The Peter Attia Drive - The world’s most important doctor to millions in the war-torn and remote villages of Sudan | Tom Catena, M.D. (#40 rebroadcast)

Episode Date: November 20, 2023

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter To support Tom’s mission and work, please visit: https://africanmissionhealthcare.org/donation/catena/.   In this episode, Tom Catena, a missionary physician who runs Mother of Mercy Hospital in the Nuba Mountains in Sudan, describes some of his extraordinary work as the only doctor in a remote, war-torn region of Africa. In terms of individual lives saved, you could argue that there is no other person on the front lines doing more than Tom. Additionally, we explore the manner in which the Nuba people die, which is in striking contrast to the ubiquity of chronic disease and self-harm in the West, despite the extreme poverty and unimaginable suffering experienced by the Nuba people. Lastly, we discuss the lessons to be gleaned from the Nuba people, who, despite their suffering, live so harmoniously, happily, and resiliently. We discuss: Background, medical training, and early days of missionary work in Africa [5:15]; Tom arrives at Mother of Mercy Hospital in the Nuba Mountains of Sudan, civil war breaks out, and his staff evacuates [12:30]; Learning surgery on the job and earning the trust of the community [37:00]; The amazing people of Nuba, and why Nuba feels like home to Tom [47:45]; NY Times article about Tom’s work, and Tom’s new venture on the board of the Aurora Prize Foundation, raising awareness and funds for other missionaries [59:45]; Tom’s mind-blowing ability to deal with chaos while seeing hundreds of patients per day [1:12:00]; The most afraid Tom has ever been, and how he copes with the emotional trauma of his daily experiences [1:19:45]; The basic tools, technologies, and medicines that Tom is lacking that could save many lives [1:30:00]; The logistical challenge of helping Tom’s hospital, and what Tom really needs [1:35:15]; Diseases in the adult population [1:38:30]; Living without possessions, finding meaning, and being a missionary [1:55:45]; Happiness, sense of purpose, and suicide: contrasting the US with Nuba [2:07:15]; Other than donations, is there a way people can help Tom and other similar causes? [2:15:15]; The food in Nuba [2:18:30]; Tom’s annual bout of malaria [2:23:45]; Patients Tom will never forget [2:26:00]; Resources for people wanting to get involved in helping Tom’s work [2:31:00]; Peter tells a story that defines Tom [2:32:00]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

Hey everyone, welcome to the Drive Podcast. I'm your host Peter Atia. This podcast, my website, and my weekly newsletter all focus on the goal of translating the science of longevity into something accessible for everyone. Our goal is to provide the best content in health and wellness, and we've established a great team of analysts to make this happen. It is extremely important to me to provide all of this content without relying on paid ads. To do this, our work is made entirely possible by our members, and in return, we offer exclusive member-only content and benefits above and beyond what is available for free.

If you want to take your knowledge of this space to the next level, it's our goal to ensure members get back much more than the price of the subscription. If you want to learn more about the benefits of our premium membership, head over to peteratia-md.com forward slash subscribe. Welcome to a special episode of the drive for this week's episode. We're going to be rebroadcasting my conversation with Dr. Tom Katena, which was originally released in February of 2019. Prior to interviewing Tom, I had known about him for three years,

but this interview was the first time I met Tom in person. And it's actually the first time in my life that I was ever nervous prior to meeting another human being. And of course, this is incredibly ironic because when you meet Tom and this of course will come across in the episode, he is quite simply the most humble person you can imagine. But I see in Tom what I consider to be the greatest of any qualities or characteristics in a person. And it really humbled me to meet him that day and to continue to get to know him better and better over the years since that time. Since about the year 2000, Tom has been a missionary physician in Africa, initially working in Kenya, and then in about 2008, he moved to a region of South Sudan called the New

Behils, or the Newba Mountains, where he continues to take care of about three quarters of a million to a million people. At the time he was the only physician in the area and there's a single hospital there, it's hard to describe how few resources he has to run it. This is something he'll explain in the podcast. It's really nothing short of a miracle. As an update to Tom's work, after several years of relative comm, Sudan is again besieged with conflict. This time, there is fighting between factions of the government.

This civil war has inflicted widespread damage across the Sudanese health system. However, even with all of this, Tom's hospital is still functioning and caring for the wounded. Not only that, but the hospital now has its own clinical training school, which has 19 physician, assistant students, and 30 midwife students. In 2008, when the hospital was founded, there were 15 staff members, including Tom and a few ex-patriot Catholic nuns, and the local Nuba were not formally trained at the time. As of today, there are 270 staff and over 50 formerly trained newbie health workers, including nurses, pharmacists, laboratory technicians, and anesthetists.

And the first woman doctor from the besieged area of the newbie mountains is now also working with Tom. In my conversation with Tom, we talk about a lot of things. We cover some of the unimaginable suffering that he sees and how he himself copes with death and copes with being in a situation that I certainly don't think I could be in and I suspect many of you listening would relate to that. We talk about a crisis of purpose.

I think it's easy to look at what Tom does and feel sorry for him or feel sorry for the people that he serves, but I must admit I came away from this interview actually feeling more sorry for us in a way. And Tom so eloquently, without judgment, explains some of the differences between people with all the privilege in the world, like most of us listening to this, and the people that he serves. We also talk about the sense of community that exists in Nuba. And what you start to realize is that the way we die in this country and the way that we live in this country is so different from the way that people live and die in other parts of the world. It's not surprising

that people there don't die from complications of type two diabetes, but instead they die from infectious diseases and trauma. There's also a more subtle point here, which is that we are in many ways prisoners of our own world and our own mind and our own possessions. Tom's work is so important to me that I wanna be sure anybody listening to this can get access to all the notes

that we're going to put together on this topic. And as such, for this episode, the show notes will be free and available to everyone, including those who are not subscribers. Lastly, and perhaps most importantly, if anyone is curious about how to support Tom and his amazing work, we will have a link at the top of the page of the show notes where you can give directly to the work Tom does. My wife and I have been giving to Tom for about six years now, and I can say that it is unquestionably the highest ROI money that we contribute to any cause. In other words, for every dollar we give, we really have a sense of how it's being used and how it is changing lives.

So without further delay, please enjoy or potentially re-enjoy my conversation with Dr. Tom Ketana. Oh. Oh. Oh. Oh. Oh. Hey, Tom. Thank you so much for making the time to come over here today.

It's your pleasure. My pleasure. Yeah, there are a few people that would be giving up more that they deem important work than you. So I know, I know your time is tight. How often do you come to the US? Well, this is my first time out in more than three years. So last time I was in the US was November 2015. I was here for about five days. I was in my hometown of Amsterdam, New

York. And it wasn't much of a trip. I was US about malaria. I was sick as a dog of malaria. So I was like in bed with my whole time. The last day I felt a bit better, just in time to go back to Africa. So it's been a long time, it's having back. You grew up in upstate New York. Your pedigree is like this star, right? You went to Brown, you played football, you went to Duke Medical School.

Right. At what point did you realize you wanted to do something a little different to vis-a-vis working outside you know, outside of the US, for example. This desire to do this kind of work really was planted in when I was in college, when I was at Brown, and I always wanted to do some kind of mission work, and that term has several connotations, but I wanted to be a missionary. Whatever that meant, I wasn't quite sure what meant at the time, but I just had this idea. I wanted to work in the cultures and the society, do mission work. But I was as you a mechanical engineering major, and that didn't really fit with doing mission work.

This was in the 1980s, and most of the jobs then were in the defense industry. They were, you know, they were good jobs, but I didn't really want to do that kind of work. So I graduated college and kind of floating around for while I was offered a job by GE. Working with they were kind of nuclear submarine program. But we've been a really good job, but I just wasn't interested in that kind of floating around for while I was offered a job by GE. Working with there were kind of nuclear submarine program. It would have been a really good job,

but I just wasn't interested in that kind of work. And number one day it was kind of odd. It was coming back from my great aunts funeral. I was with my brother Felix. And I did just kind of popped in my head. I should go into medicine because I could, if I do that, then I could do mission work. And you know, I'd like the sciences,

like a state of the sciences, do mission work, help people. Just kind of that general idea. And, and it up go into medical school and I've kind of kept that desire to mission work and that kind of evolved into wanting to work in Africa, to work with people that don't have a lot of options for healthcare, you know, 15 years later, ended up in Sudan.

So you started out in Kenya, is that right? Right. So we don't want to finish medical school then I did five years in the US Navy. I didn't even scholarship for medical school. So I'd have to pay that time back then went to my residency. I did family practice in Tarot, Indiana.

Now it was time to kind of be free and do what I want. So I thought, well, let me just go and, let me do this thing that's been kind of an itch for so many years. So I teamed up with Catholic Medical Mission Board and I said, okay, we have an opening in Kenya at this mission hospital. Maybe go there. It's okay. I'll go for one year. I'll see what goes. If I like it, maybe I'll stay longer. Otherwise, me all just come back and start a practice and went down to Kenya and fell in love with the place and decided to stay. What was the first thing that you remember when you got there as far as how different this was

from the way you had trained because you did your residence in the United States, right? Right, do my residency in the US and I do family practice. And the program I went to was kind of geared towards rural health. So I thought, okay, if I want to do admission medicine, I'd be doing more than just kind of outpatient

all this stuff. I need to do something with a little more meat to it. So, you know, a little bit of statics. We did a bit of surgery, mostly just these sections. So when I first got there, I think what struck me was just the volume of patients. I mean, it was a resident and, you know, in clinic days, we'd see like five or six patients, you know,

and get all every little detail down in each one. And now, I mean, in this rural hospital in Kenya, and I'm interesting 50, 60 patients, huge numbers. The clinic, the wards are full. You go to the ward round, I was in charge of the adult ward, and there were, you know, at the time I thought was a huge, I mean, like 30, 40 patients there,

and I was responsible for all of them. It's just this year volume of patients you had to go through every day in the variety of diseases. So not only the tropical stuff, which I didn't know much about, I mean, here's malaria, TB, Lychmoniasis, all this kind of stuff I had no idea about. I had to learn about when I was there. You know, learned to thank God some, a couple more senior doctors there that I could learn from. But just a volume of patients in the variety of diseases you had a face. So what year did you get to Kenya? I arrived in Kenya January 17th 2000. That's so interesting.

I arrived at NIH, when I was in medical school on January 17th 2000. No way, yeah. That was, which was NIH, being at NIH while I was in medical school was one of the sort of more formative parts of my experience. So how long before you went to Sudan

and what led to that transition, I'm trying to think of my geography, right? Kenya is south of Sudan, correct? Sort of southeast of Sudan? South, right, south of the bit east, exactly. Okay, and much more stable, right? I mean, Kenya is a relatively safe place to be. Right.

Sudan is not, right? It's divided into these provinces and the one that got all the attention was Darfur, which is the furthest west. Correct, exactly. And that basically was a war zone. I mean, a killing field, right? So Bashar was basically killing his own people there, wasn't he?

Right. So to go from Kenya to Sudan, what were you thinking? I think maybe the modus operandi in my life is always looking for what's the opposite of greener pastures. I'm looking for browner pastures. When I was there in Kenya, this was, as I said, I got there in January 2000. The Civil War in Sudan was really raging at that time. And I was in Kenya learning a ton of stuff, really enjoyed the work. And I kept hearing about Sudan, the Civil War in Sudan, and how it's so terrible.

And the conditions there were terrible. And the, you know, it was such a lack of any kind of health services. I thought, man, I'd really like to get involved in that, in that struggle just to go and work with the help of people there just because it was so, health facilities were so limited. I thought that's kind of the place I want to go to. So I had this general thought. This is 2000, that's kind of the place I want to go to. So I had this general thought. This is 2000, 2001, 2002. Now, this was in June of 2002. I left my first posting, which was in a real place called Motomo, it was there for two and a half years. I went up to

Northern Kenya, a place called Tercana. It was at the Ka-Kamon Mission Hospital, which is up in the Tercana Desert near the refugee camp. A woman named Diedra Burns. So Diedi was there, I think her first time up in Tercana. And I was talking to her.. So, Diedi was their, I think, her first time up in Tacana, and I was talking to her. She's an American. She was in a kind of short term mission there. She's a surgeon and a family practice doctor. She did both. She was doing primarily surgery. And she said, look, there's a bishop I know. He's a bishop in Akram Gaseis. He was building a hospital in Sudan. I think he might be interested in going there. And that said, whoa, that's exactly what I've been thinking about doing, you know, for the past couple of years. It's back to 2002. So she's, look, he's got an office in

Nairobi. He's living there in exile. Maybe you can make contact with his office because I was due to go to Nairobi and start working there. Anyway, to make a long story short, I ended up working in Nairobi, I linked up with his office and we started kind of making plans for the hospital and how it would run, staff who would need all that kind of stuff. And then it took six years, but six years later, who funded the hospital? Is all funded through the Catholic diocese. I see. So as a Catholic diocese of Elabade, Bishop Gassiz was the Bishop of the Elabade diocese, and he and his office were able to get funding through the church mechanism to fund the hospital.

So now it's O809, and that's when you go. Right. So I went to New Mountains, arrived there, arrived there, March 10th, 2008. Was there? I landed there in the Mammothins. Tell the listener a little bit about where Nuba is. I mean, I know it's in the southern part of Sudan. It's to the east of Darfur.

Right. But it's pretty rugged country, isn't it? Right. So the New Mammothins is probably one of the most remote places in the world. It's a region which for many years, and Sudan was kind of kept off limits before when Sudan was kind of a colony, it was under the, called the Anglo-Egyptian condominium, partly kind of administered by UK and by Britain and by Egypt.

They decided to kind of keep the new besiever. They said, these people have a unique culture, our new people. They didn't really allow a unique culture, our new people. They didn't really allow a lot of open tourism or people to go in there. It was kind of a closed area. So they really kind of have maintained this separateness and this isolation over centuries. It's difficult to reach. It's semi-arid. It's got this thing in rainy seasons, it's got to dry season. But more hills, they aren't real high mountains, but sort of, you know, 3,000 foot hills, that kind of, that kind of range. My history is not great, but I sort of remember that basically Sudan was granted sort of, I forget the term, but when you're given your independence for a lack of a better word,

that would have been in the 50s, right? Right. 56. Okay. And then what was the religious sort of map of Sudan? And did that figure into how it was divided? And was that partly why Nuba was, was it religiously diverse? Was it mostly Muslim, mostly Christian? Yeah, you know, Sudan is a very interesting place. So you've got, it was one country up until 2011 when they divided the North and South. Now, the religious makeup is in the North.

So North of Nuba Mountains, it's primarily Muslim, almost all Muslim in the north. The south is primarily Christian. Nuba is right in the middle, and interestingly enough, Nuba is a mix. It's about, let's say, half Christian, half Muslim, and everybody's an animus, but half our Christian, half our Muslim.

And the Nuba are unique, I think a unique tribe in the world, where you have families which are mixed. You have Nuba Muslims and Nuba Christians and there's no conflict amongst them. For instance, my wife is Nuba, her father, both her parents when they were born, they were just followed the traditional legends. The Christianity and Islam had not been introduced yet to the area. Now, as they got older, her father became Muslim, mother became Christian, they married. Her father's a pigmas, so two eyes,

both eyes are Christian, their oldest son is a Muslim, the rest of the children are Christian, and nobody's really bothered by this. That's in Nuba. Now, the country itself, this difference between Muslim and Christian was really a big issue in the previous Civil War. You know, we had sort of the Southern African people that were mostly Christian against the Northern

Arab people that were all Muslim fighting each other. And there was very much a religious context to that previous Civil War. And also in the Mammoth Mountains, the Mammoth people joined the Southerners. They're all African and new, but they joined the Southerners fighting the Northern Arab Muslim people in the North. And in the 1990s there was a jihad against the New but people. So there was a real genocide in the 1990s against the New but who issued this jihad? The ID log behind us is a guy who just died last year. His name is Hassan Al-Turabi. And Trabi was a member of the Muslim Brotherhood. Very bright guy went to Sorbonne in Paris,

and was covered in intellectual, but really kind of an evil genius. If I can use that word, he was a real ideologue in the Muslim Brotherhood, and he managed to convince some of the imams in the North to sign off a Fantua to allow G-Hot against the Nuba. And many imams rejected it. They said, you can't do that. Even's, you know, even though he'd be killing Muslims

within nuba, right? Exactly. His response to this was, okay, you can have a jihad because the Christians are fair game in the jihad and then the Muslims are apostates from the religion because they associate with Christians. Some of them eat pork, some of them drink local beer. They're not real Muslims.

Like this thing with the new bar very much communal and to have Muslims and Christians together at functions, it was an nothing but the fact we could have Christians and Muslims in the same family was a huge scandal to him. He just couldn't tolerate that kind of stuff. So he said, now these guys are also fair game because they're not real Muslims. So what year was that Fatwa issued?

