The Peter Attia Drive - The world's most important doctor to millions in the war-torn and remote villages of Sudan

00:00:00.000 Hey, everyone. Welcome to the drive podcast. I'm your host, Peter Atiyah. This podcast,

00:00:16.580 my website, and my weekly newsletter all focus on the goal of translating the science of longevity

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00:00:53.260 of the subscription. If you want to learn more about the benefits of our premium membership,

00:00:58.080 head over to peteratiyahmd.com forward slash subscribe. Welcome to a special episode of

00:01:06.180 the drive. For this week's episode, we're going to be rebroadcasting my conversation with Dr. Tom

00:01:11.720 Katana, which was originally released in February of 2019. Prior to interviewing Tom, I had known about

00:01:17.840 him for three years, but this interview was the first time I met Tom in person. And it's actually

00:01:23.500 the first time in my life that I was ever nervous prior to meeting another human being. Now, of course,

00:01:28.280 this is incredibly ironic because when you meet Tom, and this of course, we'll come across in the

00:01:32.420 episode, he is quite simply the most humble person you can imagine. But I see in Tom what I consider

00:01:39.300 to be the greatest of any qualities or characteristics in a person. And it really humbled me to meet him that day

00:01:46.380 and to continue to get to know him better and better over the years since that time.

00:01:52.100 Since about the year 2000, Tom has been a missionary physician in Africa, initially working in Kenya.

00:01:57.400 And then in about 2008, he moved to a region of South Sudan called the Nuba Hills or the Nuba

00:02:03.020 Mountains, where he continues to take care of about three quarters of a million to a million people.

00:02:08.580 At the time, he was the only physician in the area, and there's a single hospital there. It's hard to

00:02:14.020 describe how few resources he has to run it. This is something he'll explain in the podcast.

00:02:18.680 It's really nothing short of a miracle. As an update to Tom's work, after several years of

00:02:23.800 relative calm, Sudan is again beseeched with conflict. This time, there is fighting between

00:02:29.580 factions of the government. This civil war has inflicted widespread damage across the Sudanese

00:02:35.020 health system. However, even with all of this, Tom's hospital is still functioning and caring for

00:02:40.160 the wounded. Not only that, but the hospital now has its own clinical training school, which has 19

00:02:45.720 physician assistant students and 30 midwife students. In 2008, when the hospital was founded,

00:02:52.140 there were 15 staff members, including Tom and a few expatriate Catholic nuns. And the local Nuba

00:02:57.840 were not formally trained at the time. As of today, there were 270 staff and over 50 formally trained

00:03:05.280 Nuba health workers, including nurses, pharmacists, laboratory technicians, and anesthetists.

00:03:10.800 And the first woman doctor from the besieged area of the Nuba mountains is now also working with Tom.

00:03:16.020 In my conversation with Tom, we talk about a lot of things. We cover some of the unimaginable

00:03:19.860 suffering that he sees and how he himself copes with death and copes with being in a situation

00:03:24.580 that I certainly don't think I could be in. And I suspect many of you listening would relate to that.

00:03:29.760 We talk about a crisis of purpose. I think it's easy to look at what Tom does and feel sorry for him

00:03:34.780 or feel sorry for the people that he serves. But I must admit, I came away from this interview

00:03:38.400 actually feeling more sorry for us in a way. And Tom so eloquently, without judgment, explains

00:03:43.880 some of the differences between people with all the privilege in the world, like most of us

00:03:48.040 listening to this, and the people that he serves. We also talk about the sense of community that

00:03:52.640 exists in Nuba. And what you start to realize is that the way we die in this country and the way

00:03:57.640 that we live in this country is so different from the way that people live and die in other parts

00:04:01.360 of the world. It's not surprising that people there don't die from complications of type two

00:04:05.480 diabetes, but instead they die from infectious diseases and trauma. There's also a more subtle

00:04:10.220 point here, which is that we are in many ways prisoners of our own world and our own mind and

00:04:14.840 our own possessions. Tom's work is so important to me that I want to be sure anybody listening to this

00:04:21.000 can get access to all the notes that we're going to put together on this topic. And as such,

00:04:25.260 for this episode, the show notes will be free and available to everyone, including those who are

00:04:29.280 not subscribers. Lastly, and perhaps most importantly, if anyone is curious about how

00:04:34.340 to support Tom and his amazing work, we will have a link at the top of the page of the show notes

00:04:39.960 where you can give directly to the work Tom does. My wife and I have been giving to Tom for about six

00:04:46.600 years now, and I can say that it is unquestionably the highest ROI money that we contribute to any

00:04:54.660 cause. In other words, for every dollar we give, we really have a sense of how it's being used and

00:05:00.380 how it is changing lives. So without further delay, please enjoy or potentially re-enjoy my

00:05:05.860 conversation with Dr. Tom Katana.

00:05:13.220 Hey Tom, thank you so much for making the time to come over here today.

00:05:16.640 Sure, Peter. My pleasure.

00:05:17.740 Yeah, there are a few people that would be giving up

00:05:20.240 more that they deem important work than you. So I know your time is tight. How often do you come to

00:05:25.900 the U.S.? Well, this is my first time out in more than three years. So last time I was in the U.S.

00:05:31.620 was November 2015. I was here for about five days. I was in my hometown of Amsterdam, New York.

00:05:37.980 And it wasn't much of a trip. You asked about malaria. I was sick as a dog with malaria. So I was

00:05:41.940 in bed with malaria the whole time. The last day I felt a bit better, just in time to go back to

00:05:46.520 Africa. So it's been a long time since I've been back.

00:05:50.060 You grew up in upstate New York.

00:05:51.680 Yep.

00:05:52.320 Your pedigree is like the star, right? You went to Brown. You played football. You went to Duke

00:05:56.700 Medical School.

00:05:57.780 Right.

00:05:58.220 At what point did you realize you wanted to do something a little different vis-a-vis working

00:06:04.180 outside of the U.S., for example?

00:06:06.520 This desire to do this kind of work really was planted when I was in college, when I was at Brown.

00:06:11.060 And I always wanted to do some kind of mission work. And that term has several connotations,

00:06:16.700 but I wanted to be a missionary, whatever that meant. I wasn't quite sure what it meant at the

00:06:20.200 time, but I just had this idea. I wanted to work in other cultures, in other society, do mission

00:06:23.760 work. But I was, as you, a mechanical engineering major. And that didn't really fit with doing

00:06:29.380 mission work. This was in the 1980s. And most of the jobs then were in the defense industry.

00:06:35.740 They were good jobs, but I didn't really want to do that kind of work.

00:06:38.120 So I graduated college and kind of floating around for a while, I was offered a job by

00:06:42.140 GE, working with their kind of nuclear submarine program. It would have been a really good job,

00:06:46.580 but I just wasn't interested in that kind of work. And I remember one day, it was kind

00:06:51.180 of odd. I was coming back from my great aunt's funeral. I was with my brother, Felix, and

00:06:57.260 idea just kind of popped in my head. I should go into medicine because I could, if I do that,

00:07:01.900 then I could do mission work. And, you know, I like the sciences. I could stay in the sciences,

00:07:05.600 do mission work, help people, just kind of that general idea. And I ended up going to

00:07:10.260 medical school and kind of kept that desire to mission work. And that kind of evolved into

00:07:14.700 wanting to work in Africa, work with people that don't have a lot of options for healthcare.

00:07:20.000 You know, 15 years later, I ended up in Sudan.

00:07:22.300 So you started out in Kenya, is that right?

00:07:23.900 Right. So, you know, when I finished at medical school, then I did five years in the U.S. Navy.

00:07:29.580 I had a Navy scholarship for medical school, so I had to pay that time back. Then I went to

00:07:33.600 my residency. I did family practice in Terre Haute, Indiana. Now it was time to kind of be free and

00:07:39.280 do what I want. So I thought, well, let me just go and let me do this thing that's been kind of

00:07:42.920 an itch for so many years. So I teamed up with the Catholic Medical Mission Board, and they said,

00:07:48.280 okay, we have an opening in Kenya at this mission hospital. Maybe go there. I said, okay,

00:07:52.580 I'll go for one year. I'll see how it goes. If I like it, maybe I'll stay longer. Otherwise,

00:07:56.300 I'll just come back and start a practice. And went down to Kenya and fell in love with the place

00:08:00.780 and decided to stay. What was the first thing that you remember when you got there as far as

00:08:05.160 how different this was from the way you had trained? Because you did your residence in

00:08:08.520 the United States, right? Right. I did my residency in the U.S., and I did family practice.

00:08:12.800 And the program I went to was kind of geared towards rural health. So I thought, okay,

00:08:17.880 if I want to do admission medicine, I've got to be doing more than just kind of outpatient office

00:08:21.600 stuff. I need to do something with a little more meat to it. So, you know, a little bit of

00:08:26.120 obstetrics. We did a bit of surgery, mostly just C-sections. So when I first got there,

00:08:30.920 I think what struck me was just the volume of patients. I mean, I was a resident and,

00:08:36.460 you know, in clinic days, we'd see like five or six patients, you know, and get all every little

00:08:41.540 detail down in each one. And now, I mean, in this rural hospital in Kenya, and I mean,

00:08:46.800 you're seeing 50, 60 patients, you know, huge numbers. The clinic, the wards are full. You go do

00:08:52.340 ward round. I was in charge of the adult ward. And there were, you know, at the time,

00:08:57.360 I thought it was a huge, I mean, like 30, 40 patients there. And I was responsible for all

00:09:00.520 them. It's just the sheer volume of patients you had to go through every day in the variety

00:09:04.840 of diseases. So not only the tropical stuff, which I didn't know much about. I mean, here's

00:09:09.980 malaria, TB, Leishmaniasis, all this kind of stuff I had no idea about. I had to learn about when I was

00:09:16.120 there, you know, learned to thank God some couple more senior doctors there that I could learn from,

00:09:20.160 but just the volume of patients and the variety of diseases you had to face.

00:09:24.540 So what year did you get to Kenya?

00:09:26.420 I arrived in Kenya, uh, January 17th, 2000.

00:09:30.300 That's so interesting. I, I arrived at NIH when I was in medical school on January 17th, 2000.

00:09:36.580 No way.

00:09:37.060 Yeah. Yeah. That was, uh, which was NIH being at NIH while I was in medical school was one of the

00:09:42.620 sort of more formative parts of my experience. So how long before you went to Sudan and what

00:09:48.220 led to that transition? I'm trying to think of my geography, right? Kenya is south of Sudan,

00:09:53.560 correct? Sort of south, east of Sudan.

00:09:55.980 South, right. South and a bit east. Exactly.

00:09:57.840 Okay. And, and much more stable, right? I mean, Kenya is a relatively safe place to be.

00:10:02.600 Right.

00:10:03.900 Sudan is not, right? It's divided into these provinces and my, the one that got all the

00:10:09.340 attention was Darfur, which is the furthest west.

00:10:11.800 Correct. Exactly.

00:10:12.460 And that basically was a war zone. Right. I mean, a killing field, right? So Bashar was

00:10:17.860 basically killing his own people there, wasn't he? Right.

00:10:21.020 So to go from Kenya to Sudan, what were you thinking?

00:10:24.420 I think maybe the modus operandi of my life was always looking for what's the opposite of

00:10:28.860 greener pastures. I'm looking for browner pastures. When I was there in Kenya, this was, uh, as I said,

00:10:34.860 I got there in January 2000, the civil war in Sudan was really raging at that time. And I was in Kenya

00:10:41.100 learning a ton of stuff, really enjoyed the work. And I kept hearing about Sudan, the civil war in Sudan

00:10:45.860 and how it's so terrible. And the conditions there were, were terrible. And the, you know,

00:10:51.000 there's such a lack of, of any kind of health services. I thought, man, I'd really like to get involved

00:10:55.200 in that, in that struggle just to go and work with the, help the people there just because it was so

00:11:00.020 health facilities were so limited. I thought that's kind of the place I want to go to. So I had this

00:11:04.180 general thought, this is 2001, 2002. Now this one in June of 2002, I left my first posting,

00:11:11.620 which was in a rural place called Motomo. I was there for two and a half years. I went up to

00:11:14.660 Northern Kenya, a place called Turkana. I was at the Kakuma Mission Hospital, which is up in the

00:11:18.980 Turkana desert near the refugee camp. A woman named Deidre Burns. So Didi was there, I think her first

00:11:25.060 time up in Turkana. And I was talking to her, she's an American, she was doing a kind of short-term

00:11:29.740 mission there. She's a surgeon and a family practice doctor. She did both, was doing

00:11:33.100 primarily surgery. And she said, look, there's a bishop I know. It was Bishop Makrim Gassiz,

00:11:37.520 who was building a hospital in Sudan. I think he might be interested in going there. And that,

00:11:40.820 say, whoa, that's exactly what I've been thinking about doing, you know, for the past couple of

00:11:44.340 years. It's back in 2002. So she said, look, he's got an office in Nairobi. He's living there in

00:11:49.160 exile. Maybe you can make contact with his office because I was due to go to Nairobi and start working

00:11:52.540 there. Anyway, to make a long story short, I ended up working in Nairobi, linked up with his office. And

00:11:58.340 we started kind of making plans for the hospital and how would it run, the staff we would need,

00:12:03.080 all that kind of stuff. And then it took six years, but six years later.

00:12:06.400 Who funded the hospital?

00:12:07.760 It was all funded through the Catholic Diocese.

00:12:09.660 I see.

00:12:10.040 So it was the Catholic Diocese of El Abade. Bishop Gassiz was the bishop of the El Abade Diocese.

00:12:14.180 And he and his office were able to get funding through the church mechanism to fund the hospital.

00:12:19.060 So now it's 08, 09, and that's when you go.

00:12:23.060 Right. So I went to Newham Mountains, arrived there March 10th, 2008.

00:12:27.540 It was the day I ever landed there in Newham Mountains.

00:12:29.560 Tell the listener a little bit about where Nuba is. I mean, I know it's in the southern part

00:12:33.880 of Sudan. It's to the east of Darfur, but it's pretty rugged country, isn't it?

00:12:39.900 Right. So the Nuba Mountains is probably one of the most remote places in the world.

00:12:44.840 It's a region which for many years in Sudan was kind of kept off limits. Before when Sudan was a

00:12:51.100 kind of a colony, it was under the, called the Anglo-Egyptian condominium,

00:12:54.040 partly kind of administered by UK and by Britain and by Egypt. They decided to kind of keep the

00:13:01.260 Nuba separate. They said, look, these people have a unique culture and are unique people.

00:13:04.960 They didn't really allow a lot of open tourism or people to go in there. It was kind of a closed

00:13:09.140 area. So they really kind of have maintained this separateness and this isolation over centuries.

00:13:15.520 It's difficult to reach. It's semi-arid. It's got a distinct rainy season. It's got a dry season,

00:13:21.700 but more hills. They aren't real high mountains, but sort of 3,000 foot hills, that kind of range.

00:13:27.160 My history is not great, but I sort of remember that basically Sudan was granted sort of,

00:13:33.120 I forget the term, but when you're given your independence, for lack of a better word,

00:13:36.520 that would have been in the 50s, right?

00:13:37.780 Right. 56.

00:13:38.540 Okay. And then what was the religious sort of map of Sudan? And did that figure into how it was

00:13:45.200 divided? And was that partly why Nuba was, was it religiously diverse? Was it mostly Muslim,

00:13:51.620 mostly Christian?

00:13:53.020 Yeah. You know, Sudan is a, it's a very interesting place. So you've got, it was one country up until

00:13:57.380 2011 when they divided the North and South. Now the religious makeup is in the North. So North of

00:14:02.980 Nuba mountains, it's primarily Muslim, almost all Muslim in the North. The South is primarily Christian.

00:14:07.660 And Nuba is right in the middle. And interesting enough, Nuba is a mix. It's about, let's say,

00:14:14.400 half Christian, half Muslim. And everybody's an animist, but half are Christian, half are Muslim.

00:14:19.480 And the Nuba are unique. I think a unique tribe in the world where you have families which are mixed.

00:14:26.680 You have Nuba, you have Nuba Muslims and Nuba Christians, and they, there's no conflict amongst

00:14:30.540 them. For instance, my wife is, is a Nuba. Her father, both her parents, when they were born,

00:14:36.660 they were just followed the traditional religions. The, the Christianity and Islam had not been

00:14:40.640 introduced yet to the area. Now, as they got older, her father became Muslim, mother became

00:14:45.400 Christian. They married her father's a polygamist. So two eyes, both wives are Christian. Their oldest son

00:14:50.080 is a Muslim. The rest of the children are Christian and nobody's really bothered by this. That's in Nuba.

00:14:56.120 Now the country itself, this difference between Muslim and Christian was, was really a big issue

00:15:01.780 in the previous civil war. You know, we had sort of the Southern African people that were mostly

00:15:07.420 Christian against the Northern Arab people that were all Muslim fighting each other. And there

00:15:11.640 was very much a religious context to that previous civil war. And also in Nuba mountains, the Nuba

00:15:17.420 mountains, the Nuba people joined the Southerners. They're all African in Nuba. They joined the Southerners

00:15:21.720 fighting the Northern sort of Arab Muslim people in the North. And in the 1990s, there was a

00:15:27.640 jihad against the Nuba people. So there was a real genocide in the 1990s against the Nuba.

00:15:32.760 Who issued this jihad?

00:15:34.160 The ideologue behind this is a guy who just died last year. His name is Hassan al-Tarabi.

00:15:40.320 And, uh, Tarabi was a member of the Muslim Brotherhood, very bright guy, went to Sorbonne

00:15:46.000 in Paris and was kind of intellectual, but really kind of a, kind of an evil genius, if I can use

00:15:50.800 that word. He was a real ideologue in the Muslim Brotherhood. And he managed to convince some

00:15:57.060 of the imams in the North to sign off a fatwa to allow a jihad against the Nuba. And many

00:16:02.300 imams rejected it. They said, well, you can't, you can't do that. It's, you know,

00:16:05.180 Even though he'd be killing Muslims with a Nuba.

00:16:07.580 Right. Exactly. His response to this was, okay, you can have a jihad because the Christians are,

00:16:12.280 are fair game in the jihad. And then the Muslims are apostates from the religion because they

00:16:16.840 associate with Christians. Some of them eat pork. Some of them drink local beer. They're not real

00:16:21.420 Muslims. Like this thing with the Nuba are very much communal and to have Muslims and Christians

00:16:26.160 together at functions. It was nothing but to him. The fact you could have Christians and Muslims in

00:16:31.800 the same family was a huge scandal to him. He just couldn't tolerate that kind of stuff. So he said,

00:16:36.520 no, these guys are also fair game because they're not real Muslims.

00:16:38.840 So what year was that fatwa issued?

00:16:40.740 That was in the, I think in the early nineties, it would have been 93, 94.

00:16:46.040 So Bashir was already in power, right? His coup was like late eighties, right?

00:16:50.040 He took power in 89. And this guy Torabi helped him in this coup. He was kind of the brains behind

00:16:56.620 the coup. And Torabi, I mean, he was, you know, he was, he was kind of a power hungry guy. He said,

00:17:01.260 okay, his figure, he figured if he helped Bashir get into power, Bashir was a military guy. And he

00:17:06.120 thought, okay, if I help Bashir get into power, I'm much more intelligent than Bashir. I'll just kind

00:17:10.000 of find a way to get rid of him and I'll take over. And Bashir said, look, I'm the one in power. You're not,

00:17:14.220 you're not taking over. So he kind of always kept, uh, Torabi at a distance. And there are always these,

00:17:18.260 he would always, he was always throwing Torabi in prison afterwards because Torabi started speaking

00:17:21.180 out against him. So we put him in a quote unquote prison, maybe, you know, living in some luxury

00:17:25.480 apartment in Khartoum, but they kind of were at odds with each other. But Torabi was the

00:17:29.920 ideologue behind a lot of this movement. He's the one that invited Osama bin Laden to Sudan in the

00:17:35.080 early nineties. So bin Laden lived in. When bin Laden was exiled from Saudi Arabia, which was,

00:17:39.220 yeah, in the early 2000s. Right. Well, that was before then he invited, uh, what's his name? He

00:17:43.160 invited bin Laden to Khartoum. So he lived in Sudan for a while. And a lot of, you know,

00:17:47.760 Al Qaeda had a lot of training camps in the desert, in the North of Sudan.

00:17:51.260 I had totally forgotten that fact that the chapter of Al Qaeda that I'd sort of forgotten.

00:17:56.660 So you basically have a bunch of incredibly evil people who are deciding to kill their

00:18:03.000 own citizens effectively. Right.

00:18:05.520 You got there in 08, you said, or 09?

00:18:08.520 08. So he arrived March, 2008. So historically that was the interim peace period. So since they

00:18:15.000 got independence in 1956, Sudan's been at civil war, various parts have been at civil war for

00:18:20.440 almost the entire history. That's 60, that's how many years? 62, 63 years. Most of the history

00:18:27.060 they've been at civil war. So this was one of the brief periods, actually it wasn't even

00:18:31.020 priesthood because Darfur started 2003. Darfur rebels started fighting against the government

00:18:35.440 2003. So this wasn't, the whole country was not a piece of the time, but the big war between

00:18:39.600 the South and the North, the peace agreement was signed in 2005. So when we arrived in 2008,

00:18:45.080 the peace agreement was still in effect and there was no active fighting. And then we were kind of

00:18:49.740 waiting for this referendum to take place. The referendum, the way the peace agreement was signed

00:18:53.220 up was Southerners. So South Sudan would have the choice for self-determination and that would be

00:19:00.240 done by referendum. So the people actually have a vote, straight up vote. If the majority vote to

00:19:04.780 secede, they secede. The majority vote to stay and stay as one country, they stay. Now, 2011,

00:19:10.420 they have the vote and like 99.99% vote to secede from the North. So South Sudan separates.

00:19:16.920 In the peace agreement- I'm sorry, is Nuba considered South or North in this cessation?

00:19:21.260 Right. This is part of the problem because in the peace agreement, Nuba was separate.

00:19:24.200 Okay. And what they said was, okay, South Sudan will have a referendum. The Nuba mountains was not

00:19:28.240 included as part of South Sudan. Nuba and Blue Nile were separate regions. And they said in these two

00:19:33.720 regions, they're called the two areas, they'll have what's called a popular consultation,

00:19:39.580 which was a very vague system where there'd be committees set up. They would go and they would

00:19:44.780 talk to people in the villages and kind of get their opinions on things and see what they wanted

00:19:48.020 to do. If they wanted to separate, stay, it was very vague. And I think it was purposely vague

00:19:53.340 because the government knew it was kind of a bargaining chip for the North to allow South Sudan

00:19:59.340 to have this referendum. They said, okay, because they knew in the end they would keep Nuba mountains

00:20:02.900 because this thing was too vague, you know, and they would be able to manipulate it enough.

