the first view. And then you before you know what you're finished with the children's ward, taking the breast, 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. That was one o'clock, 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? Maybe 40, 50. Again, I don't even know what that means. How many patients would you see in clinic typically? Maybe 40, 50. Again, I don't even know what that means. 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? What's the extent to your diagnostic toolkit? So until recently, you had nothing. I mean, now you have an ultrasound. We've had the ultrasound from the beginning. Okay, so we've had it the whole time That's been hugely helpful. You don't have an x-ray machine x-ray we do now Okay, and we just got that about a year ago So you can do a chest x-ray at least if you want some assistance with this this person I've pneumonia or a new

Methorax or something like that so prior to your go we didn't have the x-ray now we do it's 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. We'll get into the machine, work it for a while, then it just stops working.

We can't do a CBC. Chemistry tests, we can sometimes do a creatinine, but then the machine breaks. And you know, you can't do a creatinine. Sometimes you can do ALT, ST, machine breaks, can't do anything. But with 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 brought in with next year's supplies? Would that make life easier for the care you guys provide? It would help. And, you know, like there's a, just saw this chemistry analyzer was 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 hard to 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 guys in the lab can do the other tests, but the machines are just very sorry. It's less about the human. It's more about the, you need a robust machine,

a very robust machine. So this is kind of a thing. And that's about 14 grand. If we have one of those and some of the discs which have the reagents, time embedded in them. So if you had a year's supply of test strips or reagents, discs, and then the machine, you could do a CBC and a Chem 7 or a metabolic panel of some sort. That would definitely help. We're pretty limited. We can do a peripheral blood film, so take a blood, you know, guys can do the film, we

can look at that. So you're a pathologist now too. Yeah, and a very hematologist. I'm terrible at it, but I can pick up like a chronic leukemia, chronic myelogis, chronic macidic 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 in. 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 end hospital they could get decent care, but they just can't do it. So what do you, can you treat with chemotherapy a child? Not with leukemia. If a child is leukemia, we often will give steroids to try to, you know, target them a bit. Yeah, for leukemias. For chronic leukemias, these are again, usually adults.

If it's a chronic liver cycle, leukemia, it will treat them with cyclophosphamide. We don't have tablets, we'll get periodic injections, and that can kind of waddle them a bit. CML, chronic malicycle leukemia, we don't have treatment for, I would like to have at least some hydroxy urea, which is kind of an older drug for it. You know this drug, Gleeback. Yeah, it's about to say Gleeback 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 Gleeback, I was so excited, like a month or two ago, and reading the Gleeback is now in generic. Mm-hmm. Oh my God. Maybe we can buy Gleeback, because we get a few a year. We don't get a huge number of CML patients. We get a few. I think

a man, we wouldn't need a huge amount, you know. So, to look it up and it is okay, Gleeback is going on generic. So the price went from 8,, okay, Glebach's going on a generic. So the price went from 8,000 a month to 7,000 a month. Yeah, this is another one of these ridiculous systems, you know, 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. You know, there are a lot of things that are just beyond our scope of being on the pay

for it. That's something that to me is, it's really difficult to consider. I mean, if 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? 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 were faced with that decision every single day. 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 100 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 just one example of money. 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 got a bunch of kids. I got to talk to her in clinic and try to figure something out with her. She walks, I don't know how long she helped her, she walks to reach us. I mean, it's absolutely agonizing. I cannot send her

anywhere. It's just as totally impossible. I just can't do it. So if we had, we wouldn't need mountains of Gleevec. I mean, a small amount would be enough to at least get her through a year. There are a 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. I'll tell you the story. Logistically, would it even be possible for someone to provide one year's worth of Gleeve Act 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 specific or project-based funding to your mission?

If they could get the drug, certainly had access to the physical drug here in the US. Maybe if they sent it to say a 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 on a media the time before last, we met some guys and they were supposed to do some glue back program that you can register. Like the patient can register and they can get drugs

at either low cost or low cost. So I went through all this thing, kind of the person, she said, okay, all you have to do is have thought these forms have the patient go to cartoon, get the drugs. That's absolutely impossible. We can't get the cartoon.