That was in the, I think in the early 90s, we've been 93s. So Bashir was already in power right. His coup was like late 80s right. He took power in 89. Okay. And this guy, Trabi helped him in this coup. He was kind of the brains behind the coup. And Trabi, I mean he was, you know, he was kind of a power hungry guy. He said, okay, he figured if he helped Bashir getting the power, but she was a military guy. And he thought, okay, if I help Bashi or getting the power, I'm much more intelligent than Bashi or I'll just kind of find a way to get rid of him and I'll take over.

And Bashi said, look, I'm the one in power. You're not taking over. So he kind of always kept Trabi at a distance. And there always, he was always throwing Trabi in prison afterwards because Trabi started speaking out against him, but put him in a quote unquote prison. He'd be, you know, living in some luxury apartment in Cartoum. But they kind of were at odds with each other.

But probably was the ideologue behind a lot of this moment. He's doing that invited Osama bin Laden to Sudan in the early 90s. So bin Laden lived in, when bin Laden was exiled from Saudi Arabia, which is, yeah, in the early 2000s. Right. Well, that was before then. He invited, what's his name?

He invited bin Laden to Cartoum. So he lived in Sudan for a while. And a lot of, you know, a kind of a lot of training camps 2000s right well that was before then he invited what's his name he invited been lawton to cartoon So he lived in Sudan for a while and a lot of you know a kite had a lot of training camps in the desert in the north of Sudan I had totally forgotten that fact that the chapter of Valkyra that I'd prefer gotten So you basically have a bunch of incredibly evil people who are Deciding to kill their own citizens effectively right You got there in oh eight, eight, you said it on nine. Oh, eight. So he arrived March, 2008. So historically, that was the interim peace period.

So since they got independence in 1956, Sudan's been a civil war. Various parts have been a civil war for almost the entire history. That's, that's 60, that's how many years, 62, 63 years. Most of the history they've been at Civil War. So this was one of the brief periods. Actually, it wasn't even priesthood, because there were four of us started in 2003. There were four of us started fighting

as the government doesn't three. So this wasn't, the whole country was not a piece of the time, but the big war between the South and North, the peace agreement was signed in 2005. So when we arrived in 2008, the peace agreement was still 2005. So when we arrived 2008, the peace agreement was still in effect, and there was no active fighting. And then we were kind of waiting for this referendum to take place. The way the peace agreement was signed up was southern or so south Sudan would have the choice for a self-determination, and that

would be done by referendum. So the people actually have a vote. Straight up vote. The majority vote to secede, they secede. The majority vote to stay, and stay as one country, they stay. Now, 2011 they have the vote, and like 99.99%. Vote to secede from the North. So South Sudan separates. In the peace agreement, I'm sorry, is Nuba considered South or North in this cessation?

Right, this is part of the problem, because in the peace agreement, Nuba was separate. Okay, and what they have said was, okay, South Sudan will have it for our friend. The Nubah Mountains was not included as part of South Sudan. Nubah and Blue Nile were separate regions. And they said, in these two regions, they're called the two areas, they'll have what's called a popular consultation, which was a very vague system where there would be committee set up, they would go and they would talk to people in the villages and kind of get their opinions on things

and see what they want to do. If they wanted to separate, stay, it was very vague. I think it was purposely vague because the government knew it was kind of a bargaining chip for the north to allow South Sudan to have this referendum. It's okay. Because they knew in the end they would keep the mommons because this thing was too vague. And they would be able to manipulate it enough. they will keep the mommones. Because this thing was too vague, you know, and they would be able to manipulate it enough. They will keep the nub on their side. So South Sudan

separates. There are elections in new mommones in 2011 and May, the candidate for Bashir's party, of course, wins the governorship in the parliament. This is a side note. Before that election, the guy's name is Ahmed Haroon, who was running against the guy named Abdulaziz. Anyway, Ahmed Haroon was the candidate for Bashir's party, that's from Congress party. And before the election, Bashir said, Ahmed Haroon is our candidate,

and he will win this election, whether by the ballot or by the bullet. So going into it, it doesn't look like it's gonna be a free and fair election. Right, and Bashir, at this point, does he already have basically a warrant out for his arrest? Right, so he's got the warrant for his arrest. That was I think 2009. I think Amadharun also is indicted by the ICC for crimes. He was one of the architects of the genocide. genocide. Yeah.

Darfur. So Amadharun, who is our governor, as under is indicted by the ICC, by shares and that it by the ICC. It also was the defense minister wasn't that it by the ICC. So I'm going to her wins. They go and say, okay, now our party is there in South quarterfantastate in the mountains. There are still SPLA soldiers like southern soldiers living in this region. The Northern Army came and said, you know, did a forced disarmament of these SPLA soldiers.

And that's when violence broke out. So June 2011, June 6, 2011, Civil War breaks out in New Beamountains against the government. Now, I've heard you speak about this in the past. It was overnight that most of the staff in your hospital left. So prior to that, leading up to that, the referendum and that the breakout of war, you've got this three-year period where you're in the hospital, you're working there. As far as Nuba can be tranquil, this is the greatest tranquility you've seen. The staff is what? It's you. It's what else? Right, so at this time, we started the hospital. March 2008, we went there with about eight expatriates, including myself. So I was the only

doctor we had a few nurses and esotist, the lab person. We had those eight ex-pagerates. They were mostly from, they're often Kenya or Uganda. Those eight ex-pagerates myself and we had 15 local staff, Nuba. And the Nuba, I think the most educated person, had finished primary school. They were not nurses. They were just kind of local people that could read and write a bit of English. They could speak English. So they had to be taught everything. We first started. They couldn't weigh a patient. They couldn't take a temperature or let alone give an injection or start an IB. Anyway, with time we got these guys trained up a bit so they had some pretty good skills.

A lot of most of that was done by these ex-patriate nurses. Now we still kept ex-patriates, but over time we added more and more on the job-trained people. We kept adding more primary school graduates or eventually got a few secondary school people starting training them on the job. We didn't have any trained numer nurses, nuba nurses by the time the worst started in 2011. So now worst stars June 6th to 11th. By June 16th is 10 days into the fighting. Things are getting pretty hairy. There's a lot of fighting within Nuba, Arab bombardments all the time and the diocese. And this is all from the North.

The North is right. Fighting within Nuba Mountains. The resistance is posed by whom. Is it former Southern who have not seceded or are trying to basically, are the North in the South now fighting for Nuba? Right, so what happens is the South Sudan is totally separate. Got it. So within Nuba mountains, you've got a lot of soldiers that were southern soldiers,

S.P.L.A soldiers, a lot of whom were Nuba. Most of them were Nuba, but you also had other southern tribes in their mountains kind of left over from the previous conflict. And they were there in the barracks. So that all those kind of trapped S.P.L.A. soldiers are fighting the Sudan army. Now they call themselves, instead of S.P.L.A. called S.P.L.A. North. So from that point forward, these guys are called S.P.L.A. North.

They have kind of a new identity as a separate military force from the S.P.L.A. which is in South Sudan. So fighting is going on, Arab environments. June 16th, the diocese says, look, we're setting a plane in, and this plane is in a command to evacuate anybody who wants to get out of there. Okay, because it's...

And the plane was gonna go to Uganda or to Sudan. The plane was flying into Newman Mountains to pick up whoever wanted to get out. They would get out and leave. Now, this was a bit dicey because at this time, there were a few flights coming into the mountains, mostly getting people out, but they have to change the airstrip. There were a few airstrips around, but they would give the location of the airstrip the last moment

and they would have a code name for it because if there were a lot of spies around, and if the North found out, they would come with their bombers and come and bomb the airstrip. They would try to bomb the plane on the ground or bomb the people that were trying to get the plane to escape. So all of a sudden, was top secret. A plane comes in, and this is like we come in, we land, and we're taking off in 10 minutes. You better be at the air strip waiting, get your butts on the air blinning.

We have to be out by 10 minutes, where all these guys will come and bomb. And they do this at night, I'm assuming. Now they did it early in the morning, because you can't, there's no lights or anything for the planes to land, so it's all just by it by sight. So it was coming in the morning, land, and they would get out. So, you know, all of our expats that were there with us, they had all the knowledge. I mean, our anesthetist, our lab person, pharmacist, the nurses that were warden charges,

the ones that were doing most of the work and doing the leadership, they all decided to leave. Now, did you all sit down together and have this sort of heart to heart, which is each of you had to make a very difficult decision, which is you feel committed to this work you're doing, but now your life is at exponentially greater danger. Right. So yeah, we met with everybody. We had a group talk and we met in the vigilance and said, look, this plane is coming in. This is the last plane that the diocese can send in. This is it, you know, once, once this plane comes and once it leaves, you might never get out of here. Because you have no idea what's going to happen the next day. You don't know if the sitting arm is going to overrun us.

This is the last chance. How did you think about that? Was there a moment when you thought maybe I should leave and go back to Kenya or go to Uganda or go somewhere else. I mean, what was that thought process like? Right. So, you know, I was encouraged to leave by some different people. I said, look, why don't you come out and you stay in Kenya for a while, then when things blow over, then you can go back when it's safer.

I thought, and I thought, geez, you know, first, I mean, you have no idea. This is just total chaos. You have no idea what's going to happen. What I did know is that we were getting people wounded or well, the destruction was ever coming in all the time, you know. So I knew if I leave, it's not like they can go somewhere else. They were no other hospital, surgical capability, okay. There wasn't a single one. There was a small hospital nearby, run by a German group. Like, I do some inpatient stuff, and outpatient, and some minor stuff.

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

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

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

Don't worry about it. So we want to give them full latitude to lead in peace and not feel they are abandoning people there. So I think everybody's pretty much at peace with the decision. The X-Pats left. And I mean, sure enough, they left June 16th, the morning of June 16th. they left around six in the morning. They had to get out there early because they had to get this plan and just get out of the place.

And we had to keep everything secret. So all of our staff didn't know these guys were leaving. We had to keep it a secret from everybody. And they up and left and then the staff came to work at 730. And so you had an anesthesiologist. It was one of the people that left. Right. So talk to me about 10 o'clock on that morning, the first time, or whenever the first surgical case comes in, who's running anesthesia? That was the biggest problem. So these guys leave around six.

In a clock, casualty start rolling in. People that were, there was a bombing from one of the Sudan Air Force planes called an Antonov, that has barrel bombs. They bombed in a location near us. Maybe an hour, a couple hours away. We hear these in the film, The Heart of Nuba, which we'll talk about in a few minutes, but...

Right. So like two hours later, all these megal bodies start coming in. Yeah, we describe what this... I mean, so I did my training in Baltimore. In many ways, trauma was a feature of the training program because if you're training in surgery, you know, one of my mentors said, you know, to be able to train in a place like Hopkins is a great honor because you really get to understand surgical anatomy in trauma. And it's penetrating trauma in the United States is mostly gunshot wound and stab wounds. But I have no idea what you were seeing. So what explained to me what things you actually saw, what types of injuries are you seeing?

Right, so this was very start because when Antonov bombs, they're a huge shards of metal. I mean, weighing, you know, 10 pounds. I've got a bunch of the scraps. I have them as a souvenir Megan Nuba. So imagine a scrap of metal weighs 10 pounds, red hot, just going through your body. So it slices off legs, slices of arms, cuts through people So imagine a scrap of male waste 10 pounds red hot just going through your body. So it slices off legs, slices of arms, cuts through people with just massive tissue loss and massive trauma. So I'm here one young lady who was 16. Her name was Urshaleem, which means Jerusalem in the Arabic and her arm was just totally mangled. I mean, just shattered.

She came in, her cousin came in, his hand was blown off by the Antennaupt Schrapnel. So these guys, both the interpretations, the girl, we did a dysarticulation of the shoulders. So we had a couple of our, on the job train nurses there, and they had done something, they've been taught how to do spinal anesthetic by the anesthetist. So they said, they said,

they couldn't do GA. For the listener, GA general anesthetics, they couldn't intubate and put the patient fully to sleep. And I had never intubated a patient before. I remember when I was in the military, we intubated and intubate goats for as part of our ATLS training.

I think I remember, but I never done it either. It's like, what the heck? So, I was so afraid, I'm like, what am I doing with these people? So, I remember reading the book. We have a book there, kind of, basically, I'm a steeger book. So, I bring you through with the protocols, okay, first give some ketamine, so I remember reading the book. We have a book there that kind of basically got a steja book. So I bring you through the protocols. Okay, first give some

ketamine. You knock them out with that. They go to sleep, give it a little batch of pain, you give it sucks, no, cold, to paralyze them, and to bait and you give pancreatium. You have a hell of a steja, put the tube in the bubble, decide to bait, and go, okay, let's do it. So we took some guys back and you know, I would go and get the drug. I had a nurse there at kind of child. It's okay. Give the ketamine. You would push it in, push the succino-slexino-collein out into bait. And I guess I should explain for the person listening to this because we use these terms so commonly. So intubation is a very important step where if you screw this up, you're going to kill a person. Literally, you will kill them, but you have to put a breathing tube into the endotracheal space.

So this is now to allow a machine to breathe for someone while they're under anesthesia. And we do these things in medical school. We did them in residency. A lot of our critical care training required that. But I have to tell you, and I was not trained as an anesthesiologist, I never intubated somebody without being incredibly nervous

because it's so easy to put that tube accidentally into the esophagus and you think you're doing it right. And all of a sudden, you get the tube in, you hook it up to the ventilator, you think everything's going well, and by the time you realize you're providing oxygen to their stomach instead of their lungs, it can be too late.

And then of course, the panic that ensues is often what kills the patient, right? Because you're getting nervous and then you can't do it, you're starting to shake. You know, the problem is, as I said before, my training was family practice. I did an internal medicine internship, you know, and they had family practice. I never intimidated somebody. I never did anesthesia rotation in medical school that was not part of our training at all. So I was very green with this. Anyway, by the grace of God,

managed to get the patient-intivated, connected to the help we've had really primitive structure called an OMV, Huxford Benetra ventilator. It's got a set of bellows. It's like turn of the century kind of stuff, turn of the 20th century. So, you know, intubating,

so we have to get to manual ventilation for the patient. We'll go throughout the whole surgery. Yeah, for the whole surgery. As long as I parallelize, you've got to, you've got to ventilate manually. Usually, with the hell of thing, after you manually ventilate for about 20 minutes, they can breathe in their own. And it's a bit of an art to try to keep them under enough, where they can breathe in their own, but they're not in pain. So it's a big art to this kind of, and I work, but it's all manual. I just have to go off on a tangent for a moment, which perhaps only the people listening to this who have medical training will appreciate what you're saying.

I'm guessing you don't have blood gases. No. Okay, so you can't measure a patient's PAO2 or PACO2, and yet your anesthetist has to figure out how to ventilate, which again, means how much oxygen the person needs and how much CO2 you take off. And if you screw either of those two up, you will kill someone. Right. And if you told me to walk into mass general or NYU or pick your favorite hospital and said, Peter, we're going to do everything for you. We're going to intubate

the patient. We're gonna do this. All you have to do is be the guy that manually ventilates them. I wouldn't be able to do that. Like I would overdo it or underdo it. There's no way you'd hit that sweet spot. You'd cause an alkylosis acid, you would just, and then to be able to not have the laboratory tools to know when you're off the rails.

Yeah, in those days we didn't have a pulse ox. Now we have a pulse ox, similar to which you measure the prescriptions. The oxygen saturation. That's a saturation blood. That's how we know pulse ox. Some of this stuff, maybe ignorance is bliss because you can't measure it.

So you just hope and pray that things are going okay, but managers got the guy into the... I mean, you couldn't do veterinary medicine like this in the United States. Right. Yeah. You know, it was pretty hairy. We managed to get through and this one, it was pretty hairy. We managed to

get through and this one, we eventually got an anesthetist to come. This was after about a month or two. Well, and in that month or two, what types of casualties did you see? Oh, I mean, everything. Abdomel trauma, lots of lecturing. We did a number of general anesthetics during that time. We had a baby that came in with interception. This was the worst case. It was a nine-month-old baby who came in, who had an interception, which is kind of an intestinal obstruction. Yeah, I explain what that looks like, the telescope being part of.

Right. So interception is when the intestine telescopes on itself and basically causes a blockage of the intestine and then when the longer you delay, that intestine can die and the person will die of the baby will die from infection. Anyway, maybe that ignoses it. I'm just like, oh, God, you know, we supposed to do with this kid. Anyway, we take the baby to the upper room and say, we got to try something.

So I'm intubating an adult is hard. Baby is really, really hard. We managed to get the kid intubated. So I didn't pay the baby. I started on the ventilated pelvic thing. When I scrubbed for the case, came back, we opened the baby up did a ball resection, put it back together close baby up and he'd be great. He's, uh, how does the baby now? He's white baby. He's eight years old now.