00:20:06.800 They'd be able to keep the Nuba on their side. So South Sudan separates. There are elections

00:20:11.200 in Nuba mountains in 2011 in May. The candidate for Bashir's party, of course, wins the governorship

00:20:17.280 in the parliament. Just as a side note, before that election, the guy's name is Ahmed Haroun,

00:20:23.700 who was running against the guy named Abdulaziz. Anyway, Ahmed Haroun was the candidate for Bashir's

00:20:28.520 national Congress party. And before the election, Bashir said, Ahmed Haroun is our candidate and he

00:20:34.120 will win this election, whether by the ballot or by the bullet. So going into it, it doesn't look

00:20:39.040 like it's going to be a free and fair election. Right. And Bashir at this point, does he already

00:20:43.040 have basically a warrant out for his arrest? Right. So he's got the warrant for his arrest.

00:20:46.720 That was, I think, 2009, I think. Ahmed Haroun also is indicted by the ICC for war crimes. He was one

00:20:53.800 of the architects of the genocide in Darfur. So Ahmed Haroun, who was our governor, is indicted by

00:21:01.020 the ICC. Bashir is indicted by the ICC. He also was a defense minister, was indicted by the ICC.

00:21:05.880 So Ahmed Haroun wins. They go and say, okay, now our party is there in South Kordofan State,

00:21:10.600 Nuba Mountains. There are still SPLA soldiers, like Southern soldiers living in this region.

00:21:15.580 The Northern Army came and said, did a forced disarmament of these SPLA soldiers. And that's

00:21:21.500 when violence broke out. So June, 2011, June 6th, 2011, civil war breaks out in Nuba Mountains

00:21:26.720 against the government. Now I've heard you speak about this in the past. It was overnight that most

00:21:33.380 of the staff in your hospital left. So prior to that, leading up to that, the referendum and that

00:21:39.960 the breakout of war, you've got this three-year period where you're in the hospital, you're

00:21:46.240 working there. As far as Nuba can be tranquil, this is the greatest tranquility you've seen.

00:21:50.900 The staff is what? It's you. It's what else?

00:21:54.600 Right. So at this time, you know, we started the hospital, March 2008. We went there with about

00:21:58.200 eight expatriates, including myself. So I was the only doctor. We had a few nurses, an esthetist,

00:22:04.480 a lab person. We had those eight expatriates. They were mostly from, they're all from Kenya or

00:22:09.560 Uganda. Those eight expatriates, myself, we had 15 local staff, Nuba. And the Nuba, I think the

00:22:18.400 most educated person had finished primary school. They were not nurses. They were just kind of local

00:22:22.240 people that could read and write a bit of English and could speak English. So they had to be taught

00:22:26.320 everything. When we first started, they couldn't weigh a patient. They couldn't take a temperature,

00:22:30.180 let alone give an injection or start an IB. Anyway, with time, we got these guys trained

00:22:35.160 up a bit. So they had some pretty good skills. A lot, most of that was done by these expatriate

00:22:40.040 nurses. Now we still kept expatriates, but over time we added more and more on the job trained

00:22:45.120 people. We kept adding more primary school graduates or eventually we got a few secondary

00:22:49.520 school people, started training them on the job. We didn't have any trained Nuba nurses by

00:22:55.800 the time the war started, 2011. So now war starts June 6th, 2011. By June 16th, this is 10 days into

00:23:02.540 the fighting. Things are getting pretty hairy. There was a lot of fighting within Nuba,

00:23:06.220 Arab bombardments all the time, and the diocese-

00:23:09.780 And this is all from the north?

00:23:11.140 The north is-

00:23:11.780 Right. Fighting within Nuba mountains.

00:23:14.100 The resistance is posed by whom? Is it former Southern who have not seceded or are trying to

00:23:20.800 basically, are the North and the South now fighting for Nuba?

00:23:23.800 Right. So what happens is the South Sudan is totally separate. Okay. So within Nuba mountains,

00:23:28.580 you've got a lot of soldiers that were Southern soldiers, SPLA soldiers, a lot of whom were Nuba.

00:23:33.800 Most of them were Nuba, but you also had other Southern tribes in the Nuba mountains kind of left

00:23:38.000 over from the previous conflict and they were there in the barracks. So all those kind of trapped SPLA

00:23:44.220 soldiers are fighting the Sudan army. Now they call themselves, instead of SPLA, they're called SPLA

00:23:49.920 North. Okay. So from that point forward, these guys are called SPLA North. They have kind of a new identity

00:23:55.600 as a separate military force from the SPLA, which is in South Sudan. So fighting is going on,

00:24:00.980 Arab bombardments. June 16th, the diocese says, look, we're having, we're sending a plane in

00:24:05.400 and this plane is going to come in to evacuate anybody who wants to get out of there.

00:24:10.420 Okay. And the plane was going to go to Uganda or to Sudan?

00:24:13.800 The plane was flying into Nuba mountains to pick up whoever wanted to get out and they would get

00:24:19.160 out and leave. Now this was a bit dicey because at this time there were a few flights coming into

00:24:24.400 Nuba mountains, mostly getting people out, but they have to change the airstrip. There are a few

00:24:29.000 airstrips around, but they would give the location of the airstrip at the last moment and they would have

00:24:33.500 like a code name for it because if there were a lot of spies around and if the North found out,

00:24:37.740 they would come with their bombers and come and bomb the airstrip. They would try to bomb the

00:24:41.360 plane on the ground or bomb the people that were trying to get the plane to escape. So all this

00:24:45.200 stuff was top secret. A plane comes in and they say, look, we come in, we get, we land, we have,

00:24:50.960 and we're taken off in 10 minutes. You better be at the airstrip waiting, get your, get your butts

00:24:54.720 on the airplane. We have to be out by in 10 minutes or else these guys will come and bomb.

00:24:57.680 And they do this at night, I'm assuming.

00:24:59.500 No, they did it early, early in the morning because you can't, you know, there's no lights or anything

00:25:02.980 for the planes to land. So it's, it's all just by, by sight. So they would come early in the

00:25:06.900 morning, land and they would get out. So, you know, uh, all of our expats that were there with

00:25:11.960 us, they had all the knowledge. I mean, our anesthetist, our lab person, pharmacist, the

00:25:16.080 nurses that were awarding charges, the ones that were doing most of the work and doing the leadership,

00:25:20.580 they all decided to leave.

00:25:22.320 Now, did you all sit down together and have this sort of heart to heart, which is each of you had

00:25:27.760 to make a very difficult decision, which is you feel committed to this work you're doing,

00:25:31.400 but now your life is at exponentially greater danger, right? So yeah, we met with everybody.

00:25:37.260 We had a group talk and we met individually and said, look, this plane is coming in. This is the

00:25:41.560 last plane that the diocese can send in. This is it. You know, once, once this plane comes and once

00:25:47.540 it leaves, you might never get out of here, you know, cause you have no idea what's going to happen

00:25:51.280 the next day. You don't know if the, their sitting army is going to overrun us. And this is the last

00:25:55.860 chance. How did you think about that? I mean, was there a moment when you thought maybe I should

00:26:02.080 leave and go back to Kenya or go to Uganda or go somewhere else? I mean, what, what was that

00:26:08.440 thought process like? Right. So, you know, I was encouraged to leave by some different people. I

00:26:13.380 said, look, why don't you come out? You stay in Kenya for a while. Then when things blow over,

00:26:17.460 then you can go back when it's safer. I thought, and I thought, geez, you know, first, I mean,

00:26:21.980 you have no idea. This is just total chaos. You have no idea what's going to happen. What I did know is

00:26:25.700 that we were getting people wounded or bowel destruction was ever coming in all the time,

00:26:30.760 you know? So I knew if I leave, it's not like they can go somewhere else. There were no other

00:26:35.960 hospital with surgical capability. Okay. There wasn't a single one. There was another small

00:26:40.020 hospital nearby run by a German group that could do some inpatient stuff and outpatient and some minor

00:26:44.460 stuff. But really if somebody needed a C-section or something more serious, they, they would just die.

00:26:50.160 Okay. And that says nothing of the casualties that are going to start coming in as a result of this

00:26:54.680 attack. Right. So all these people that came in that were wounded would just, would just die a

00:26:58.820 miserable death. And I knew that. So for me, it was a very easy decision. I thought, you know,

00:27:03.820 there's no way I can, in good conscience, leave this place and go out. It was a very, very stark

00:27:09.520 reality. And to be honest with you, it was not a difficult decision. I think the sisters that were

00:27:13.920 there, the two Kamboni sisters that stayed, the priestess that stayed, we all were of the same mind.

00:27:18.420 We all thought the same thing. Let's just stick it out. We're here as missionaries. Let's do what we're

00:27:22.800 supposed to do and take care of the people the best we can and come what may. We have faith in God.

00:27:26.760 We'll see what happens. And it wasn't, you know, we didn't feel like it was some big thing. It was

00:27:31.560 just like, well, no, we can't go. You know, we got, we got stuff to do here. And, and the, you know,

00:27:36.280 the other expats said, look, I've got a family, I've got this, I've got that. And we said, look,

00:27:40.200 we are, we're not going to hold anything against anybody. This has to be a very individual decision.

00:27:44.360 If you guys want to go, we'll find a way to keep going. Don't worry about it.

00:27:47.780 So we want to give them full latitude to leave in peace and not feel they were abandoning

00:27:53.860 people there. So I think everybody's pretty much at peace with the decision. The expats left.

00:27:59.720 And I mean, sure enough, they left, uh, June 16th, the morning, June 16th,

00:28:03.840 they left around six in the morning. They had to get out there early. Cause they had to get the,

00:28:08.660 you know, get this plan and just get out of the place. And we had to keep everything secret.

00:28:12.100 So all of our staff didn't know these guys were leaving. We had to keep it a secret from everybody

00:28:15.640 and lay up and left. And then the staff came to work at seven 30.

00:28:19.220 And so you, you had an anesthesiologist. It was one of the people that left.

00:28:22.960 Right.

00:28:24.140 So talk to me about 10 o'clock on that morning, the first time or whenever the first surgical

00:28:29.760 case comes in, who's running anesthesia. That was the biggest problem. So these guys

00:28:34.700 leave around six, eight o'clock casualties start rolling in people that were, there was a, there was

00:28:39.000 a bombing from one of the Sudan air force planes called an Antonov that has barrel bombs.

00:28:42.660 They bombed in a location near us, maybe an hour, a couple hours away.

00:28:46.820 We hear these in the film, the heart of Nuba, right. Which we'll talk about in a few minutes,

00:28:52.380 but right. So like two hours later, all these mangled bodies start coming.

00:28:55.460 Yeah. Describe what this, I mean, so I did my training at, in Baltimore in many ways,

00:29:00.840 trauma was a feature of the training program, because if you're training in surgery, you know,

00:29:05.640 one of my mentors said, you know, to be able to train at a place like Hopkins is a great honor

00:29:09.440 because you really get to understand surgical anatomy in trauma. And it's penetrating trauma

00:29:14.560 in the United States is mostly gunshot wound and stab wounds. But I have no idea what you were

00:29:20.800 seeing. So what, explain to me what things you actually saw, what types of injuries are you

00:29:26.840 seeing?

00:29:27.600 Right. So this was very start because when Antonov bombs, there are huge shards of, of metal.

00:29:33.480 I mean, weighing, you know, 10 pounds, I've got a bunch of the scraps. I have them as a souvenir

00:29:38.020 back in Nuba. So imagine a scrap of metal, it weighs 10 pounds, red hot, just going through your

00:29:44.180 body. So it, it slices off legs, slices up arms, cuts through people with just massive tissue loss

00:29:51.440 and massive trauma. So I'm here, one young lady, she was 16. Her name was Urshalim, which means

00:29:57.600 Jerusalem in the Arabic. And, and her arm was just totally mangled. I mean, just shattered.

00:30:03.480 She came in, her cousin came in, his hand was, his whole hand was blown off by the Antonov

00:30:07.500 shrapnel. So these guys both in the amputations, the girl, we did a disarticulation from the

00:30:12.820 shoulders. So we had a couple of our on the job trained nurses there and they had done

00:30:17.980 some, they'd been taught how to do spinal anesthetic by the anesthetist. So they had

00:30:21.500 some spinals, they couldn't do GA.

00:30:23.120 For the listener, GA general anesthetic, meaning they couldn't intubate and put the patient

00:30:26.500 fully to sleep.

00:30:27.520 And I, I had never intubated a patient before. I remember when I was in the military, we intubated,

00:30:31.240 had intubated goats for as part of our ATLS training, I think, if I remember, but I'd

00:30:35.780 never done it either. It's like, what the heck? So I'm, you know, I was so afraid. I'm

00:30:39.240 like, God, what do I do with these people? You know? So I remember reading the book. We

00:30:41.840 have a book there, kind of basic anesthesia book. So I bring you through the protocols.

00:30:45.580 Okay. First give some ketamine, you knock them out with that. They go to sleep, give it

00:30:49.660 labatropine, you give it seleccional choline to paralyze them, intubate, then you give

00:30:53.560 pancoronium. You have a health anesthesia, put the tube in, blah, blah, blah, decide

00:30:57.760 intubate. Like, okay, okay, let's, let's do it. So we took some of these guys back

00:31:01.960 and, you know, I would go and give the drug. I had a nurse there, kind of on child. It's

00:31:07.020 okay. Give the ketamine. He would push it in, push the seleccional choline. I would

00:31:11.700 intubate.

00:31:12.700 And I guess I should explain for the person listening to this, because we, we use these

00:31:16.160 terms so commonly. So intubation is a very important step where if you screw this up,

00:31:21.260 you're going to kill a person. Literally you will kill them, but you have to put a

00:31:24.080 breathing tube into the endotracheal space. So this is now to allow a machine to breathe

00:31:30.340 for someone while they're under anesthesia. And we do these things in medical school.

00:31:34.660 We did them in residency. A lot of our critical care training required that. But I have to tell

00:31:39.960 you, and I was not trained as an anesthesiologist, I never intubated somebody without being incredibly

00:31:45.280 nervous because it's so easy to put that tube accidentally into the esophagus and you think

00:31:51.900 you're doing it right. And all of a sudden you, you know, you get the tube in, you hook

00:31:56.520 it up to the ventilator, you think everything's going well. And by the time you realize you're

00:32:01.940 providing oxygen to their stomach instead of their lungs, it can be too late. And then

00:32:06.540 of course the panic that ensues is often what kills the patient.

00:32:10.620 Right. Cause you're, you're getting, you're getting nervous and then you can't do it.

00:32:13.580 You're starting to shake. You know, the problem is my, like I said before, my training was

00:32:16.780 family practice. I did an internal medicine internship, you know, the family practice. I never

00:32:20.740 intubated somebody. I never did anesthesia rotation in medical school. That was not part

00:32:24.600 of our training at all. So I was very green with this. Anyway, by the grace of God, managed

00:32:29.580 to get the patient intubated, connected to help. We have a really primitive structure called

00:32:33.640 an OMV Oxford miniature ventilator. It's got a set of bellows. It's like turn of the century

00:32:38.700 kind of stuff, turn of the 20th century. So, you know, intubating. So we had to, you had

00:32:43.240 to do manual ventilation for the patient.

00:32:45.460 Wait, wait, throughout the whole surgery?

00:32:46.820 Yeah. Throughout the whole surgery. Yeah. As long as they're paralyzed, you gotta, you've

00:32:49.160 gotta ventilate manually. Usually with the hella thing, after you manually ventilate for

00:32:53.560 about 20 minutes, they can breathe on their own. And it's a bit of an art to try to keep

00:32:58.060 them under enough where they can breathe on their own, but they're not in pain. So it's

00:33:02.340 a big art to this kind of work, but it's all manual.

00:33:04.960 I just have to go off on a tangent for a moment, which perhaps only the people listening to this

00:33:08.660 who have medical training will appreciate what you're saying. I'm guessing you don't have

00:33:13.500 blood gases. No. Okay. So you can't measure a patient's PaO2 or PaCO2. And yet your anesthetist

00:33:21.200 has to figure out how to ventilate, which again means how much oxygen the person needs and how

00:33:28.040 much CO2 you take off. And if you screw either of those two up, you will kill someone.

00:33:33.200 Right. And if you told me to walk into Mass General or NYU or pick your favorite hospital

00:33:40.360 and said, Peter, we're going to do everything for you. We're going to intubate the patient.

00:33:44.780 We're going to do this. All you have to do is be the guy that manually ventilates them.

00:33:49.100 I wouldn't be able to do that. Like I would, I would overdo it or underdo it. There's no way

00:33:53.620 you'd hit that sweet spot. Yeah. You'd cause an alkalosis, acid, you would just, and then to be able

00:33:59.100 to not have the laboratory tools to know when you're off the rails. Right. Yeah. In those days,

00:34:04.540 we didn't have a pulse ox. Now we have a pulse oximeter, which can measure the percent of oxygen

00:34:08.200 saturation of blood. That time we had no pulse ox. Some of this stuff, maybe ignorance is bliss

00:34:13.880 because you can't measure it. So you just hope and pray that things are going okay. But we managed

00:34:17.820 to get the guy intubated. I mean, you couldn't do veterinary medicine like this in the United States.

00:34:21.660 Right. Yeah. You know, it was pretty hairy. We managed to get through and this went out. We

00:34:26.660 eventually got an anesthetist to come. This was after about a month or two.

00:34:30.520 Well, and in that month or two, what types of casualties did you see?

00:34:34.180 Oh, I mean, everything, abdominal trauma, lots of leg trauma. We did a number of general

00:34:38.420 anesthetics during that time. We had a baby that came in with intussusception. This was the worst

00:34:43.380 case. It was a nine month old baby who came in, who had an intussusception, which is kind of an

00:34:48.020 intestinal obstruction. Yeah. Explain what that looks like, the telescoping part.

00:34:50.940 Right. So intussusception is when the intestine telescopes on itself and basically causes a

00:34:56.460 blockage of the intestine. And then the longer you delay, that intestine can die and the person

00:35:02.120 will die, the baby will die from infection. And we made the diagnosis and I'm just like,

00:35:06.900 oh God, you know what we supposed to do with this kid? So anyway, we take the baby to the

00:35:11.560 bathroom. I said, we got to try something. So I mean, intubating an adult is hard. A baby

00:35:16.960 is really, really hard. And we managed to get the kid intubated. So I did intubate the baby,

00:35:22.300 started on the ventilated pelethean, went out, scrubbed for the case, came back. We opened the

00:35:27.340 baby up, did a bowel resection, put it back together, closed the baby up. And he did great.

00:35:31.300 He's a, well, how old is the baby now? He's a white baby. He's eight years old now,

00:35:34.520 eight, nine years old. So he's cruising. But that's kind of one of the many miracles we've seen.

00:35:40.160 And when these bits of shrapnel are going through people, I mean, you're seeing liver lacerations,

00:35:44.420 you're seeing bowel injuries, hemoneumothoraces, head trauma. I mean,

00:35:49.100 give me a sense of the mortality. There are some cases that obviously just can't be saved.

00:35:53.900 Right. Well, you know, I'll tell you, Peter, I think what happens, sometimes people say,

00:35:57.180 why do you have so many extremity traumas?

00:35:59.800 Because they're the ones that make it in.

00:36:01.220 They're the ones that survive. So, you know, the ones that get a really

00:36:03.980 terrible trapping with the chest, they bleed out in the field. Because we're, you know,

00:36:08.320 we're six hours. Sometimes these patients come a day. We've had people with penetrating abdominal

00:36:12.840 trauma with multiple holes in their intestines come three, four days afterwards and survive.

00:36:19.100 So imagine that you're, you're leaking, you're leaking feces into the abdomen for three or

00:36:24.060 four days. So imagine how strong these people are and they come and it's just a mess and you open

00:36:29.500 them up and, and some of them pull through, you know, anemic, dehydrated, they haven't eaten in

00:36:34.100 several days and these guys can survive. So some of it is the people are just tough as nails,

00:36:38.900 but we get a lot of penetrating. I mean, kidneys get torn to shreds, liver lacks, massive kidney

00:36:44.420 trauma, liver trauma. I remember one guy had, we counted, he had 23 holes in his intestines

00:36:51.200 that we had to, you know, resect here, resect there, stitch this one. It just took forever.

00:36:56.640 How did you learn surgery?

00:36:58.660 Right. So, you know, I trained in family practice and when I went to Kenya, we're doing a lot of,

00:37:04.320 you know, tons of tropical medicine, a lot of obstetrical care, did a lot of C-sections,

00:37:08.520 but I realized a lot of the disease burden in Africa was surgically related. A lot of it. I

00:37:14.660 mean, a lot of it, of course, is tropical medicine. Okay. You do all those things and

00:37:17.560 say, well, a good, seemed like half of what we were seeing was surgically related, either just

00:37:22.180 wound care, miscarriages, laparotomies, amputations, kind of the run of the mill kind

00:37:27.920 of surgical stuff. There's a lot of it. So I thought I really need to learn how to do this stuff

00:37:30.580 if I'm going to stay here long-term. So luckily where I've been, both rural Kenya and Nairobi,

00:37:36.700 I met up with people that were willing to teach me things. So really it was like doing another

00:37:40.960 residency. I mean, I would, I was in Nairobi, I had a whole day in the operating room and we'd do

00:37:45.240 tons of cases. And there was an American missionary doctor there named Mike Johnson. So I'm like,

00:37:49.020 would you sit there and teach me stuff? You know, I would, I would do the, just like he did in

00:37:52.140 residency. I would do the case, he would assist me and just kind of walk me through it.

00:37:56.860 There was a Kenyan surgeon there. Dr. Rucho was a fantastic, he was like a magician.

00:38:00.960 He was not so hands-on, but if he was always, he was there in the operating room. So he would say,

00:38:05.520 go ahead and start the case. After he had a little bit of experience, we'd say, start the case,

00:38:08.740 if you have problems, call me. So I'd start, open up, look around a bit, say, okay, I'm stuck.

00:38:12.580 What do I do? He'd come in, look around, say, I'll do this, do that. I'll do this and that. And

00:38:15.700 things would go ahead. Before you know it, you're doing thyroids and laparotomies and

00:38:20.460 resecting bowel and stitching liver and taking kidneys out and doing amputations. And I mean,

00:38:25.360 you know how it is, you just kind of, once you learn a few, you have a few skills, you can add the next

00:38:29.620 case, the next one, the next one. And I mean, it took, I was there for seven and a half years in Kenya.

00:38:34.520 It was like doing another residency.

00:38:36.440 I mean, at some point though, you have to be making mistakes that are harming patients because even in

00:38:41.260 our, and I say that not being critical, right. But just saying like, that's the nature of medicine.