That's on the other side of the enemy lines. And you just can't reach there. So it gets back to your point of providing the money is half the battle, but logistics of actually getting it in there. And I mean, just spitballing, you can't have these things air drop to air lifted in because the enemy fighters will obliterate anything that's trying to get 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, City where it will 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 like I'm an individual or even a small organization that's trying to apply to one of these big organizations, they just get through that application process to get funds and into account for it and do monitoring evaluation and follow up. It's a very daunting task.

You need people who are training 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 to be administrative staff to apply for the funds and follow up and accountability and accounting and all that kind of stuff.

Right, and you've, I mean, you've got tons of extra time, I'm sure, to do that, right? Right, just can't, I just can't do it. I just can't do it unless it can be made fairly simple. Or someone's okay, I got the drug. I'll send it to Catholic Medical Mission Board and then the Catholic Medical Mission Board will send it down and we get the drug. At least as far as Juba, then we can try to figure out a way to get it out. 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 the sort of the young life, 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 lot of cirrhosis, liver cancers, and that's... There's a huge appetite, that's fat. That's a huge appetite.

We do, we screen all of our pregnant women for hep B. Do you guys have a hep B vaccination program? We do. The reason we start screening the pregnant women is just to get an idea about the basic rate, and it's about close to 20%. Theatitis B positive, just in general populations, are people who are not sick. They're pregnant with children. So what we're doing is, I mean, 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 preventing this baby from giving Hepatitis B as a good older, and prevent all the complications from that. We'd haven't really scaled up to the point where we have so many heavy 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, right? Because the majority of these birds are outside of your hospital. Right. Exactly. I mean, eventually we like to have kind of been wise to these places and have the testing capability to test all these people for hepatitis B. Or if people delivered in these clinics, you look, we can't do the testing,

but we just give the vaccine. We'll assume the kid has hepatitis B, you get the vaccine, because they have to get have B anyway as part of the Pentavalent series. So after that first shot, we continue with Pentaellan, which is D.P.T. Dipper Ptosus Tetanus, Hepatus B and M.H.O.V.L.S. Influenza B. I've heard that kids actually can get diptheria in Africa. Yeah. Has there been a case of diptheria in the United States since the 40s? No, I think that I think that- I don't even know what diptheria is. I mean like I sound stupid to say that, but I

remember learning about it in medical school and I know we all get the vaccine for it. What is the disease? What is, how does it manifest? We've only had, from what I remember, one case, and I think she had the Pythias, it was in an adult, but it's cornea-backed here in the Therii, 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, I just think it's thick and they can't lay swallow,

they can't lay 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?

Exactly. It's a lecopacterium lepros Exactly. It's like a bacterium lepride. It's a micro bacterium 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 our wives' tale? Yeah.

It's really transmitted by respiratory droplets and it should be prolonged close contact. So somewhat, somewhat tedious. It's not a real, it's a very slow growing organism, but prolonged close contact. So somewhat similar to TB, it's not a real, it's a very slow-growing organism, but prolonged close contact, respiratory droplets, you can affect it and it affects the nerves and the skin. And with 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, 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, and I think a lot of it was that people themselves would kind of withdraw due to shame and due to the fear of I was 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 to look come and eat with us.

It's okay, but she will not come and eat with other people. She always insists to kind of eat by herself. She does it herself. She's kind of a self-isolation from society. She's pulled herself out. So she'll talk to you and chat and interact with you. But then with eating you 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%. Maybe point something, maybe point 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. Now, prostitution is not really part of that society. Ivey drug use is unheard of. It's all through, like with most of Africa's through heterosexual transmission.

And I think just the, it's starting to get a little bit of a toe hold 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 race can a skyrocket. That's what happened in South Sudan. The night is is there because we have a lot of STDs. Gallery is a very common syphilis.

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 stuff. I don't know. I don't think we see it. What I see as syphilis is we have, we do video oral test and we have a lot of video positives, which are not, you know, we do a VDRL test and we have a lot of VDRL positives, which are not, you know, it's 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. We don't see the shankers or the secondary syphilis. That's really, really rare, but the VDRL 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 may be in their 60s, 70s, that's an heart failure. And it's like bacterial, or I remember there was some bacteria like shagas, something or other that, when we get a heart muscle, is it that type of a heart failure?