He'd nine years old. So he's, he's cruising. But that's kind of one of the many miracles. And when these things bits of shrapnel are going through people, I mean, you're seeing liver lacerations, you're seeing bolognauries, hemonymothoruses, head trauma. I mean, give me a sense of the mortality. There are some cases that obviously just can't be saved. Right. Well, you know, tell you Peter, what I think what happens is some of these people say, why do you have so many extremity traumas?

Because there's the ones that make it in. The ones that survive. Yeah. So, you know, the ones that get a really terrible shrapnel with the chest, they bleed out in the field. Because ones that survive. So, the ones that get a really terrible trap in the chest, they bleed out in the field. Because we're six hours, sometimes these patients come a day, we've had people with penetrating abdominal trauma, with multiple holes in their intestines,

come three, four days afterwards and survive. So imagine that. You're leaking feces into the abdomen for three or four days. So imagine how strong these people are. And they come and it's just a mess and you open them up and some of them pull through. You know, anemic dehydrated, they have an eaten in several days and these guys can survive.

So some of the people are just tough as nails. But we get a lot of penetrating. I mean, kidneys get torn to shreds, liverlacks, massive kidney trauma, liver trauma. I'm here, one guy had, we counted, he had 23 holes in his intestines that we had to, you know, resect here, resect there, stitch this one, I just took forever. How did you learn surgery? Right, so, you know, I trained in family practice and when I went to Kenya, we're doing a lot of, you know, tons of tropical medicine, a lot of

obstetrical care, a lot of c-sections, but I realized a lot of the disease burden in Africa was surgically related. A lot of it. A lot of it courses tropical medicine, like you do all those things and say, well, a good, similar half of what we were saying was surgically related, either just wound care, miscarriages, laparotomy, imputations, one of the milk kind of surgical stuff, there's a lot of it. So I thought I really need to learn how to do this stuff, if I'm going to stay here long term. So luckily, where I've been, both rural Kenya and Nairobi, I met up with people that were willing to teach me things.

So really it was like doing another residency. I mean, I would, it was Nairobi had a whole day in the operating room, and we would do tons of cases, and there was an American missionary doctor there and they might Johnson, so I'm like, we just sit there and teach me stuff. You know, I would, I would do it just like you did in residency. I would do the case, he would assist me and just kind of walk me through it.

There was a Kenyan surgeon there, Dr. Rucho, it was a fantastic, it was like a magician. He was not so hands-on, but if he was always there in the operating room, so he would say, go ahead and start the case. After you had a little bit of experience, he would start the case, he'd have a problem, he'd call me. So I'd start open up, look around a bit, so, okay, I'm stuck, I'm going to do a come in, look around, I'll do this, do that, I'll do this and that and things will go ahead. Before you know it, you're doing thyroid and laparotomy's and

reciting bowel and stitching liver and taking kidneys out and doing imputations. And I mean, you know, it is just kind of once you learn a few, you have a few skills you can add the next case, the next one, the next one. And I mean, it took, I was there for seven, half years in Kenya. It was like doing other residency. I mean, at some point though, you have to be making mistakes that are harming patients because even in our, and I say that not being critical, right? But just saying like, that's the nature of medicine. I mean, I, I think of every time I hurt somebody, even, you know, I, I remember once causing a hemonymothorax in a patient when I put a central line in them.

It was my 500th central line. So at this point, you'd think I could do it blindfolded and yet to cause that complication, which in my case, I'm lucky enough to have an x-ray to see that I've caused this complication You don't even I mean you're missing so many of the basic tools that could act as sort of a safety net So what was that process like? I think what I wanted to make sure of what I was in Kenya I think those whole seven half years. I was in Kenya I always had either somebody assisting me in the case or somebody in the room or in the next room over So I think I was pretty well covered during that time and by the time I was finished seven half years

I felt pretty confident. I go well. I'm my own and do and do surgery I think it's this concept, you know better than I do about 10,000 hours You know, and I think in residency you have to like a thousand cases Supposed like a thousand cases at least let that's like a minimum number of cases. Yeah, maybe 1200 or something. Yeah. So I did, you know, but time I finished my time in Kenya, I done. But for you, it's harder because you're doing a breadth of cases

that like even if you took something as broad as general surgery, I mean, you're still doing basically orthopedic surgery as well. Right. And obstetrics. Right. And a lot of erology, there's a mix. And I think maybe the trade-off is the surgery in Africa is much broader but less depth. Like we don't have any laparoscopic stuff.

Of course, we have many of these divinci, you know, all that and all this high-tech stuff. You trade-off kind of depth of surgery for breath. I felt after doing around 2,000 c-sectionssections and over a thousand other major cases, I felt okay, I think I can do whatever we're doing in Nairobi, I can do that I think safely in Sudan. I mean, obviously, you know, we have complications and other problems. And there are a lot of limitations in terms of going into the case. So you tend to do more laparotomy because you don't have a diagnosis. You don't have a CT scanner. Right, no CT scanner. You don't exactly what's going on.

To get a tissue diagnosis, might take you six months. So you say, go, hey, let's do laparotomy and see what that thing is. That's your CT scan in the end. But that's about the best you can do. So I think what I always, what I try to do when I approach a case is, the premium known known cherry, first do no harm.

So if you think you'll make the patient worse by doing this, like, okay, I'm not an expert at doing this case. And sometimes I say, I'm not gonna do it. I won't do it. If I think I really cannot improve this patient's health, I think, okay, this is too much of a risk. Sometimes they look, I just, I'm not really comfortable

doing this, but usually I'll feel, I say, okay, I think it's better if we try to do this operation. I think we can be patient and improve and we'll go ahead and it works. I mean, it only works out pretty well. I was talking with my wife and my daughter a couple days ago and about how we were going to be speaking today and they had so many questions. You know, we all watched the heart of new but together. And one of the questions my wife had was, how do you deal with exactly that type of situation you described, which is what we would consider, quote unquote, end of life here in the United States

or palliative care? What do you do in a situation where somebody comes in and your judgment says this person is not an operative candidate, but also by not operating, they need to be palliated. I mean, they're not going to, they're not like, you know, they're gonna walk home. How do you deal with that?

And more importantly, I guess, than medically how you deal with that, it's emotionally and how is that communicated to the community because you're still a foreigner, right? Right. Right, I was still a foreigner and it will always be one. So I would say we first started 10 years ago, people did not trust us.

And it was incredibly nerve-wracking, something we just got here. People kind of have this, because these people have been traumatized and oppressed for so many years. They're not going to trust some foreigners showing up saying, is there a help them? So you've got to prove yourself. It's something, you know, it got into these operations. What if we have bad outcomes? You know, what happens?

It was really nerve-racking for all of us. And, you know, thank God things went pretty well. We went ahead. So, the issue with palliative care, you know, we try to just talk to the family, talk to the patients, they look, we think we can't do much for you. And as we go home, we'll take care of the pain and what the things we can do. One good thing there is the people, their expectations are extremely low. And I'm not saying that negative, I'm saying that positive, boy, they don't expect,

they don't really expect miracles. They wanna be treated as a human. They want that human touch. They wanna talk to us and they talk to you and say, okay, what can we do? Every time, look, we can't do much. They're not saying, they're not like, they're not very demanding, saying,

now you gotta forget something in Nairobi for a second opinion, they're very accepting., saying, now you've got to get it. Somebody in Nairobi for a second opinion, they're very accepting. I think that's just because of their lives are very hard. They're not used to good outcomes. So I think first off, they're very accepting. So when you tell them, look, I think there's not much we can do. We often will talk to the relatives. Culturally, usually the relatives will say, well, they don't like telling the patient,

which is very different from here in the US. So we just talk with relatives and they're usually very accepting. They say, okay, we, you know, we see we see them, we'll take them home, we come comfortable there. They have some of their local traditional things they might try with the person at home. But they're usually very accepting of negative outcomes or bad news. When you're kind of at the edge of survival all the time, when you get this kind of bad news, it's not so shocking to you. It's like, well, yeah, that's what happens. People die, you know, and people have bad outcomes, bad things happen to you. So it's not so unusual for them, you know, in the US, we're kind of anesthetized that everything has to be perfect. And we're not supposed to die. We're

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

Right. Right. And at some point, you're showing up and you're coming from a place of science as sort of simple as you describe your work in medicine. It is still grounded in the fundamental principles of Western medicine. You use antibiotics, for example. You wash your hands before you operate. What was the landscape like as far as the other types of medicine being practiced? And are they still being practiced now?

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

back of the neck and the elbows. There are certain points where they burn the person, they try to release the, whatever it is. The spirit or the spirit of evil humors that are causing the problem. And when they see that kind of smoke and they see the fat under the skin burning, they feel relieved, okay, the thing is gone, now I'm better.

So they burn, they cut, a lot of people have cut marks in their arms or in their abdomen, where they think that'll also release things, they cut down to have cause some blood loss that'll relieve some of the, release some of the problem. And that's what you've done in the home home usually by the father or the mother or the grandparents will do that kind of thing. That's kind of a local treatment.

That is still practice less so than when we came I would say. I mean everybody, all of our staff have burn marks when they were kids. Now we still see patients come with the burn marks. When it comes with a simple malaria, they've been at home four days, they've been roasting the kids. It's like, why, you know, just gives a chance. Anyway, so burning, cutting, that's one level. They do have some herbal remedies

that don't seem that prevalent. They were there, I think, traditionally, some people still use those. And I don't know, you know, some they still swear by it. If you use the neem tree or this Kayla, this plant that they use for malaria, they still swear that that thing works for that.

A lot of local fruits and vegetables they use for GI problems are the things. And those seem to work okay. And the third level is the, what's called the Kujur, Kujur is like a Kallikashaman. And the Kujur is like the priest for the village. The traditional legend there is ancestor, kind of ancestor worship. It's coming in with the ancestors. So if you're sick, if you have a problem,

whether it's physical, psychological, whatever, you go to the Cajur, you have a little ceremony with the family, I'll get together. Cajur will talk with your ancestors and then kind of give you a report back saying, well, your kid is sick because your goats wandered on this guy's land and ate his crops. So you need to make up with this guy and you go and give him something and then you pay the cajur or something and then this thing is kind of lifted. Childish get better. Those three things are kind

of traditional treatment. The cajur is still very, very prevalent in this society and they still often go to the cajur and they still will often delay the treatment when they go to the cougure. So how many people does your hospital serve? Catchment area is roughly a million, and they were from 70,000 to a million people, is in our catchment area. And the physical region is around the size of Austria, somewhere in that range. The people there, for example, how many of the people that you serve would understand what you meant if you were going to New York?

Like, how big is their world? Well, it's interesting. You've asked that, I mean, even the ones that have finished secondary school wouldn't have an idea. Look, if they ended up here, or I mean, it would blow their mind. Maybe I'll give an example. My mother-in-law is probably in her 70s, so we went to talk to my wife who's talking about writing a book.

Actually, she started writing her book. And we went to my mother-in-law and we said, let's go and interview your mother as part of your book. You know, I can write about her life. My wife didn't actually know a lot of facts about her mother. They don't have that, you know. mothers and daughters there are not like buddy buddy. You know, the girls are, you know, once they, once they get wean from the breast, they start working, carrying water and firewood or anything else and cooking for the family.

So I went to talk to her mom and my wife asked her mother, her mother only speaks the tribal language. She doesn't speak Arabic or English or anything else. So we talked to each other. She's talking on the tribal language saying, do you know where Tom is from? And she said she thought from it. She doesn't speak Arabic or English or anything else. So we talk to you. She's talking on the tribal language. So I think, do you know where Tom is from? And she said she thought from it. She says he's from Kenya. And she said that for this place, she can imagine. Right. Because she's heard of Kenya. So in her mind, anybody who's not from Newham mountains must be from Kenya. Doesn't matter who you are. You know, so that's the outside world. And we say, well, now he's from America. I've never heard of America

No, she never heard of it had no concept of America Have you ever you know what an ocean is no concept of an ocean no concept of a lake No concept of Africa. She didn't know she was in Africa So what she knew was her local area is just a few of the villages there. She's been in cartoon one. She's My wife's mother has leprosy. We've treated her for leprosy and they've been rotated. I think all of her fingers at one point or other. She's really quite disabled. She got on the cartoon some years previously

to get treatment there and not getting treated. But besides that brief trip to Cartoon, she'd never been out of that local area. A lot of my wife's siblings have never been out of this 15-square mile radius. You can't imagine the world view. Presumably, your wife also hadn't experienced things siblings have never been out of this 15-square mile radius. You can't imagine the worldview. Presumably your wife also hadn't experienced things

outside of that until she met you. And what was the first time she left or traveled with you or the first time you- Given especially that you don't travel much. Right, so the first time we traveled was after we married was just this past June. We went to Armenia. So that was really her first time out of rural Africa. She

went to nursing school, but that was in South Sudan, in a while, which is, I mean, for South Sudanese, they call it a city, but it's a village, you know, it's a big village. So imagine we went from, we went from either if G camped down to Juba, which is the capital. I mean, Juba is more or less a city, but it's really not very nice. Then we fly from Juba to Dubai. And we were in the Dubai airport. I mean, which I was just there a month ago, even for someone who's from the United States, the Dubai airport is an overwhelming, yeah, I mean, it's terrifyingly huge. It's a city.

I mean, it's a major city. So we get there and her eyes are the size of saucers. Has she seen that much electricity in one place? No, I mean, not even close, not even close. Has she seen fresh water to that extent? No, I mean, I tried to give she'd never seen a tap. No, we had taps in the hospital. We have a pump that pumps water up and we have some, some taps in the hospital. But you know, flush toilets, where you should never see before

I'm gonna hold this stuff. Elevator. Elevator. So that was one of the things we get in there. We're at the airport. We get in this, you know, pressure button, this door opens, we get this thing in the press of the button, and the thing goes up.

And we get off, she's like, what was that? So no concept of an elevator. We got in the escalator, and she's like, falling over the place. We go to get off the escalator. She's like, what, how's this thing moving? I think when she was in nursing school in a while, I think they had one set of stairs. There might have been a second floor, but just the concept of walking upstairs is something

strange, little moving staircase. So all these things were very new to her. Now we get to Armenia, and I mean, just being in a city, I mean, the Irvine is a capital of Armenia, not like New York, but a very different experience for her. Now she came to the US for the first time, just this past October. And I mean, she was in Times Square. I mean, I saw the ocean for the first time. She went to my brother lives in near Boston and North Shore, Boston.

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

Right. Goes to my brother's place. He's up in Rockport, Massachusetts. He's the ocean for the first time. He's a train for the first time. Goes to malls, to Walmart. You know, she loved the dollar store. And, you know, my family just went crazy with her.

They had so much fun being with her, you know, seeing all these things for the first time through her eyes. And, I mean,'s very, has a very common, infectious joy to her. And they really kind of tapped into that. And it was really, and the flip side of that is we can sit here and have this discussion. And of course, most of us would be thinking how amazing at all the things that they don't have. But I'll share with you a story that I suspect will resonate and you will understand it. This past Christmas, my daughter's school, each grade picks something they're going to do. And that grade decided that they were going to buy Christmas presents for all of the kids at the Sudanese community center in San Diego. And so they're basically all refugees.

And this was very interesting because we had already watched the heart of Nuba, which was her first time even. I should have known what Sudan was, and she certainly didn't understand why there would be refugees leaving this place. So on the day that we take all the presents there, and the kids have done an amazing job, right? They've bought like four or five presents for each and every kid there. And we spend the whole day there.

So we go, it's my whole family. So it's me, my wife, three kids. And our youngest is like a year and a half old. So there's another little kid there, a Sudanese girl who's also about the same age. So the two of them are playing together, but you know, you feel like you got a sort of keep an eye on them because they can fall off the stairs or hurt themselves.

So there's a woman that's holding the Sudanese girl and she's sort of keeping an eye on our son as well. And so that gives us time to go and do these other things and see the other kids and do all the other stuff. And about four or five hours later when we're leaving, my wife goes over to the woman who's has been holding this little Sudanese girl the whole time and says,

what's your daughter's name? And she says, oh, I don't know, this is not my daughter, I don't even know whose kid this is basically. And we couldn't stop talking about that, right? Which was talk about a different sense of community, right? There was nothing odd to this woman who was probably 20 to just say, Hey, there's like this little 18 month old running around. I'm going to take care of her.