00:38:45.500 I mean, I, I think of every time I hurt somebody, even, you know, I, I remember once causing a

00:38:51.060 hemopneumothorax in a patient when I put a central line in them, it was my 500th central line. So at

00:38:56.500 this point you'd think I could do it blindfolded. And yet to cause that complication, which in my case,

00:39:02.480 I'm lucky enough to have an x-ray to see that I've caused this complication. You don't even,

00:39:07.360 I mean, you're missing so many of the basic tools that could act as sort of a safety net.

00:39:12.120 So what was that process like?

00:39:14.680 I think what I wanted to make sure of when I was in Kenya, I think those whole

00:39:17.740 seven and a half years I was in Kenya, I always had either somebody assisting me in the case or

00:39:23.780 somebody in the room or in the next room over. So I think I was pretty well covered during that time.

00:39:28.380 And by the time I was finished seven and a half years, I felt pretty confident. I go out on my

00:39:32.820 own and do, and do surgery. I think it's this concept, you know, better than I do about 10,000

00:39:37.740 hours, you know, and I think in residency after like a thousand cases, it was like a thousand

00:39:42.160 cases at least, like that's like a minimum.

00:39:44.000 Yeah. Maybe 1200 or something.

00:39:45.340 Yeah. So I did, you know, by the time I finished my time in Kenya, I'd done.

00:39:48.340 But for you, it's harder because you're doing a breadth of cases that like, even if you took

00:39:53.360 something as broad as general surgery, I mean, you're still doing basically orthopedic surgery

00:39:59.120 as well and obstetrics.

00:40:00.960 Right. Tons of obstetrics, a lot of urology. There's a mix. And I think maybe the trade-off

00:40:06.520 is the surgery in Africa is much broader, but less depth. Like we don't have any laparoscopic

00:40:12.340 stuff. Of course we have any of the, these Da Vinci things and all that and all this high-tech

00:40:16.100 stuff. You trade off kind of depth of surgery for breadth. I felt after doing around

00:40:23.180 2000 C-sections and over a thousand other major cases, I felt, okay, I think I can do

00:40:27.880 whatever we're doing in Nairobi. I can do that. I think safely in Sudan. I mean, obviously,

00:40:33.300 you know, we have complications and other problems and there are a lot of limitations in terms

00:40:37.820 of going into the case. So you tend to do more laparotomies because you don't have a diagnosis.

00:40:43.340 You don't have a CT scanner.

00:40:44.340 Right. No CT scanner. You don't know exactly what's going on. To get a tissue diagnosis might

00:40:48.380 take you six months. So you say, go, Hey, let's do laparotomy and see what that thing

00:40:51.860 is. That's, that's your CT scan in the end, but that's about the best you can do. So I

00:40:56.780 think what I always, what I try to do when I approach a case is, you know, the premium

00:41:01.780 no known cherry first do no harm. So if you think you'll make the patient worse by doing

00:41:06.740 this, like, okay, I'm not an expert at doing this case. Um, and sometimes I say, I'm not

00:41:10.980 going to do it. You know, I won't, I won't do it up. If I think I really cannot improve

00:41:13.960 this patient's health, I think, okay, this is too much of a risk. Sometimes I say, look, I

00:41:18.220 just, I'm not really comfortable doing this, but usually I'll feel, I say, okay, I think

00:41:22.420 it's better if we try to do this operation. I think we can, the patient can improve and

00:41:26.580 we'll go ahead and it works. I mean, it normally works out pretty well.

00:41:30.520 I was talking with my wife and my daughter a couple of days ago and about how we were

00:41:34.560 going to be speaking today. And they had so many questions, you know, we all watched

00:41:38.020 the heart of new, but together. And, um, one of the questions my wife had was how do you

00:41:43.160 deal with exactly that type of situation you described, which is what we would consider

00:41:46.720 quote unquote end of life here in the United States or palliative care? What do you do

00:41:51.040 in a situation where somebody comes in and your judgment says this person is not an operative

00:41:54.920 candidate, but also by not operating, they need to be palliated. I mean, they're not going

00:41:59.440 to, they're not, it's not like, you know, they're going to walk home. How do you deal with

00:42:02.460 that? And more importantly, I guess, than medically, how you deal with that it's emotionally. And how

00:42:08.020 is that communicated to the community? Because you're still a foreigner, right?

00:42:12.980 Right. Right. I'm still a foreigner and will always be one. So

00:42:16.640 I would say when we first started 10 years ago, people did not trust us and it was incredibly

00:42:24.620 nerve wracking. Something we just got here. People did kind of have this cause they've

00:42:28.520 been, these people have been traumatized and oppressed for so many years. They're not

00:42:32.200 going to trust some foreigner showing up saying he's there to help them. So you got to prove

00:42:35.020 yourself. So I'm thinking, well, you know, I got them doing these operations. What if we

00:42:38.260 have bad outcomes? You know, what happens? So it was really nerve wracking for all of us.

00:42:43.540 And, you know, thank God things went pretty well and we went ahead. So the issue with palliative

00:42:49.200 care, you know, we try to just talk to the family, talk to the patient and say, look,

00:42:53.880 I think we can't do much for you. And so if you go home, we'll take care of the pain and

00:42:58.320 other things we can do. One good thing there is the people, their expectations are extremely,

00:43:04.440 are low. And I'm not saying that in a negative way, I'm saying in a positive way. They don't expect,

00:43:08.260 they don't really expect miracles. They want to be treated as a human. They want that human touch.

00:43:14.280 They want to, they want to talk to somebody, talk to you and say, okay, what, what can we do?

00:43:17.700 If you tell them, look, we can't do much. They're not, they're not saying, they're not like

00:43:22.080 demand, they're not very demanding saying, no, you got to get somebody to Nairobi for a second

00:43:26.240 opinion. They're very accepting. I think that's just because of their lives are, are, are very hard.

00:43:30.760 They're not used to good outcomes. So I think first off, they're, they're very accepting. So when you

00:43:35.520 tell them, look, I think there's not much where we can do, we often will talk to the relatives

00:43:38.540 culturally, usually the relatives will say, well, just, you know, they don't, they don't like telling

00:43:44.140 the patient, which is very different from here in the U S. So we just talk with relatives and they're

00:43:48.460 usually very accepting. They say, okay, we, you know, we see if done what you can, we'll take them

00:43:52.240 home and make them comfortable there. They have some of their local traditional things they might try

00:43:57.900 with the person at home, but they're usually very accepting of negative outcomes or bad news.

00:44:04.500 When you're kind of at the edge of survival all the time, when you get this kind of bad news,

00:44:08.880 it's not so shocking to you. It's like, well, you know, that's what happens. People die, you know,

00:44:12.080 and people have bad outcomes, bad things happen to you. So it's not so unusual for them. You know,

00:44:17.000 in the U S we're kind of anesthetized that everything has to be perfect and we're not

00:44:20.980 supposed to die. We're supposed to, you know, have this kind of outlook on life. It's, it's a very

00:44:24.980 different way of doing things. So they're fairly easy in that respect. They understand this stuff.

00:44:29.520 You know, most people have some level of faith, whether Christian or Muslim, they can accept this stuff

00:44:33.120 in a theological sense. Also, it's not so difficult. When you showed up, how primitive was

00:44:39.460 the extent to which people were receiving, I don't know what, how to describe the type of care,

00:44:45.100 but there must've been local traditions and shaman and stuff like that. Right. Right. And at some

00:44:50.480 point you're showing up and you're coming from a place of science as sort of simple as you describe

00:44:57.320 your work in medicine, it is still grounded in the fundamental principles of Western medicine.

00:45:01.300 You use antibiotics, for example, you wash your hands before you operate. What was the

00:45:07.000 landscape like as far as the other types of medicine being practiced and are they still being

00:45:12.260 practiced now? Yeah, they're still being practiced. So their scope of medicine, you have kind of the

00:45:17.780 local level in the home and what they'll do is almost any febrile illness. So some kids got a fever,

00:45:23.700 someone's got a fever, they burn the person so that everybody there, my wife included, they have burn

00:45:27.860 marks. They look like cigarette burns. They're not cigarettes, but they take a round thing that's

00:45:33.080 put in the fire and they burn on the back of the wrist, back of the neck and the elbows. There are

00:45:37.320 certain points where they burn the person to try to release the whatever it is, the spirit or evil

00:45:44.440 humors that are causing the problem. And when they see that kind of smoke and they see the fat under the

00:45:49.020 skin burning, they feel relieved. Okay, the thing is gone. Now I'm better. So they burn, they cut. A lot

00:45:54.720 of people have cut marks on their arms or abdomens where they think that'll also release things. So

00:45:59.360 they cut down to cause some blood loss. That'll release some of the problem. And that's usually

00:46:05.220 done in the home, usually by the father or the mother or the grandparents will do that kind of

00:46:09.700 thing. That's kind of the local treatment. That is still practiced, less so than when we came,

00:46:14.340 I would say. I mean, everybody, all of our staff have burn marks from when they were kids. Now we

00:46:20.160 still see patients come with the burn marks. Somebody comes with a simple malaria. They've

00:46:24.380 been at home four days and they've been roasting the kid. It's like, why, you know, just give us a

00:46:27.860 chance. Anyway, so burning, cutting, that's one level. They do have some herbal remedies that don't

00:46:34.360 seem that prevalent. They were there, I think, traditionally, some people still use those. And I don't

00:46:39.040 know, you know, some, they still swear by it. If you use the neem tree or this Kala, this plant that

00:46:43.420 they use for malaria, they still swear that that thing works for that. A lot of kind of local fruits

00:46:48.700 and vegetables they use for GI problems or other things. And those seem to work okay. And the third

00:46:54.860 level is what's called the kujur. Kujur is kind of like a shaman. And the kujur is like the priest for

00:47:03.020 the village. The traditional religion there is ancestor, kind of ancestor worship. It's communion

00:47:08.460 with the ancestors. So if you're sick, if you have a problem, whether it's physical, psychological,

00:47:13.340 whatever, you go to the kujur, you have a little ceremony with the family, all get together. Kujur

00:47:18.780 will talk with your ancestors and then kind of give your report back saying, well, your kid is sick

00:47:23.920 because your goats wandered on this guy's land and ate his crops. So you need to make up with this guy.

00:47:29.740 You need to go and give him something. And then you pay the kujur something. And then this thing is

00:47:33.180 kind of lifted. The child should get better. Those three things were kind of traditional treatment.

00:47:37.820 The kujur is still very, very prevalent in the society. And they still often go to the kujur

00:47:42.460 and they still will often delay treatment when they go to the kujur.

00:47:45.740 So how many people does your hospital serve?

00:47:50.140 The catchment area is roughly a million, anywhere from 750,000 to a million people is in our catchment

00:47:55.580 area. And the physical region is around the size of Austria, somewhere in that range.

00:48:01.340 The people there, for example, how many of the people that you serve would understand

00:48:07.820 what you meant if you were going to New York? Like how big is their world?

00:48:13.980 Well, it's, it's interesting you asked that. I mean, even the ones that have finished secondary

00:48:19.820 school wouldn't have an idea. Like if they ended up here or, I mean, it'd be, it would blow their mind.

00:48:25.020 Maybe I'll give you an example. My mother-in-law is probably in her seventies.

00:48:29.420 So we went to talk to, my wife was talking about writing a book. Actually, she started writing her

00:48:33.500 book and we went to my mother-in-law and we said, let's go and interview your mother as part of your

00:48:38.220 book. You know, I can write about her life. My wife didn't actually know a lot of facts about her

00:48:42.700 mother because they don't have that, you know, mothers and daughters there are not like buddy,

00:48:46.460 buddy. You know, the girls are, you know, once they, once they get weaned from the breast,

00:48:50.860 they start working, carrying water and firewood and everything else and cooking for the family.

00:48:54.220 So we went to talk to her mom and my wife asked her mother, uh, her mother only speaks the tribal

00:49:00.300 language. She doesn't speak Arabic or English or anything else. So we talked to her. She's talking

00:49:03.500 on the tribal language saying, do you know where Tom is from? And she said, she thought for a minute,

00:49:07.660 she says, he's from Kenya. And she said, that's the furthest place she can imagine.

00:49:12.780 Right. Because she's heard of Kenya. So in her mind, anybody who's not from Nuba

00:49:17.180 mountains must be from Kenya. It doesn't matter who you are, you know? So that's the outside world.

00:49:22.940 And we said, well, no, he's from America. You ever heard of America? No, she'd never heard of it,

00:49:26.540 had no concept of America. Have you ever, you know what an ocean is? No concept of an ocean,

00:49:31.020 no concept of a lake, no concept of Africa. She didn't know she was in Africa. So what she knew

00:49:36.700 was her local area is just a few of the villages there. She'd been to Khartoum once. She's,

00:49:41.980 my wife's mother has leprosy. We've treated her for leprosy and have amputated,

00:49:45.020 I think all of her fingers at one point or another. She's really quite disabled.

00:49:49.340 She had gone to Khartoum some years previously to get treatment there and ended up not getting

00:49:53.340 treated. But besides that brief trip to Khartoum, she'd never been out of that local area. A lot of

00:49:59.340 my wife's siblings have never been out of this 15 square mile radius. You can't imagine the worldview.

00:50:06.460 Presumably your wife also hadn't experienced things outside of that until she met you. And

00:50:11.580 what was the first time she left or traveled with you or the first time,

00:50:15.420 given, especially that you don't travel much.

00:50:17.020 Right. So the first time we traveled was after we married. It was just this past June. We went to

00:50:21.660 Armenia. So that was really her first time out of rural Africa. She'd been, she went to nursing

00:50:26.780 school, but that was in South Sudan in a while, which is, I mean, for, for South Sudanese, they

00:50:31.900 call it a city, but it's, it's a village, you know, it's a big village. So imagine we went from,

00:50:36.540 we went from a URFG camp down to Juba, which is the capital. I mean, Juba is more or less a city,

00:50:42.140 but it's really not very nice. Then we fly from Juba to Dubai and we were in the Dubai airport.

00:50:48.780 And I mean,

00:50:49.340 Which, which I was just there a month ago, even for someone who's from the United States,

00:50:53.580 the Dubai airport is an overwhelming.

00:50:55.980 Yeah. It's, I mean, it's, it's terrifyingly huge. It's a city. I mean, it's a, it's a major city.

00:51:01.100 So we get there and her eyes are, you know, the size of saucers.

00:51:04.060 Has she seen that much electricity in one place?

00:51:07.340 No. I mean, not even close, not even close.

00:51:10.220 Has she seen fresh water to that extent?

00:51:13.340 No. I mean, I try to think if she'd ever seen a tap. No, we had taps in the hospital. We have a

00:51:18.220 pump that pumps water up and we have some, some, uh, taps in the hospital, but you know, flush toilets

00:51:23.820 or she never seen before all this stuff. Elevators.

00:51:27.100 Elevators. So that was one of the things we get in there. We're at the airport. We get in this,

00:51:31.740 you know, pressure button, this door opens, we get this thing and press on the button and the thing

00:51:34.780 goes up and we get off. She's like, what was that? So no concept of an elevator. We've gotten

00:51:41.180 the escalator and she's like falling over the place. We go to get off the escalator. She's like,

00:51:44.620 what is the house? How's this thing moving? I think when she was in nursing school and wow,

00:51:48.300 I think they had one set of stairs. There might've been a second floor, but just the concept of walking

00:51:52.780 upstairs is something strange, little moving staircase. So all these things were very new to her.

00:51:58.780 Now we get to Armenia and I mean, just being in a city, I mean, the air van is the capital of

00:52:02.460 Armenia, not like New York, but very different experience for her. Now she came to the U S for

00:52:07.420 the first time just this past October. And I mean, she was in Times Square. I mean, saw the ocean for

00:52:13.660 the first time. She went to my brother lives in near Boston on North shore of Boston. So that was the

00:52:18.300 first place she went. So first place she went to, went to Boston and our hospital was getting an award

00:52:25.020 by a group called medicines for humanity, which supports us. And they were giving us an award for

00:52:28.940 the work that our outreach team is doing. So nobody could make it. You know, I couldn't go my,

00:52:32.940 you know, other staff couldn't go. So my wife went to accept the award on behalf of the staff.

00:52:38.700 So she lands in Boston. And the first thing she does is goes to the Harvard club to get this award.

00:52:43.740 It was a very opulent place. Right.

00:52:45.180 It was my brother's place. He's up in Rockport, Massachusetts, and sees the ocean for the first time.

00:52:49.340 She's a train for the first time, goes to malls, to Walmart, you know, she loved the dollar store.

00:52:56.380 And, you know, my family just went, went crazy with her. They had so much fun being with her,

00:53:01.580 you know, seeing all these things for the first time through her eyes. And, uh, I mean, she's very,

00:53:06.460 has a very kind of infectious joy to her and they really kind of tapped into that. And, uh,

00:53:10.940 it was really, and the flip side of that is we can sit here and have this discussion. And of course,

00:53:15.420 most of us would be thinking how amazing at all the things that they don't have, but I'll,

00:53:20.860 I'll share with you a story that I suspect will resonate and you will understand it. This past

00:53:28.060 Christmas, my daughter's school, each grade picks something they're going to do. And that grade

00:53:34.940 decided that they were going to buy Christmas presents for all of the kids at the Sudanese

00:53:42.060 community center in San Diego. And so they're basically all refugees. And this was very

00:53:47.980 interesting because we had already watched the heart of Nubo, which was her first time,

00:53:51.900 even I, she didn't know what Sudan was and she certainly didn't understand why there would be

00:53:56.860 refugees leaving this place. So on the day that we take all the presents there and the kids have done

00:54:03.900 an amazing job, right? They've bought like four or five presents for each and every kid there.

00:54:07.820 And we spend the whole day there. So we go, it's my whole family. So it's me and my wife,

00:54:12.860 three kids. And our youngest is like a year and a half old. So there's another little kid there,

00:54:18.540 a Sudanese girl, who's also about the same age. So the two of them are playing together, but you know,

00:54:22.780 you feel like you got to sort of keep an eye on them because they can fall off the stairs or hurt

00:54:26.300 themselves. So there's a woman that's holding the Sudanese girl and she's sort of keeping an eye

00:54:32.300 on our son as well. And so that gives us time to go and do these other things and see the other

00:54:36.060 kids and do all the other stuff. And about four or five hours later, when we're leaving,

00:54:41.500 my wife goes over to the woman who's has been holding this little Sudanese girl the whole time

00:54:46.060 and says, um, you know, what's your daughter's name? And she says, oh, I don't know. This is not

00:54:53.340 my daughter. I don't, I don't even know whose kid this is basically. And, and we couldn't stop

00:54:59.020 talking about that. Right. Which was talk about a different sense of community. Yeah. Right.

00:55:04.060 There was nothing odd to this woman who was probably 20 to just say, hey, there's like this

00:55:09.740 little 18 month old running around. I'm going to take care of her. And by the way, like she's taking

00:55:13.660 care of our kid too. Right. And, and so for as many things as they lack, right. They have something

00:55:19.660 we don't have. Right. That, that taps into Peter. Something you always hear about the negative side of

00:55:25.840 places like Sudan. People think of Sudan, what are the images? War, poverty, disease, starving kids.

00:55:30.180 The positive side is not shown. And some things that always stick in my mind. One is we'll have

00:55:37.660 patients that will come to us that it's a seven or eight day walk to reach us. And on the way,

00:55:43.240 like they'll start their journey and start walking. Now nighttime comes in the society there, you can

00:55:49.500 stop in somebody's hut and knock, you know, just kind of knock on the, whatever, or just show up and

00:55:54.840 say, look, I'm going, you know, I've got a long journey. Uh, would you mind if I, if I kind of spend the

00:55:59.640 night with you and I don't know where to stay? So that family will take this person and total

00:56:02.760 stranger, give him place to sleep, give him food, get some water for them to wash, take care of him

00:56:07.800 that night. The next day he'll continue on his journey. Next day, stop another total stranger's

00:56:12.200 place. That stranger will take this person in, give him some food, hang out this next day, same thing

00:56:18.280 until they reach the hospital. And this is the normal way of doing things there. The concept of

00:56:23.060 community and what stuff belongs to you. What is a stranger, totally different than our outlook here.

00:56:30.520 So when you're there like, well, geez, who's really, really has it all and who's doing the

00:56:35.340 right thing, which society is on the right track. You know, it's really, it's really mind blowing.

00:56:41.320 Well, especially for you, because I guess it's one thing to know nothing that, but, but you've seen

00:56:46.920 both worlds and I've read enough about you to know, I've seen enough interviews to know, I mean,

00:56:53.260 correct me if I'm wrong, but you've described being more at home there than anywhere else.

00:56:57.260 Right. Which I have to admit, you know, Tom, when I watch the videos of that, the first thought that

00:57:04.020 comes to my mind is not, I wish I was there. I realized that probably just speaks to me being

00:57:09.860 sort of a vapid, shallow person. But if I'm going to be brutally honest, right, I don't look at that

00:57:15.420 and think I want to be there. Right. I think I would never want to give up my family. I would

00:57:20.780 never want to give up my comfort, my safety, my whatever. You couldn't fake it. I mean, so it's

00:57:28.700 obviously so genuine for you and any, you know, the other people like John who are serving as

00:57:33.720 missionaries there. I know that on some level you'll say the answer is faith, but there must be

00:57:37.500 more to it than, than simply your faith. Well, you know, some of it, Peter, I think is just,

00:57:42.180 I think everybody is kind of geared a bit differently. So, you know, we grew up in a

00:57:46.940 big family and, you know, my brothers could never, could never be there, but at the same

00:57:51.840 time I could not do what they're doing. So I think, I think all of us are really, we're

00:57:55.180 kind of wired a bit differently, even people in the same family. So I think I'm very comfortable

00:57:59.740 there, but I couldn't maybe fit working in New York, you know, but I think the good thing

00:58:04.300 is I don't attach a value to all this. Everybody has something to contribute. I really, I really

00:58:10.340 believe that it's not just kind of blowing smoke. My thing is, is being there in the mountains.