Yeah, no, we don't have shagas disease in our area. It's just old age. But do you think it's atherosclerotic in origin? I don't think so. I've heard of anybody that could say, I think this person had an MI. I did not a single one in 10-1,000 years. Some is hypertension, just kind of untreated hypertension, and we'll let people come in with a pressure of 250 over 180.

Really? How prevalent is obesity overweight type 2 diabetes? Obesity about 0.001 percent, almost not 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. So let me see, older people come in and just new diagnosis of diabetes.

Maybe someone is 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? And no, no, I think, no, never. I can't remember a single case when I've seen fat deliver. What kind of cancers, I think, no, never. I can't remember a single case when I've seen fat deliver. What kind of cancers, I mean, you do so much cancer surgery, especially in children, but there are cancers we don't see that much here.

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, or 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, or Burkis 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 laryaholoendemic regions. So we're in that it's called a brachid zone, and that's a great cancer because it's curable with just like a phosphamide. Sixth course is like a phosphamide, and you cure a cancer. It's great for his satisfying, but it's rare to have a cancer in cure, obviously. For adults, liver cancer is probably probably most common, and that's, I think, a lot of cellular carcinoma, carcinoma, and probably all related to hepatitis B liver cancer is probably probably most common and that's I'll think I'll have a Patocelular carcinoma, Pococelular carcinoma, and probably all related to hepatitis V positivity.

They drink a fair bit, there's a local beer that make them sorghum, but the alcohol content is not very very high, it's fully weak. So it'll have to be related cancer will liver. We have a fair bit of cancer to the cervix. So for females, probably cancer to the cervix is the most common. And can you screen for HPV? Are you the local gynecologist as well? Right. Can you do a pap smear? No.

Pap smear would be a little bit impractical because we have to do the swab and get that sent off and do it high level. You don't get it off to a pathologist. Is there any, 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. One would be this Gardasil, the HPV vaccine, or made available, either 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, 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, you know, 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 in one big push. That would make a huge difference. So start with that. The treat cancer of the cervix treat earlier versions. They call it a sea and treat technique. I've not done it, but it's not, I prefer to start with a YouTube video on it. The problem is I think,

I think there is actually, you paint the cervix with something. I can't even decide on it or some substance. And you look for irregularities in the cervix. And then you freeze it. You have the little nicotine nitrogen cylinder with some probes, put that in the cervix, and you freeze it, make a nice ball of the cervix, then you kill those pre-cancerous cells, and hopefully those people will not go on to develop invasive cancer of the cervix. You would need some personnel for that, because that would be pretty labor intensive, because that's more of a preventive medicine thing. We would come in and examine them, because you're not treating people with the cancers. You're going to get the pre-cancerous lesions.

You get the screening. I'm going to do a lot of these screening things. We paint the cervix with some substance. Look and see it. You don't even need a culposcope. 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 cavity in between thing before Garda's cell becomes available.

At least we do a screening of young women, chit-the-servics, see what it looks like when you paint this stuff and then treat it with liquid nitrogen. We don't have the equipment. I think 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 so we can feel a lump. No one's getting a mammogram. Right. No mammograms or we don't do other stuff to diagnose the MRIs where we have. So we may 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 nose and things that look. So, in that situation you still do modified radical mastectomies? We do.

We usually modify radical mastectomy and then follow with Adrian Myson, Psychophosphychema, 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 get 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 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, super 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 don't need you wouldn't even need a radiologist at some point You know 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 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 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's 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 this, I don't even know how much

an extra machine would cost. This one costs 33,000, which of course, in the United States, that's the cost of like getting your gall bladder removed. I mean, literally, that's the cost of a colonist's tech to me. Yeah, so it was something for us, was a big expense, but we do it quite a few x-rays now, or operating, the guys actually taking the,

or x-ray texts are the operating room guys. But the guys in the operating room, my lab, my assistant's in operating room, are the ones we taught how to take x-rays now are operating. The guys actually taking the X-ray, techs are the operating room guys. But the guys in operating room got my lab, my assistant's in 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 we could use. It was very small, lightweight, simple,