And by the way, like she's taken care of our kid, too. Right. And so for as many things as they lack, they have something we don't have. Right. That types of the Peter something. You always hear about the negative side of place like Sudan people think of Sudan or the images were poverty disease starving kids. The positive side is not shown and something's always stick in my mind. One is we'll have patients

that come to us that it's a separate day walk to reach us. And on the way, like they'll start their journey and start walking. Now, nighttime comes. And the society there, you can stop in somebody's hut and it's not, you know, just kind of knock on the whatever or just show up and say, look, I'm going, you know, I've got a long journey. Would you mind if I kind of spend the night with you? I'm in a rest day. So that family would take this person in total stranger, give him place to sleep, give him food, get some water for them to wash, take care of that night. The next day, he'll continue on his journey. Next day, stop another total stranger's place. That stranger will take this person in, give him some

food, hang out, this next day, same thing until they reach the hospital. And this is the normal way of doing things there, the concept of community and what stuff belongs to you, what is a stranger, totally different than our outlook here. So when you're there, like, well, geez, who's really, really has it all, and who's doing the right thing, which society is on the right track. You know, it's really, it's really mind blowing. Well, especially for you, because I guess it's one thing to know nothing that, but you've seen both worlds. And I've read enough about you to know, I've

seen enough interviews to know. I mean, correct me if I'm wrong, but you've described being more at home there than anywhere else. Right. Which I have to admit, you know, Tom, when I watch the videos of that, the first thought that comes to my mind is not, I wish I was there. I realize that probably just speaks to me being sort of a vapid, shallow person, but if I'm gonna be brutally honest, right, I don't look at that and think I want to be there.

I think I would never wanna give up my family. I would never want to give up my comfort, my safety, my whatever. You couldn't fake it. I mean, so it's obviously so genuine for you and any, you know, the other people like John who are serving as missionaries there. I know that on some level, you'll say the answer is faith, but there must be more to it than simply your faith. Well, you know, some of it Peter, I think, is just just I think everybody is kind of geared a bit differently. So, we grew up in a big family and my brothers could never be there.

But at the same time I could not do what they're doing. So I think all of us are really wired a bit differently even people in the same family. So I think I'm very comfortable there but I couldn't maybe fit working in the York. But I think the good thing is, I don't attach a value to all this, because everybody has something to contribute. I really, I really believe that. It's not just kind of blowing smoke.

My thing is being able to amount, you know, it's part of the puzzle. Somebody else might be in the York, but you're doing a podcast, you're helping us in New York tremendously by helping get the message out. If you're in Sudan doing the same work I'm doing, we don't have this. So I think everybody has something to offer.

If we try to get in this thinking like, gosh, I'm not doing what he's doing. I should be doing what he's doing. I think we must have a point. We miss out on our shared abilities. You've got unbelievable talents and a brain twice the size of mind and you're using it in an area that you are comfortable with that is probably maximizing your abilities. I think it's good to be aware of what's going on in the world and everybody should think about their brothers and sisters elsewhere and contribute and do something to help other

people. At the same time, don't spend too much time stressing that you're not doing enough for you. I'm doing something, but it shouldn't be something which is agonizingly painful. I think just the way I'm geared, that kind of life is a pretty comfortable fit for me. I don't see it. It's a sacrifice. It is.

I miss the family like crazy. I'm missing a lot and not being with my man I've spent more than three years and I've come here Missed my parents my nieces and nephews my brothers my sister. I do I miss all that stuff But I'm pretty comfortable in that and that weird remote setting any of the mountains so I learned about you through My really dear friend Rickerson, his brother Mark Gerson,

and ultimately met John. And I think they learned about you through a piece that Nick Christoff wrote in the New York Times in 2015. How did Nick come to find you? Because that story, we're going to link to that story. The story is amazing, right? It leads off with about a 10 minute video that I watched over and over and over again. And I came home and I made my family watch it.

And I sent it to my family back home. And there's a part in it that just says everything about it. I mean, first of all, I think Christoph did an amazing job framing the story and he was there, which is in and of itself, I wanna actually understand how someone actually gets there, because that strikes me as quite a challenge logistically.

But he ends the article with a story of a Muslim man who proclaims that you are Jesus Christ. And I always, at the title of the article, if I'm not mistaken, he's Jesus Christ, which coming from a Muslim man also speaks to the religious harmony that you've described. And for people like me who aren't especially religious, it makes you think, well, I guess that's what religion should be about. It shouldn't be about most of what we think of religion as. Religion has its taboos here, but I think the point Christoph makes and makes it beautifully is if you want to be critical of all of the religious hypocrisy by all means do so, but you can't

then fail to acknowledge the times when in the name of religion people are doing these incredible things. In the name of all religions, by the way, it's not just your religion, I mean, as you know, it's people of all faiths that are doing these things. But in many ways, I think that story brought amazing attention to your work, that it breaks my heart to think, are there other tombs out there whose stories are not being told? So how did Christophe find you or how did you guys find each other? He has an interest in Sudan. I think he's had it for a number of years. And I think for him, he saw this, what Bashi was doing as such an egregious affront to humanity, then

he felt obligated to go and see firsthand what was happening. So, he made a couple of trips into the mountains. You can fly into Juba, then you got to fly up to the refugee camp in Ida, and then manage to come into the mountains. You don't come in with official permission of the Sudan government. So, you're sneaking into the country? Right. Because he's sneaking in, you get a permit from the rebel government, and they allow you

to come in. And I think he just has an interest in that permit from the rebel government and they allow you to come in. And I think he just has an interest in that part of the world and really wanted to do something that shed light on the situation there against busher. And he had been to Newbuy, I think, one previous time, and I heard about the hospital when they come and see us there and see what kind of work we were doing to see for himself and was there for a few days. He's a, I mean, he's a really intrepid traveler and incredible journalist. I mean, he's unbelievable. And what I respect about him the most is he can disagree with you, like, you know, whatever, religiously, politically, not agree with

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

God, it's about three and a half years ago now. Right. So the world's a better place. Certainly the new but mountains are a better place because of Nicholas's work. Right, and he tends to highlight people that are kind of not well known. And there are others that are out there.

And it's actually part of what we're trying to now with Aurora. Aurora's focus is on highlighting what they say is unsung heroes, but people that are kind of operating in the weeds that nobody knows about. So shine a bit of spotlight on them. Not so much for publicity, but to help them both in their work

and to raise, by raising their profile, you raise the issues that they're involved with. So, tell people a little bit about what the Aurora Prize is and what it means for you to now be, you're the 2018 recipient, is that right? 2017. 2017 recipient. So, what is the Aurora Prize?

I know it's based on, I know a few things about it So I'll fill in the little bits that I know it's a prize that has a finite life correct it was began in 2015 or 16 and it will run till about 2022-23 and that duration if I recall is meant to commemorate the length of the Armenian genocide in 11ish 1915. Well, it's a hundred years onward. The genocide went on for about eight years. Okay. 1915 and 1923. So this is 100 years henceforth, those eight years, those eight years that were surprisingly given out.

Yes. And it's a substantial prize. You were selected. And my understanding is, first of all, it takes an active Congress to get you out of Nuba to be doing this other work. But it speaks to, I think, your understanding of how valuable this will be to the broader mission that you're serving. Right.

What I saw was I'm very comfortable being in Nuba and doing the everyday medical work. And I definitely want to go back to that environment, longer term, and get involved more with teaching the local people. And once these guys come back from medical school that we have out there really working with them to get their skills up. But I thought maybe using Aura as a vehicle, it was time to come out to kind of see what was out there with Aura to try to expand the model that we have in the mountains. that we have in New Mammones. So find a way to bridge the gap between, say, big donors or people that have resources and small organizations, small people on the ground that are kind of doing a lot of the grassroots work and doing it very efficiently. Because I think there are a lot of other people that are doing the work nobody knows about. And there should be a way to try to connect them

to resources. So through Aurora, that's one of my main goals. I wanted to come out and try to expand what we're doing. I felt that was, we're in Nuba doing our thing, but maybe a little bit pigeonholed. How do we expand that? And get outside of Nuba, get into South Sudan, to Central, from public to Chad, to New Share, other places which are really neglected parts of the world, hopefully, in some conflict zones. That was my main thinking coming out. And my time now, I've got three months out of the world, hopefully, into some conflict zones. That was my main thinking coming out.

And my time now, I've got three months out of the mountains. I'm traveling all over the place, speaking on behalf of Aurora, kind of doing some, basically, or some promotion for them, but also meeting a lot of people in trying to formulate which direction

we need to go in Aurora. So we physically out for these three months, there'll be three months later in the year from September through November. Besides those two, three months periods, I'll be back into the mountains. Do my usual work at the hospital. What does more money solve in this problem? I remember recently Mark sent us an update about sort of where the dollars were going and it was sort of hard to believe that so much could be done with so little. And I don't think the stats are, I think they're so overwhelming

that it's almost hard to put it in context, but it's worth trying. For about a million dollars is an annual budget. What have you been able to do in the past year? A million dollars is pretty generous. That's probably more than we'd need for the basic work, but let's say it was a million dollars, we can see about 130,000 outpatients.

130,000 outpatients do close to 2,000 operations. See, maybe 5,000, 6,000 inpatients. I mean, vaccinate tens of thousands of children. See, I don't know, I'm not sure what numbers of maternity, anti-noclinic patients, but a lot, several thousand maternity patients for that. A lot of that million dollars, I'm not sure what numbers of maternity, anti-noclinic patients, but a lot, several thousand maternity patients for that. A lot of that million dollars, I mean, most of that,

gosh, I think it's, I mean, the number that comes that I use is about seven and 50,000, but somewhere between 70,000 and a million, if I'm being conservative, if someone gave us a million bucks, we could easily run the hospital for a year and probably expand, expand quite a bit of what we're already doing. That would be very a very generous amount of money for us for one year.

Which is very interesting. Anyone listening to this who has some understanding of the economics of the US healthcare system would find everything you just said to be sort of comical because just the costs here are so artificial and so inflated and so ridiculous. Now, when you think about where those dollars go, I mean, how do you get these supplies? How, I mean, where did these things come from? I remember once asking, I knew somebody who was, I think on the board of doctors without borders, and I said, hey, how come you guys aren't in Sudan, you know,

because I remember once reading, you guys couldn't even get certain vaccines in antibiotics, you just physically because I remember once reading, you guys couldn't even get certain vaccines in antibiotics. You just physically couldn't get the supplies. Right. So you're really doing the work that nobody else can do here. Yeah, it's tricky.

I mean, are number one problem, when people say, what's your biggest problem there? I always say logistics is the hardest thing because you don't have infrastructure. Infrastructure is not there. And if you want anything, you want chemotherapy drugs, you want antibiotics, you want a role of gauze, you've got to buy that in Nairobi.

Nairobi is two countries away. It's South Sudan and Kenya. So it's got to come from Nairobi, like this past ship and a drug came from Nairobi by truck up to actually through Uganda, up to the border with South Sudan, where they just harassed the heck out of the drivers and all kinds of people. You have to bribe the guards. You've got to bribe the guards and they give you a hard time

and they won't want you going through and they say no, they're always changing the rules. You know, see I know there's a duty, you've got to have all this paperwork, I mean just reams a paperwork to get this stuff through. So we've got some people that are in Juba that don't actually work for us but work for the church that help us through all this process to get this truck through. Now from there, there are, I don't know, 30 or 40 checkpoints from the border of Uganda and South Sudan up to the refugee camp in Ida. And it takes a few weeks. It takes about three weeks to get up there just because of the checkpoints and the delays and everything else. You can take three weeks to get

up to this refugee camp in Ida. Then from there, it's offloaded. We've got to go and pick it up. We got to find a way to get it from Ida up to our place. Not you personally. No, not me personally. But we've got to get some trucks or something to go down there and pick it up or find someone that can carry it up and carry it for us. That that's about six hours it's not really a road it's a dirt track I mean there are roads there these these terrible dirt tracks you get from heat up to where we are that's about six hours in the best day just during the dry season so rainy season which runs from about June through October you can't go with the trucks you can't really even go with a like a land cruiser usually we don't we don't move. You can't really even go with a, like a land cruiser.

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

So in the hospital on any given day, how much do you have in terms of IV fluids, gauze, antibiotics, soap? Right, I mean, things that we just, we can't even imagine not taking for granted in an American hospital. Right, I mean, if we have, if this truck makes it through, because we make our order,

we make a fairly generous order, just because we know it's so difficult to get stuff out there. If that stuff makes it all through, we're in pretty good shape for how long for a year. So we try to make it one full year on that supply that gets sent in. And the problem comes because sometimes you order stuff in Nairobi and it's not in stock and you just can't order one off things. There's no system that gets stuff up to us. That's really hard. If you can't load everything on that truck for this one go, we're a bit stuck.

You've got to really be creative trying to get these other small things up. Is there like a chief logistics officer that is in charge of the ordering and the procurement and the management of this product? Because that sounds like a, I mean, that's a bottleneck, right? It's a terrible job.

So John Fielder through F commission healthcare has a woman who's in his, he's gotten off a small office in Nairobi. He got a few staff. So she did all of our procurement. So we sent her the list of things we needed. I mean, it's, it's a lot of items. A lot. So she has to go out and source all this stuff and get it in Nairobi from a few different

vendors, get the trucks or all that stuff, get it through. We've got a couple people in Cuba that help us with logistics and not employees of ours, but they're just helping us out, just kind of random people and they can help shepherd that stuff through, but it's really, really difficult. It's a lot of work for those people. What does the pattern of mortality look like in New? My guess is infant mortality must still be quite high. Right. How much of that is due to challenges with prenatal care

versus the actual deliveries and postnatal care? I think a lot of the neonatal deaths are just from difficult deliveries. They're maybe as it's fixated, maybe it's born and dies. There is a stillborn or dies who not their birth. And there are very few deliveries done. I mean, 99% of women, they're still delivered home. The deliver in a clinic with maybe a triathlon birth attendant is rare, let alone in a hospital. So I think a lot of it is just due to, you know, most of those people probably would end up in a cease with a cease section if they were at a hospital in the US or even in Kenya.

If it had access to care or they would end up with a seasection, we're, you know, we have one place to in seasections that are actually two now that do some- How many babies do you deliver in a typical year? I think there are maybe three or four hundred in our hospital, somewhere on there. I became an exact number, so it's, you know, it's really, it's not, it's a very small number compared to a number of deliveries. So the vast majority of women still deliver at home. But you're doing presumably more of the high risk ones. I mean, if a child is breached, can you deliver a breached baby at home?

That's, I mean, the risk would be enormous. Right. Some make it out, but a lot of those babies are going to yeah because they just get they get stuck they get fixated and maybe dies So I mean when we do our antenatal clinic, you know these women will come and they the midwife there fills the cart out for them So okay, they've had ten deliveries and four living children, you know This one died at birth this one died at birth this one died from diarrhea this one died from fever You know this kind of thing So it's a lot of... And what about the mother's, what is the maternal mortality like?

I don't know. That's something I really wish I could have a grip on. Because you hear occasionally, you know, we don't, it's not that often we hear about it, but what's on your eye? You have this woman died from, she blooded death, you know, after you've been birthed the baby, as some remote village. There's not really, it's so remote and people are so spread out. There's not really a system to collect that kind of information.

So I don't really know, it's got to be, it's got to happen because, you know, we have a lot of women that we end up doing C-sections on that would have died without that. You know, you know, how many times a baby is stuck? Well, it's already septic and you know, we have to do C-section or something. And this says nothing of preeclampsia and all of the other things that would just show up even under the most normal, you know, we have to do C-section or something. And this says nothing if preeclampsia and all of the other things that would just show up even under the most normal circumstance. Right, and getting one with the eclampsia is not uncommon. So if you get a clampsia at home,

especially young, you know, most of them are primates that are very young, they're not gonna survive when they start convulsing. And the get to us is a chore. I mean, it's really hard to reach us. What are the patterns of diseases like there? I mean, when we're watching, and again, I keep mentioning this because it's just such an important film, The Heart of Nuba, you see these things that you're doing, Tom, that just,

I mean, they blow my mind. And maybe because I know enough about medicine that I can watch what you're doing and appreciate, the partial nephrectomy is you're doing on kids with, you know, tumors in their kidneys and like, how did you even learn to do that operation? Even within the realm of surgery, that's not a trivial operation to do on a child that size. Yeah, I'd done some nephrectymies before, totally. Nephrectymies on, for tumors or for trauma or for whatever. So I'm meaning, remove the whole kidney.

Me, whole kidney. So I wasn't so worried about that, But I was worried about was the other kidney. It's harder to take part of the kidney out because you have to be able to preserve the blood flow to the part that remains. Right. And you know, the kidney completed that. So if it was just say, a tumor was partially involved in the kidney

and say you're doing the operation and you can't stop the bleeding, your backup is just to take the whole thing out. But you couldn't do that in this case. Because this child had one kidney that had to fully come out and then there was a partial note. So, you basically, this kid would die if you couldn't save half of the remaining kidney. Right.