00:58:14.840 You know, it's a, it's a part of the puzzle. Somebody else might be in New York, but you're

00:58:19.960 doing a podcast. You're helping us in Nuba tremendously by getting, helping get the message

00:58:25.280 out. You know, if you're in Sudan doing the same work I'm doing, we don't have this, you

00:58:30.520 know? So I think everybody has something to offer. And if we try to get in this thinking

00:58:36.540 like, gosh, I'm not doing what he's doing. I should be doing what he's doing. I think

00:58:40.320 we missed the point. We miss out on our shared abilities. You've got unbelievable talents and

00:58:46.300 a brain twice the size of mine and you're using it in an area that you are comfortable with

00:58:52.000 that is probably maximizing your abilities. I think it's good to be aware of what's going

00:58:57.660 on in the world and everybody should think about their brothers and sisters elsewhere and

00:59:02.680 contribute and do something to help other people. At the same time, don't, don't spend

00:59:06.940 too much time stressing that you're not doing enough or you're not doing anything, do something,

00:59:11.160 but it shouldn't be something which is agonizingly painful. You know, I think just the way I'm

00:59:15.420 geared, that kind of life is a pretty comfortable fit for me, you know? So I don't see it. Yeah,

00:59:20.520 it's a sacrifice. It is. And, uh, I miss the family like crazy and I'm missing a lot and

00:59:25.480 not being with my, you know, it's been more than three years since I've come here. I'm missing

00:59:28.860 my parents, my nieces and nephews, my brothers, my sister. I do. I miss all that stuff, but I'm

00:59:35.340 pretty comfortable in that, in that weird remote setting in the mountains.

00:59:40.140 So I learned about you through my really dear friend, Rick Gerson, his brother, Mark Gerson,

00:59:46.840 and ultimately met John. And, and, and I think they learned about you through a piece that, uh,

00:59:51.840 Nick Kristoff wrote in the New York times in 2015. How did Nick come to find you? Because that story,

00:59:58.260 we're going to link to that story. The story is amazing, right? It leads off with about a 10

01:00:02.400 minute video that I watched over and over and over again. And I came home and I made my family watch it

01:00:11.280 and I sent it to my family back home. And there's a part in it that just says everything about it.

01:00:19.280 I mean, first of all, I think Kristoff did an amazing job framing the story and he was there,

01:00:24.420 which is in and of itself, I want to actually understand how someone actually gets there.

01:00:28.620 Cause that's, that's, that strikes me as quite a challenge logistically, but he ends the article

01:00:33.460 with a story of a Muslim man who proclaims that you are Jesus Christ. And I always, that's the title

01:00:40.480 of the article, if I'm not mistaken, he's Jesus Christ, which coming from a Muslim man also speaks

01:00:45.700 to the religious harmony that you've described. Right.

01:00:48.260 And for people like me who aren't especially religious, it makes you think, well, I guess

01:00:53.920 that's what religion should be about, right? It shouldn't be about most of what we think of

01:00:59.180 religion as religion has, has its taboos here. But I think the point Kristoff makes and makes it

01:01:05.100 beautifully is if you want to be critical of all of the religious hypocrisy, by all means do so,

01:01:10.180 but you can't then fail to acknowledge the times when in the name of religion, people are doing

01:01:16.300 these incredible things in the name of all religions, by the way, it's not just your

01:01:19.480 religion. I mean, as you know, it's, it's people of all faiths that are doing these things.

01:01:23.620 But in many ways, I think that story brought amazing attention to your work that it breaks

01:01:28.480 my heart to think, are there other Toms out there whose stories are not being told? So how

01:01:32.740 did Kristoff find you or how did you guys find each other?

01:01:34.740 He has an interest in Sudan. I think he's had it for a number of years. And I think for him,

01:01:40.860 he saw this, what Bashir was doing as such an egregious affront to humanity that he felt

01:01:46.300 obligated to go and see firsthand what was happening. So he made a couple of trips into

01:01:50.000 the mountains. You can fly into Juba. Then he got a flight up to the refugee camp in Ida

01:01:53.760 and then managed to come into the mountains. You know, you don't come in with official

01:01:57.660 permission of the Sudan government.

01:01:59.040 So you're sneaking into the country.

01:02:00.480 Right. Basically sneaking in, you get a permit from the rebel government and they allow you

01:02:04.100 to come in. And I think he just has an interest in that, in that part of the world and really

01:02:08.840 wanted to do something that shed light on the situation there against Bashir. And he'd been

01:02:14.040 to Nuba, I think one previous time and heard about the hospital, wanted to come and see

01:02:17.780 us there and see what kind of work we were doing to see for himself and was there for

01:02:22.040 a few days. I mean, he's a really intrepid traveler and incredible journalist. I mean,

01:02:26.680 he's unbelievable. And what I respect about him the most is he can disagree with you,

01:02:32.320 like, you know, whatever, religiously, politically, not agree with your beliefs, but he can realize

01:02:37.960 what you're doing has benefit. He can look at it objectively and say, okay, you know,

01:02:42.220 I don't believe in this religion, but I see what these guys are doing and highlight that.

01:02:46.540 You know, not many people are willing to do that.

01:02:48.500 I thought it was very elegant how he framed that in that piece in the New York Times.

01:02:52.520 And that video, though, it's only about 10 minutes. That was really my first introduction

01:02:56.740 to you. Oh God, it's about three and a half years ago now.

01:03:00.160 So the world's a better place. Certainly the Nuba mountains are a better place because of

01:03:04.100 Nicholas's work.

01:03:05.460 Right. And he tends to highlight people that are kind of not well-known. And there are others

01:03:10.520 that are out there. And that's actually part of what we're trying to do now with Aurora.

01:03:14.720 Aurora's focus is on highlighting what they say is unsung heroes, but people that are kind of

01:03:19.880 operating in the weeds that nobody knows about. So shine a bit of spotlight on them,

01:03:24.700 not so much for publicity, but to help them both in their work and to raise,

01:03:28.460 by raising their profile, you raise the issues that they're involved with.

01:03:31.500 So tell people a little bit about what the Aurora prize is and what it means for you to now be,

01:03:37.100 you're the 2018 recipient. Is that right?

01:03:39.980 2017.

01:03:40.440 2017 recipient. So what is the Aurora prize? I know it's based on, I know a few things about it. So

01:03:45.620 I'll fill in the little bits that I know. It's a prize that has a finite life, correct? It was

01:03:49.700 began in 2015 or 16, and it will run until about 2022, 23. And that duration, if I recall,

01:03:55.560 is meant to commemorate the length of the Armenian genocide in 1911-ish, 1915.

01:04:00.660 Well, it's 100 years onward. The genocide went on for about eight years, from 1915 to 1923. So

01:04:06.040 this is 100 years, henceforth, those eight years, those eight years, the Aurora prize will be given

01:04:11.240 out.

01:04:11.600 Yes. And it's a substantial prize. You were selected. And my understanding is, first of all,

01:04:20.460 it takes an act of Congress to get you out of Nuba to be doing this other work. But it speaks to,

01:04:25.260 I think, your understanding of how valuable this will be to the broader mission that you're serving.

01:04:31.280 Right. What I saw was, I'm very comfortable being in Nuba and doing the everyday medical work.

01:04:37.040 And I definitely want to go back to that environment longer term and get involved more

01:04:42.240 with teaching the local people. And when these guys, once these guys come back from medical school

01:04:45.800 that we have out there, really working with them to get their skills up. But I thought,

01:04:50.660 maybe using Aurora as a vehicle, it was time to come out to kind of see what was out there

01:04:56.880 with Aurora to try to expand the model that we have in Nuba Mountains. So find a way to bridge the gap

01:05:03.960 between, say, big donors or people that have resources and small organizations, small people

01:05:11.480 on the ground that are kind of doing a lot of the grassroots work and doing it very efficiently.

01:05:15.900 Because I think there are a lot of other people that are doing the work nobody knows about.

01:05:19.480 And there should be a way to try to connect them to resources. So through Aurora,

01:05:24.320 that's one of my main goals. I wanted to come out and try to expand what we're doing. I felt that

01:05:28.940 we're in Nuba doing our thing, but maybe a little bit pigeonholed. How do we expand that and get

01:05:34.520 outside of Nuba, get into South Sudan, to Central African Republic, to Chad, to Niger, other places,

01:05:39.460 which are really neglected parts of the world, hopefully into some conflict zones. That was my main

01:05:44.960 thinking coming out. And my time now, I've got three months out of Nuba Mountains. I'm traveling

01:05:49.280 all over the place, speaking on behalf of Aurora, kind of doing some, basically some promotion for

01:05:54.700 them, but also meeting a lot of people and trying to formulate which direction we need to go in

01:06:00.140 Aurora. So I'll be physically out for these three months. It'll be three months later in the year

01:06:04.540 from September through November. Besides those two or three-month periods, I'll be back in Nuba

01:06:08.740 mountains and do my usual work at the hospital.

01:06:10.820 What does more money solve in this problem? I remember recently, Mark sent us an update about

01:06:16.360 sort of where the dollars were going. And it was sort of hard to believe that so much could be done

01:06:21.080 with so little. And I don't think the stats are, I think they're so overwhelming that it's almost hard

01:06:27.100 to put it in context, but it's worth trying. For about a million dollars as an annual budget,

01:06:34.060 what have you been able to do in the past year?

01:06:36.500 A million dollars is pretty generous. That's probably more than we'd need for the basic work,

01:06:42.200 but let's say if it's a million dollars, we can see about 130,000 outpatients.

01:06:47.420 130,000?

01:06:48.660 130,000 outpatients. Do close to 2,000 operations. See maybe 5,000, 6,000 inpatients. I mean,

01:06:56.780 vaccinate tens of thousands of children. See, I don't know, I'm not sure what numbers of maternity

01:07:02.700 antenatal clinic patients, but a lot, several thousand maternity patients for that. A lot of

01:07:08.480 that million dollars, I mean, most of that, gosh, I think it's, the number that comes that I use is

01:07:13.220 about 750,000, but somewhere between 750,000 and a million, if I'm being conservative. If someone

01:07:18.400 gave us a million bucks, we could easily run the hospital for a year and probably expand quite a bit

01:07:24.040 of what we're already doing. That'd be a very generous amount of money for us for one year.

01:07:28.760 Which is very interesting. Anyone listening to this who has some understanding of the economics

01:07:33.120 of the US healthcare system would find everything you just said to be sort of comical because just

01:07:39.460 the costs here are so artificial and so inflated and so ridiculous. Now, when you think about where

01:07:47.040 those dollars go, I mean, how do you get these supplies? How, I mean, where do these things come

01:07:53.240 from? I remember once asking, I knew somebody who was, I think, on the board of Doctors Without

01:07:57.960 Borders and I said, hey, how come you guys aren't in Sudan? You know, because I remember once reading,

01:08:02.820 you guys couldn't even get certain vaccines and antibiotics. You just physically couldn't get the

01:08:06.920 supplies. Right. So you're really doing the work that nobody else can do here. Yeah. It's tricky. I

01:08:12.980 mean, our number one problem, when people say, what's your biggest problem there? I always say

01:08:17.160 logistics. It's the hardest thing because- You don't have infrastructure. Infrastructure is not

01:08:21.960 there. And if we want anything, you want chemotherapy drugs, you want antibiotics, you want

01:08:26.980 a roll of gauze. You've got to buy that in Nairobi. Nairobi is two countries away. It's South Sudan and

01:08:31.620 Kenya. So it's got to come from Nairobi. Like this past shipment of drugs came from Nairobi by a truck

01:08:38.580 up to, actually through Uganda, up to the border with South Sudan, where they just harassed the heck

01:08:44.460 out of the drivers and all kinds of paperwork. You have to bribe the guards? You've got to bribe the

01:08:48.880 guards and they give you a hard time and they won't like, they don't want you going through. And they

01:08:52.360 say, no, it's always, they're always changing the rules. You know, so you know, there's a duty. You've

01:08:56.320 got to have all this paperwork. I mean, just reams of paperwork to get this stuff through. So we've got

01:09:00.940 some people that are in Juba that don't actually work for us, but work for the church that help us

01:09:06.420 through all this process to get this truck through. Now, from there, there are, I don't know, 30 or 40

01:09:12.240 checkpoints from the border of Uganda and South Sudan up to the refugee camp in Ida. And it takes a few

01:09:17.680 weeks. It takes about three weeks to get up there just because of the checkpoints and the delays and

01:09:21.680 everything else. It can take three weeks to get up to this refugee camp in Ida. Then from there,

01:09:26.460 it's offloaded. We've got to go and pick it up. We've got to find a way to get it from Ida up to

01:09:31.340 our place. Wait, not you personally. No, not me personally, but we've got to get some trucks or

01:09:36.900 something to go down there and pick it up or find someone that can carry it up, carry it for us.

01:09:41.300 And that's about six hours. It's not really a road. It's a dirt track. I mean, there aren't

01:09:47.900 roads there, these terrible dirt tracks you get from Ida up to where we are. That's about six

01:09:52.760 hours and the best day just during the dry season. So rainy season, which runs from about June through

01:09:59.140 October, you can't go with the trucks. You can't really even go with a, like a land cruiser. Usually

01:10:05.700 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

01:10:09.740 bike and that can usually get you in or out. But sometimes even then, if it's a flash, if it's a

01:10:13.820 heavy rainfall and you have a flash flooding, these dry river beds, if that fills up with water, you

01:10:18.920 got to wait. Maybe have to wait a day, a few hours. So in the hospital on any given day, how much do you

01:10:26.680 have in terms of IV fluids, gauze, antibiotics, soap? Right. I mean, things that we just, we can't even

01:10:34.040 imagine not taking for granted in an American hospital. Right. I mean, if we have, if this truck makes it

01:10:39.400 through, cause we make our order and we make a fairly generous order just cause we know it's so

01:10:43.160 difficult to get stuff out there. If that stuff makes it all through, we're in pretty good shape.

01:10:47.120 For how long?

01:10:47.820 For a year. So we try to make it one full year on that supply that gets sent in. And the problem

01:10:53.720 comes cause sometimes you order stuff in Nairobi and it's not in stock. And you know, you just can't,

01:10:58.320 you can't order one-off things. There's no, there's no system to get stuff up to us.

01:11:02.240 That's really hard. If you can't load everything on that truck for this one go,

01:11:05.920 we're a bit stuck. And we've got to really be creative trying to get these other small things

01:11:11.380 up. Is there like a chief logistics officer that is in charge of the ordering and the procurement

01:11:16.840 and the management of this product? Cause that sounds like a, I mean, that's a, that's a bottleneck,

01:11:21.600 right? Yeah. It's a, it's a terrible job. So John Fielder through F commission healthcare has a woman

01:11:26.580 who's in his, he's gotten off a small office in Nairobi. They got a few staff. So she did all of our

01:11:30.920 procurement. So we sent her the list of things we needed. I mean, it's, it's, it's a lot of items,

01:11:35.880 a lot. So she has to go out and source all this stuff and get it in Nairobi from a few different

01:11:40.920 vendors, get the trucks or less stuff, get it through. We've got a couple of people in Juba

01:11:46.040 that help us with logistics that are not employees of ours, but they're just kind of, they're helping

01:11:49.840 us out, just kind of random people and they can help shepherd that stuff through. But it's,

01:11:54.160 it's, it's really, really difficult. It's a lot of work for those people.

01:11:58.040 What does the pattern of mortality look like in Nuba? My guess is infant mortality must still

01:12:06.320 be quite high. How much of that is due to challenges with prenatal care versus the actual

01:12:13.980 deliveries and postnatal care? I think a lot of the neonatal deaths are just from difficult

01:12:19.800 deliveries. You know, they're, they're maybe gets asphyxiated, maybe he's born and dies.

01:12:24.540 Is there, is a stillborn or dies soon after birth? And there are very few deliveries done. I mean,

01:12:31.680 99% of women there still live at home. To deliver in a clinic with maybe a traditional birth attendant

01:12:37.300 is rare, let alone in a hospital. So I think a lot of it is just due to, you know, most of those people

01:12:43.680 probably would end up in a C, with a C-section if they were at a hospital in the U S or even in

01:12:46.920 Kenya. If they had access to care or they would have the C-section, you know, we have one place

01:12:50.820 doing C-sections or actually two now that do C-sections. How many, how many babies do you

01:12:54.160 deliver in a typical year? I think there are maybe three or 400 in our hospital, somewhere around

01:12:59.260 there. I became the exact number. So it's, it's, you know, it's really, it's not, it's a very small

01:13:05.920 number compared to the number of deliveries. So the vast majority of women still deliver at home.

01:13:11.960 And, but you're doing presumably more of the high risk ones. I mean, if, if, if a child is breached,

01:13:17.180 is there, can you deliver a breached baby at home? That's saying the risk would be enormous,

01:13:22.940 right? Some make it out, but a lot of those babies are going to die because they just get,

01:13:26.520 they get stuck. They get asphyxiated and the baby dies. So, I mean, when we do our antenatal clinic,

01:13:31.780 you know, these women will come and they, the midwife there fills the cart out for them.

01:13:35.480 So, okay, they've had 10 deliveries and four living children. You know, this one died at birth.

01:13:40.360 This one died at birth. This one died from diarrhea. This one died from fever, you know,

01:13:43.520 this kind of thing. So it's a lot of. And what about the mothers? What, what, what is the

01:13:46.480 maternal mortality? Like, I don't know. And that's something I really wish I could have a grip on

01:13:51.220 because you hear occasionally, you know, we don't, it's not, it's not that often we hear about it,

01:13:55.120 but once I hear, oh yeah, this woman died from, she bled to death, you know, after giving birth to

01:13:58.480 the baby at some remote village, there's not really, it's so remote and people are so spread out.

01:14:04.060 There's not really a system to collect that kind of information. So I don't really know. It's got to be,

01:14:09.020 it's got to happen. Cause you know, we have a lot of women that we ended up doing C-sections on that

01:14:12.900 would have died without that. Yeah. You know, they've, you know, how many times the baby is

01:14:17.160 stuck? Well, it's already septic and you know, we have to do a C-section or something.

01:14:21.680 And this says nothing of preeclampsia and all of the other things that would just show up even

01:14:26.200 under the most normal, you know, circumstance. Right. And getting women with eclampsia is not

01:14:30.280 uncommon. So if you get eclampsia at home, especially young, you know, most of them are primates that are

01:14:35.240 very young. They're not going to survive when they start convulsing. And to get to us is a chore.

01:14:39.560 I mean, it's really hard to reach us. What are the patterns of diseases like there? I mean,

01:14:44.580 when, when we're watching, and again, I keep mentioning this because it's just such an

01:14:48.460 important film, the heart of Nuba, you see these things that you're doing, Tom, that just,

01:14:54.200 I mean, they blow my mind. And maybe because I know enough about medicine that I can watch what

01:15:00.240 you're doing and appreciate, you know, the partial nephrectomies you're doing on kids with,

01:15:04.620 you know, tumors in their kidneys. And like, how did you even learn to do that operation?

01:15:10.040 Even within the realm of surgery, that's not a trivial operation to do on a child that size.

01:15:15.360 Yeah. I'd done some nephrectomies before, total nephrectomies on for tumors or for trauma or for

01:15:20.280 whatever. So meaning remove the whole kidney. Remove the whole kidney. So I wasn't so worried

01:15:23.800 about that, but I was worried about was the other, the other kidney. It's harder to take part of the

01:15:27.380 kidney out because you have to be able to preserve the blood flow to the part that remains. Right.

01:15:31.060 And you, you know, they can bleed in that. So if it, if it was just say a tumor was partially involved in

01:15:34.620 the kidney and say you're doing the operation and you can't stop the bleeding,

01:15:37.000 your backup is just to take the whole thing out, but you couldn't do that in this case.

01:15:40.920 Cause this child had one kidney that had to fully come out and then there was a partial. So you

01:15:45.380 basically, this kid would die if you couldn't save half of the remaining kidney.

01:15:50.280 Right. Exactly. So it was a lower, the tumor was in the lower pole of the kidney. So we had to take

01:15:54.060 out half the, half the kidney. So there was a visiting, actually a visiting as a friend of mine

01:15:58.420 was who was visiting. He's a family practice doctor. Corey Chapman was there and we were talking

01:16:02.280 about this case and going back and forth. And he said, let's look on YouTube if there's something

01:16:05.760 because I read, reading about it and everything I was reading was talking about all these fancy

01:16:10.480 things. You know, there's some kind of a slush, like an ice slush that you have to bathe the kidney

01:16:14.820 in to get the metabolism weighed down. So you can do the operation, just different things we didn't have.

01:16:20.280 So we looked on YouTube and I'm just, when I think about it now, I wonder how we did it because

01:16:25.420 normally we can't watch YouTube there because we have internet, we have a satellite edition internet,

01:16:29.300 but the speed is very, very slow. So normally we can't watch any videos cause it's just too,

01:16:33.360 it's just too slow. But for some reason we were able to see this video and it was this group of

01:16:38.840 Polish surgeons that were doing the partial nephrectomy and with a fairly low tech approach.

01:16:44.040 So we watched that and said, okay, I think, I think I can do it following what these guys are advising.

01:16:48.120 We kind of followed their system, managed to put these sort of buttresses like on the,

01:16:53.960 on the lower pole, the kidney to kind of staunch the bleeding and it worked and the child did very

01:16:58.080 well. That was helped by YouTube. I mean, I think that really helped us out in that case.

01:17:03.240 Like the Khan Academy of Surgery.

01:17:05.420 That's right.

01:17:06.120 How long do you just spend rounding? I mean, how many inpatient beds do you have in this hospital?

01:17:10.420 Yeah, it's 435 beds.

01:17:12.400 And what's your typical capacity? I mean, your typical utilization, how many patients are in there?

01:17:16.820 I mean, it's, it's about a hundred percent occupancy. It's, it's a bit less now than it

01:17:20.760 was saying the peak of the fighting. And the peak of the fighting, it was crazy. It'd be five,

01:17:23.960 500 people there, 550. So there were, you know, several children's war, several to a bed.

01:17:29.160 We have wounded all over the place. I mean, not even in beds, just wherever we could, we could fit them.

01:17:34.240 It looks like when you see movies in war zones and you see the tents that are serving as,

01:17:41.440 you know, hospitals and you just see amputation, nose completely missing, you know, sort of the

01:17:49.580 most gruesome things. That's what it looks like you're in. I mean, you are literally in a war zone.

01:17:54.980 Right. I'm thinking back to residency. If we had to round on 20 patients in the morning,

01:18:00.860 we were moaning and groaning like it was going to be the end of the, oh my God,

01:18:05.700 I'm not going to have time for breakfast today before the OR. I've got to round on 24 patients.

01:18:11.180 Yeah.

01:18:11.780 So you're rounding on 300 patients. I mean, I don't even know how you do that.

01:18:15.980 Now probably 300. Those days was more. I mean, I remember one time we had this measles

01:18:19.560 epidemic and just on children's ward, we had 225 patients. So a hundred normal cases,

01:18:26.240 malarious, bowel obstructions.

01:18:27.760 You don't have vaccines, I'm guessing. Is that the reason the kids all get the measles?

01:18:31.300 Well, with the first three years of the fighting, we didn't have them. So the usual provider

01:18:34.560 stopped providing them. The usual big organization that provides them stopped providing the vaccines.

01:18:38.960 Why? Just logistically couldn't get them in?

