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Peter Attia MDThe world’s most important doctor to millions in the war-torn villages of Sudan (#40 rebroadcast)
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CHAPTERS
- 0:11 – 5:14
Rebroadcast Intro: Who Tom Catena Is and Why His Work Matters
Peter Attia introduces the rebroadcast, describing Tom Catena as a humble missionary physician caring for up to a million people in the Nuba Mountains. He previews the themes of suffering, purpose and community, notes updates on the hospital's growth, and explains how listeners can support Tom's work.
- •Tom has been a missionary physician in Africa since about 2000 and in the Nuba Mountains since about 2008
- •The hospital now has 270 staff, a clinical training school and over 50 formally trained Nuba health workers
- •Themes include coping with death, a crisis of purpose and the sense of community in Nuba
- •Peter and his wife have given to Tom's work for about six years and call it the highest-return giving they do
- 5:14 – 10:21
From Brown to Kenya: How Tom Became a Missionary Doctor
Tom describes his upbringing and his early desire for mission work, which led him from engineering to medicine. He recounts the Navy, residency and his first culture shock of high patient volumes and tropical disease at a rural Kenyan hospital.
- •Tom wanted to do mission work since college and chose medicine as the route
- •He repaid a Navy scholarship and did a family practice residency before going to Kenya in January 2000
- •In Kenya he was struck by the volume of patients and the variety of tropical diseases
- •He kept looking for the 'opposite of greener pastures'
- 10:21 – 18:05
Road to the Nuba Mountains and Sudan's Religious and Political History
Tom explains how a contact in Kenya led him to Bishop Gassisi's planned hospital and to the Nuba Mountains in March 2008. He describes Nuba's isolation, its mixed Christian and Muslim families, the 1990s jihad against the Nuba and the political figures behind it.
- •The hospital was funded through the Catholic Diocese of El Obeid and Tom arrived March 10, 2008
- •Nuba is remote and was kept separate under the Anglo-Egyptian Condominium
- •Nuba families mix Muslims and Christians without conflict, including Tom's wife's family
- •Hassan al-Turabi pushed a fatwa for jihad against the Nuba in the early 1990s
- 18:05 – 28:24
2011 Referendum, War Breaks Out, and the Staff Evacuation
Tom walks through the peace agreement, South Sudan's 2011 secession, the disputed Nuba elections and the outbreak of war in June 2011. He then describes the final evacuation flight and his decision to stay when most of the expatriate staff left.
- •The 2005 peace agreement left Nuba in a vague 'popular consultation' rather than the referendum
- •Civil war broke out in Nuba on June 6, 2011
- •A secret evacuation flight on June 16 took out the expatriate anesthetist, lab person and ward nurses
- •Tom stayed because there was no other surgical hospital and wounded would die
- •Two Comboni sisters and the priests also stayed
- 28:24 – 36:56
Improvised Anesthesia and the First Wave of War Casualties
After the expatriate anesthetist left, Tom had to intubate patients for the first time while Antonov barrel-bomb victims arrived. Peter and Tom discuss the dangers of manual ventilation without blood gases or pulse oximetry, the injuries seen, and a baby saved from intussusception.
- •Antonov shrapnel caused massive limb and tissue loss
- •Tom had never intubated a patient and worked from a basic anesthesia book
- •Manual ventilation was done without blood gases or a pulse oximeter
- •Survivors often arrived days after injury, showing how tough the patients are
- 36:56 – 44:36
Learning Surgery on the Job and Earning the Community's Trust
Tom explains how he learned surgery through seven and a half years of mentored practice in Kenya, trading depth for breadth. He and Peter discuss his 'first do no harm' approach and how palliative care is handled with families who have low expectations.
- •Mentors like Mike Johnson and Dr. Ruchu taught him as in a second residency
- •He did about 2,000 C-sections and over 1,000 other major cases before going to Sudan
- •With no CT scanner, exploratory laparotomy often serves as diagnosis
- •He declines operations when he cannot improve the patient's health
- •Families accept bad news and usually the relatives, rather than the patient, are told
- 44:36 – 53:12
Traditional Healing and How Small the World Is for Nuba People
Tom describes local healing practices such as burning, cutting, herbal remedies and the kujur, and the hospital's catchment area. He illustrates how limited the Nuba worldview is through his mother-in-law and his wife's first encounters with Dubai, elevators, the ocean and the US.