Exactly. So, the tumor was in the lower pool of the kidney, so I had to take out half the kidney. So, there was a visiting, actually a visiting, as a friend of mine was who was visiting. He's a family practice doctor, a Corey Chapman was there, and we were talking about this case and going back and forth, and he said, let's look on YouTube if there's something. Because I read, when you're reading about it, and everything else reading was talking about all these fancy things.

There's some kind of a slush, like an ice slush that you have to bathe the kidney in to get the metabolism way down. So you do the operation. Just different things we didn't have. So we looked on YouTube, and I'm just, when I think about it now, I wonder how we did it because normally we can't watch YouTube there because we have internet, we have a satellite

dish near the end of it, but the speed is very, very slow. So normally we can't watch any videos because it's just too, it's just too slow. But for some reason, we were able to see this video. And it was this group of Polish surgeons that were doing the partial infrectimate. And with a fairly low tech approach, so we watched that. So, okay, I think I can do it following what these guys are advising. We kind of followed their system managed to put these sort of buttresses on the lower pole,

the kidney, the kind of staunchly bleeding, and it worked, and the child did very well. That was held by YouTube, I think they really helped us out in that case. Like the Khan Academy of Surgery, right? How long do you just spend rounding? I mean, how many inpatient beds do you have in this hospital?

It has 435 beds. And what's your typical capacity? I mean, your typical utilization, how many patients are in there? I mean, it's about 100% occupancy. It's a bit less now than it was saying the peak of the fighting. The peak of the fighting, it was crazy.

Be 500 people there, 550. So several children was war, several to a bed. We had wounded all over the place. I mean, not even in bed, just wherever we could fit them. It looks like when you see movies in war zones and you see the tents that are serving as hospitals and you just see

amputation, nose completely missing, sort of the most gruesome things. That's what it looks like you're in. I mean, you are literally in a war zone. I'm thinking back to residency. If we had to round on 20 patients in the morning, we were moaning and groaning, like it was gonna be the end of the, oh my God, I'm not gonna have time for breakfast today

before the OR, I've got around on 24 patients. Yeah. So you're rounding on 300 patients? I mean, how, I don't even know how you do that. And now probably through, and to those days was more. I mean, I remember one time we had this measles epidemic, and just on children's ward, we had 225 patients.

So 100 normal cases, malaria is by all instructions. You don't have vaccines, I'm guessing, is that the reason they can't all get their measles? We, with the first three years of the fighting, we didn't have them. So the usual provider stopped providing them, the usual big organization that provides them, stopped providing the vaccine, so I don't have any.

Just logistically, couldn't get them in. Logistically, and they, we were in rebel held territory, and a lot of these people, like, big organizations don't want to violate the sovereignty of the host government by providing something as simple as vaccines. This is just how it is, which really shocked me. The sovereignty of a government that kills its own people needs to be respected. It's the theater of the absurd. It's crazy. So yummy runs would just, they would take hours. We started seven, 30 in the morning and two o'clock, I'd be finishing up and just try to get through

all those people. But then you're not you being interrupted every hour by some trauma that comes in because, right, there's stuff coming in, there's stuff, there's other emergencies. I mean, the other stuff was still coming. I mean, somebody comes in to a woman, it comes in who's having a miscarriage bleeding,

we have to break into a C-section on somebody who can't deliver. So all this stuff was still coming. I mean, somebody comes into, a woman comes in who's having a miscarriage, bleeding, we have to break into a C-section on somebody who can't deliver. So all this stuff was still going on. It was pretty crazy. I mean, it really had to just go as fast as you could. And it was a lot of just putting out fire. And we weren't able to spend a lot of time with these patients, obviously.

It was really, I had to go pretty rapid fire through all those cases. It was exhausting. Psychologically, it was rough. One of the other questions my daughter wanted me to ask you is, what's the most afraid you've ever been there? She was sort of taken aback, and we told her before the movie,

I said, look Olivia, this isn't a Disney movie. You're gonna see people getting killed. You're gonna see bombs dropping on innocent people, and it's not a movie, it's real. So are there times when you are just afraid for your own safety? Yeah, I think every time they bomb the hospital twice and they bombed our local region

kind of within a half kilometer several times. So the first time the area was bombed, or we were at church, and the church was just outdoors. It's not really a church, it's kind of outdoors thing. And we were finishing up and the the cow to kiss was up there talking to people and we heard they are playing overhead. We were used to it because every day their playing came overhead, but we've never been or immediate vicinity, never been and never been bombed. So we just got out of our heads going to bomb somewhere. And is that because you had this belief that said even these people as wicked as they are wouldn't actually bomb a hospital.

Is there some sort of view of we'll respect at least one sanctity of life? Yeah, so that was the bit in the back of our minds and we had them in Bombing. This was a couple years into it. All right, we had them in Bomb directly. There weren't commercial flights. So anytime you heard an airplane, it was going to bomb somewhere. And then we hear the airplane, then invariably a few hours later, one dude would show up, a bomb somewhere

and people were wounded, wounded show up. This day it was a bit different. We heard the airplane overhead and the mass was over and kind of stand in there. Also, and somebody says, everybody get down. So we just dive in the ground, there was a line flat. And I heard the airplane drone overhead

in this Antonov sound. Then I heard the pitch change, it was high pitched like a worrying sound, almost like a jet engine noise, and then boom, this incredibly loud explosion, it felt like it was two feet away. I mean, it was like half a kilometer away, it wasn't right in it, but it was so loud,

and it circled again, then I realized that what that worrying sound was, was a sound of the bomb falling through the air So then I now so now I know what that sounds like then is happened six and bomb six times you kept hearing this thing comes around again bombs and You're lying there Terrified thinking you just you feel like you want to burrow yourself into the ground and disappear, you know, we just lying flat exposed Think it what you know what happens and the thinking is Not even so much being killed

But what if what if my you know what my leg is blown off or my arm gets blown off you have no control over this You're totally at the at the mercy of these people and you feel like you're you feel like you're just like a hunted animal That's the that's what I felt like I feel like I'm a hunted animal. And at that time, since we hadn't been bombed, we didn't have the, the foxholes dug around. So immediately after that, we went and we dug foxholes all over the hospital grounds. And that's what you see in the film. It was actually one point when you're being interviewed and the bomb

start coming in, you guys have to jump into these foxholes. Right. Right. Then at another time, we were bomb-dose in the hospital and just down on the floor of the hospital, you know, you're thinking, well, you're just thinking, this might be it. This thing might, because you can't tell where it's gonna fall.

You hear that worrying sound. And we hear that worrying sound. You don't know if that's gonna fall on top of you, if it's gonna fall right next to you and just then shatter your body, you have no idea. So it's really terrifying. I mean, there's no other way to describe it. I mean, you know, when you see this stuff that's happening in Syria, people living in these

cities, I mean, you can imagine what that is like in the kids that are in that situation. That's something I'll never grow that fear and that feeling of being bombed. You really, you feel like you're a haunted animal. I think it's the closest thing I can, not that I've ever been haunted or I'm an animal, but you just feel like, I remember thinking to myself, we were down, this is after,

this is a few bombings later, we're down in the foxhole. And there was a Sukhoi 24 jet going overhead. Sukhoi 24 is a supersonic jet bomber, bombing villages, huts. What are these people doing? I'm rethinking to these guys and I say, how can they bomb us? Don't they know there are people down here? That's what I felt.

It was some exercise where they made a mistake. Of course, they know exactly there are people down there. That's what they're bombing, you know? But I really hope someday I will meet these pilots. Not that I don't even feel any animosity towards them. They're feeling it's never strange. You don't feel anger. You don't feel animosity towards these people. Just kind of wonderment, like, what are they doing? Like, why are they doing this? So I would love to meet these guys someday and say, what were you thinking? You know, what, what they tell you before you did your mission?

You know, I was a flight surgeon in the Navy. So I know you have a briefing before the pilots fly out. They discussed the mission. Today, everyone that fly here, we're going to bomb this target. This is our objective. What were you told in the briefing room? And they say, okay, today, guys are going to bomb a hospital. There are a bunch of siblings there. I mean,

presumably if you're trying to put your psychology hat on, you have to believe that they are being told that the people that they are bombing are somehow a threat to them or their sovereignty or supporting rebel. I mean, you'd have to concoct a story that's so orthogonal to the truth. Right. Maybe that might be because I mean, after one of the concoct a story that's so orthogonal to the truth. Right. Maybe that might be it because I mean, after one of the times the hospital's bombed, one of our staff heard a radio broadcast from Elabade, which is a city in the north.

And the way they portrayed it on this radio was they admitted they bombed hospital. They said we bombed an American church hospital in Kowtah, which is the kind of capital the rebel held territory Hospital taking care of the rebel soldiers. That's how it's portrayed So your American hospital and America of course is a great enemy is a Christian hospital. Therefore, they're no good And it's taking care of rebels take care of rebels So you're you're justified in this in this act. And my guess would be that's what these guys were fed. Who knows that the pilots were true believers? Yeah, I know work with a lot of pilots in the US military and they would

they would not go along with the mission that they say you're going to the Bama Hospital with civilians. They wouldn't do it. It was they looked man, we're not doing this. I know these guys, they were not these guys that they love to fly and they love the country, but they were not interested in killing civilians. And I still hope someday I can meet these guys, they loved the fly, they loved the country, but they were not interested in killing civilians. I still hope someday I can meet these guys and just have a talk with them. Just to know what they were thinking and what went on in their brains, whether they know this, how do they feel about it. I'm just interested in what they would say. How do you cope with what I could only imagine is stress and anxiety aren't the right words, but just sort of the gravity of it. Like, you know, when you describe a

day in your life, you know, getting up at 5 30 in the morning, making rounds at 7 operating, if you said Peter, you got to go do this for a month. I mean, first of all, I could provide no assistance to you. That's the unfortunate reality. Despite my medical training, I month. I mean, first of all, I could provide no assistance to you. That's the unfortunate reality. Despite my medical training, I could put IVs in patients. And I don't think I could provide any benefit. But let's assume I could even magically provide benefit. I can't imagine how physically, but more so emotionally exhausted I would be at the end of 30 days, right?

Even thinking back to my training where, you know, you'd have every other night call, but on one of the nights in between, you didn't get to go home. And so you've been in the hospital for three and a half days, and it's been one trauma after another, like even that feeling is just, is physically tired as you are, there's something different going on, which is just an emotional depletion. Right. So to imagine that you're now eight, no more,

you're coming up to 11 years into this, and this is just in Sudan. Right. I don't understand how you can do that. I think it hit the nail in the head. I think probably the emotional trauma and upset is probably worse in the physical degradation your body takes by just always being on call.

And just even when you're not called at night, it's hard to sleep. There's a lot of kind of fear and worry about things. But there's always that less so now because they're not bombing, but there's always that sense of worry about being physical danger. But even when you're out of that,

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

And I don't know, I just, you know, a couple of things is one, of course, is I do draw on my faith all the time. And I think that does help me keep centered a lot. You know, I go to church every day and that's, I think helps put things in a bit of perspective. That's just how it is. And besides that, I think you see the people there,

they see the strength and resilience of the human people. You say, well, okay, if they can put up this environment and keep functioning, keep going ahead, let me just try to keep taking care of them as best I can. So I definitely get a lot of strength from the people there and their attitudes. They've been in this for their whole lives and they're not given up. They're pushing ahead with things. So let me see if I can also just keep going. It's not easy by any stretch, both physically and mentally and emotionally. It's very, very draining. But I don't know. It's weird. I mean, you get up in the morning and you, you know, have this huge number of patients to get through and you kind of say, man, I'm sure if I can, so I'm tired already, I think I feel like,

and you kind of see the first view, and then before you know what you're finished with the Children's Award, taking the rest, okay, I got through all the children, now let me go to the female award. You get through there, you pick up pace a bit, you get to the male award, you go through them, see the maternity patients.

That was one o'clock, okay, I finished the rounds, we go to clinic, go to clinic, and there's a big line of people. How many patients would you see in clinic typically? Maybe 40, 50. Again, I don't even know what that means. I think most US physicians would have a hard time seeing that many patients in a week in clinic.

Do you have any blood tests you can do? Can you do CBCs or UAs even? I mean, what's the extent to your diagnostic toolkit? So until recently, you had nothing. I mean, now you have an ultrasound. Right. We've had the ultrasound from the beginning. Okay.

So we've had it the whole time. That's been hugely helpful. You don't have an X-ray machine. X-ray we do now. Okay. And we just got that about a year ago. So you can do a chest X-ray at least if you want some assistance with business person, I have pneumonia or a pneumothorax or something like that.

So prior to your go, we didn't have the X right now we do. It's been a help. Lab has been difficult. We can do a urine, they can check our stool. We can do a hemoglobin. Sometimes we can do a CBC, but the machine always seems to be broken. We'll get in the machine, work it for a while,

then it just stops working. Can't do a CBC. Chemistry tests, we can sometimes do a creatinine, but then the machine breaks. And, you know, we can't do a creatinine. Sometimes you can do ALTST, machine breaks, can't do anything. But with those things matter, in other words,

if someone's listening to this and says, well, gosh, if it's $50,000 to buy a new lab, piece of laboratory equipment, can we have one of those brought in with next year's supplies? Would that make life easier for the care you guys provide? It would help. And, you know, like there's a, just saw this chemistry analyzer was called a piccolo,

which is supposed to be kind of built for these remote locations. It's pretty doctor-proof. I mean, you kind of have this thing that's pretty hardy. You slip in a disc, you put a drop of blood on it and it gives you a result. So our guys in the lab can do that. Our guys in the lab can do the other tests, but the machines are just very... Yeah, it's less about the human.

It's more about the, you need a robust machine. You need a very robust machine. So this is kind of a thing. And that's about 14 grand. If we have one of those in some of the discs, which have the reagentsents time embedded in them. So if you had a year's supply of test strips or reagents discs and then the machine,

you could do a CBC and a Chem 7 or a metabolic panel of some sort. That would definitely help. We're pretty limited. We can do a peripheral blood film. So, taking blood, you know, guys can do the film. We can look at that. So you're a pathologist now too.

Yeah, and a very hematologist. Yeah, I'm terrible at it, but I can pick up like a chronic leukemia, chronic myologis, chronic myocidic or an acute leukemia. Those are, if it's pretty obvious, we can pick those up, but a lot of blood films I'm baffled in. And when you have a child that has leukemia, I assume you send them to Kenya.

It's impossible. Why? It's too far, it's too expensive, it's too difficult, like just the administrative stuff to get them there, and the chance in Kenya of them being, I mean, maybe at a higher at hospital, they could get decent care, but they just can't do it. So what do you, can you treat with chemotherapy a child? Not with leukemia. If a child is leukemia, we often will give steroids to try to, you know,

target them a bit. Calutative care. Yeah, for leukemias. For chronic leukemias, these are again, usually adults. If it's a chronic liver cycle leukemia, it will treat them with cyclophosphamide. We don't have tablets, we'll get periodic injections and that can kind of waddle them a bit. CML, chronic myocytylchemia, we don't have treatment for.

I would like to have at least some hydroxyurea, which is kind of an older drug for it. You know this drug, Gleeback. Yeah, it's about to say Gleeback would cure most cases of CML. I mean, it's a very expensive drug in the United States, of course. That's the problem. So with Gleeback, I was so excited like a month or two ago. I'm reading that Gleeback is now in generic. Mm-hmm. Oh my god. Maybe we can buy Gleeback because we get a few a year. We're gonna get a huge number of CML patients. We get a few. I think, man, we wouldn't need a huge amount, you know, so to look it up and it is okay, Gleeback's going on generic, so the price went from 8,000 a month to 7,000 a month.

Yeah, this is another one of these ridiculous systems, you know, problems, which is a lot of times when drugs go from being branded to generic, there's virtually no change in price. Right. We just can't do that. You know, there's a lot of things that are just beyond our scope of being on the pay for it. That's something that to me is, it's really difficult to consider. I mean, if we can be as critical as we want

of the US healthcare system for all of its buffoonery, but in large part, it's because we can be buffoons. Right, right, it's because we have infinite resources, though we don't, right? But in the short term, we have infinite resources. And so we never have to ask the question of what are we optimizing for? And how do we triage expenses? On the other hand, you were faced with that decision every single day. So you would look at a patient with CML and say, we're not going to spend $80,000 a year to save this person's life, because as much as we believe every life is equal, we sort of know that $80,000 can save a hundred lives in another way.