where we 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? Is digital? So it's a tiny little device mounted on this little thing. And I actually select 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 is operates by Bluetooth between 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 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 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. Now it gets all a fixed cost that you've covered and now you can, the more you use it, the better. You're getting more read. absolutely. And the power is also the other thing was the power needed because we're on, 100% on solar. We've got a backup generator. It's 12.5 kilowatts. How long does 12.5 kilowatts last the hospital if the panels were to go out? We could run things on it. The problem with the rate limit factor there is the fuel. Right now I think we left with maybe- Oh, so if you have enough fuel for the generator, you could run indefinitely off it if you

needed to. Yeah, but we have to give probably big breaks of time. It's a fairly concise thing. And the hospital is the only thing that has electricity, but you don't have electricity in your home. No, there's no grid. So it's just just the hospital has power. That's you know, we run on the solar, I mean pretty much 24-7. We really don't need the, as long as the batteries are there, everything's functioning, we don't need to generate it at all. And we try to, we try to find the time when it's these batteries are going to order a new set and new panels,

wherever you 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 would be 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 the 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 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 all the person there are probably in the 70s and his or her 70s I don't think they they live much beyond that and do you see cognitive impairment in that population? Really rare you rarely as somebody 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 don't see it. The point you just made that reminds me there's a mute 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. 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 met in one of November 21st, so when that day comes around, well, usually do something. She's always surprised, like, what, what are you doing? Oh. Okay. So she doesn't give me a hard time

for not buying flour, if we could buy flowers. So it's pretty, it's pretty easy to be married to a new building. 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 heavily with things because I've got a wife and I wanted to kind of look after her and make sure she's okay. There's been a little bit of a per changing 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 if things are early 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. 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. I think one thing, and one thing I remind my wife of is that I finish work late and I'm always often preoccupied with things and things with the hospital and all this sort of stuff. But at least I'm there every evening. The weekend's a little bit of time on a Sunday, but together. And even though the work is very much all encompassing, there's no commute and there's no distractions. You know, we don't have, 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. If life continues like that in Newport, there's not any travel involved. I'm just there. I must don't see that. 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 distractions and our travel and our this and our that. Life here is much more hectic I mean, it seems almost like right you feel out of place here even though you grew up here I mean when you walk down park Avenue or Madison Avenue or you sort of like what in the hell is this place? I do I do feel a bit out of place and a sense I do enjoy it

Like I've never even when I was like grew up in upstate New York I never spent time in New York City. So this is really kind of, it's exciting. I like it, but I don't think I could stay long term. I mean, a lot of people I'm sure say 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, 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 No, I really don't I think that was been my character since I was a kid I'm very much I think I'm very much a minimalist since I was born. All these clothes you see me wearing from the socks, the trousers, both these shirts,

I bought when I came out of New Bill last month. So I have scrubs. I had scrubs, I won pair of trousers, I had a suit, a few T-shirts, and that was it. And they're like, hey, look, you gotta go and meet people. You can't be wearing those crumbs around. So I had to buy all this crap when I came out. It was painful for me to buy clothes.

Like I just don't like it. When I go back, I said, look, when I go back to my mountains, all this is winter coats and this stuff, I'm not taking this stuff back with me. I'll keep it in Armenia. I'll keep it in Armenia. I'll keep it in Armenia. I don't know what I want.

My suit, I do have one suit that I wore to the ceremony and Armenia, the World Prize ceremony. But I bought that suit in 1985. So I haven't. I haven't bought 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 one I had, same one I used for interviewing for medical school. And then I've used it when I came out for this World Prize ceremony, I'll take it when I come out for this sort of price ceremony, and I'll take it out and see what the blue shirt in a tie, but I'm all a crap in 1985.