01:18:41.840 Logistically. And they, we were in rebel held territory. And a lot of these people,

01:18:46.160 large big organizations don't want to violate the sovereignty of the, of the host government

01:18:51.440 by providing something as simple as vaccines. This is just how it is, which really shocked me.

01:18:56.420 The sovereignty of a government that kills its own people needs to be respected.

01:18:59.940 It's the theater of the absurd. It's crazy. So yeah, I mean, runs were just,

01:19:05.540 they would take hours and we started at seven 30 in the morning and two o'clock I'd be finishing up

01:19:09.680 and just try to get through all those people.

01:19:12.120 But then you're, aren't you being interrupted every hour by some trauma that comes in?

01:19:15.740 Right. There's stuff coming in. There's stuff, there's other emergencies. I mean,

01:19:19.500 the other stuff was still coming. I mean, somebody comes in, a woman comes in who's

01:19:22.840 having a miscarriage, who's bleeding. We have to break into a C-section on somebody who can't

01:19:26.360 deliver. So all this stuff was still going on. It was, it was pretty crazy. I mean, it was,

01:19:32.080 you really had to just go as fast as you could. And it was a lot of just putting out fires and we

01:19:36.820 weren't, we weren't able to spend a lot of time with these patients, obviously. It was really,

01:19:40.000 had to go pretty rapid fire through all those cases. It was exhausting. Psychologically, it was,

01:19:44.960 it was rough.

01:19:45.780 One of the other questions my daughter wanted me to ask you is, what's the most afraid you've ever

01:19:51.540 been there? You know, she was sort of taken aback and we told her before the movie, I said,

01:19:56.860 look, Olivia, this is, uh, this isn't a Disney movie. You're going to see people getting killed.

01:20:02.280 You're going to see bombs dropping on innocent people and it's not a movie. It's real.

01:20:06.480 Right. So are there times when you are just afraid for your own safety?

01:20:11.700 Yeah. You know, I think every time they bombed the hospital twice and they bombed our local region

01:20:16.540 kind of within a half kilometer, several times. So the first time the area was bombed or we were at

01:20:22.040 church and the church was just outdoors. It's not really a church. It's kind of outdoors thing. And

01:20:26.280 we're finishing up and the, the catechist was up there talking to people and we heard the airplane

01:20:30.380 overhead. We were used to it because every day their plane came overhead, but we'd never been,

01:20:34.580 or immediate vicinity, they'd never been, and they've been bombed. So we just got out of the

01:20:37.360 airplanes overhead. It's going to bomb somewhere. And is that because you had this belief that said

01:20:41.300 even these people as wicked as they are, wouldn't actually bomb a hospital? Is there some sort of

01:20:48.000 view of, we'll respect at least one sanctity of life? Yeah. So that was, that was the bit in the

01:20:53.040 back of our minds and we hadn't been bombed yet. This was, this was a couple of years into it.

01:20:56.680 All right. We hadn't been bombed directly. There weren't commercial flights. So anytime you heard an

01:21:00.400 airplane, it was going to bomb somewhere. And then we hear the, we hear the airplane,

01:21:03.620 then invariably a few hours later, wounded would show up. They bombed somewhere and people were

01:21:08.200 wounded and wounded show up. This day it was a bit different. We hear the airplane overhead

01:21:11.860 and the mass was over and kind of, we're standing there. All of a sudden somebody says, everybody

01:21:17.880 get down. So we, we just dive on the ground. It was lying flat. And I heard the airplane drone

01:21:23.500 overhead, you know, this Antonov sound. Then I heard the, the pitch change as far as high pitched,

01:21:27.460 like a whirring sound, almost like a jet engine noise. And then boom, this incredibly loud explosion.

01:21:34.040 It felt like it was two feet away. I mean, it was like half a kilometer away. It wasn't right,

01:21:37.780 but it was so loud. And it circled again. Then I realized that what that whirring sound was,

01:21:43.760 was a sound of the bomb falling through the air. So then I, now, so now I know what that sounds like.

01:21:49.760 Then it's happened six, it bombed six times. You kept hearing this thing, comes around again,

01:21:54.120 bums. And you're lying there, terrified thinking, you just, you feel like you want to burrow yourself

01:22:02.380 into the ground and disappear. You know, you're just lying flat, exposed thinking what, you know,

01:22:07.640 what happens? And the thinking is not even so much being killed, but what if, what if my, you know,

01:22:12.760 what if my leg is blown off or my arm gets blown off? You have no control over this. You're totally

01:22:16.620 at the, at the mercy of these people. And you feel like you're, you feel like you're just an,

01:22:21.640 like a hunted animal. That's the, that's what I felt like. I feel like I'm, I'm a hunted animal.

01:22:25.940 And at that time, since we hadn't been bombed, we didn't have the, the foxholes dug around.

01:22:31.480 So immediately after that, we went and we dug foxholes all over the hospital grounds.

01:22:36.640 And that's what you see in the film. There's actually one point when you're being interviewed

01:22:40.080 and the bombs start coming and you guys have to jump into these foxholes.

01:22:43.140 Right. Right. And then another time we were bombed. I was in the hospital

01:22:45.880 hospital and just down on the, on the floor of the hospital, you know, and you're thinking,

01:22:50.560 well, you know, we just, you're just thinking this, this might be it. This thing might,

01:22:55.540 cause you can't tell where it's going to fall. You hear that whirring sound.

01:22:58.920 And when you hear that whirring sound, you don't know if that's going to fall on top of you.

01:23:01.540 If it's going to fall right next to you and, and, and just then shatter your body.

01:23:05.260 You have no idea. So it's really, it's, it's really terrifying. I mean, there's no other

01:23:10.380 way to describe it. And I mean, you know, when you see this stuff that's happened in Syria,

01:23:14.980 people living in these cities, I mean, you can, you can imagine what that is like.

01:23:20.180 And the kids that were in that situation, that's something will never, never outgrow that fear

01:23:24.260 and that feeling of, of being bombed. You really, you feel like you're a hunted animal. I think

01:23:28.760 it's the closest thing I can, not that I've ever been hunted or I'm an animal, but you just feel

01:23:34.460 like, I remember thinking to myself, we were down, this is after, this is a few bombings later,

01:23:40.300 we were down in the foxhole. And there was a Sukhoi 24 jet going overhead. A Sukhoi 24 is a

01:23:47.440 supersonic jet bomber, you know, bombing villages, you know, huts. I'm thinking, what are these

01:23:52.440 people doing? I remember thinking to these guys, I said, how can they bomb us? Don't they know

01:23:57.300 there are people down here? That's what I felt, you know, like it was some exercise where they

01:24:01.200 made a mistake. And of course they knew exactly there are people down there. That's why they're

01:24:04.920 bombing, you know, but I, I really hope someday I will meet these pilots. Not that I don't even

01:24:11.960 feel any animosity towards them. The feeling is never as strange. You don't feel anger. You don't

01:24:16.440 feel animosity towards these people, just kind of wonderment. Like, what are they doing? Like,

01:24:20.260 why are they doing this? So I would love to meet these guys someday and say, what, what were you

01:24:25.720 thinking? You know, what, what'd they tell you before you did your mission? You know, I was a flight

01:24:29.100 surgeon in the Navy. So I know you have a briefing before the pilots fly out. They discuss the

01:24:34.780 mission. Today we're going to fly here. We're going to bomb this target. This is our objective.

01:24:39.400 What were you told in the briefing room? They say, okay, today you guys are going to bomb a hospital.

01:24:44.060 There are a bunch of civilians there. I mean, presumably if you're, if you're trying to put

01:24:48.920 your psychology hat on, you have to believe that they are being told that the people that they are

01:24:54.840 bombing are somehow a threat to them or their sovereignty or supporting rebel. I mean, you,

01:25:00.640 you'd have to concoct a story that's so orthogonal to the truth.

01:25:05.180 Right. Maybe that might be it. Because I mean, after one of the times the hospital was bombed,

01:25:08.880 one of our staff heard a, a radio broadcast from El Abed, which is a city in the North.

01:25:15.440 And, um, the way they portrayed it on this radio was they admitted they bombed a hospital. They said,

01:25:20.680 we bombed an American church hospital in Cauda, which is the kind of capital of the rebel held

01:25:25.660 territory. Hospital taking care of the rebel soldiers. That's how it's portrayed. So you're

01:25:32.740 an American hospital and America of course is a great enemy. It's a Christian hospital. Therefore

01:25:37.660 they're no good. And it's taking care of rebels. Taking care of rebels. So you're, you're justified

01:25:42.560 in this, in this act. And my guess would be, that's what these guys were fed. Who knows that the

01:25:48.700 pilots were true believers. I know, worked with a lot of pilots in the U S military and they would,

01:25:52.980 they would not go along with the mission that they said, you're going to Obama hospital with

01:25:56.700 civilians. They wouldn't do it. I would say, look, man, we're not doing this. I know these guys,

01:26:00.880 they were not, uh, these guys, they love to fly and they love the country, but they were not

01:26:04.280 interested in killing civilians. And, uh, I still hope someday I can meet these guys and just have

01:26:09.940 a talk with them. And, uh, just to know what they were thinking and what, what went on in their

01:26:15.240 brains, like whether they know this, how they feel about it. I'm just interested what they would,

01:26:19.240 what they would say. How do you cope with what I could only imagine is stress and anxiety aren't

01:26:28.000 the right words, but just sort of the gravity of it. Like, you know, when you describe a day in your

01:26:32.380 life, you know, getting up at five 30 in the morning, making rounds at seven operating. If you

01:26:38.880 said, Peter, you got to go do this for a month. I mean, first of all, I could provide no assistance

01:26:44.120 to you. That's the unfortunate reality. Despite my medical training, I'll, I would, I mean,

01:26:48.880 I could, you know, put IVs in patients and that's about, I mean, I, I don't think I could

01:26:52.800 provide any benefit, but let's assume I could even magically provide benefit. I can't imagine

01:26:59.500 how physically, but more so emotionally exhausted I would be at the end of 30 days.

01:27:06.540 Right.

01:27:07.200 Even thinking back to my training where, you know, you'd have every other night call,

01:27:13.100 but on one of the nights in between, you didn't get to go home. And so you've been in the hospital

01:27:16.360 for three and a half days and it's been one trauma after another. Like even that feeling

01:27:22.300 is just, as physically tired as you are, there's something different going on, which is just

01:27:26.320 an emotional depletion.

01:27:28.600 Right.

01:27:29.420 So to imagine that you're now eight, no more, you're coming up to 11 years into this, and

01:27:37.000 this is just in Sudan.

01:27:38.360 Right.

01:27:38.620 I don't understand how you can do that.

01:27:41.680 I think it hit the nail on the head. I think probably the emotional trauma and upset is

01:27:46.520 probably worse than the physical degradation your body takes by just always being on call

01:27:50.820 and just, even when you're not called at night, it's hard to sleep. You know, always

01:27:54.340 there's a lot of kind of fear and worry about things, but there's always that less so now

01:27:59.140 because you're not bombing, but there's always that sense of worry about your being physical

01:28:03.300 danger. But even when you're out of that, when the physical, the risk of physical danger

01:28:06.900 is not there, it's just the, the psychological thought of always being responsible for the,

01:28:12.460 for the patients and not having a psychological rest. Like I can't refer these people somewhere.

01:28:17.560 There aren't other colleagues we can talk to or get an advice on or have somebody else

01:28:21.800 see these patients. It is very draining. And, um, I don't know. I just, you know, a couple

01:28:28.200 things is one, of course, is I do draw on my faith all the time. And I think that does

01:28:33.980 help me keep centered a lot. You know, I go to church every day and that's, I think

01:28:38.500 helps put things in a better perspective. That's just how it is. And besides that, I

01:28:43.700 think you see the people there, they see the strength and resilience of the Nuba people.

01:28:48.540 You say, well, okay, if they can put up with this environment and keep functioning, keep

01:28:52.900 going ahead, let me just try to keep taking care of them as best I can. So I definitely

01:28:58.120 get a lot of strength from the people there and their attitudes. And they've been

01:29:02.480 in this for their whole lives and they're, they're not giving up. They're pushing ahead

01:29:05.680 with things. So let me see if I can also just keep going. It's not easy by any stretch,

01:29:10.760 both physically and mentally and emotionally. It's, it's, it's very, very draining, but I

01:29:16.100 don't know. It's weird. I mean, you get up in the morning and you, you know, have this

01:29:20.120 huge number of patients to get through and you kind of say, man, I'm sure if I can. So I'm

01:29:24.740 tired already. Like I feel it's been, you kind of see the first few. And then you've,

01:29:27.600 before you know it, you're finished with the children's ward, take a deep breath.

01:29:30.720 Okay. I got through all the children. Now we go to the female ward, you get through

01:29:34.680 there, you pick up pace a bit, you get to the male ward, you go through them, see the

01:29:37.520 maternity patients. Now it's one o'clock. You're okay. I finished the rounds. We go

01:29:42.760 to clinic, go to clinic. And there's a big line of people.

01:29:44.900 How many patients would you see in clinic typically?

01:29:47.820 Uh, maybe 40, 50.

01:29:50.740 Again, I don't even know what that means. I mean, I think most U S physicians would have a

01:29:54.960 hard time seeing that many patients in a week in clinic. Do you have any blood tests

01:29:59.060 you can do? Can you do CBCs or UAs even? I mean, what, what's the extent to your diagnostic

01:30:04.860 toolkit? So until recently you had nothing. I mean, now you have an ultrasound.

01:30:09.440 Right. We've had the ultrasound from the, from the beginning.

01:30:11.640 Okay.

01:30:11.900 So we've had that the whole time. That's been hugely helpful.

01:30:14.120 You don't have an X-ray machine.

01:30:15.420 X-ray we do now.

01:30:16.400 Okay.

01:30:16.680 So we just got that about a year ago.

01:30:18.120 So you can do a chest X-ray, at least if you want some assistance with, does this person

01:30:21.680 have pneumonia or a pneumothorax or something like that?

01:30:24.680 So prior to a year ago, we didn't have the X-ray. Now we do. It's, it's been a help.

01:30:29.240 Lab has been difficult. We can do a urine. We can check out stool. We can do a hemoglobin.

01:30:34.840 Sometimes we can do a CBC, but the machine always seems to be broken. You know, we'll get

01:30:38.560 in the machine, work it for a while, then it just stops working. Can't do a CBC chemistry

01:30:43.360 tests. We can sometimes do a creatinine, but then that machine breaks.

01:30:48.120 And you know, you can't do a creatinine. Sometimes you can do ALT, ST, machine breaks,

01:30:52.640 can't do anything.

01:30:53.480 But would those things matter? In other words, if, if, if, if someone's listening to this

01:30:57.020 and says, well, gosh, if it's $50,000 to buy a new lab piece of laboratory equipment,

01:31:02.420 can we have one of those, you know, brought in with next year's supplies? Would that change?

01:31:07.540 Would that make life easier for the care you guys provide?

01:31:11.620 It would help. And you know, like there's a, just saw this chemistry analyzer, it was called

01:31:16.380 a piccolo, which is supposed to be kind of built for these remote locations. It's pretty doctor

01:31:20.560 proof. I mean, you kind of have this thing that's pretty hardy. You slip in a disc, you

01:31:24.100 put a drop of blood on it and it gives you a result. So our guys in the lab could do that.

01:31:27.740 Not our lives, our guys in the lab can do the other tests, but the machines are just very

01:31:30.600 sensitive.

01:31:31.400 It's less about the human. It's more about the, you need a robust machine.

01:31:34.900 You need a very robust machine. So this is kind of a thing. And that's about 14 grand.

01:31:39.000 And if we had one of those in some of the discs, which have the reagents kind of embedded in them.

01:31:44.880 So if you had a year's supply of, of test strips or reagent discs and then the machine,

01:31:49.880 you could do a CBC and a chem seven or a metabolic panel of some sort.

01:31:55.140 Right. That would, yeah, that would definitely help. We're pretty limited. We can do a peripheral

01:31:58.920 blood film. So taking blood, you know, guys can do the film. We can look at that.

01:32:02.400 So you're a pathologist now too.

01:32:04.120 Yeah.

01:32:04.420 You're a hematologist.

01:32:05.980 I'm terrible at it, but I can pick up like a chronic leukemia, chronic myelogist,

01:32:10.020 chronic lymphocytic or an acute leukemia. Those are, if it's pretty obvious, we can pick those up.

01:32:14.460 But a lot of blood films I'm baffled by.

01:32:15.800 And when you have a child that has leukemia, I assume you send them to Kenya?

01:32:19.500 It's impossible.

01:32:21.040 Why?

01:32:21.600 It's too far. It's too expensive. It's too difficult. Like just the administrative stuff to get them there.

01:32:27.160 And the chance in Kenya of them being, I mean, maybe at a higher ed hospital,

01:32:31.800 they could get decent care, but there's just, we just can't do it.

01:32:34.940 So what do you, can you treat with chemotherapy, a child?

01:32:38.320 Not with leukemia. If a child has leukemia, we often will give steroids to try to, you know,

01:32:42.880 palliative care.

01:32:44.360 Yeah. For leukemias, for chronic leukemias, these are again, are usually adults. If it's a chronic

01:32:49.260 lymphocytic leukemia, we'll treat them with cyclophosphamide. We don't have tablets,

01:32:52.820 we'll give periodic injections and that can kind of whitelium a bit. CML, chronic myelocytic leukemia,

01:32:57.780 we don't have treatment for. I would like to have at least, at least some hydroxyurea,

01:33:03.400 which is kind of an older drug for it. You know, this drug Gleevec?

01:33:06.360 Yeah. I was just about to say Gleevec would cure most cases of CML.

01:33:09.700 Right.

01:33:09.840 I mean, it's a very expensive drug in the United States, of course.

01:33:12.100 That's the problem. So with Gleevec, I was so excited like a month or two ago,

01:33:16.000 I'm reading that Gleevec is now in generic. Oh my God, maybe we can buy Gleevec because we get a

01:33:20.560 few a year. We don't get a huge number of CML patients. We need a few. I think, man,

01:33:24.620 we wouldn't need a huge amount, you know? So I'll look it up and it's okay. Gleevec's gone on

01:33:29.160 generic. So the price went from 8,000 a month to 7,000 a month.

01:33:33.720 Yeah. This is another one of these ridiculous systems, you know, problems, which is a lot of

01:33:39.700 times when drugs go from being branded to generic, there's virtually no change in price.

01:33:44.540 Right. We just can't do that. You know, there are a lot of things that are just beyond our scope

01:33:48.640 of being able to pay for it. That's something that to me is, it's really difficult to consider.

01:33:54.120 I mean, if, you know, we can be as critical as we want of the U.S. healthcare system for all of

01:33:57.700 its buffoonery, but in large part, it's because we can be buffoons, right? It's because we have

01:34:03.960 infinite resources, though we don't, right? But in the short term, we have infinite resources.

01:34:09.280 And so we never have to ask the question of what are we optimizing for and how do we triage expenses?

01:34:16.180 On the other hand, you're faced with that decision every single day.

01:34:21.880 So you would look at a patient with CML and say, we're not going to spend $80,000 a year to save

01:34:28.320 this person's life because as much as we believe every life is equal, we sort of know that $80,000

01:34:33.860 can save a hundred lives in another way. And are you the one that has to make that decision by yourself?

01:34:40.360 Yeah. It's agonizing. It's absolutely agonizing. That's just one example of many. I've got a woman

01:34:45.860 that comes all the time with CML and she's got a huge spleen that hurts. She's anemic and she's got

01:34:52.280 a bunch of kids. I got to talk to her in clinic and try to figure something out with her. And she

01:34:58.340 walks, I don't know how long, how far she walks to reach us. I mean, it's absolutely agonizing.

01:35:03.300 I cannot send her anywhere. This just is totally impossible. Just can't do it. So

01:35:08.640 if we had, we wouldn't need mountains of Gleevec. I mean, a small amount would be enough to at least

01:35:15.520 get her through a year. There are a few people that have CML. It's a few, it's not a huge number.

01:35:19.720 If someone's listening to this and they say, I'm going to tell you a story in a moment called the

01:35:23.460 starfish story, but I want to save one starfish. That's that's, I'll tell you the story.

01:35:27.800 Logistically, would it even be possible for someone to provide one year's worth of Gleevec to a

01:35:31.880 patient in your hospital? Is that something that they could do through the American, the African

01:35:36.120 mission? How would someone even logistically go about providing specific or project-based funding

01:35:42.280 to your mission? If they could get the drug, say they had access to the physical drug here in the

01:35:48.180 US, maybe if they sent it to say the Catholic Medical Mission Board, which is my sponsoring lay

01:35:54.100 sending agency. And they also help us a lot with logistics and with the overall managing the

01:35:59.080 hospital, they might be able to find a way to get it down to us, at least get it to Juba. And then

01:36:03.200 we could figure out a way to get it up to us if they could get the physical drug. There was a

01:36:07.620 program when I was in Armenia the time before last, we met some guys and there's supposedly some Gleevec

01:36:12.740 program that you can register, like the patient can register and they can get drugs at either low

01:36:16.720 cost or no cost. So we went through all this thing, contacted the person. She said, okay, all you have to do

01:36:20.560 is fill out these forms, have the patient go to Khartoum and get the drugs. That's absolutely

01:36:27.220 impossible. We can't get the Khartoum. That's on the other side of the enemy lines. And you just can't

01:36:31.980 reach there. Which gets back to your point of providing the money is half the battle, but the

01:36:38.440 logistics of actually getting it in there. And I mean, just spitballing, you can't have these

01:36:43.300 things airdropped or airlifted in because the enemy fighters will obliterate anything that's trying

01:36:48.440 to... It's not like you can fly the Cessna in there to get this stuff in there. There's been no

01:36:52.760 non-bombing aircraft in our airspace for... It's been since November, 2011.

01:36:57.800 So even foundations like the Gates Foundations, which do a ton of great stuff in Africa. I mean,

01:37:02.480 Sudan's basically off limits.

01:37:03.980 You know, say they were able to provide money for a bunch of Gleevec. One of the problems,

01:37:09.040 and one of the problems I've decided to go with Aurora is a lot of these funds are kind of

01:37:14.080 unassailable. If you're... Like I'm an individual or even a small organization that's trying to apply

01:37:19.960 to one of these big organizations to just get through that application process to get funds

01:37:25.140 and then to account for it and do monitoring evaluation and follow-up, it's a very daunting

01:37:30.160 task. You need people who are trained in this area of writing proposals and monitoring evaluation,

01:37:38.300 all this sort of stuff, to really follow through with all this. It's very difficult to access some

01:37:43.700 of these big funds and big organizations. You know, a lot of these bigger groups are set up to do that

01:37:48.520 kind of work. And their administrative size has grown exponentially because in order to get

01:37:54.060 these, this funding, you need a big administrative staff to apply for the funds and follow-up and

01:37:58.480 accountability and accounting and all that kind of stuff.