And are you the one that has to make that decision by yourself? Yeah, it's agonizing. It's absolutely agonizing. That's that's I'm that's just one example of many I've got a woman that comes all the time with CML and she's got a huge spleen that hurts. She's anemic and She got a bunch of kids. I got to talk to her in clinic and try to figure something out with her She walks I don't know how long I'm how far she walks to reach us. I Mean it's absolutely agonizing. I cannot send her anywhere. It's just as totally impossible. I just can't do it. So, if we had, we wouldn't need mountains of Gleevec. I mean, a small amount would be enough to at least get her through a year. There are a few people that

have CML. It's a few. It's not a huge number. If someone's listening to this and they say, I'm going to tell you a story in a moment called the Starfish story, but I want to save one starfish. I'll tell you this story. a moment called the Starfish story, but I want to save one starfish. I'll tell you the story. Logistically, would it even be possible for someone to provide one year's worth of Gleeve Act to a patient in your hospital? Is that something that they could do through the American, the African mission? How would someone even logistically go about providing specific or project-based funding

to your mission? If they could get the drug, so they had access to the physical drug here in the US. Maybe if they sent it to say, a Catholic Medical Mission Board, which is my sponsoring lay sending agency, and they also help us a lot with logistics and the overall managing the hospital,

they might be able to find a way to get it down to us, at least get it to Juba, and then we could figure out a way to get it up to us. And they could get the physical drug. There was a program, when I was on Armenia, the time before last, we met some guys, and there was supposedly some Gleeback program that you can register, like the patient can register,

and they can get drugs at either low cost or no cost. So we went through all this thing, counted the person, and she said, okay, all you have to do is have thought these forms have the patient go to Cart to cartoon, get the drugs. That's absolutely impossible. We can't get the cartoon. That's on the other side of the enemy lines

and you just can't reach there. So it gets back to your point of providing the money is half the battle, but the logistics of actually getting it in there. And I mean, just spitballing. You can't have these things air dropped or air lifted in because the enemy fighters will obliterate anything that's trying to, you can fly to Cessna in there to get this stuff in there. There's been no non-bombing aircraft in our airspace for, it's been since November 2011.

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

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

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

I just can't do it unless it can be made fairly simple. Or someone's okay, I got the drug, I'll send it to Catholic Medical Mission Board, and then Catholic Medical Mission Board will send it down, and we get the drug. You know, at least as far as 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 with access, and just getting through the administrative things you have to do to get some of this stuff. It's just, it's really, there's a problem with excess and just getting through the administrative things you have to do to get some of this stuff. There's, so there are several kind of different levels

of difficulty. So going back to the sort of state of disease as you see, if a person makes it out of their sort of, the young life, right? If a person's sort of your age or my age, what are they gonna to die from? Middle-aged people, we have a lot of cirrhosis liver cancers and that's, there's a huge appetite at this age.

Hepatitis B, huge. Like, we do, we screen all of our pregnant women for hep B. Do you guys have a hep B vaccination program? We do. The reason we start screening the, the pregnant women is just to get an idea about the basic rate and it's about close to 20%. Hepatitis B positive just in general population is that people are not sick. They're pregnant with children.

So what we're doing is we encourage the mother when the baby is born, we give the baby Hepatitis B vaccine immediately after birth. Now we hope with that that we'll stop preventing this baby from giving him an hepatitis B as a get older and prevent all the complications from that. We haven't really scaled up to the point where we have so many heavy positive people. And can you only vaccinate the women who are coming in for deliveries, or are you able to get the vaccine into the community for the women who are still delivering at home?

No, we haven't, we haven't reached that point yet. So you're only scratching the surface, right? And because the majority of these birds are outside of your hospital. Right. Exactly. I mean, eventually we like to have kind of been wise to these places and have the testing capability to test all these people for hepatitis B. Or if people delivered in these clinics, you look, we can't do the testing, but we just give the vaccine. We'll soon the kid has hepatitis B, you get the vaccine because they have to get have

to be anyway as part of the PentaVellan series. So after that first shot, we continue with PentaVellan, which is D.P.T., diphtyriptosis tetanus, hepatitis B and um, um, am I supposed influenza B? I've heard that kids actually can get diphtheria in Africa. Yeah. Has there been a case of diphtheria in the United States since the 40s? No, I think that, I think this is- I don't even know what diphtheria is. I mean, like, like, it sounds stupid to say that, but I remember learning about it in medical school and I know we all get the vaccine for it. What is the disease? What is, how does it manifest?

We've only had, from what I remember, one case, and I think she had that there was, it was in an adult, but it's cornea-neem-backed here in the theory eye, and it's a bacterial infection. It affects the throat, and it looks almost like a thick scab that forms in the throat. They kind of die from airway problems. You know, I just think it's thick and they can't lay swallow, they can't really breathe well and they can die from airway problems. It's a horrible, really a terrible disease. And you mentioned your mother-in-law has leprosy.

Right. Again, I've never seen that in my life. It's a bacteria as well. Is it in the tuberculosis family or something like that? Exactly. It's a micro-bacterium lepride. It's a micro-bacterium. And it's transmitted by respiratory droplets. Oh, it's not by touch.

I thought leprosy was sort of contagious through touch. Yeah. Is that a wives tale? Yeah. It's really transmitted by respiratory droplets. And it should be prolonged close contact. So somewhat similar to TB, it's not a real, it's a very slow growing organism,

but prolonged close contact, respiratory droplets, you can affect it and it affects the nerves and the skin. And by that nerve infection, people lose sensation, they get cuts or wounds, they don't take care of things, they burn themselves, they don't pay attention to what gets infected, bone gets infected, you have to amputate the digit. Are these people prior to your arrival that were kind of outcast and they would be not touched or anything like that?

Yeah, there was definitely discrimination against them. They didn't have like separate places where they would make them outcast, but people would kind of avoid them. Like my mother-in-law, still, and I think a lot of it was that people themselves would kind of withdraw, do the shame and do the fear of just giving it to somebody else. Like my mother-in-law, kind of withdrew.

She stays by herself. She doesn't eat with the other family. They keep telling her, look, come and eat with us, it's okay. But she will not come and eat with other people. She always insists to kind of eat by herself. She does it herself. She's kind of self-isolation from society. She always insists to kind of eat by herself. She does it herself. She's kind of self-isolation from society.

She's pulled herself out. So she'll talk to you and chat and interact with you. But then with eating and with more social interactions, she'll kind of pull back and eat by herself. And how prevalent is tuberculosis? Very, very prevalent. And for our place, our HIV rate is quite low, which is what?

It's much less than 1%, maybe 1.0. Oh wow. Point something, maybe 0.1%. And is that an artifact of where you are geographically or is that as part of the benefit of some of the aid relief that made its way in the early part of 2000s? Yeah, I think the main reason is our isolation. Is there drug use there?

Prostitution, I mean, which I assume would be the two most dominant modes of transmission. Prostitution, I mean, which I assume would be the two most dominant modes of transmission. Now, prostitution is not really part of that society. Drug, I be drug use is, is unheard of. It's all through like with most of Africa's through heterosexual transmission. And I think just the, it's starting to get a little bit

of a toe hold in Nuba, but still our rate is very low. I'm worried that if, if peace comes and the place opens up and you've got more movement of people in and out, the rate's gonna skyrocket. That's what happened in South Sudan. The night is is there because we have a lot of STDs. Gallery is a very common syphilis some we do. Do you see tertiary syphilis and really advanced cases?

I don't think so, but maybe some of us not were saying it's just undiagnosed tertiary stuff. I don't know. I don't think we see it. What I see as syphilis is we have, we do VDRL test and we have a lot of VDRL positives, which are not, you know, it's not a very accurate test. We have a lot of false positives. We have a lot of VDRL or RPR positive people. We do that screening. We're just screening now with the pregnant mothers for VDRL and we have a lot of positivity. We don't see the shankers or the secondary civilists.

That's really, really rare. But the video positives are very common. So we talked about liver cancer. Do you see heart disease? No, heart failure. So in the older population, we'll see a fair bit of heart failure. Somebody may be in their 60s, 70s, that's an heart failure. And it's like bacterial, or I remember there was some bacteria,

like shagas, something or other that, when we get a heart muscle, is it that type of a heart failure? Yeah, no, we don't have shagas disease in our area. It's just old age. But do you think it's atherosclerotic in origin? I don't think so. I've heard of anybody that could say,

I think this person had an MI. I did not a single one in 10-1,5 years. Some is hypertension, just kind of untreated hypertension, and we'll let people come in with a pressure of 250 over 180. Really? How prevalent is obesity overweight type 2 diabetes? Obesity about 0.001 percent, almost not existent. An occasional person is a bit overweight but really, really rare. And how often do you see type 2 diabetes? We'll see it, not so prevalent, but it's definitely there. So let me see, older people come in and just new diagnosis of diabetes. Maybe someone is 40s or 50s.

Do you ever see fatty liver? Like when you're operating on a patient, do you ever see that the liver is fatty? And no, no, think, no, never. I can't remember a single case when I've seen fat deliver. What kind of cancers? I mean, you do so much cancer surgery, especially in children, but there are cancers we don't see that much here. Right. What types of cancers do the people in Nuba get versus basically not get?

I mean, in the United States, of course, you'd have lung breast colon prostate or the lion's share of cancers followed by pancreas. So those are the big five. How prevalent are those cancers in Nuba? Not so. I mean, like if we go to kids first, or Berkis lymphoma is fairly common. That's an EBV related, if I recall, right? Epstein-Barr virus is epstemoral or the virus.

And you only, you really just see that in Larry Holoendemic regions. So we're in that, it's called a Birkett zone. And that's a great cancer, because it's curable with just like a phosphamide. Six courses, like a phosphamide, and you cure a cancer, it's great for it's satisfying. But it's rare to have a cancer in cure, obviously.

For adults, liver cancer is probably most common, and that's, I think, a lot of cellular carcinoma, carcinoma, and probably all related to hepatitis B positivity. They drink a fair bit, there's a local beer they make from sorghum, but the alcohol content is not very high, it's fully weak. So it's a healthy, related cancer of the liver. We have a fair bit of cancer of the cervix. So for females, probably cancer of the cervix is the most common. And can you screen

for HPV? Are you the local gynecologist as well? Right. Can you do a pap smear? No. Pap smear would be a little bit impractical because we have to do the swab and get that sent off and do it high level. You know, get it off to a pathologist or not. Is there any, I mean, again, if someone were listening to this and said, oh my God, like, if I could have an impact on eradicating cervical cancer for these women, is that even feasible to have the equipment there to, after you do the swab assess for HPV?

No, for cancer cervix, two approaches. One would be this Gardasil, the HPV vaccine, or made available, either very low cost or just giving us part of, I think it's, I actually just heard today as part of the WHO package. So, they can be integrated into the system where HPV is given to young girls, even young boys. But then we're back to the logistics problem, right? Is how, even if the WHO or any of the foundations came along

and said we wanna provide HPV vaccination on mass to Africa, you're still somewhat excluded, right? We give other vaccines. If they can be lumped into your annual supplies, right? And just do it to get stuff out there, but if you do it in one big push, you know, get it out there, it's gotta be all coaching. It's really, it's really hard, but it's doable. Get this stuff out there one big push. That will make a huge difference. So start with that.

The treat cancer, the surface treat earlier versions. They call it a sea and treat technique. I've not done it, but it's not, I prefer probably a YouTube video on it. The probably is, I think, I think there is actually, you paint the cervix with something. I can't even decide on it or some substance. And you look for irregularities in the cervix and then you freeze it. You have the little nickel nitrogen cylinder with some probes, put that in the cervix and you freeze it, make a nice ball of the cervix, then you kill those pre-cancerous cells and hopefully those people will not go on to develop invasive cancer of the cervix. You would need some personnel for that because that would be pretty labor intensive because that's more of a preventive medicine thing.

We would come in and examine them because you're not treating people with the cancers, you want to get the pre-cancerous lesions. So you get to screen them, do a lot of these screening things. We paint the cervix with some substance. Look and see, you don't even need a culposcope. It's something even more simple than that. I know they're doing it in Uganda, and they have this equipment. So that might be cavity between thing before Garda still becomes available.

At least we do a screening of young women, check the cervix, see what it looks like when you paint this stuff and then treat with liquid nitrogen. We don't have the equipment. I've done that stuff as there, nor the knowledge to do it. What about breast cancer? How prevalent is that? It's definitely there. The problem with breast cancer is by the time we diagnose it. We only diagnose so we can feel a lump. No one's getting a mammogram.

Right. No mammograms or we don't do other stuff to diagnose the MRIs where we have. So we may present with a palpable mass that they're feeling and they show up. Right. So usually they come with a palpable mass and they're feeling and they show up. Right. So usually they come with a palpable mass and they already have nose and things. So in that situation, you still do modified radical mastectomies? We do. We usually modify radical mastectomy and then follow with Adrian Myeson, Psychophosphamide chemo and do that sort of every month

for about six cycles. And I mean, it's still the results are pretty dismal. I mean, usually they get a couple of years, but two years on, two and a half years on, they come back and they've got another lump, they get lump in the axilla, there's another tumor in the chest. So the chemotherapy almost assuredly isn't helping, is it?

No. I really don't think it's doing much. So it's really frustrating. Would getting a mammogram machine at value? I mean, of course, there's all the futility and the controversy around mammography per se, but I'm just sort of thinking of like, what are some finite resources that could be added to,

I mean, you're serving a million people basically that live in a world we can't even imagine as far as even the simplest acts of prevention. Right, the problem with that to do the screening, the scale up to that level. Yeah, you need a whole new staff to get people through, right? And the same thing with cancer, severe screening, it's maybe possible. So it's not just a matter of supplying the machine. You need the radio.

You need someone who's dedicated to reading mammograms all day long. Or I mean, I guess the other option is, I mean, AI should actually make mammography. This is probably one of the most important applications of machine learning is actually reading X-rays. And you wouldn't even need a radiologist at some point. You know, there will be a day when you could run a million women through a mammogram in a year, and there's a machine that's reading it and basically giving you the answer.

And then you still need the logistics of a person taking the patients through the machine and operating the machine. But anyway, we gotta think big, Tom. We gotta, we gotta think of these other ideas. I think these are areas where technology and medicine and developing where there's not always a good marriage, but there are some areas where you have technological leaves. Like for instance, our extra machine,

part of the reason we waited eight years to get one, first of all, they were expensive as heck. How much did it, I don't even know how much an X-ray machine would cost. This one cost 33,000. Which of course, in the United States, that's the cost of getting your gallbladder removed. I mean, literally, that's the cost

of a colonist's tech to me. Yeah. For us, it was a big expense, but we do it quite a few X-rays operating. The guys actually taken the X-ray texts are the operating room guys. I think I was in the operating room, but my lab, my assistant's in operating room are the ones we taught how to take X-rays and they do a pretty good job. We waited that long because we wanted a model that we could use. It was very small, lightweight, simple, or we didn't have to use the chemicals and developers and all that sort of stuff.

And we just waited, and now we have a model where, is it digital? Is digital? So it's a tiny little device mounted on this little thing. And I actually like the size of a small, like a tiny box, that has the X-ray tube in it, and it's a laptop. And the screen is operates by Bluetooth between X-ray machine and the computer.

Take the X-ray. That shows up on the computer screen. And it's all there. And you can take that X-ray and adjust it. You can darken it, lighten it. You can focus in certain areas. I mean, it takes a beautiful X-ray. And you can just play around with it.

So you really get a nice picture. And there's very little variable cost at this point. It's all a fixed cost that you've covered. And now you can, the more you use it, the better. You're getting more read. Absolutely. And the power is also the other thing was the power needed because we're 100% on solar.

We've got a backup generator. It's with the rate limit factor there is the fuel. Like right now I think we'd, I think we're left with maybe. Oh, so if you have enough fuel for the generator, you could run indefinitely off it if you needed to. Yeah, but I mean, we have to give probably big breaks of time, you know, it's a pretty, it's a fairly good-sized thing. And the hospital is the only thing that has electricity, but you don't have electricity in your home. No, there's no grid. So it's just the hospital has power.

That's, you know, we run on the solar, I mean, pretty much 24-7. We really don't need the, as long as the batteries are there, everything's functioning, we don't need the generator at all. And we try to find the time when it's, these batteries are going to order new set and new panels wherever you need to re-up that. So we're I think three years into this set of batteries. What about colon cancer?

Do you see that? Pretty rare. We've had what would be two or three cases in ten years. I mean, it's really, really rare. The folks who are the most elderly within the community live to what age? I mean, what is considered old? There, you know, nobody there knows the age. You know, they don't have any birth records.

Even my wife doesn't know her age. She's somewhere in her 30s probably. So they don't really know their exact age. But I would guess they're probably, and all the person they're probably in the 70s, and his or her 70s, I don't think they live much beyond that. And do you see cognitive impairment in that population? Really rare.

You rarely, somebody say, I think this person is Alzheimer's. Really, really rare to see that. I mean, I think they should die of something else before they reach that stage. You just don't see it. The point you just made that reminds me, there's a mute movie, which you may have seen.