And I know that 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. 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, what have you learned about this and 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. Just schlepper around New York and talk to idiots like me. No, I tell you, Peter, I really do believe that the more detached you become, not like in this Buddhist kind of Narvada sense, but the more detached you are from things that easier life is, it just simplifies your life. For me, look at a lot of possessions and things and attachments, just adding more complications. You know, let me come so complicated. It's much harder

here in the US. I see my sister and how she's interacting with the kids. 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. What does medicine have in you exist? Why is there a huge building in medicine avenue? These guys are very good with what they do. They're convincing, they've managed to convince all of us to get things that really don't need and convinces that will be only happy and fulfilled and satisfied if we have those things. So you 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 realize, well, geez, I don't have any of this a place where you can't have anything that kind of

realize, well, geez, I don't have any of this stuff and I kind of like it. It just makes things much easier for me. I've always been a bit of a minimalist even 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 one of my favorite books. And this might be a local therapy.

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 each person. Whether it's kids, whether it's your pets, whether it's your your job But to try to get something in your life that's meaningful and if you're looking for it This is me philosophy. I think if you're looking for in material 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 over 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, he says, 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 to keep 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, I think he wanted to justify himself. See, I'm, 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, celebrating your 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 this guy stuff in a way and not proud to go for people. But in some way, get rid of your baggage and come and follow it. Yeah, because it could be metaphorically get rid of your stuff, right? Exactly. I don't think it's necessarily literal, right?

Right. It does me throw your couches out, but it doesn't mean, you know, it doesn'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 and the car you drive and the, what kind of beer, drink or whatever, or is your value more in people and what you're

doing and 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 the attachment from that. I just think it's more difficult. You know, it talks about this passage about, it's more difficult for Richmond to enter the community of heaven than is for a camel to go through the eye of the needle.

That's kind of something. I mean, the needle is, it's supposed to be where the camels were and the keep them out of the city. And I think it looked like an eye of an needle and, well, I've been eaten. It's supposed to be where the camels were and the keep them out of the city. And I think it looked like an I have an eaten on the camera going to go through there. It's not saying being rich is bad. Rich people are bad people. That's totally, that's nothing that'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 judgment. I don't mean that, but certainly for me, it's much better having less, like 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, I don't actually picture you. I picture someone going into a remote part of the world and hitting people with bibles. Right? 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, and 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 of the 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 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 he said, St. Francis is like many people, he's my favorite saint. A friend of a CC who lived in the 12th, early 1200s, he said, preach always and sometimes use words. And I think that's exactly what I think we try to do, a mission, show the love of Christ by who you are in what you're doing, Coloss. And don't get too rektrony axle about how it's gonna 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 don't have the, I'm not a guy that's going to have just the right thing to say and to, you know, school somebody on something. I can't do that, you know. But I can do my best to show the love of Christ to these people. And that's what I feel comfortable with. You know, if you ask me why I'm a Christian, I can talk to you about it. My words might be a bit jumbled and goofy, but preach always sometimes use words. Are there any cases of suicide in Nuba?

We have one guy who's the husband of one of our staff and 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 one of the refugee camps. So, it 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. As the only case I know of, it's extremely rare. Extrem 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, sense of purpose. They are 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, you know, 10 to 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, 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. 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 live in a world that has won 1,000th 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, the initial thought that comes to me is that people are when you're really gripped in this struggle to survive. So 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 don't, your mind isn't drift off to the things. You don't think about so much about your life is hard, your life is this, your life is miserable.

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, 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, it's not to say that I'm not heartbroken by anybody who hurts themselves, but what you see is so staggering. Do you see this as an even greater source of tragedy? For me, I would equate that with the five-year-old girl who's got the shrapnel ripping her out of my mouth. I would see, I would feel the same sense 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 in the whole family is that a steady 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

at the decided to take their own life, but for the people who rip the line. 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 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 not fighting, just to survive there, the amount of work it takes to get up in the morning to make food, to cultivate crops, to keep the animals out of your garden. I mean, it's a tremendous struggle. There's a book, I think the book is called Tribe, Sebastian Younger. Have you heard of this?

I have heard of it. I can give you a copy, actually. I have a copy here, so I'll give it to you. There's one more possession to have. Right. But he writes about how post 9-11 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 there's something that unites people It can presumably distract from some of that pain that can otherwise hurt us. Right. It's interesting I because I fairly recently was hearing about this PTSD and And I mean how many veterans have killed themselves. That's another heartbreaking thing.