01:38:00.300 Right. And you, I mean, you've got tons of extra time, I'm sure, to do that, right?

01:38:04.500 I just can't, I just can't do it. I just can't do it unless it can be made fairly simple.

01:38:09.700 Or someone's okay. If I got the drug, I'll send it to Catholic Medical Mission Board and then

01:38:13.760 Catholic Medical Mission Board will send it down and we get the drug. You know, at least as far as

01:38:17.780 Juba and we can try to figure out a way to get it up, but it's just, it's really, there's a problem

01:38:22.440 with access and just getting through the administrative things you have to do to get some

01:38:26.320 of this stuff. There's, um, so there, there, there are several kind of different levels of, of

01:38:32.500 difficulty. So going back to the sort of state of diseases you see, if a person makes it out of

01:38:38.740 their sort of the young life, right? If a person's sort of your age or my age,

01:38:43.160 what are they going to die from?

01:38:46.260 Middle-aged people, we have a lot of cirrhosis, liver cancers, and that's, there's a huge-

01:38:52.120 Is it hepatitis-based?

01:38:52.920 Hepatitis B, yeah, huge. Like we do, we screen all of our pregnant women for hep B.

01:38:57.140 Do you guys have a hep B vaccination program?

01:38:59.700 We do, we do. Um, the reason we started screening the, the pregnant women is just to get an idea

01:39:03.600 about the basic rate. And it's about close to 20%. Hepatitis B positive, just in general

01:39:09.000 population. These are people who are not sick. They're pregnant with children. So what we're

01:39:12.920 doing is we encourage a mother when the baby's born, we give the baby hepatitis B vaccine immediately

01:39:18.440 after birth. And we hope with that, that we'll stop, prevent this baby from giving hepatitis B

01:39:23.200 as they get older and prevent all the complications from that. We haven't really scaled up to the

01:39:27.780 point where we have so many hep B positive people.

01:39:30.900 And can you only vaccinate the women who are coming in for deliveries or are you able to get

01:39:35.340 the vaccine into the community for the women who are still delivering at home?

01:39:40.640 No, we haven't, we haven't reached that point yet.

01:39:42.920 So you're only scratching the surface then because the majority of these births are outside

01:39:46.800 of your hospital.

01:39:47.860 Right. Exactly. I mean, eventually we'd like to have kind of midwives of these places and

01:39:51.580 have the testing capability to test all these people for hepatitis B. Or if people delivered

01:39:56.780 in these clinics, you say, look, we can't do the testing, but we'll just give the vaccine.

01:40:00.540 We'll assume the kid has hepatitis B, get the vaccine because they have to get hep B anyway.

01:40:03.660 It's part of the pentavalent series. So after that first shot, we continue with pentavalent,

01:40:08.780 which is DPT, diphtheria, pertussis, tetanus, hepatitis B, and, um, a marvelous influenza B.

01:40:13.280 I've heard that kids actually can get diphtheria in, in Africa.

01:40:16.860 Yeah.

01:40:17.220 Has there been a case of diphtheria in the United States since the forties?

01:40:20.880 No, I think that, I think.

01:40:22.340 I don't even know what diphtheria is. I mean, like, it sounds stupid to say that, but I remember

01:40:26.580 learning about it in medical school and I know we all get the vaccine for it. What, what is the

01:40:30.160 disease? What is, how does it manifest? We've only had, from what I remember, one case,

01:40:34.560 and I think she had diphtheria, it was in an adult, but it's a coronibacterium diphtheriae and it's a

01:40:39.960 bacterial infection. It affects the throat and they get like a, it looks almost like a thick scab

01:40:45.460 that forms in the throat. They kind of die from airway problems. You know, they just think it's

01:40:51.460 thick and they can't really swallow, they can't really breathe well, and they can die from airway

01:40:54.640 problems. It's a horrible, really a terrible disease.

01:40:57.620 And you mentioned your mother-in-law has leprosy.

01:41:00.320 Right.

01:41:00.780 Again, I've never seen that in my life. It's a bacteria as well. Is it in the tuberculosis

01:41:05.940 family or something like that?

01:41:06.900 Exactly. It's mycobacterium leprae. It's a mycobacterium and it's transmitted by respiratory

01:41:13.980 droplets.

01:41:15.000 Oh, it's not by touch. I thought leprosy was sort of contagious through touch.

01:41:19.020 Yeah.

01:41:19.520 Is that a wife's tale?

01:41:21.080 Yeah. It's really transmitted by respiratory droplets and it should be prolonged close contact.

01:41:25.880 So somewhat similar to TB. It's not a real, it's a very slow growing organism, but prolonged

01:41:30.700 close contact, respiratory droplets, you can infect it and it affects the nerves and the

01:41:35.400 skin. And by that nerve infection, people lose sensation. They get cuts or wounds. They

01:41:41.720 don't take care of things. They burn themselves. They don't pay attention to it. It gets infected.

01:41:45.260 Bone gets infected and you have to amputate the digit.

01:41:47.440 Are these people prior to your arrival that were kind of outcast and they would be not touched

01:41:53.600 or anything like that?

01:41:54.800 Yeah. There was definitely discrimination against them. They didn't have like separate

01:41:59.120 places where they would make them outcast, but people would kind of avoid them. Like my mother-in-law

01:42:04.080 still, and I think a lot of it was the people themselves would kind of withdraw due to shame and

01:42:10.020 due to the fear of, of us giving it to somebody else. Like my mother-in-law kind of withdrew.

01:42:14.300 She stays by herself. She doesn't eat with the other family. They keep telling her, look,

01:42:18.140 come and eat with us is okay, but she will not come and eat with other people. She always insists

01:42:21.880 to kind of eat on it by herself. She does it herself. She's kind of a self-isolation from

01:42:26.800 society. She's pulled herself out. So she'll talk to you and chat, interact with you. But

01:42:30.980 then with eating and with more social interactions, she'll kind of pull back and eat by herself.

01:42:35.260 And how prevalent is tuberculosis?

01:42:37.760 Very, very prevalent. And for our place, our HIV rate is quite low.

01:42:41.340 Which is what?

01:42:42.400 It's less than, much less than 1%.

01:42:44.900 Oh wow.

01:42:45.360 Point something. Maybe 0.1%.

01:42:48.000 And is that an artifact of where you are geographically, or is that as part of the

01:42:54.120 benefit of some of the aid relief that made its way in the early part of 2000s?

01:42:59.000 Yeah. I, I, I think the main reason is our isolation.

01:43:01.760 Is there drug use there? Prostitution? I mean, which I assume would be the two most dominant

01:43:05.840 modes of transmission.

01:43:07.100 No, prostitution is not really part of that society. And drug, IV drug use is, is unheard of.

01:43:11.520 It's all through, like with most of Africa is through heterosexual transmission.

01:43:16.500 And I think just the, it's starting to get a little bit of a toehold in Nuba, but still our

01:43:20.660 rate is very low. I'm worried that if, if peace comes and the place opens up and you've got more

01:43:26.400 movement of people in and out, the rate's going to skyrocket. That's what happened in South Sudan.

01:43:31.140 The nidus is there because we have a lot of STDs. Gonorrhea is very common. Syphilis.

01:43:36.180 Do you see tertiary syphilis and really advanced cases or?

01:43:40.380 I don't think so, but maybe some of the stuff we're seeing is just undiagnosed tertiary syphilis.

01:43:44.400 I don't know. I don't think we see it. What I see is syphilis is we have, we do VDRL tests and

01:43:48.840 we have a lot of VDRL positives, which are not, you know, it's not a very accurate test.

01:43:52.520 We have a lot of false positives. We have a lot of VDRL or RPR positive people. We do that,

01:43:58.140 um, screening, we're just screening now with the pregnant mothers for VDRL and we have a lot of

01:44:03.200 positivity. We don't see the chancres or the secondary syphilis. That's, that's really,

01:44:07.540 really rare, but the VDRL positives are very common.

01:44:10.760 So we talked about liver cancer. Do you see heart disease?

01:44:14.660 No, heart failure. So in the older population, we'll see a, you know, a fair bit of heart failure.

01:44:19.980 Somebody may be in their sixties, seventies, that's in heart failure.

01:44:22.540 And it's like bacterial or I remember there was some bacteria like Chagas something or other that

01:44:28.000 would weaken the heart muscle. Is it that type of a heart failure?

01:44:30.820 Yeah. No, we don't have Chagas disease in our area. It's just old age.

01:44:34.620 But do you think it's atherosclerotic in origin?

01:44:36.980 I don't think so. I've never seen anybody that could say, I think this person had an MI.

01:44:41.080 Just not a single one in 10 and a half years. Some is hypertension, just kind of untreated

01:44:45.900 hypertension. And we'll let people come in with blood pressure of 250 over 180.

01:44:51.120 Really?

01:44:51.580 Yeah.

01:44:51.820 How prevalent is obesity, overweight, type 2 diabetes?

01:44:57.200 Obesity about 0.0001%, almost, almost non-existent. An occasional person is a bit

01:45:03.340 overweight, but really, really rare.

01:45:06.040 And how often do you see type 2 diabetes?

01:45:08.700 We'll see it. Not so prevalent, but it's, it's definitely there. Somebody see older,

01:45:12.800 you know, older people come in and just new diagnosis of diabetes. Maybe someone who's 40s or 50s.

01:45:17.880 Do you ever see fatty liver? Like when you're operating on a patient, do you ever

01:45:21.380 see that the liver is fatty?

01:45:24.020 No. No, I think, no, never. I can't remember a single case when I've seen fatty liver.

01:45:29.600 What kind of cancers, I mean, you do so much cancer surgery, especially in children,

01:45:34.320 but they're cancers we don't see that much here.

01:45:37.480 Right.

01:45:37.780 What types of cancers do the people in NUBA get versus basically not get? I mean,

01:45:43.320 in the United States, of course, you'd have lung, breast, colon, prostate are the lion's

01:45:48.700 share of cancers followed by pancreas. So those are the big five. How prevalent are those cancers

01:45:54.160 in NUBA?

01:45:55.700 Not so. I mean, like in, if we go to kids first, our Burkitt's lymphoma is fairly common.

01:46:01.100 That's an EBV related, if I recall, right? Epstein-Barr virus is.

01:46:04.860 Epstein-Barr virus. And you only, you really just see that in malaria holoendemic regions. So we're

01:46:10.000 in that, it's called a Burkitt zone. And that's a great cancer because it's curable with, with just

01:46:14.680 cyclophosphamide. Six courses, cyclophosphamide, and you cure a cancer. It's great. Very satisfying,

01:46:20.220 but it's rare to have a cancer you can cure, obviously. For adults, liver cancer is probably,

01:46:26.280 probably the most common. And that's all, I think all.

01:46:29.800 Hepatocellular carcinoma.

01:46:30.740 Hepatocellular carcinoma. And probably all related to hepatitis B positivity.

01:46:34.060 They drink a fair bit. There's a local, a local beer they make from sorghum,

01:46:37.880 but the alcohol content is not very, very high. It's fully weak. So hep B related cancer of the

01:46:43.720 liver, we have a fair bit of cancer of the cervix. So for females, probably cancer of the cervix is

01:46:49.000 the most common.

01:46:49.860 And can you screen for HPV? You're the local gynecologist as well.

01:46:54.040 Right.

01:46:54.560 Can you do a pap smear?

01:46:56.120 No. Pap smear would be a little bit impractical because we have to do a swab and get that sent

01:47:01.160 off and do it high level, you know, get it off to a pathologist.

01:47:04.300 Is there any way, I mean, again, if someone were listening to this and said, oh my God,

01:47:07.540 like if I could have an impact on eradicating cervical cancer for these women, is that even

01:47:13.180 feasible to have the equipment there to, after you do the swab, assess for HPV?

01:47:18.860 No. For cancer of the cervix, two approaches. One would be this Gardasil, the HPV vaccine,

01:47:26.900 were made available either at very low cost or just giving us part of, I think it's, I actually

01:47:32.260 just heard today as part of the WHO package. So they can be integrated into the system where

01:47:37.180 HPV is given to young girls, even young boys.

01:47:39.940 But then we're back to the logistics problem.

01:47:41.660 Right.

01:47:41.860 Is how do you, how, even if the WHO or any of the foundations came along and said, we want

01:47:46.800 to provide HPV vaccination en masse to Africa, you're still somewhat excluded, right?

01:47:52.360 We give other vaccines.

01:47:53.600 If they can be lumped into your annual supplies.

01:47:56.820 Right. And just do it to get stuff out there. But if you do it in one big push, get it out

01:48:01.540 there, it's got to be all cold chain. It's really, it's really hard, but it's doable.

01:48:04.880 Get this stuff out there. One big push. That would make a huge difference. So start with

01:48:09.040 that. To treat cancer, the cervix, treat earlier versions, they call it a see and treat technique.

01:48:15.300 I've not done it, but it's not, I prefer something.

01:48:17.760 There's probably a YouTube video on it.

01:48:19.220 There probably is, I think. I think there is actually. You paint the cervix with something,

01:48:22.680 I can't remember if it's iodine or some substance, and you look for irregularities in the cervix.

01:48:27.400 And then you freeze it. You have the little nickel nitrogen cylinder with some probes, put that

01:48:32.860 in the cervix and you freeze it, make a nice ball of the cervix. Then you kill those precancerous

01:48:38.260 cells. And hopefully those people will not go on to develop invasive cancer to the cervix.

01:48:42.120 You would need some personnel for that because that would be pretty labor intensive. That's

01:48:46.680 more of a preventive medicine thing. We'd come in, examine them. Because you're not treating

01:48:50.080 people with the cancers. You want to get the precancerous lesions. You have to screen them

01:48:53.700 and do a lot of these screening things. We paint the cervix with some substance. Look

01:48:58.020 and see it. Probably you don't even need a colposcope. It's something even more simple

01:49:03.620 than that. I know they're doing it in Uganda and they have this equipment. So that might

01:49:08.580 be kind of an in-between thing before Gardasil becomes available. At least we do a screening

01:49:12.520 of young women, check the cervix, see what it looks like when you paint this stuff and then

01:49:17.740 treat with liquid nitrogen. We don't have the equipment. None of that stuff is there, nor the

01:49:21.840 knowledge to do it. What about breast cancer? How prevalent is that?

01:49:26.400 It's definitely there. The problem with breast cancer is by the time we diagnose it, we only

01:49:31.700 diagnose it when you can feel a lump. No one's getting a mammogram. Right. No mammograms or we

01:49:35.540 don't do other stuff to diagnose it, memorize what we have. So women present with a palpable mass that

01:49:41.320 they're feeling and they show up. Right. So usually they come with a palpable mass and they already

01:49:46.180 have a nose and axilla. So. So you do, in that situation, you still do modified radical mastectomies?

01:49:52.500 We do. We usually do a modified radical mastectomy and then follow with adriomycin,

01:49:56.460 sycophosphamide chemo and do that sort of every month for about six cycles. And I mean, it's still,

01:50:02.780 the results are pretty dismal. I mean, usually they, they get a couple of years, but two years on,

01:50:07.700 two and a half years on, they come back and they've got another lump. They got lump in the axilla.

01:50:11.320 There's another tumor in the chest. So the chemotherapy almost assuredly isn't helping, is it?

01:50:16.000 No, I really don't think it's doing much. So it's, it's really frustrating.

01:50:21.340 Would getting a mammogram machine add value? I mean, of course there's all the futility and

01:50:25.960 the controversy around mammography per se, but I'm just sort of thinking of like,

01:50:29.780 what are some finite resources that could be added to, I mean, you're serving a million people

01:50:36.180 basically that live in a world we can't even imagine as far as even the simplest acts of prevention.

01:50:43.280 Right. The problem with that to, to do the screening, the scale up to that level.

01:50:47.740 Yeah. You need a whole new staff to get people through.

01:50:50.400 Right. And the same thing with cancer of the surface screening, it's maybe possible. So it's

01:50:54.360 not just a matter of supplying the machine. You need the radio, you need someone who's dedicated

01:50:58.400 to reading mammograms all day long. Or, I mean, I guess the other option is, I mean, AI should actually

01:51:04.160 make mammography. This is probably one of the most important applications of machine learning is

01:51:09.140 actually reading x-rays and you don't need, you wouldn't even need a radiologist at some point.

01:51:13.700 You know, there will be a day when you could run a million women through a mammogram in a year

01:51:18.380 and there's a machine that's reading it and basically giving you the answer. And then now you

01:51:22.320 still need the logistics of a person taking the patients through the machine and operating the

01:51:26.760 machine. But anyway, we've got to think big, Tom. We've got to, we've got to think of these other

01:51:30.500 ideas.

01:51:31.080 I think these are areas where technology and medicine and developing where there's not always a good

01:51:36.200 marriage, but there are some areas where you have technological leaps. Like for instance,

01:51:40.440 our x-ray machine, part of the reason we waited eight years to get one, first of all, they were

01:51:46.400 expensive as heck.

01:51:47.920 How much does it, I don't even know how much an x-ray machine would cost.

01:51:51.120 This one costs $33,000.

01:51:52.840 Which of course in the United States, that's the cost of like getting your gallbladder removed.

01:51:58.000 Right.

01:51:58.440 I mean, literally that's about the cost of a cholecystectomy.

01:52:00.940 Yeah. So it was, I mean, for us it was a big expense, but we do quite a few x-rays now.

01:52:05.320 Our operating, the guys actually taken the, our x-ray techs are the operating room guys,

01:52:09.880 but the guys in the operating room, my lab, my assistants in the operating room are the

01:52:13.140 ones we taught how to take x-rays and they did a pretty good job. We waited that long

01:52:16.800 because we wanted a model that we could use. It was very small, lightweight, simple, where

01:52:22.720 you didn't have to use the chemicals and developers and all that sort of stuff. And we just waited.

01:52:26.560 Now we have a model where...

01:52:28.260 Is it digital?

01:52:28.960 It's digital. So it's a tiny little device mounted on this little thing.

01:52:33.680 And gosh, it's like the size of a small, like a tiny box that has an x-ray tube in it.

01:52:40.080 And it's a laptop and the screen is a, operates by Bluetooth between the x-ray machine and the

01:52:45.940 computer. Take the x-ray that shows up on the computer screen and it's all there. And you can

01:52:51.760 take that x-ray and adjust it. You can darken it, lighten it. You can focus in on certain areas. I mean,

01:52:57.080 it takes a beautiful x-ray and you can just play around with it. So you really get a nice picture.

01:53:00.740 And there's very little variable cost at this point. It's all a fixed cost that you've covered.

01:53:05.700 And now you can, the more you use it, the better. You're getting more...

01:53:08.300 Right. Absolutely. And it's, you know, the power is also... The other thing was the power

01:53:12.820 needed because we're 100% on solar. We've got a backup generator. It's 12 and a half kilowatts.

01:53:18.940 How long does 12 and a half kilowatts last the hospital if the panels were to go out?

01:53:23.680 We could run things on it. The problem with the rate limiting factor there is the fuel.

01:53:26.680 Like right now, I think we're left with maybe a few...

01:53:30.900 Oh, so if you have enough fuel for the generator, you could run indefinitely off it if you needed to.

01:53:36.160 Yeah. But I mean, we'd have to give probably big breaks of time. You know, it's a fairly good size

01:53:41.080 thing. And the hospital is the only thing that has electricity? Like you don't have electricity in

01:53:45.140 your home?

01:53:46.060 No. There's no grid. So it's just the hospital has power. That's... You know, we run on the solar,

01:53:52.760 I mean, pretty much 24-7. We really don't need the... As long as the batteries are there and

01:53:56.980 everything's functioning, we don't need the generator at all. And we try to find the time

01:54:01.940 when these batteries are going to order a new set and new panels, wherever you need to re-up that.

01:54:06.440 So we're, I think, three years into this set of batteries.

01:54:08.960 What about colon cancer? Do you see that?

01:54:11.020 Pretty rare. We've had, well, maybe two or three cases in 10 years. I mean, it's really, really rare.

01:54:16.780 The folks who are the most elderly within the community live to what age? I mean,

01:54:21.100 what is considered old?

01:54:23.160 They're, you know, nobody there knows their age. You know, they don't have any birth records. Even

01:54:27.060 my wife doesn't know her age. She's somewhere in her thirties probably. So they don't really know

01:54:31.520 their exact age, but I would guess they're probably, and all the person there would probably be in the

01:54:35.080 seventies, his or her seventies. I don't think they live much beyond that.

01:54:39.880 And do you see cognitive impairment in that population?

01:54:42.980 Really rare. You rarely get somebody say, I think this person has Alzheimer's. Really,

01:54:47.540 really rare to see that. I mean, I think they should die of something else before they reach

01:54:52.140 that stage. You just don't see it.

01:54:54.600 The point you just made that reminds me, there's a movie, which you may have seen. I think it's

01:54:59.420 called A Good Lie.

01:55:00.780 Yes.

01:55:01.180 It stars Reese Witherspoon. It's a beautiful story.

01:55:03.740 Yes.

01:55:04.000 After we saw The Heart of Nubo, we watched that because I wanted my daughter to sort of

01:55:08.520 understand the history of the Sudanese refugees. And that's one of the points from the movie that

01:55:14.660 I remember being very sort of moved by. They were all assigned the same birthday because nobody knew

01:55:20.840 their birthday. Like even something like that, that we would take for granted. Do they celebrate

01:55:25.140 birthdays?

01:55:26.060 No, nobody does. I mean, you know, my wife, we kind of invented a birthday or she invented one of

01:55:30.800 November 21st. So when that day comes around, we'll usually do something. I mean, she's always

01:55:35.700 surprised. She's like, what? What are you doing? Oh, okay. So she doesn't give me a hard time for

01:55:41.880 not buying flowers if we could buy flowers. So it's pretty, it's pretty easy to be married to a new

01:55:48.460 lady. You know, she doesn't, the expectations are very low.

01:55:51.720 How has your life changed since you've been married? I mean, do you have a greater sense of

01:55:57.200 obligation to not die, to put it bluntly? Yeah, I would say, yeah, definitely. So I'm like,

01:56:02.900 you know, you can't be so heavily with things because now I've got a wife and I wanted to kind

01:56:07.920 of look after her and make sure she's okay. There's been a little bit of a change in perspective

01:56:12.020 with that. And I think if, and when we get children, I think that'll change another degree

01:56:16.820 up for sure.

01:56:17.840 Do you think you could do what you do if you had children?

01:56:20.180 I think we could stay there. And if things aren't really hairy, we'd have to see how to proceed.

