A: If you’re in a situation that’s as egregious as ours was, when you’re being bombed and you’re watching civilians being maimed every day by artillery shelling or air bombardments, you really do have an obligation to say something. Because we’re there as a witness. They can squelch a Nuba person who’s speaking out, because they don’t have really a voice on the outside, and they can use propaganda and everything else, but if an unbiased – hopefully unbiased – foreigner is there, it’s a little more difficult. Click “Deep Read” (above) for more of our conversation.

Q: You have been a vocal critic of [Sudan’s long-serving President] Omar al-Bashir, sometimes against your colleagues’ advice. Why?

Tom Catena admits that the mental strain of his work has tested his faith. He’s the sole surgeon at the only hospital in the remote Nuba Mountains of Sudan, a region that’s been under assault in the government’s battles against the rebels. Dr. Catena spoke to the Monitor recently about his work and the forces shaping Sudan, one of the world’s least developed countries.

When Tom Catena moved to Sudan in 2008 to work as a surgeon in a remote, rebel-held territory, he first needed to earn the community’s trust. He learned basic Arabic, treated the local leader at his hospital, and stuck around during government airstrikes to treat the wounded.

A decade into the job, Dr. Catena, who is also a Catholic missionary, leads the Mother of Mercy Hospital in the Nuba Mountains of South Kordofan, Sudan. Indiscriminate bombing by the Khartoum government has terrorized the region’s Nuba people and blocked their access to aid.

Catena’s 435-bed facility is the only referral hospital in a region of roughly a million Sudanese. The hospital operates on a $750,000 budget, of which around half goes to salaries for local staff. Nasima, Catena’s Nuba wife, is a nurse among them.

Catena is on call every day of the week. Some patients will walk for days to reach “Dr. Tom.” With limited supplies, improvisation is key; until last year the hospital didn’t have an X-ray machine.

Catena himself traveled an unusual road to his work in Sudan. A native of upstate New York, he studied mechanical engineering at Brown University, where he was also a star football player. He then decided his professional work needed to be more mission based. That decision took him to Duke University School of Medicine on a Navy scholarship. His desire to serve ultimately led him to help others in Kenya, then Sudan.

Catena admits that the mental strain of his work has tested his faith. “Why do these kids die, innocent people?” he says. “We just have to stay faithful, you know, and just keep at it.”

In 2017, the Aurora Humanitarian Initiative awarded Catena $100,000 in recognition of his work plus additional grants for other aid groups of his choice. Raising money for small humanitarian operations can be tough. Donors expect accountability, and the paperwork piles up. What works best, Catena says, is bridging the perception gap between donors and recipients.

“Individuals need some kind of connection to the people they’re supporting. If you make it a bit personal for people, in the end there’s got to be some level of trust.”

Catena spoke to the Monitor recently about his work and the forces shaping Sudan, one of the world’s least developed countries. Here are selections from our conversation.

What do your morning prayers accomplish for the rest of your day?

I think for me I’ve got to remind myself every day that God is in charge. I need that daily reminder. I need that schedule and that discipline where every day there’s something I can go and look forward to.

You have been a vocal critic of [Sudan’s long-serving President] Omar al-Bashir, sometimes against your colleagues’ advice. Why?

If you’re in a situation that’s as egregious as ours was, when you’re being bombed and you’re watching civilians being maimed every day by artillery shelling or air bombardments, you really do have an obligation to say something. Because we’re there as a witness. They can squelch a Nuba person who’s speaking out, because they don’t have really a voice on the outside, and they can use propaganda and everything else, but if an unbiased – hopefully unbiased – foreigner is there, it’s a little more difficult. I think through some connections we had we were able to get that word out.

The fear is that if you make too much noise, you’ll be punished for it. These guys bombed us twice; they bombed our hospital. In the previous civil war they bombed hospitals routinely; it was not a big deal for them.

But I do think the converse is true: If you speak out, it makes it a little more difficult for them to do it because now people are aware, and as much as they don’t care about human life, they don’t want to be perceived by the international community as being brutal. They want us out of there, because it’s a big morale boost for the soldiers, for the people there.

To what extent then do you consider yourself a documentarian of this conflict as well as a doctor?

I think it is important to document for historical record what’s happened. We’ve got a book of all the war-wounded. I’ve got a ton of pictures of people. We’re trying to keep some evidence if [Bashir] ever does go on trial; he’s been indicted for war crimes, not in Nuba. There was genocide in Nuba in the 1990s.

You have spoken about the religious diversity in the region where you are now; there are Muslims as well as Christians. Can you talk more about how you have navigated the community?

It’s roughly half Christian, half Muslim. And all the people there follow the traditional beliefs, whether you’re Christian or Muslim. I really think it’s a very unique place in the world; there is no conflict amongst the Nuba. There are some Nuba that lived through the government that controlled sides during the previous war that maybe are more Arabized and maybe got infected by this kind of radical Islam ideology. But the Nuba in general, [whether] they’re Christian or Muslim, there’s not that conflict. Within the same family you’ll have Christians and Muslims. Husbands and wives will have different faiths, and nobody’s bothered.

Within this plural religious community, have you found that your faith has evolved?

Yes. You know faith always does better in areas of high stress. You don’t even know day to day if you’re going to survive. The faith becomes much more real, where you really have to depend on God for everything, for survival. I would say it’s grown tremendously. It’s much more difficult to maintain your faith in this [American] society. I think the stress and anxiety in this society is unbelievable, but it’s not that physical threat you feel all the time [in Sudan].

Some say that the protests might prove the biggest to challenge Bashir in his three decades in power. Is he vulnerable?

I think he is, because this is unprecedented. The last big protest was 2013; that lasted a couple days. They killed like 200 people, arrested so many people. So this is unbelievable what’s going on. It started December 19, and I think it’s still every day turning out a protest, and they’re determined to not stop until he’s gone. They’ve killed I don’t know how many – 40, 50. [Bashir] and his government are masters of survival, but this is a huge challenge and by far the biggest challenge he’s had.

What would it take for you to leave the Nuba community, if anything, at this point?

When I went there 10-and-a-half years ago, my idea was to stay until [the hospital] could stand on its own with Nuba staff, and we’re still not there yet. I think we have four people in medical school now; that’s kind of the last link. With these guys, the catch is we’ve got to get them interested and make sure they stay. If they take off, then we’re back to zero.

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How can the rising generations of physicians interested in humanitarian work best prepare themselves?

First you need to go and train somewhere; it takes time. You have to humble yourself a bit. If you want impact, you have to invest.