Somebody's fighting in the erogative. Again, it's them. They survive all that. They come back home. They get disbanded. They kill themselves. 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 their common bond with their comrades and friends and what ensues is the sponsorcy. And before we know it, we had this huge, brain of suicide amongst veterans that come back, not so much from the trauma they had during the fighting. It wasn't like flashbacks to the horrible things

that happen 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. That's what I was saying. It just makes you wonder if there is a way to, we have these dating apps here in the United States, right? You probably don't have a lot of them in your mouth. Well, dating is totally illegal. There, you were dating has 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 somebody like I can never be alone with her somewhere, like just chatting out in the public 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 him? They'd come and they beat me up,

they'll beat her up and then get this big scandal and they'd say, oh, you know, he'd be guessing, get married or what's going on here, he can't be doing this. So you have to do it, we did it very quietly. And 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. So much show interest to somebody else and they have to approach the family. But there's not really a dating. They can't go through a public dating thing.

If you're interested in marrying a girl, 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 Daury and all that sort of stuff. You can't be seen together in public sphere. It's just not just totally not allowed. So not so much in range. There's some attraction between the two, but they have to really make them move fairly early. So they don't, you know, or the problems, you don't really get to know the other person very well. It's really difficult, you know, they're good in their bad points because you're not really allowed to go through that process of dating

if they know somebody and all that sort of thing into the family. Okay, 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 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, the avoid 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 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 could a 10-year-old girl in San Diego do me another question, she said, you know, she said, well, can you ask Dr. Tom, like, what 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, because it's not like you going there is going to, you know, be a practical solution and or even provide value. I mean, even meek, 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 health care 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 impact that has is tremendous. We can't do anything and I work without financial resources. Beyond that, I think one is just becoming aware of the situations. Somehow, in this environment,

trying to understand how these people live, what their lives are like, that these really are individuals that have their own thoughts and aspirations and everything else, trying to get them into their skulls a bit and understand what their life is like and who they are. If you have kind of a knack for advocacy or through governmentist kind of thing, 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 because some of these people say, well, the government funding, the 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, are you saying so much money to Africa, they're wasting it or it's waste of money? So to give the money out, the constituents are holding the politicians' feet to the fire. If the constituents were a little more open, they'd look, let's help out. Let's

be aware 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 to allow more resources to go out into more aid and other things more benefit to give them. I mean the goal and all this stuff is eventually let these people are beneficiaries now staying in their own two feet, maybe in the next generation and next go around. This cycle of aid, I mean everybody knows a 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 and know into a feed. Talk to me about food. I heard a funny story once that is there a word for food in who but like it's like it. Gumo, so you know, newbie has like 99 different languages amongst the new the people.

So, everybody speak Arabic? Pretty much. Most of us speak Arabic. Yeah, I speak Arabic. Sure. Yeah, sure, sure, sure. The thought of my wife's language is Tira, and this came from her. The local word for food is gumu mo.

And I would say, what did you have for supper last night? And she said, I had food. I said, what kind of food? You know, food last night? And she said, I had food. I said, what kind of food? You know, food. What are you talking about? I had food. I said, what kind?

I said, well, I had an acita, you know? Acita is the kind of, it's like a cake. It had a sorghum kind of ground sorghum boiled. I mean, it's just totally tasteless. She loves it. You know, so I have to have my acita. So for them, the word food and the acita is synonymous. There's so little variety of foods.

So what do you eat? First of all, what did you weigh? Because you were a nose guard in college. Right. I've seen pictures of you. You were huge. What did you weigh in college? In college I was 230.

And this was 1985. By the way, 230 and what did you weigh when you arrived in Kenya in 2000 probably around 190 I guess and what did you weigh by the time you got to Nuba in oh wait then maybe 170 and I got down I was down about 150 up until recently now I've come out for the past month I think I've gained about 20 pounds I was down to about 120 pounds in the United States in a month. Yeah, so you were down to 150 pounds a month ago Yeah, talked to me about what you eat. Well, that's the thing I my 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 I had to 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 sasida,

and she has some sauce on top of it. So the main sauce is this okra. Okra grows pretty well. This is 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 is 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, they're a seasonal. So you can get mangoes for maybe two or three months out of the year. A megal season is there. There are tons of mangoes.