I think it's called a Good Lie. Yes. It stars Reese Witherspoon. It's a beautiful story. After we saw the heart of Nubo, we watched that because I wanted my daughter to sort of understand the history of the Sudanese refugees. And that's one of the points from the movie that I remember being very sort of moved by. They were all assigned the same birthday because nobody knew their birthday. Like even something like that that we would take for granted. Do they celebrate birthdays? No, nobody does. I mean, in my wife, we kind of invented a birthday, or she met in November 21st, so when that day comes around, well, usually do something.

And she's always surprised, like, what, what's, what are you doing? Oh, okay. So she doesn't give me a hard time for not buying five flowers if we could buy flowers. So it's pretty, it's pretty easy to be married to a new lady. She doesn't give me a hard time for not buying fly fly fly if we could buy flowers. So it's pretty, it's pretty easy to be married to a new girl. She doesn't do the expectations are very low. How has your life changed since you've been married? I mean, do you have a greater sense of obligation to not die to put it bluntly? Yeah, definitely. So I'm like, you know, you can't be so cavalier with things

because I've got a wife and I wanted to kind of look after her, I'm sure she's okay. There's been a little bit of a change in perspective with that. And I think if and when we get children, I think that'll change another degree up. For sure. Do you think you could do what you do

if you had children? I think we could stay there and if things are really hairy, we'd have to see how to proceed. But just in terms of, I mean, your wife is a nurse, so you have the luxury of working together. So as focused as you are on your work, she is there with you. Right. When you have children, they will not work with you for quite some time. I just wonder would it be challenging to sort of now be torn between two obligations that for many years will not overlap at all?

It'll be difficult. You know, I think one thing and one thing I remind my wife of is that You know, I finish work late and I'm always you know often preoccupied with things and things with the hospital and all this sort of stuff but at least I'm there every evening. The weekend's a little bit of time on a Sunday, but together. And even though the work is very much all-encompassing, there's no commute, and there's no distractions. You know, we don't have, there's no TV, there's no radio, we don't have other things that kind of occupy our minds. So when we're together at home,

we really can be present to each other. And I would hope that if we have children, I'll be able to use that to really spend time with the kids and not be always in work. If life continues like that in Newbu, there's not any travel involved. I'm just there. I must don't see that.

It's funny, when you say it that way, it's actually, you may actually spend more time with your kids than many of us do here because of our distractions and our travel and our this and our the. Life here is much more hectic. I mean, it seems almost like riding this. You feel out of place here, even though you grew up here.

I mean, when you walk down Park Avenue or Madison Avenue, are you sort of like, what in the hell is this place? I do feel a bit out of place. In a sense, I do enjoy it. Like I've never, even when I was like growing up in upstate New York, I'd never spent time in New York City. So this is really kind of, it's exciting.

I like it, but I don't think I could stay long term. I mean, a lot of people, I'm sure, say about New York, but I do feel much more at home in the New Mountains where it's very quiet and kind of sedate and your time is your own when you're off. What possessions do you value? I mean, I know you have some textbooks and things, but I mean, your home is very modest, obviously.

By the standards of someone living in the United States, it would not really, you wouldn't even really call it a home in the same way. Right. But you don't give the impression that you're wanting. No, I really don't. I think that was my character since I was a kid. I'm very much, I think I'm very much a minimalist since I was born. All these clothes you see me wearing from the socks, the trousers, both these shirts I bought when I came out of New Bill last month. So I have

scrubs. I had scrubs, I won pair of trousers, I had a suit, a few t-shirts, and that was it. And they're like, hey, look, you've got to go and meet people. You can't be wearing those scrubs around. So I had to buy all this crap when I came out. It was painful for me to buy clothes. Like, I don't, I just don't like it. When I go back, I said, look, when I go back to the mountains, all this is winter coats and this stuff. I'm not taking this stuff back with me. I'll keep it in Armenia. It'll be someone there who used it. I don't know what I want. My suit, I do have one suit that I wore to the ceremony in Armenia, the World Prize ceremony.

But I bought that suit in 1985. So I haven't. I thought once and said, probably when you were interviewing for medical school or something. Well, I was interviewing for jobs, like for engineering jobs. That's the reason I bought it. So it was one I had, same one I used for it,

it was for medical school. And then I've used it when I came out for this or a price ceremony, I'll take it out and I see what the blue shirt didn't tie. But I bought a crap in 1985. And I know that you, it's absolutely against your nature to sort of be critical of anyone. But do you spend any time thinking about the way

the world works here and how most of us are somewhat attached to our possessions? And the more possessions we have, the more complicated our lives get. I mean, you certainly hear people talk about minimalism. Few people can apply it to the extent that you can, of course. But I mean, what have you learned about this? And how could you speak to somebody like me who, you know, loves his possessions as much as the next person and can't imagine giving up these comforts? I mean, help me understand, because you don't look like you're miserable. And you look even happier in these videos in Nuba. I'm sure that this is about the hardest thing you've had to do all year.

Yeah. It is. Just schlepper around New York and talk to idiots like me. No. I'll tell you, Peter, I really do believe that the more detached you become, not like in this Buddhist kind of Narva-Nasans, but the more detached you are from things that easier life is, it just simplifies your life. I mean, for me, I look at all, at a lot of possessions and things and attachments. more detached you are from things that easier life is, it just simplifies your life.

I mean, for me, I look at all, a lot of possessions and things and attachments, I'm just adding more complications. Let become so complicated. It's much harder here in the US. I see my sister and how she's interacting with the kids. It's a reason why advertisers are good at what they do. What they want to do is convince you

to buy something you really don't need and they're very good at it. What does medicine have in you exist? Why is there a huge building in medicine? Have you these guys are very good with what they do? They're convincing they've managed to convince all of us to get things that really don't need and convinces that will be only happy and fulfilled and satisfied if we have those things. So you got all this tsunami pushing against you. For me, I think just because I'm in a place where you can't have anything that kind of realized, well, geez, I don't have any of this stuff and I kind of like it. It just makes things much easier for me. I've always been a bit of a minimalist even when I was what I was younger, but I've come to kind of feel that

that's really I do feel better with less and I think everybody is looking for some kind of meaning in life. You know, this book, this man's search for meaning, this Victor Frank, that was somehow my, is in my favorite books and this like the logo therapy. But we all really do need a sense of meaning in our lives. It's extremely important for our psychiatric makeup. Whatever that is, it's different for each person, whether it's kids, whether it's your pets, whether it's your job, but to try to get something in your life that's meaningful. And if you're looking for it, this means philosophy is a bit... Certainly, I think if you're looking for material possessions, I don't think you'll find it there. So if I can make a bit of an aside,

something I talked about earlier with the talk with the Catholic Medical Mission Board volunteers. My favorite Bible passage, I can remember the book and the verses, but the basic story is there's a guy, the guy's a very wealthy young man, and he goes to Jesus, he says, they try to justify himself and says, look, what do I have to do to get eternal life? And Jesus says, well, follow the prophets, you've got all this stuff there. Follow the Ten Commandments, follow the laws of the prophets. And you'll, you'll be okay. And the guy says, well, I do all those things. What do I need to do to really become perfect? And Christ said, you know, sell everything you

have to keep your cross and follow me. And it says something very which I think is very beautiful. it says the man went away very sad because he had many possessions. He couldn't do it. He couldn't, he wanted, I think he wanted to justify himself. See, I'm, I'm good. I'm doing all the things I need to do. I should be okay. And Christ kind of turned that on his head and said, okay, if you want to be perfect, celebrating your half and come and follow me. And I think, I think what he's saying is, look, if you really want to be perfect, really want to be happy, you know, get rid of, I mean, I'm, it's a bit of

pine this guy stuff in a way and not proud to go for, for people. But in some way, get rid of your baggage and come and follow. Yeah, because it could be metaphorically get rid of your stuff. Right. I don't think it's necessarily literal, right? It does me throw your couches out, but it's don't be wed to these things the way that I think we are. Exactly. And the theological meaning is exactly that. It's not that you can't have things, but what's your attachment to those things?

Is this thing where you put your values, is your value in the car you drive, in the what kind of beer, drink, or whatever, or is your value more in people and what you're doing and how you're helping people? There is a bit of values in that. And I think I'm sure some people can do it very well. They're very wealthy. They have a lot of stuff,

but they do have a sense of detachment from that. I just think it's more difficult. You know, it talks about this passage about it's more difficult for Richmond to enter the community of heaven than it is for a camel to go through the eye of the needle. That's kind of something I'm gonna say. Well, the needle is supposed to be where the camels were and the keep of heaven, then is for camel to go through the eye of the needle. That's kind of something. I say, well, I've been needle. It's supposed to be where the camels were and the keep them out of the city. And I think it looked like an eye of an needle and the

camel couldn't go through there. It's not saying being rich is bad. Rich people are bad people. That's totally, that's nothing's missing the point. It's just very difficult because it's very difficult to be detached from things when you have a lot of possessions. You know, I'm trying to say that without coming across as being judgmental. I don't mean that, but certainly for me, it's much better having less, I really, really think that. Well, it's funny at the outset you talked about this idea that even in college, you were sort of struck by this idea of you wanted to be a missionary and you even said something to the effect of whatever that meant. And it's sort of funny, like, if you say to me, Peter, picture a missionary,

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

I guess I think what people like you do that is regardless of one's religious views, they can't help but respect it is you're not preaching it to anybody. You're not hitting anybody over the head of the Bible. You're just sort of saying, look, I'm here to serve you. And your example is what's actually doing the talking as opposed to your words, whereas I think most of us, myself, included are far too quick to use our words to speak as opposed to our actions. Well, you're tapping into my favorite quote, which has been attributed to Saint Francis. I don't know, Saint Francis is like many people, is my favorite saint. A friend of a CC who lived in the 12, really 1200s,

he said, preach always and sometimes use words. And I think that's exactly what I think we try to do, a mission, show the love of Christ by who you are and what you're doing, Coloss. And don't don't get too rektrony axle about how it's going to play out. Remember if you're there as a missionary, you know, God is the one that changes hearts. Not me. I'm not smart enough to do that. I don't have the, I'm not a guy that's going to have just the right thing to say and to, you know, school somebody on something. I can't do that, you know. But I can do my best to show the love of Christ to these people. And that's what I feel comfortable with. You know, if you ask me why I'm a Christian, I can talk to you about it. And even my words might be a big jumbled and goofy,

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

So, it was acting a bit odd there, came back to Nuba, was acting a bit odd at home. And then, the night he was acting a bit odd, he went in, he shot himself. As the only case I know of, it's extremely rare. Extremely rare. I mean, to me, there are so many amazing contrasts between Nuba and America, right?

I mean, they're so obvious they're not worth stating. It's these subtle ones that to me are interesting, right? There must be a different sense of fulfillment, contentment, happiness, sense of purpose. They are versus here. I mean, as you know, I'm sure you're not paying close attention to statistics in the United States, but suicide is among the top 10 causes of death in every, I may be incorrect on this, but I'm not far off in every age demographic except for zero to 10.

So once you get above, you know, 10 to 20 to 30, suicide is always in the top 10 as a cause of a disease. And that doesn't include, that's what we call fast suicide, when you kill yourself immediately with a clear, but then you have all the slow suicide. So the alcohol related, right? You know, basically people that kill themselves with alcohol and drugs. Yeah, right. So when you include all of those, I've heard analyses that would suggest that self-harm would be sort of top five causes of death across the board. What does that say to you, given that you live in a world that has one-one thousandth of the privilege and for all intents and purposes, like shouldn't everybody be killing themselves in new bus? to avoid being a you know ripped apart by shrapnel?

Yeah, it's very interesting and you know my initial thought that comes to me is The people are when you're really gripped in this struggle to survive. So your your life is based on You know every day is you're just trying to survive when you have that sort of primal instinct of survival you're just trying to survive. When you have that sort of primal instinct of survival, your mind doesn't drift off to the things. You don't think about so much about your life is hard, your life is this, your life is miserable. I think you become less inward looking. Suicide is so inward looking, so focused on your own misery, that you can't come out of it. I mean, it's such a miserable thing. I mean, it breaks my heart when I hear about these things. It really does because I think, man,

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

I mean, and it's not to say that I'm not heartbroken by anybody who hurts themself, but what you see is so staggering. Do you see this as an even greater source of tragedy? For me, I would equate that with the five-year-old girl who's got the shrapnel ripping her out. I would, I would see, I would feel the same sense of pain and Heartbreak with that suicide is a similar effect where you know if a child dies from this kind of thing the effect You have in the whole family is that a steady the grief suicide the grief you leave behind I Think that's really tough and that really really breaks my heart not only for the person who was so miserable at the Side of take their own life, but for the people who are blind. Oh gosh, and that's terrible. Man, I would just never wish that on anybody.

And yet it's almost impossible in the United States to not have your life touched by suicide. I think it would be very rare that someone listening to this in America wouldn't know somebody first or second hand who hasn't taken their life either clearly and deliberately or sort of slowly and maybe less deliberately. Yeah, I think it's wrapped up in that struggle for survival. There is a will, you know, a natural will to survive. And when you're in this kind of daily grip, even when there's not fighting, just to survive there, the amount of work it takes to get up in the morning to make food, to cultivate

crops, to keep the animals out of your garden. I mean, it's a tremendous struggle. There's a book, I think the book is called Tribe, Sebastian Younger. Have you heard of it? Yes, I have heard of it. I can give you a copy, actually. I have a copy here, so I'll give it to you as one more possession to have. Right.

But he writes about how post 9-11 suicide rates went down in New York and he talks much more eloquently about this than I ever could. But I guess it speaks to what you're saying, which is when there's a real struggle, when there's something and something that can bring people together in a common goal or there's something that unites people, it can presumably distract from some of that pain that can otherwise hurt us. Right. It's interesting because I fairly recently was hearing about this PTSD and I mean, how many veterans have killed themselves? That's another heartbreaking thing. Somebody's fighting in the erogative. Canis them, they survive all that, they come back home, they

get disbanded, they kill themselves. What kept them alive during the fighting was a sense of camaraderie, togetherness, fighting for a common goal, no matter what you think about warfare and the horrible things that happen in warfare, at least they have some kind of a common bond. They come back home to the US and people are indifferent to them. Nobody pays attention to them. They've lost their common bond with their comrades and friends. And so is this bondancy. And before I know it, we

had this huge, brain of suicide amongst veterans that come back, not so much from the trauma they had during the fighting. It wasn't like flashbacks to horrible things that happened there, but the sense of loss of any bonds that human contact with other people, that sense of purpose has gone. So I found that quite interesting in that thought. That's what it was. It just makes you wonder if there is, if there is a way to, you know, we have these dating apps here in the United States, right? You probably don't have a lot of them in your mouth. Well, dating is totally illegal there. The word dating doesn't even exist.

But how did you meet your wife? Well, we have what she calls secret love. That's not like in a scandalous sense for anybody. But, you know, there you can't openly date somebody. You know, if somebody like I can never be alone with her somewhere, like just chatting out in the public, people would tell her brothers, hey this guy is talking to your sister, what are you gonna do about it? They come and they beat me up, they'll beat her up and then this big scandal and they say, oh, you know, you know, you're, you're gonna get married or what's going on here, you can't, you can't be doing this. So you have to do it. We did it very quietly.

It's difficult. We got to know each other kind of on the side. And our marriage is normally arranged. Is that why this dating process is unnecessary? Yeah, traditionally they were arranged. Now they're not so much arranged, but the families will meet together. So might show interest to somebody else

than they have to approach the family. But there's not really a dating. They can't go through a public dating thing. If you're interested in marrying a girl, you've gotta go and approach the family right away. And see, look, I wanna marry this woman, then they have to start negotiations with Dory and all that sort of stuff.

You can't be seen together in public sphere. It's just not totally not allowed. So not so much in range, there's some attraction between the two, but they have to really make them move fairly early. So they don't, you know, where the problems, you don't really get to know the other person very well.