01:56:25.340 But just in terms of, I mean, your wife is a nurse, so you have the luxury of working together. So

01:56:31.580 as focused as you are on your work, she is there with you.

01:56:35.640 Right.

01:56:36.100 When you have children, they will not work with you for quite some time. I just wonder,

01:56:41.280 would it be challenging to sort of now be torn between two obligations that for many years will

01:56:47.680 not overlap at all?

01:56:49.100 It'll be difficult. You know, I think one thing, and one thing I remind my wife of is that,

01:56:53.760 you know, I finish work late and I'm always, you know, often preoccupied with things and things

01:56:58.880 with the hospital and all that sort of stuff. But at least I'm there every evening. The weekends,

01:57:03.900 we have a little bit of time on a Sunday to be together. And even though the work is very much

01:57:09.380 all encompassing, there's no commute and there are no distractions. You know, we don't have,

01:57:14.100 there's no TV, there's no radio. We don't have other things that kind of occupy our minds.

01:57:18.160 So when we, when we're together at home, we really can be present to each other.

01:57:23.040 And I would hope that if we have children, I'll be able to use that to really spend time with the

01:57:28.620 kids and not be always in work. You know, if life continues like that in Nuba, there's not any

01:57:32.600 travel involved. I'm just there. You know, I'm a stone's throw.

01:57:35.360 You know, it's funny when you say it that way, it's actually, you may actually spend more time with

01:57:39.920 your kids than many of us do here because of our distractions and our travel and our this and our

01:57:47.540 that. Yeah. Life here is, is much more hectic. I mean, it's, it seems almost ironic to say that.

01:57:52.800 You feel out of place here, even though you grew up here? I mean, when you walk down Park Avenue or

01:57:58.380 Madison Avenue, are you sort of like, what in the hell is this place? I do. I do feel a bit out of

01:58:04.140 place. In a sense, I do enjoy it. Like I've never, even when I was, I grew up in upstate New York,

01:58:08.260 I never spent time in New York city. So this is really kind of, it's, it's exciting. I like it,

01:58:12.720 but I don't think I could, I could stay long-term. I mean, a lot of people I'm sure say that about

01:58:16.180 New York, but I do feel much more at home in the Nuba mountains where it's, it's very quiet and

01:58:21.180 kind of sedate and your time is your own when you're off. What possessions do you value? I mean,

01:58:27.220 I, I, I know you have some textbooks and things, but I mean, your home is very modest, obviously by the

01:58:33.380 standards of someone living in the United States, it would not really, you wouldn't even really call it a

01:58:37.740 home in the same way, but you don't give the impression that you're wanting.

01:58:43.120 No, I really don't. I'm, I think that was my character since I was a kid. I'm, I'm very much,

01:58:47.800 I think I'm very much a minimalist since I was born. All these clothes you see me wearing from the,

01:58:51.860 well, the socks, the trousers, both these shirts I bought when I came out of Nuba last month.

01:58:59.540 So I have scrubs, I had scrubs, I had one pair of trousers, I had a suit,

01:59:03.760 a few t-shirts and that was it. And they're like, Hey, look, you got to go and meet people.

01:59:09.520 You can't be wearing scrubs around. So I had to buy all this crap when I came out.

01:59:13.380 It was painful for me to buy clothes. Like I don't, I just don't like it. When I go back,

01:59:17.620 I said, look, when I go back to mountains, all this is winter coats and this stuff.

01:59:21.360 I'm not taking this stuff back with me. I'll keep it in Armenia. Let's be someone there.

01:59:24.200 Use it. I don't know. I don't want it. My suit, I do have one suit that I wore to the ceremony

01:59:29.660 in Armenia, the World Prize ceremony, but I bought that suit in 1985. So I haven't

01:59:35.040 bought one since then.

01:59:37.840 Probably when you were interviewing for medical school or something.

01:59:39.840 Well, I was interviewing for jobs, like for engineering jobs. That's the reason I bought

01:59:43.020 it. So it was the same one I used for interviewing for medical school. And then I've used it when

01:59:48.800 I come out for the World Prize ceremony. I'll take it out and wear that suit with a blue shirt

01:59:53.160 and a tie. I bought a bottle of crap in 1985.

01:59:55.480 And I know that you, it's absolutely against your nature to sort of be critical of anyone,

02:00:01.420 but do you spend any time thinking about the way the world works here and how most of us

02:00:07.880 are somewhat attached to our possessions and the more possessions we have, the more complicated

02:00:15.280 our lives get. I mean, you certainly hear people talk about minimalism. Few people can apply it to

02:00:20.720 the extent that you can, of course, but I mean, what have you learned about this and how, how could

02:00:27.800 you speak to somebody like me who, you know, loves his possessions as much as the next person and can't

02:00:34.040 imagine giving up these comforts? I mean, help me understand, cause you don't look like you're

02:00:39.620 miserable. And you look even happier in these videos in Nuba. I'm sure that this is about the

02:00:46.900 hardest thing you've had to do all year. Yeah, it is. To schlep around New York and talk to idiots

02:00:51.340 like me. No, no, I, you know, I'll tell you, Peter, I really do believe that the more detached

02:00:56.780 you become, not like in this Buddhist kind of Nirvana sense, but the more detached you are from,

02:01:01.160 from things, the easier life is. It just simplifies your life. I mean, for me, I look at, at all,

02:01:06.680 a lot of possessions and things and attachments as just adding more complications. You know,

02:01:11.460 life becomes so complicated. It's much harder here in the U S you know, I see my sister and

02:01:16.300 how she's interacting with the kids. You know, there's a reason why advertisers are good at what

02:01:21.040 they do. You know, what they want to do is convince you to buy something you really don't

02:01:24.860 need. And they're very good at it. Why does Madison Avenue exist? Why is there huge buildings

02:01:28.860 in Madison Avenue? These guys are very good at what they do. They're convincing. They've managed

02:01:33.400 to convince all of us to get things we really don't need and convince us that we'll be only happy

02:01:38.540 and fulfilled and satisfied if we have those things. So you've got all this tsunami pushing

02:01:43.360 against you. For me, I think just because I'm in a place where you can't have anything that kind of

02:01:50.000 realize, well, geez, I don't have any of this stuff. And I kind of like it. It's, it just makes things

02:01:53.720 much easier for me. I've always been a bit of a minimalist even when I was, when I was younger, but

02:01:58.220 I've come to kind of feel that that's really, I do feel better with less. And I think everybody is

02:02:05.380 looking for some kind of meaning in life. You know, uh, this book, this man's search for meaning,

02:02:10.680 this, uh, Victor Frank, that was something that was one of my, is one of my favorite books.

02:02:15.160 And this idea of logotherapy, but we all really do need a sense of meaning in our lives. That's

02:02:20.760 extremely important for our psychiatric makeup, whatever that is. It's different for each person,

02:02:26.100 whether it's kids, whether it's your pets, whether it's your job, but to try to get something in your

02:02:31.480 life, that's meaningful. And if you're looking for it, this is me philosophizing, but certainly

02:02:35.660 I think if you're looking for immaterial possessions, I don't think you'll find it there.

02:02:39.700 So if I can make a bit of an aside, something I talked about earlier with a talk with the Catholic

02:02:45.520 Medical Mission Board volunteers, my favorite Bible passage, I can't remember the book and the verses,

02:02:51.600 but the basic story is there's a guy, the guy's a very wealthy young man and he goes to Jesus.

02:02:56.940 He says, they try to justify himself and says, look, what do I have to do to get eternal life?

02:03:02.740 And Jesus says, well, follow the prophets. You've got all this stuff there. Follow the

02:03:06.260 Ten Commandments, follow the laws of the prophets and you'll, you'll be okay. And the guy says,

02:03:10.680 well, I do all those things. What do I need to do to really become perfect? And Christ said,

02:03:17.200 you know, sell everything you have, pick up your cross and follow me. And it says something very,

02:03:22.680 which I think is very beautiful. It says the man went away very sad because he had many possessions.

02:03:28.320 He couldn't do it. He couldn't, he wanted to, I think he wanted to justify himself. Say, I'm doing,

02:03:33.000 I'm good. I'm doing all the things I need to do. I should be okay. And Christ kind of turned that

02:03:37.440 on his head and said, okay, if you want to be perfect, sell everything you have and come and

02:03:41.840 follow me. And I think, I think what he's saying is, look, if you really want to be perfect,

02:03:46.900 they really want to be happy, you know, get rid of, I mean, it's a bit of pie in the sky stuff

02:03:52.880 in a way and not practical for, for people, but in some way, get rid of your baggage and come and

02:03:59.400 follow. Yeah. Because it could be metaphorically, get rid of your stuff, right? I don't think it's

02:04:02.860 necessarily literal, right? It doesn't mean throw your couches out, but it's going to be,

02:04:05.900 it means don't be wed to these things the way that I think we are. Exactly. And the theological

02:04:10.640 meaning is exactly that. It's not that you can't have things, but what's your attachment to those

02:04:14.960 things, you know, is this thing where you put your values, you know, is your value in the car you

02:04:19.600 drive and the, what kind of beer you drink or whatever, or is your value more in people and

02:04:25.580 what you're doing and how you're helping people? There is a bit of values in that. And I think,

02:04:30.120 I'm sure some people can do it very well. They're very wealthy. They have a lot of stuff, but they're,

02:04:33.660 they do have a sense of detachment from that. I just think it's more difficult. You know,

02:04:37.240 it talks about this passage about it's more difficult for a rich man to enter the kingdom of heaven

02:04:42.480 than it is for a camel to go through the eye of the needle. That's kind of something you say,

02:04:45.620 well, eye of the needle is supposedly where the camels were and they came out of the, out of the

02:04:48.620 city. They had a thing that looked like an eye of a needle and the camel couldn't go through there.

02:04:52.740 It's not saying being rich is bad or rich people are bad people. That's totally, that's, I think

02:04:57.400 it's missing the point. It's just very difficult because it's very difficult to be detached from

02:05:01.520 things when you have a lot of possessions. You know, I'm trying to say that without coming across

02:05:05.640 as being judgmental. I don't mean that, but certainly for me, I feel much better having less.

02:05:11.400 I really, I really think that. Well, it's funny at the outset, you talked about this idea that

02:05:16.040 even in college, you were sort of struck by this idea of you wanted to be a missionary and you even

02:05:19.980 said something to the effect of whatever that meant. And it's sort of funny. Like if you say to me,

02:05:25.200 Peter, picture a missionary, I don't actually picture you. I picture someone going into a remote

02:05:32.980 part of the world and hitting people with Bibles, right? Like that's sort of the image we have of a

02:05:37.460 missionary. But in the reality of it, I think what you're doing is far more aligned with,

02:05:44.380 in as much as one believes in sort of religious values, I guess, I think what people like you do

02:05:51.580 that is, regardless of one's religious views, they can't help but respect it is you're not

02:05:57.220 preaching it to anybody. You're not hitting anybody over the head with a Bible. You're just

02:06:00.340 sort of saying, look, I'm here to serve you. And your example is what's actually doing the talking

02:06:04.840 as opposed to your words. Whereas I think most of us, myself included, are far too quick to use

02:06:10.760 our words to speak as opposed to our actions. Well, you're tapping into my favorite quote,

02:06:16.740 which has been attributed to St. Francis. I don't know if St. Francis is like many people,

02:06:20.860 he's my favorite saint. Francis of Assisi who lived in the early 1200s. He said, preach always

02:06:27.100 and sometimes use words. And I think that's exactly what I think we try to do in a mission.

02:06:34.840 Show the love of Christ by who you are and what you're doing, Colossus. And don't get too wrapped

02:06:41.440 on the axle about how it's going to play out. Remember, if you're there as a missionary,

02:06:45.980 God is the one that changes hearts, not me. I'm not smart enough to do that. I'm not a guy that's

02:06:52.320 going to have just the right thing to say and to school somebody on something. I can't do that.

02:06:56.460 But I can do my best to show the love of Christ to these people. And that's what I feel comfortable

02:07:04.060 with. If you ask me why I'm a Christian, I can talk to you about it. And even my words might be

02:07:09.380 a bit jumbled and goofy, but preach always and sometimes use words.

02:07:15.200 Are there any cases of suicide in Nuba?

02:07:17.580 We had one guy who's the husband of one of our staff and yeah, he shot himself and that really

02:07:23.840 shocked everybody. He seemed to have some kind of a psychiatric problem. He was kind of acting a bit

02:07:30.940 strange a few days. They didn't tell us, but he'd been in one of the, in one of the refugee camps was

02:07:34.580 acting a bit odd. There came back to Nuba and was acting a bit out at home. And then the night he was

02:07:40.120 acting a bit odd, he went and he shot himself. That's the only case I know of. It's, it's extremely

02:07:44.440 rare, extremely rare.

02:07:46.700 I mean, to me, there are so many amazing contrasts between Nuba and America, right? I mean,

02:07:54.860 they're so obvious they're not worth stating. It's these subtle ones that to me are interesting,

02:07:59.040 right? There must be a different sense of fulfillment, contentment, happiness, sense of

02:08:04.700 purpose there versus here. I mean, as you know, I'm sure you're not paying close attention to

02:08:09.280 statistics in the United States, but suicide is among the top 10 causes of death in every,

02:08:14.960 I may be incorrect on this, but I'm not far off in every age demographic except for zero to 10.

02:08:20.840 So once you get above, you know, 10 to 20, 20 to 30, suicide is always in the top 10 as a cause of

02:08:26.140 a disease. And that doesn't include, that's what we call fast suicide, right? When you kill yourself

02:08:31.920 immediately with a clear, but then you have all the slow suicide. So the alcohol related, you know,

02:08:37.280 basically people that kill themselves with alcohol and drugs. Yeah. So when you include

02:08:42.220 all of those, I've heard analyses that would suggest that self-harm would be sort of top five

02:08:48.160 causes of death across the board. What does that say to you, given that you're, you live in a world

02:08:53.460 that has one, one thousandth of the privilege and for all intents and purposes, like, shouldn't

02:09:01.220 everybody be killing themselves in Nuba? So to avoid being a, you know, ripped apart by shrapnel.

02:09:06.520 Yeah. It's very interesting. And, you know, my, the initial thought that comes to me is

02:09:10.600 the people are, when you're really gripped in this struggle to survive. So your, your life is based

02:09:17.780 on, you know, every day is you're, you're just trying to survive. When you have that sort of primal

02:09:23.400 instinct of survival, you don't, your mind doesn't drift off to other things. You don't think about

02:09:28.400 so much about your life is hard. Your life is this, your life is miserable. So I think you become

02:09:32.660 less inward looking. Suicide is so inward looking, so focused on your own misery that you can't come

02:09:40.300 out of it. I mean, it's such a miserable thing. I mean, it breaks my heart when I hear about these

02:09:44.800 things. It really does. Because I think, man, to get to that point when you just, life is so

02:09:51.220 miserable for you and you are so miserable, you kill yourself. It, for me is heartbreaking.

02:09:55.080 Does that break your heart more than the tragedy that you see every day? I mean,

02:09:59.620 not to compare miseries, but like what you see breaks my heart. Maybe I'm numb. I mean,

02:10:04.900 and it's not to say that I'm not heartbroken by anybody who hurts themselves, but what you see

02:10:10.740 is so staggering. Do you see this as an even greater source of tragedy? For me, I would,

02:10:15.700 I would equate that with the five-year-old girl who's got the shrapnel ripping her arm off.

02:10:20.360 I would. I would see, I would feel the same sense of pain and heartbreak with that. Suicide has a

02:10:27.860 similar effect where, you know, if a child dies from this kind of thing, the effect you have on

02:10:31.460 the whole family is devastating. The grief, suicide, the grief you leave behind, I think that's really

02:10:38.120 tough. And that really, really breaks my heart. Not only for the person who was so miserable that

02:10:42.240 they decided to take their own life, but for the people. The ripple effect. Oh gosh. And that's

02:10:46.020 terrible. Man, I would just never wish that on anybody. And yet it's almost impossible in the

02:10:51.820 United States to not have your life touched by suicide. I think it would be very rare that someone

02:10:57.060 listening to this in America wouldn't know somebody first or secondhand who hasn't taken their life

02:11:02.900 either clearly and deliberately or sort of slowly and maybe less deliberately. Yeah. I think it's wrapped

02:11:09.340 up in that struggle for survival. There is a will, you know, a natural will to survive. And when you're

02:11:14.400 in this kind of daily grip, even when there's not fighting, just to survive there, the amount of

02:11:19.300 work it takes to get up in the morning, to, you know, make food, to cultivate crops, to keep the

02:11:25.880 animals out of your garden. I mean, it's a tremendous struggle. There's a book, I think the book is called

02:11:30.360 Tribe, Sebastian Younger. Have you heard of this book? Yes, I have heard of it. I would love to read it.

02:11:33.700 I can give you a copy actually. I have a copy here, so I'll give it to you as one more possession to

02:11:37.340 have. But he writes about how post 9-11 suicide rates went down in New York. And he talks much

02:11:45.320 more eloquently about this than I ever could. But I guess it speaks to what you're saying, which is

02:11:50.640 when there's a real struggle, when there's something and something that can bring people

02:11:56.540 together in a common goal or something that unites people, it can presumably distract from

02:12:00.820 some of that pain that can otherwise hurt us. Right. And it's interesting because I fairly recently

02:12:05.420 Dave was hearing about this PTSD. And I mean, how many veterans have killed themselves? That's

02:12:13.160 another heartbreaking thing. Somebody's fighting in Iraq or Afghanistan. They survive all that. They

02:12:17.840 come back home. They get despondent. They kill themselves. What kept them alive during the fighting

02:12:22.700 was a sense of camaraderie, togetherness, fighting for a common goal. I mean, no matter what you think

02:12:28.040 about warfare and the horrible things that happen in warfare, at least they have some kind of a common

02:12:32.120 bond. They come back home to the US and people are indifferent to them. Nobody pays attention to

02:12:36.620 them. They've lost their, the common bond with their, with their comrades and friends. And what

02:12:43.020 ensues is despondency. And before you know it, we had this huge rate of suicide amongst veterans that

02:12:47.620 come back. Not so much from the trauma they had during the fighting. You know, it wasn't like flashbacks

02:12:52.760 to horrible things that happened there, but the sense of loss of any bonds, that human contact with

02:12:58.100 other people, that sense of purpose is gone. So I found that quite interesting that, that thought,

02:13:04.160 that's what led us to me. It just makes you wonder if there was, if there is a way to,

02:13:07.720 you know, we have these dating apps here in the United States, right? You probably don't have a

02:13:10.860 lot of them in Nuba. Well, dating, dating is, is totally illegal there. The word dating doesn't even

02:13:15.900 exist. Well, how did you meet your wife? Well, we have what she calls secret love. That's not like

02:13:21.540 in a scandalous sense for anybody, but you know, there you can't openly date somebody. You know,

02:13:26.020 if, if somebody like, I could never be alone with her somewhere, like just chatting out in the public,

02:13:30.840 people would tell her brothers, Hey, this guy is talking to your sister. What are you going to do

02:13:34.160 about it? They come and they beat me up. They'll beat her up. And then this big scandal and they say,

02:13:38.860 oh, co, you know, either you guys are going to get married or what's going on here. You can't,

02:13:41.700 you can't be doing this. So you have to do it. We did it very quietly. You know, it's got the,

02:13:45.760 it's, it's difficult. We got to know each other kind of on the side. And our marriage is normally

02:13:49.900 arranged. Is that why this dating process is unnecessary? Yeah. Traditionally they were arranged. Now they're

02:13:55.840 not so much arranged, but the families will meet together. Somebody, you know, someone might show

02:13:59.500 interest in somebody else. Then they have to approach the family, but there's not really a

02:14:03.220 dating. They can't go through a public dating thing. If you, if you're interested in marrying a girl,

02:14:08.520 you've got to go and approach the family right away and say, look, I want to marry this woman.

02:14:11.880 Then they have to start negotiations with dowry and all that sort of stuff. You can't be seen

02:14:16.480 together in the public sphere. It's just, it's just totally not allowed. So not so much arranged.

02:14:21.180 There's, there's some attraction between the two, but they, they have to really make the move fairly

02:14:25.840 early. So they don't, you know, one of the problems, you don't really get to know the other

02:14:28.500 person very well. It's, it's really difficult. You know, they're good and they're bad points because

02:14:32.060 you, you're not really allowed to go through that, that, that process of dating if they know

02:14:36.160 somebody and all that sort of thing and know the family. All right. So there's definitely no

02:14:39.740 Nuba version of Tinder. Um, so, so I think where I was going with that was in the same way that we

02:14:46.720 have these dating apps, it's all, which are basically trying to pair people, right? Similar

02:14:50.420 interests at a meta level. It's, it would be interesting if, if there would be a way to pair

02:14:55.660 a void that exists here in this country and, and for much of the civilized world, right? The

02:15:01.560 avoid of purpose with a part of the world where purpose is not lacking, but resources are lacking.

02:15:08.180 And in many ways, I think that's what philanthropy sort of tries to do. But of course the question is,

02:15:12.620 it's more than just that, right? I mean, I don't think it's just giving. I think there's more to

02:15:18.140 it, right? I mean, I, I, and I was sort of thinking about this, knowing we were going to speak today

02:15:22.600 that, because my daughter asked me another question. She said, you know, she said, well,

02:15:27.120 can you ask Dr. Tom, like what could a 10 year old girl in San Diego do to help a 10 year old girl

02:15:34.200 in Nuba? And I thought, and I thought, and I thought, and I was like, I don't know. Cause it's not

02:15:41.280 like you going there is going to, you know, be a practical solution and, or even provide value.

02:15:46.160 I mean, even me, even if I decided, Tom, please, I'm going to come for a year and work at your side,

02:15:50.880 I would slow you down. I mean, I would be a waste of like, you'd spend a year just teaching me how to

02:15:55.900 get out of my own way. So how can people help? I mean, giving is of course the most obvious you've,

02:16:03.040 you've outlined so many clear, tangible examples of where even modest resources by the standards of our

02:16:10.980 healthcare system would have profound step function changes there. Is there something else people can

02:16:16.680 do to help? Yeah. First of all, never underestimate the value of a donation to, to someone you trust

02:16:23.260 or a group you trust or an organization you trust. The amount, the impact that has is tremendous. We

02:16:27.860 can't do anything in our work without financial resources. Beyond that, I think one is just becoming

02:16:34.540 aware of the situations somehow in this environment, trying to understand how these people, how they live,

02:16:42.220 what their lives are like, that these really are individuals that have their own thoughts and aspirations

02:16:48.020 and everything else, trying to get it into their skulls a bit and understand what their life is like and who they

02:16:53.060 are. If you have kind of a knack for advocacy or work through governments and this kind of thing, be aware of the

02:16:59.840 political situations there, advocate on behalf of some of these people that are oppressed or having

02:17:05.420 difficult lives, whether it's working in issues of poverty or poor health, poor education. I think people

02:17:12.080 have a, have a voice to offer and people do have an influence over governments. So government policies,

02:17:19.920 government funding is a reflection of the constituents. And I just came to realize this full well in this

02:17:26.900 trip because some of these people say, well, the government funding, a lot of these administrative

02:17:31.860 requirements, these beneficiary organizations have become more stringent and more difficult because

02:17:37.200 governments require these things because they're accountable to their constituents. Their constituents

02:17:41.340 are saying, why are you sending so much money to Africa? They're wasting it or it's a waste of money.