Then 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 here to here. So mangoes are there periodically. Lemons, you get for fruits, that's about it. Oranges are not there, you know, pineapples. Are there tomatoes and 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 that. Even the tomatoes will kind of cook up a bit and make the ochre slime to it and put that over the acida. That's not bad actually. We'll have that quite a bit. Or the thing we'll have during the rainy season is milk also. Milk is only there for a couple of months. The cows will only give birth during the rainy season and therefore they're only lactating during

the rainy season. So the get milk sort of tours in the rainy season those last couple months and since there's no refrigeration most times we'll have it sour sour milk. So get milk out but it's said for a while and becomes sour and that'll also decontaminated a bit. There's a lot of brusselosis there and it takes the milk, which is kind of curdled in, you know, I think people have had sour milk before and you pour that over the aceto, over the sorghum paste. That just doesn't sound tasty.

It's not very good. It's really, it's kind of eating like, oh man, you know, the problems you eat it, you're kind of hungry a bit, but there's no way you're going back for seconds. I was like, that was enough. It's kind of going to bed, you know, or go back to work. I was like, okay, I guess I've finished. My wife really, she does a great job cooking with limited resources we have, but 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, a plant Parmesan is my favorite food in the world. So my system made that when I was down there. Hamburger's, I just crave cheeseburgers, like just a good sandwich, you know, some chicken sandwich or something. It's just 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 to 10 and a half years. 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 on your misery.

You're pretty sick with it. It's worse than influenza, right? Yeah. An influenza, anybody who's actually had the flu will test. That's 10 days of really bad living. Yeah, malaria is pretty miserable. I mean, real bad headache, nausea, vomiting, you can't sleep, just a high fever, body aches, terrible body aches. And sometimes

you get a bit luck, you take medicine, you're over it in a few days, but in a lot of times it'll drag on for a month. But you don't take prophylaxis throughout the year, just during the rainy season, which I'm assuming is when it's endemic. Right, I don't take prophylaxis throughout the year, just during the rainy season, which I'm assuming is when it's endemic. Right, I don't take prophylaxis. Just because of the cost and... Yeah, I just don't want to take the drug. I just want to say, okay, let me just not take and if I start losing 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 just like, oh gosh, it's 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, I was a strange night or it started feeling sick the night before, it was on a Tuesday night. And it started taking, I took some oral drugs, I think I co-arked, which is a scene in derivative. Took that at night, I went to bed, 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 like, I be quenning, like, what's going on here?

The doctor needed treatment. That's right. But I was really out of it. There 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 this to have, because I was in the operating room day on Wednesday. And our guy that's our assistant there, I didn't show up, you know, for the,

I was down there by 730 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. He thought I was dead. He was like, hey, Dr. Dan, you know, he'll be okay running in. Anyway, he had to die, so I just,

that was out of it for quite a while, but then I recovered pretty quickly. I can't even imagine. I just, I can't. When you think back, Tom, about all of the people you've taken care of in the last 10 or 11 years, so just 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. If I even think about these patients, I'll tear up. I mean, just, unfortunately, they're all bad outcomes as the ones that, 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 came in in a Sunday morning and he had been the Antonov bombed

in the trap that 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 days after that. And his face was just mangled, so we took the stitches out and his all just pus, they were coming out.

I mean, just didn't clean the wound out. So we took all these stitches out, cleaned the wound out well, put them in the body. A couple of days later, we go on, he's got high fever and he can't swallow. I'm like, no, crap, he's got, he's got tetanus. So it kick his tetanus. I remember, well, the day before then, remember the antenna came overhead, the antenna was the air pulling that bombs. And we saw the kid, he was like a, maybe 10 years old.

He was standing in 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 the next day, he gets a real high fever, he can't swallow, put him in isolation, put NG2 down to feed him, and he just died from tetanus, like overnight, he died from tetanus.

I remember this kid's face and how face 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 was just a few years ago. He was bombed, he and his aunt, and it was an incendiary bomb from the Antonov. And I don't know what they had, they bombed whatever, but it bombed him. And he had, I don't know.