It's really difficult, you know, they're good at their bad points because you're not really allowed to go through that process of dating if they know somebody and unless they think of the family. Okay, so there's definitely no nuba version of Tinder. So I think where I was going with that was, in the same way that we have these dating apps, which are basically trying to pair people with similar interests. At a meta level, it would be interesting if there would be a way to pair a void that exists here in this country and for much of the civilized world, right, the avoid of

purpose, with a part of the world where purpose is not lacking, but resources are lacking. And in many ways, I think that's what philanthropy sort of tries to do, but of course the question is, it's more than just that, right? I mean, I don't think it's just giving. I think there's more to it, right? I mean, I was sort of thinking about this knowing

we were gonna speak today that, because my daughter asked me another question, she said, you know, she said, well, can you ask Dr. Tom, like, what could a 10-year-old girl in San Diego do to help a 10-year-old girl in Nuba? And I thought, and I thought, and I thought, and I was like, I don't know, because it's not like you going there is going to, you know, be a practical solution and or even provide value. I mean, even meek, even if I decided, Tom, please, I'm going to come for a year and work at your side. I would slow you down. I mean, I would be a waste of like, you'd spend a year just teaching me how to get out of my own way. So how can people help? I mean, giving is of course the most obvious. You've outlined so many

people help. I mean, giving is of course the most obvious. You've outlined so many clear tangible examples of where even modest resources by the standards of our healthcare system would have profound step function changes there. Is there something else people can do to help? Yeah, first of all, never underestimate the value of a donation to someone you trust, there are a group you trust, an organization you trust, the impact that has is tremendous. We can't do anything, and I work without financial resources. Beyond that, I think one is just becoming aware

of the situations, somehow in this environment, trying to understand how these people, how they live, what their lives are like, that these really are individuals that have their own thoughts and aspirations and everything else, trying to get them into their skulls a bit and understand what their life is like and who they are. If you have kind of a knack for advocacy or through government and this kind of thing, be aware of the political situations there, advocate on behalf of some of these people that are oppressed or having difficult lives, whether it's working in issues of poverty or poor health, poor

education, I think people have a voice to offer and people do have an influence over governments. So government policies, government funding is a reflection of the constituents. And I just came to realize this full well in this trip, because some of these people say, well, the government funding, a lot of these administrative requirements, these beneficiary organizations have become more stringent and more difficult, because governments require these things, because they're accountable to their constituents.

Their constituents are saying, are you saying so much money to Africa, they're wasting it, or it's waste of money? So to give the money out, the constituents are holding the politicians' feet to the fire. If the constituents were a little more open, said, look, let's help out. Let's be aware what's going on and try to help some of these people get out of their misery. So they can eventually help themselves through education, better health, all these sort sort of things that would free the politicians up a bit to allow more resources to go out into more aid and other things, more benefit to give them. The goal and all this stuff is eventually let these people who are beneficiaries now stay

in their own two feet, maybe in the next generation and next go around. This cycle of aid, I mean, everybody knows a cycle of aid and dependency is a bad thing. Great, but how do you get out of that? So what are some creative ways we can do that? But you can't do anything without some help at this point, but geared towards getting these people to stand and know into a feed. Talk to me about food. I heard a funny story once that is there a word for food?

And who but like that? It's like, it, gumo. So, you know, a new new but has a like 99 different languages amongst the new people so everybody speak Arabic pretty much most of you speak Arabic yeah I speak it but I'm sure yeah sure yeah sure yeah the thought of my wife's languages tira and this came from her the look word for food is gumu mo. And I would say, what did you have for supper last night?

And she said, I had food. I said, what kind of food? You know, food, what are you talking about? I had food. I said, what kind? I said, well, I had an acita, you know? Acita's the kind of, it's like a cake, me and a sorghum, kind of ground sorghum boiled.

I mean, just totally tasteless. She loves it. I have to have my acita. So for them, the word food and the acetate is synonymous. The so little variety of foods. So what do you eat? First of all, what did you weigh? Because you were a nose guard in college.

I've seen pictures of you. You were huge. What did you weigh in college? And college I was 230 and this was 1985. By the way 230 and what did you yeah what did you weigh when you arrived in Kenya in 2000? Probably around 190 I guess. And what did you weigh by the time you got to Nuba? Oh yeah. Then maybe 170 and got down, I was down about 150 up until recently now I've come out for the past month. I think I've gained about 20 pounds. What was down

about one? You've gained 20 pounds in the United States in a month. Yeah. So you were down to 150 pounds a month ago. Yeah. Talk to me about what you eat. Well, that's the thing. I eat, but my wife makes the food there. So is this food. What did you eat before you got married? Then I was living on the hospital compound. So we'd have a lot of, they would send them food in from Kenya normally, like once a year they'd send food in. So usually rice, kidney beans, some kind of lentils.

So we'd have that every day, once I had to have chicken, but usually it was just kind of rice and beans, kind of stuff. So now when I got married and moved off the compound, my wife makes a sasida. I'll show you some sauce on top of it. So the main sauce is this okra. Okra grows pretty well.

They say they gochua, they dry it, and they pulverize it in the powder. They mix that in with water and some other stuff. And it makes like a really slimy sauce that you pour over the sorghum paste and it tastes about as good as it sounds. I mean, it's really pretty bland. Where is the protein?

You know, I think the sorghum actually has a high protein level. I think it's a grain. And I'm saying that because the people are pretty muscular. Like, that's what they eat. They eat that and they'll have maybe some sorghum porridge in the morning. And that's pretty much it for the day. And I mean, a few peanuts, they have peanuts too, but not huge numbers of peanuts. What about fruits or other vegetables? For fruits, there are seasonals. So you can get mangoes for maybe two or three months out of the year. You know, a mango season is

there. There are tons of mangoes, then they, when they're gone, they're gone. You don't see a mango for several more months, then there's two seasons for mangoes usually, but it varies quite a bit here to here. So, mangoes are there periodically. Lemons, you get for fruits, that's about it. Oranges are not there, you know, pineapples. Are there tomatoes and tomatoes are there for a couple months, sort of towards the end of the rainy season. You can get tomatoes and you can get some greens. They grow a few kind of greens there, and they'll put that on top of that. Like even the tomatoes will kind of cook up a bit and make the ochre slime to it and put that over the seed up.

That's not bad actually. We'll have that quite a bit. Or the thing we'll have during the rainy season is milk also. Milk is only there for a couple months. The cows will only give birth during the rainy season, milk also. Milk is only there for a couple of months. The cows will only give birth during the rainy season and therefore they're only lactating during the rainy season. So the get milk sort of tours in the rainy season those last couple of months. And since there's no refrigeration, most times we'll have it sour, sour milk. So get milk out, but it's said for a

while it becomes sour, that'll also decontaminated a bit. There's a lot of brusolosis there. And it take the sour milk, which is kind of curdled. And I think people have had sour milk before. And you pour that over the aceto, over the sorghum paste. That just doesn't sound tasty. It's not very good.

It's really, it's kind of eating like, man, you know, probably you eat it, you're kind of hungry a bit, but there's no way you're going back for seconds. I was like, that was enough. It's kind of going to bed, you know, or go back to work. I was like, okay, I guess I've finished. My wife really, she does a great job cooking with, but limit resources we have, but it's pretty stark. Is there food that you particularly looked forward to having when you knew you were coming

to the United States? Yeah, like, you Peter Italian, right? Yeah. So, pizza, eggplant, Parmesan is my favorite food in the world. So, my system made that when I was down there. Hamburgers, I just crave cheeseburgers, like just a good sandwich, you know, some chicken sandwich or something. Is this really nice with a good bread, you know, this kind of stuff? You've been sick when you're there. I mean, how many times have you had malaria? Well, I've been to 10 and a half years. I've gotten malaria every year, except for 2018.

How bad is malaria? Sounds awful. It's pretty bad. I mean, you sometimes you're wishing somebody comes in and just shoots you and puts out your misery. It's, you're pretty sick with it. It's worse than influenza, right? Yeah.

And influenza, anybody who's actually had the flu will test, that's 10 days of really bad living. Yeah, Larry's pretty miserable. I mean, real bad headache, nausea, vomiting, you can't sleep, just a high fever, his body aches, terrible body aches. And sometimes you get a bit luck, you take medicine, you're over it in a few days,

but in a lot of times it'll drag on for a month. But you don't take prophylaxis throughout the year, just during the rainy season, which I'm assuming is when it's endemic. Right, I don't take prophylaxis just because of the cost. And yeah, I just don't want to take the drug. I just want to say, okay, let me just not take it. And take it once you get it.

Right, once I get it, sometimes it'll drag on a bit longer. I mean, sometimes you get it just for a month. You take the medicine, you feel a bit better for a couple of days. Then next evening, you start feeling the chills and shaking and the headache comes again and you're like, oh, gosh, it's still with me. It can really drag on for a long time. So every year you've got it, every year, that was in a coma four years ago. Just, God, it was a strange night or it started feeling sick the night before is on a Tuesday night. And it started taking, I took some oral drugs. I think I co-arct them, which is a

scene in derivative. Took that at night, I went to bed, just kind of had a kind of fitful sleep. And then I woke up the next morning and all these staff were in my room. I have an IV in my arm and I'm an IV queen. Like what's going on here? The doctor needed treatment. But I was really out of it. There was like 11 o'clock when I woke up and I was really, you know, they tried to get me up in the morning some of this stuff because I was in the operating room

day on Wednesday. And our guy that's our assistant there, I didn't show up for the, I was down there by 730 and I didn't show up so he came up to the room. He tried to wake me up and I couldn't get up. Like I didn't respond to him. So he thought I was dead. He was like, hey, Dr. Dan,

you feel okay running in? Anyway, he had to die. So I just, that was out of it for quite a while, but then I recovered pretty quickly. I can't even imagine. I just, I can't, when you think back, Tom, about all of the people you've taken care of in the last 10 or 11 years, so just even just limiting it to the time in Nuba. Is there any one particular patient that just stays with you that haunts you one case, one story, one child, one adult? I mean, I have those stories.

I've got one or two, probably three stories that have stayed with me from my training. If I even think about these patients, I'll tear up. I mean, just, unfortunately, they're all bad outcomes as the ones that, but they're also, they're not like the only bad outcomes I've seen, but there's just, there was some emotional connection that happened and then it's, maybe it's sometimes you're projecting what's happening there onto your own life or something, but do you have those cases? Yeah, probably like you.

The ones you really remember are the ones that have been outcomes or ones that didn't go well. Gosh, we had one kid, I remember he came in on a Sunday morning and he had been the Antonov bomb in the trap and the wet in his face and just tore his face to shreds. And he went to some clinic somewhere and they put a few stitches in it, like Chromic stitches. And he came a couple days after that.

And his face was just mangled, so we took the stitches out and his all just pus, they were coming out. I mean, just they didn't clean the wound out. So it took all these stitches out, clean the wound out well, put them on some antibiotics. A couple days later, we go on, he's got high fever and he can't swallow. And like, no, crap, he's got, he's got tetanus.

So it kick his tetanus. And remember, the day before then, remember the Antonov came overhead. The Antonov is the air-punette bombs. And we saw the kid, he was like a, maybe 10 years old. He was standing in the wall, just shivering when he heard the airplane. Just shaking, he was so traumatized. He was so traumatized, he was shaking like this.

Then the next day, he gets a real high fever, he can't swallow, put him in isolation, put NG2 down to feed him, and he just died from tetanus, like overnight, he died from tetanus. I remember this kid's face and I said, what the heck, it was a ten-year-old kid with this thing. We had another kid, there was a child who was a few years ago, he was bombed, he and his aunt, and it was an incendiary bomb from the Antonov. I don't know what they had, they pung whatever, but it bombed him. And he had, I don't know, he had 30 re-burons on probably 60, 70% of his body.

And he lived. Is that even survivable? No, he lived like two months with this. And both he and his aunt were the same. And I mean, we tried everything with these kids. The amount of work the nurses did every day just to try to address him. The agony went through before he died. Remember, you know, his aunt had these scabs, and I remember there were, her eye was burned with this thing. And I remember there were maggots coming out of her eye, you know. I think, what the heck are we doing? You know, it's just crazy.

What are, who are these are civilians? Burn a death, you know. There were other six other kids that were in an area that was being shelved. So they sit in and I would shelve their village like all night and then they'll bomb there in the day. So they were at nighttime, they would sleep in the foxholes for protection.

So right next to them was a straw, Rakuba, kind of a straw that was structured. So they're truly a shell fire and hit the racuba, think it was just like a kind of lean to with a bit of grass and wood. It said this thing on fire and it fell into the foxhole. And there were I think nine people in the foxhole all sleeping. Three were burned to death immediately. Six of them came to the hospital with very degrees of burns a couple, we're just like 80% full thickness burns.

They lived for quite a while before they died. Two of them. One girl started improving. They developed tetanus and diphonate tetanus. These are ones that really kind of stick out. Maybe one of the soldiers I remember best is a guy that, he was the guy I told you before. He had 23 or 4 holes in his intestines. We opened him up and we just I mean we hours we operating this guy. Posted up he was doing great. I mean it was cruising and starting feeding him to

set up in bed. The next time I'm called down the sea and he's changed condition as they say. Anyone down here he's already dead. He was a Darfur who was fighting with the newbie rebels And I went down to his already dead. He was a Darfur, who was fighting with the Nuba Rebels. And I just remember thinking, what would this life for his, like this guy's got a family? You know, he's fighting in this place. He's been somewhere in Darfur. What's happening? That they've been had deal with happening here. So many terrible things. You know, there was a young, one young kid, he was about 16. And he, this, he was approaching on our area. So the rebels ran out there to kind of repulse them

and then people just kind of jumped on vehicles to go out and fight, you know. So this kid just jumped on the vehicle. He didn't have a gun, they were up in the name of him. It was just a civilian, he goes out there. He gets shot in the head with, you know, a machine gun or something. He comes in with, you know, part of his. He comes in with, with, you know,

part of the skull missing and his brain tissue kind of pulsating out. I mean, he survived for two or three weeks like that. You know, he had been steroids and different things in antibiotics, try to count things down and it up just kind of going south and dying. So these are all, all people I'll never forget. And there are many, many, many beyond that. If people want to get involved in any way, shape, or form, where would you recommend they look to as a resource? I think in like an African Mission Healthcare Foundation, there was something on their website

about the hospital that's one source to go to. And their website is asamhf.us. www.amhf.us. So that's a pretty good source to start. There's a group called Take Heart Foundation, which was set up to kind of the harness the whatever support to be through the heart of Nuba movie, which was made by my friend Ken Carlson, which I recommend everybody watch it. I think it's a I'm sure it was done on a shoe string budget, but it's so well done. Yeah, you know, it just sort of speaks for itself.

So anything raised through them goes to African-American healthcare, which comes to us without anything taken out. Catholic Medical Mission Board is another good source. That's my sponsoring organization. They're here in New York. They've been here for, I think, over 100 years. And there's cmmb.org, I think, is their website. These are probably the main sources for our work in Nuba.

I'll close with a story, Tom, that I think in many ways kind of defines you. I remember when I decided I wanted to go to medical school, I was applying for this scholarship, and in the end I didn't get the scholarship, but I remember during the interview, this guy asked me a question, he said, what do you want to be?

And at the time when I went to medical school, I wanted to be a pediatric oncologist. And I know what the guy was me a question. He said, you know, what do you want to be? And at the time when I went to medical school, I wanted to be a pediatric oncologist. And I know what the guy was doing in retrospect. I mean, I think he was just trying to push me. And he basically said, like, why would you want to do that? You can't possibly make a difference, you know, without dedicating your life to research, you're not going to have a difference

saving one kid's life at a time, et cetera, et cetera. And I remember thinking of a story after, which in many ways exemplifies you to an extent that probably no one else, which is, in medicine you can do two things, right? You can do something very scalable through research. You can devote yourself to working on treatments for cancer or developing a new drug to treat

this disease or that disease. Or you can be on the front lines trying to save one life at a time. So the story is there's these two guys walking down the beach and it's after a really high tide and the beach is covered in starfish. And the starfish are going to die pretty soon if they don't get back in the water, which means they're pretty much all going to die. The two guys are walking and every few steps, one of the guys bends down and he picks up a starfish and he throws it back in the water. Five steps later, he does it again and again and again. After like the tenth one, the one guy says to me, he goes, what are you doing?

And he says, well, you know, if these starfish don't get back in the water, you know, they're going to die. And he goes, have you looked and seen how many of them there are? You can't possibly make a difference. And he throws another one in the water and he says, well, it made a difference to that one. Right. And I think for doctors that don't have the privilege of being able to affect the larger

through research or policy changes, whatever, for people in the front lines, I don't think there's a human being on this planet who throws more starfish back in the water than you In the end medicine is individual is the beauty of our profession and it's a huge privilege to have the the opportunity to affect one person and in the end you close the door and it's you and the patient Whether you're in new amounts whether you're here in New York, and that's an incredible privilege. And I think if we keep that focus, just one person at a time. I think people can kind of relax a bit. You can see that what you're doing for that one person.

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

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

And I know that for you being outside of Nuba is the toughest thing imaginable, which is of course the irony sitting here in the plush New York City, and yet all you're doing is pining to go back to a place where your own life is in danger. But, you know, I remember thinking, God, I really just, I'd love to be able to interview Tom, and I remember thinking, there's no way he could justify making the time to do this when his time in the US is so short. So when I asked Rick and Mark and John, and they said that Tom would be happy to sit down, I just couldn't believe it.

And I might make the case that of all the interviews I've ever done or will do. This is the one I feel most privileged to. So thank you. Thank you so much. Yeah, thanks Peter. This has been a real privilege for me to be here with you. And thanks for giving us the platform to spread the word a bit. Thank you so much.

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