02:17:45.180 So to give the money out, the constituents are holding the politicians' feet to the fire. If the constituents

02:17:51.860 were a little more open and said, look, let's help out. Let's, let's be aware of what's going on

02:17:55.940 and, and try to help some of these people get out of their misery so they can eventually help

02:18:00.020 themselves through education, better health, all these sorts of things that would free the politicians

02:18:04.820 up a bit to allow more resources to go out and to more, more aid and other things, more benefit to give

02:18:10.840 them. I mean, the goal in all this stuff is eventually let these people who are beneficiaries

02:18:14.680 now stand in their own two feet, maybe in the next generation, next go around. This cycle of aid, I mean,

02:18:20.900 everybody knows a cycle of aid and dependency is, is, is a bad thing. Great. But how do you get out of that?

02:18:25.900 So what are some creative ways we can do that? But you can't do anything without some help at this

02:18:31.220 point, but geared towards getting these people to stand in their own two feet.

02:18:35.300 Talk to me about food. I heard a funny story once that, is there a word for food in Nuba? Like it's

02:18:41.920 like it.

02:18:43.920 Gumo. So, you know, Nuba has, uh, I don't know, like 99 different languages amongst the Nuba people.

02:18:50.880 So does everybody speak Arabic?

02:18:52.540 Pretty much. Most will speak Arabic.

02:18:53.880 And you speak Arabic.

02:18:54.620 Yeah, I speak, I speak.

02:18:55.500 Shwaya.

02:18:56.000 Yeah, Shwaya, Shwaya, Shwaya. The tarif. My, uh, wife's language is Tira and this came from her.

02:19:02.700 The local word for food is Gumo. And I would say, what did you have for supper last night?

02:19:07.580 And she said, well, I had food. I said, what kind of food? She said, no food. What, what are you talking

02:19:12.180 about? I had food. I said, what kind? I said, well, I had a sida, you know? A sida is the kind of the,

02:19:17.020 it's like a cake made out of sorghum, kind of ground sorghum boiled. I mean, it's just totally

02:19:21.040 tasteless. She loves it. You know, so I have to have my, my sida. So for them, the word food and,

02:19:26.260 and this sida is synonymous.

02:19:28.980 There's so little variety.

02:19:30.900 So little variety of foods.

02:19:32.720 So what do you eat?

02:19:34.060 First of all, what did you weigh? Cause you were a nose guard in college.

02:19:37.860 Right.

02:19:38.020 I've seen pictures of you. You were huge. What did you weigh in college?

02:19:43.880 In college, I was two 30 and this was 1985. I weighed two 30.

02:19:49.220 And what did you, yeah. What did you weigh when you arrived in Kenya in 2000?

02:19:53.980 Probably around one 90, I would guess.

02:19:57.240 And what did you weigh by the time you got to Nuba?

02:20:00.080 Oh God.

02:20:01.260 Then maybe one 70. And I got down, I was down about one 50 up until recently. Now when I've come

02:20:07.160 out for the past month, I think I've gained about 20 pounds. I was down to about one 50.

02:20:10.860 You've gained 20 pounds in the United States in a month.

02:20:13.300 Yeah.

02:20:13.620 So you were down to 150 pounds a month ago.

02:20:16.080 Yeah.

02:20:16.640 Talk to me about what you eat.

02:20:18.280 Well, that's the thing. I, I, I eat, but my wife makes the food there. So it's this food.

02:20:23.020 This is the.

02:20:23.860 What did you eat before you got married?

02:20:25.880 Then I was living on the hospital compound. So we'd have a lot of, um, they would send them

02:20:29.900 food in from Kenya normally. Like once a year they'd send food in. So usually rice, uh,

02:20:34.760 kidney beans, some kind of lentils. So we'd have that every day. Once I'd have chicken,

02:20:39.480 but usually it was just kind of rice and beans kind of stuff. So now when I got married and

02:20:43.260 moved off the compound, my wife makes a sassita and she has some sauce on top of it. So the

02:20:49.140 main sauce is this okra. Okra grows pretty well. They take okra, they dry it and they pulverize

02:20:54.620 it in the powder. They mix that in with water and some other stuff. And it makes like a really

02:20:58.880 slimy sauce that you pour over the sorghum paste and it tastes about as good as it sounds. I mean,

02:21:05.220 it's really pretty bland.

02:21:08.040 Where's the protein?

02:21:09.960 You know, I think the sorghum actually has a high protein level. I think it's a grain.

02:21:14.100 And I'm saying that because the people are, are pretty, are pretty muscular. Like that's what they

02:21:20.200 eat. They eat that and they'll have maybe some sorghum porridge in the morning. And that's pretty

02:21:24.860 much it for the day. And I mean, a few peanuts, they have peanuts too, but not huge numbers of

02:21:28.900 peanuts.

02:21:29.980 What about fruits or other vegetables?

02:21:32.060 For fruits, there are seasonal. So you can get mangoes for maybe two or three months out of the

02:21:37.780 year. You know, a mango season is there. There are tons of mangoes. Then they, when they're gone,

02:21:41.720 they're gone. You don't see a mango for several more months. Then there's two seasons for mangoes

02:21:45.540 usually, but it varies quite a bit year to year. So mangoes are there periodically. Lemons you can get

02:21:51.780 for fruits. That's about it. Oranges are not there. You know, pineapples.

02:21:57.820 Are there tomatoes?

02:21:59.260 Tomatoes are there for a couple months, sort of towards the end of the rainy season. You can get

02:22:03.880 tomatoes and you can get some, some greens. They grow a few kind of greens there and they'll put

02:22:08.340 that on top of it. Like even the tomatoes will kind of cook up a bit and then make the okra slime

02:22:13.620 to it and put that over the seed. That's not bad actually. We'll have that quite a bit. Or the other

02:22:19.620 thing we'll have during the rainy season is milk also. Milk is only there for a couple months.

02:22:24.620 The cows will only give birth during the rainy season and therefore they're only lactating

02:22:29.580 during the rainy season. So they get milk sort of towards the end of the rainy season, those last

02:22:33.220 couple months. And since there's no refrigeration, most times we'll have it sour, sour milk. So we'll

02:22:40.220 get milk out, let it sit for a while and become sour. That'll also decontaminate it a bit. There's a lot

02:22:45.560 of brucellosis there. And you take the sour milk, which is kind of curdled and, you know, I think

02:22:51.080 people have had sour milk before and you pour that over the aceta, over the sorghum paste.

02:22:55.800 That just doesn't sound tasty.

02:22:57.740 It's not very good. It's really, it's, you kind of eat it and you're like, oh man, you know,

02:23:01.860 the problem is you eat it, you're kind of hungry a bit, but there's no way you're going back for

02:23:05.280 seconds. Like, okay, that was enough. It's kind of go to bed, you know, or go back to work. It's like,

02:23:11.080 okay, I guess I'm finished. My wife really, she does a great job cooking with what limited

02:23:16.000 resources we have, but it's pretty stark. Is there a food that you particularly

02:23:20.780 looked forward to having when you knew you were coming to the United States?

02:23:24.160 Yeah. Like pizza. You're Italian, right? Yeah. So pizza, eggplant, parmesan is my favorite food

02:23:29.260 in the world. So my sister made that when I was down there. Hamburgers, I just crave cheeseburgers,

02:23:34.540 like just a good sandwich, you know, with some chicken sandwich or something. Is this really nice

02:23:39.200 with a good bread? You know, this kind of stuff. You've been sick when you're there. I mean,

02:23:43.980 how many times have you had malaria? Well, I've been there 10 and a half years. So I've gotten

02:23:48.040 malaria every year, except for 2018. How bad is malaria? It sounds awful. It's pretty bad. I mean,

02:23:54.360 you, sometimes you're wishing somebody comes in and just shoots you and put you out of your misery.

02:23:57.700 It's, it's, you're, you're pretty sick with it. It's worse than influenza, right? Yeah. And influenza,

02:24:02.620 anybody who's actually had the flu will attest that's 10 days of really bad living. Yeah.

02:24:08.500 Larry's pretty miserable. I mean, real bad headache, nausea, vomiting, you can't sleep,

02:24:13.860 just high fevers, body aches, terrible body aches. And sometimes you get a bit lucky,

02:24:18.860 you take medicine, you're, you're over it in a few days, but you know, a lot of times it'll

02:24:22.860 drag on for a month. But you don't take prophylaxis throughout the year, just,

02:24:26.840 or during the rainy season, which I'm assuming is when it's endemic. Right. I don't, I don't take

02:24:30.500 prophylaxis. Just because of the cost and. Yeah. I just don't want to take the drug. I just want to

02:24:34.960 say, okay, let me just not take it. Take it once you get it. Right. Once I get it.

02:24:38.960 Sometimes it'll drag on a bit longer. I mean, sometimes you get it just for a month,

02:24:42.220 you take the medicine, you feel a bit better for a couple of days. Then next evening you start

02:24:46.520 feeling the chills and shaking and the headache comes again. And it's like, oh gosh, still with

02:24:50.680 me. It can really drag on for a long time. So every year you've got it. Every year.

02:24:55.140 That was in a coma a few years ago. Just, uh, God, it was a strange night or it started feeling

02:25:02.240 sick the night before. It was on a Tuesday night and started taking, I took some oral drugs,

02:25:06.740 I think a court, which is, um, seen in derivative. Took that at night. I went to bed, just kind

02:25:12.800 of had a kind of fitful sleep. And then I woke up the next morning and all these staff were

02:25:17.000 in my room. I have an IV in my arm and I'm an IV quinine. Like what, what's going on here?

02:25:22.280 The doctor needed treatment.

02:25:23.780 That's right. But I was really out of it. That was like 11 o'clock when I woke up and I was

02:25:28.380 really, you know, they tried to get me up in the morning. Some of the staff, cause I was in

02:25:31.280 operating room day on Wednesday. And, uh, our guy, that's our assistant there, I didn't

02:25:36.660 show up. I, you know, for the, I was on there by seven 30 and I didn't show up. So he came

02:25:40.620 up to the room. He tried to wake me up and I couldn't get up. Like I didn't respond to

02:25:44.300 him. So he thought I was dead. He was like, Hey, people came running in. Anyway, I didn't

02:25:49.440 die. So I just, uh, I was out of it for quite a while, but then I recovered pretty quickly.

02:25:53.660 I can't even imagine. I just, I can't. When you think back, Tom, about all of the people

02:25:59.420 you've taken care of in the last 10 or 11 years. So just even just limiting it to, to

02:26:05.060 the time in Nuba, is there any one particular patient that just stays with you? That haunts

02:26:11.140 you one case, one story, one child, one adult. I mean, I have those stories. I've got one

02:26:16.580 or two, three, probably three stories that have stayed with me from my training. Right.

02:26:22.080 That if I even think about these patients, I'll tear up. I mean, just, you know, they're

02:26:25.960 unfortunately, they're all bad outcomes as the ones that, but they're also, they're

02:26:31.360 not like the only bad outcomes I've seen, but there's just some, there was some emotional

02:26:34.260 connection that happened. And then it's maybe it's sometimes you're projecting what's

02:26:38.700 happening there onto your own life or something, but do you have those cases?

02:26:41.760 Yeah. Probably like you, the ones you really remember are the ones that have bad outcomes

02:26:45.300 or ones that didn't go well. Gosh, we had one kid. I remember he, he came in on a Sunday

02:26:51.160 morning and he had been, the Antonov bombed in the shrapnel went in his face and just

02:26:56.800 tore his face to shreds. And he went to some clinic somewhere and they, they put a few stitches

02:27:00.860 in it, like chromic stitches. And it came a couple of days after that and his face was

02:27:06.700 just mangled. So we took the stitches out and it was all just pus and dirt coming out.

02:27:10.240 I mean, just they didn't clean the wound out. So we took all these stitches out, cleaned the

02:27:13.380 wound out well, put them on some antibiotics. A couple of days later, we go on, he's got high

02:27:18.640 fever and he can't swallow. I'm like, no crap. He's got, he's got tetanus. So a kid

02:27:22.680 gets tetanus. I remember the day before then, I remember the Antonov came overhead. The Antonov

02:27:27.380 is the airplane that bombs. And we saw the kid, he was like a, maybe 10 years old. He

02:27:32.260 was standing against the wall, just shivering when he heard the airplane, just shaking.

02:27:35.080 He was so traumatized.

02:27:35.900 He was so traumatized. He was shaking like this. Then like the next day he gets a real high

02:27:40.340 fever. He can't swallow. He put him in isolation, put NG tube down to feed him. And he just

02:27:44.440 died from tetanus like overnight. He died from tetanus. And I remember this

02:27:48.500 kid's face and how, and I said, what the heck? It was a 10 year old kid with this thing.

02:27:53.940 We had another kid, this is a few years ago. He was, he was bombed, he and his aunt, and

02:27:59.440 it was an incendiary bomb from the Antonov. And I don't know what they had, napalm or whatever,

02:28:04.100 but it bombed him. It just, he had, I don't know. He had third degree burns on probably 60,

02:28:09.180 70% of his body.

02:28:10.500 And he lived.

02:28:11.220 Is that even survivable?

02:28:12.420 No, he lived like two months with this and both he and his aunt were the same. And I

02:28:16.220 mean, we tried everything with these kids. The amount of work the nurses did every day

02:28:21.940 just to try to address him and the agony he went through before he died. I remember, you

02:28:25.800 know, this, his aunt would have these scabs and I remember there were, there were, her eye

02:28:31.160 was, was burned with this thing. And I remember there were maggots coming out of her eye, you

02:28:35.720 know? I think, what, what the heck are we doing? You know, this is crazy. What, what, who are

02:28:41.780 these, these are civilians? Burned to death, you know? There were other, six other kids

02:28:47.040 that were in an area that was being shelled. So the Sudan army would shell their village

02:28:51.780 like all night and then they would bomb during the day. So they were, at nighttime, they would

02:28:56.760 sleep in the foxholes for protection. So right next to them was a straw rakuba, kind of a straw

02:29:02.720 little structure. So the artillery shell fired and hit the rakuba. Thing burst, rakuba was just

02:29:07.720 like a, kind of a lean to with, made of grass and wood. It set this thing on fire and it

02:29:13.360 fell into the foxhole. And there were, I think, nine people in the foxhole all sleeping. Three

02:29:18.880 were burned to death immediately. Six of them came to the hospital with varied degrees

02:29:24.700 of, of burns. I mean, a couple were just like 80% full thickness burns. I mean, just, they

02:29:29.580 lived for quite a while before they died. Two of them, one girl started improving. They

02:29:35.400 developed tetanus and died from the tetanus. So these are ones that really kind of stick

02:29:40.140 out. Maybe one of the soldiers I remember best is a guy that, he was a guy that I told

02:29:43.640 you before, he had 23 or four holes in his intestines. We opened him up and we just, I

02:29:48.140 mean, hours we operated in this guy. Post-op, he was doing great. I mean, he was cruising,

02:29:54.080 started feeding him. He was set up in bed. The next time I'm called down to see him, he's

02:29:57.560 changed condition, as they say. And I went down there, he's already dead. He was a, he was a,

02:30:02.400 Darfuri, who was fighting with the Nuba rebels. And I just remember thinking, you know, what,

02:30:07.140 what would this like for his, like, this guy's got a family, you know, he's fighting in this

02:30:11.660 place. His family's somewhere in Darfur. What's happening? Do they have any idea what's happening

02:30:16.800 here? So many terrible things. You know, there was a young, one young kid, he was about 16 and he,

02:30:24.140 the Sudan army was encroaching on our area. So the rebels ran out there to kind of repulse them.

02:30:29.800 And then people just kind of jumped on the vehicles to go out and fight, you know?

02:30:33.740 So this kid just jumped on the vehicle. He didn't have a gun, any weapon, anything. It was just a,

02:30:37.360 he was a civilian. He goes out there, he gets shot in the head with, with, you know, machine gun or

02:30:42.460 something. He comes in with, with, you know, part of his skull missing and this brain tissue kind of

02:30:47.460 pulsating out. I mean, he survived for two or three weeks like that. You know, he had steroids and

02:30:52.720 different things, antibiotics, try to count things down and ended up just kind of going south and dying.

02:30:56.900 So these are all, all people I'll never forget. And there are many, many, many beyond that.

02:31:03.480 If people want to get involved in any way, shape or form, where would you recommend they,

02:31:07.460 they look to as, as a resource?

02:31:09.600 I think like an African-American healthcare foundation, there was something on their website

02:31:13.700 about the hospital. That's one source to go to.

02:31:16.900 And their website is sort of...

02:31:18.340 It's amhf.us.

02:31:20.520 Yeah.

02:31:20.600 www.amhf.us. So that's a pretty good source to start. There's a group called Take Heart

02:31:27.380 Foundation, which was set up to kind of, to harness the, whatever support to be through

02:31:33.680 the Heart of Nuba movie, which was made by my friend, Ken Carlson.

02:31:36.980 Which I recommend everybody watch it. I think it's a, I'm sure it was done on a shoestring

02:31:42.180 budget, but it's so well done.

02:31:43.920 Yeah.

02:31:44.280 You know, it just sort of speaks for itself.

02:31:46.100 So anything raised through them goes to African-American healthcare, which comes to us without

02:31:49.860 anything taken out. Catholic Medical Mission Board is another good source. That's my, they're

02:31:55.060 my sponsoring organization. They're here in New York. They've been here for, I think, over

02:31:58.460 a hundred years. And their cmmb.org, I think is their website. These are probably the main

02:32:04.180 sources for our work at Nuba.

02:32:05.960 You know, I'll close with a story, Tom, that I think in many ways kind of defines you.

02:32:09.800 I remember when I decided I wanted to go to medical school, I was applying for this scholarship

02:32:16.700 and in the end I didn't get the scholarship. But I remember during the interview, this guy

02:32:20.860 asked me a question. He said, you know, what do you want to be? And at the time when I went

02:32:23.720 to medical school, I wanted to be a pediatric oncologist. And I know what the guy was doing

02:32:28.860 in retrospect. I mean, I think he was just trying to push me. And he basically said like,

02:32:34.260 why would you want to do that? You can't possibly make a difference, you know, without

02:32:39.240 dedicating your life to research, you're not going to have a difference saving one kid's life at a

02:32:44.680 time, et cetera, et cetera. And, you know, I remember thinking of a story after, which in many

02:32:49.740 ways exemplifies you to an extent that probably no one else, which is, you know, in medicine,

02:32:54.820 you can do two things, right? You can do something very scalable through research. You know,

02:33:00.400 you can devote yourself to working on, you know, treatments for cancer or developing a new drug to

02:33:07.000 treat this disease or that disease. Or you can be on the front lines trying to save one life at a

02:33:12.300 time. So the story is there's these two guys walking down the beach and it's after a really

02:33:17.240 high tide and the beach is covered in starfish. And the starfish are going to die pretty soon if

02:33:22.280 they don't get back in the water, which means they're pretty much all going to die. The two guys

02:33:25.680 are walking and every few steps, one of the guys bends down as he picks up a starfish and he throws

02:33:30.460 it back in the water. Five steps later, he does it again and again and again. After like the 10th one,

02:33:35.700 the one guy says to me, he goes, what are you doing? And he says, well, you know, if these

02:33:39.300 starfish don't get back in the water, you know, they're going to die. And he goes, have you looked

02:33:44.360 and seen how many of them there are here? You can't possibly make a difference. And he throws

02:33:49.620 another one in the water and he says, well, it made a difference to that one. And I think for

02:33:54.700 doctors that don't have the privilege of being able to affect the larger through research or policy

02:34:01.600 changes, whatever for people on the front lines, I don't think there's a human being on this

02:34:05.280 planet who throws more starfish back in the water than you.

02:34:09.100 In the end, medicine is individual. It's the beauty of our profession. And it's a huge privilege

02:34:14.820 to have the opportunity to affect one person. And in the end, you close the door and it's you and the

02:34:22.660 patient, whether you're in Nuba mountains, whether you're here in New York, and that's an incredible

02:34:27.160 privilege. And I think if we keep that focus, just one person at a time, I think people can kind

02:34:34.360 of relax a bit. You can see that what you're doing for that one person, you know, I think people look

02:34:38.440 at Africa and say, you know, what you're doing is a drop in the ocean. I really liked that story

02:34:43.420 because when you're there, you don't see a drop in the ocean. You see a person, you see a life,

02:34:47.540 you see a life and you see somebody that, that can laugh and can cry and can play and can,

02:34:52.500 you know, has aspirations and is a living, breathing human being. You think, man,

02:34:57.700 we helped this one person. That's a huge thing, you know? And I think that helps to stave off some

02:35:04.220 of the burnout and the cynicism. The fact that you are, this is a very individual thing. So one

02:35:09.980 person is really a big deal. It's everything to that one person, that one person's family.

02:35:15.400 And, uh, I think we really have to keep that in mind, especially with this growing realm of cynicism

02:35:21.820 and sort of negativity that we see now. Tom, I have been wanting to meet you for three years.

02:35:28.660 I didn't know that I'd ever get a chance to. So it's, it's sort of beyond a privilege.

02:35:33.660 And I know that for you being outside of Nuba is the toughest thing imaginable, which is of course,

02:35:40.560 the irony sitting here in the plush New York city. And yet all you're doing is pining to go back to a

02:35:46.960 place where your own life is in danger. But, you know, I remember thinking, God, I really just,

02:35:52.020 I'd love to be able to interview Tom. And I remember thinking there's no way he could justify

02:35:55.520 making the time to do this when his time in the U S is so short. So when I asked Rick and Mark and

02:36:02.240 John, and they said that Tom would be happy to sit down, I just, I couldn't believe it. And I might

02:36:07.540 make the case that of all the interviews I've ever done or will do, this is the one I feel most

02:36:11.440 privileged to. So thank you. Thank you so much. Yeah. Thanks, Peter. This has been a real

02:36:15.340 privilege for me to be here with you. And thanks for giving us the platform to spread the word a

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The Peter Attia Drive - November 20, 2023

The world's most important doctor to millions in the war-torn and remote villages of Sudan ｜ Tom Catena, M.D. (#40 rebroadcast)

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