He had 30 reburons on probably 60-70% of his body. Is that even survivable? No, he lived like two months with this. Both he and his aunt were the same. We tried everything with these kids. The amount of work the nurses did every day just to try to address him. The agony he went through before he died. His aunt had these scabs. I remember, you know, this his aunt had these scabs and I remember there were there her eye was was burned with this thing and I remember there were maggots coming out of her eye, you know. I think what what the heck are we doing, you know, it's just crazy. What what who are these are civilians, burn a death, you know, there were other six other kids that were in an area that

was being shell. So they sit in and I would shell their village like all night and then they'll bomb there in the day. So they were at nighttime they would sleep in the foxholes for protection. So right next to them was a straw, racuba kind of a straw that was structures. So they're totally shell, fire and hit the racuba. Thing burst, it was just like a kind of lean to with made of grass and wood. It said 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 very degrees of burns. I'm 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, they developed tetanus and dived in the tetanus. So these are ones that really kind of stick out. Maybe one of the soldiers I remember best is a guy that, he was a guy I told you before,

he had 23 or four holes in his intestines, and he opened them up and we just, I mean, we hours we operating this guy Post-op he was doing great. I mean it was cruising and starting feeding him. He was set up in bed The next time I'm called down to see him. He's changed condition as they say Anyone down he's already dead. He was that he was a Darfur. He was fighting with the new rebels And I just remember thinking you know what? What would this like his, like this guy's got a family, you know? He's fighting in this place. He's found me somewhere in Darfur.

What's happening? That they've been had deal with happening here. So many terrible things, you know, there was a young, one young kid, he was about 16, and he, this family was approaching on our area. So the rebels run out there to kind of repulse them and then people just kind of jumped on vehicles to go out and fight, you know. So this kid just jumped on the vehicle. He didn't have a gun, they were up and they were just, it was a civilian, he goes out there. He gets shot in the head with, with, you know, a 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. I mean steroids and different things in antibiotics try to count things down And it 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 resource? I think like an African-American healthcare foundation involved in any way, shape, or form, where would you recommend they look to as a resource? I think in like an African Mission Health Care foundation, there was something on their website about the hospital. That's one source to go to.

And their website is sort of 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 the 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 shoe string budget, but it's so well done. You know, it just sort of speaks for itself. So anything raised through them goes to African-American health care, which comes to us without anything taking out.

Catholic Medical Mission Board is another good source. 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 C-M-B.org I think is their website. These are probably the main sources for our work in 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? At the time when I went

to medical school, I wanted to be a pediatric oncologist, and I know what the guy was doing in retrospect. I mean, I think he was just trying to push me. He basically said, like, why would you want to do that? You can't possibly make a difference 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. I remember thinking of a story after which in many ways exemplifies you to an extent that probably no one else, which is, in medicine you can do two things, right?

You can do something very scalable through research. You can devote yourself to working on 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 in every few steps. One of the guys bends down and 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 tenth one, the one guy says to me, 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? 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. Right. And I think for doctors that don't have the privilege of being able to affect the larger three research or policy changes, whatever, for people in 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. It's a huge privilege to have the opportunity to affect one person. In the end, you close the door and it's you in the patient, whether you're in Newham, Mounds, or here in New York. That's an incredible privilege. 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, you know, 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, one of the kind.

You see a life, and you see somebody that can laugh, and can cry, and can play in the ocean, you see a person. You see a life, one of the kind. You see somebody that can laugh and can cry and can play and can, you know, has aspirations and is a living, breathing human being. Thank man, we have this one person. That's a huge thing, you know? And I think that helps to stave off some of the burnout in the cynicism. The fact that you are, this is a very individual thing.

So one person 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 sort of beyond a privilege.

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 I 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, 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 of it. Thank you so much. You can find all of this information and more at peteratiamd.com forward slash podcast. There you'll find the show notes, readings, and links related to this episode. You can also find my blog at peteratia-md.com. Maybe the simplest thing to do is to sign up for my subjectively non-lame once a week email where I'll update you on what I've been up to, the most interesting papers I've read, and all things related to longevity, science, performance, sleep, etc. On social, you can find me on Twitter, Instagram, and all things related to longevity, science, performance, sleep, etc. On social,

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