- •Febrile illness is often treated by burning or cutting, and the kujur often delays treatment
- •The catchment area is 750,000 to a million people over a region the size of Austria
- •Tom's mother-in-law had no concept of America or the ocean
- •His wife saw Dubai's airport, elevators and Boston for the first time
- 53:12 – 59:40
Community, Contentment, and Why Nuba Feels Like Home
Peter tells a story of a refugee woman casually caring for his toddler, prompting Tom to describe Nuba's strong hospitality toward strangers. Tom explains why he feels at home there, says everyone is wired differently, and says people should contribute without agonizing over not doing more.
- •Peter's story shows a different sense of community among Sudanese refugees
- •Travelers walking seven or eight days to the hospital are taken in by strangers each night
- •Tom feels comfortable in Nuba and says people are wired differently
- •He says everyone has something to offer and should not stress about not doing what he does
- 59:40 – 1:06:11
The New York Times Story and the Aurora Prize
Peter and Tom discuss Nicholas Kristof's 2015 article that brought attention to Tom's work and how Kristof came to Nuba. Tom explains the Aurora Prize, his role highlighting unsung heroes and his hope to connect small grassroots groups with resources.
- •Kristof sneaked into Nuba with a rebel-government permit to see the hospital
- •Tom respects Kristof for objectively crediting work he doesn't share beliefs with
- •The Aurora Prize runs eight years, matching the length of the Armenian Genocide
- •Tom wants to bridge big donors and small organizations and expand into other neglected regions
- 1:06:11 – 1:11:59
What a Million Dollars Buys and the Logistics of Supplying the Hospital
Tom explains that roughly 750,000 to a million dollars can run the hospital for a year and serve huge patient numbers. He describes the supply route from Nairobi through checkpoints, bribes and impassable rainy-season tracks, and the people who handle procurement.
- •About $1 million could cover 130,000 outpatients, nearly 2,000 operations and thousands of inpatients
- •Logistics is the biggest problem, with a three-week trip through 30 to 40 checkpoints
- •The rainy season makes the dirt tracks impassable to trucks
- •The hospital orders a year's supplies at once, and missing items are hard to get later
- 1:11:59 – 1:26:22
Maternal and Infant Health, Rounding, and Surviving Bombings
Tom discusses neonatal and maternal deaths since nearly all women deliver at home, a child's partial nephrectomy guided by YouTube, and the hospital's crowded wards during the fighting. He then recalls the terror of being bombed and the foxholes dug afterward, and speculates on the pilots' mindset.
- •99% of women deliver at home and many neonatal deaths come from difficult deliveries
- •A partial nephrectomy on a child was done by following a low-tech YouTube video
- •The 435-bed hospital ran at about 100% occupancy and peaked at 500 to 550 patients
- •Vaccines stopped coming for three years of fighting
- •Being bombed made Tom feel like a hunted animal
- 1:26:22 – 1:29:57
Coping with Emotional Exhaustion and Daily Chaos
Peter asks how Tom copes with the emotional depletion of years of this work. Tom says the psychological burden of sole responsibility is worse than the physical toll, and describes drawing on daily church and the resilience of the Nuba, and getting through his rounds and clinic one step at a time.
- •The psychological weight of being responsible with no one to refer to is draining
- •Tom draws on faith and daily church
- •The Nuba people's resilience gives him strength
- •He sees 40 to 50 patients in clinic after morning rounds
- 1:29:57 – 1:38:33
Diagnostic Gaps, Drug Costs, and Painful Triage
Tom describes limited lab and imaging tools and the unaffordable price of drugs such as Gleevec. Peter and Tom reflect on triage decisions and on the funding and administrative barriers that keep resources from reaching the hospital.
- •The hospital has ultrasound and a new X-ray but unreliable lab machines
- •A roughly $14,000 Piccolo analyzer could help
- •Children with leukemia can only be given palliative steroids
- •Generic Gleevec is still too expensive, and patient assistance programs require reaching Khartoum
- •Large funding sources require administrative capacity Tom doesn't have
- 1:38:33 – 1:58:24
Disease Patterns in Nuba: Hepatitis B, Cancer, and Heart Disease
Tom describes what adults die of in Nuba, including hepatitis B-related liver disease, leprosy, TB and cervical and breast cancer. He notes the near absence of obesity, fatty liver and heart attacks, and discusses prevention options such as HPV vaccination and the new X-ray.
- •Hepatitis B affects close to 20% of pregnant women screened and liver cancer is the most common adult cancer
- •Leprosy spreads by respiratory droplets and patients like Tom's mother-in-law isolate themselves
- •HIV is under 1%, which Tom attributes mainly to isolation
- •Tom has never seen a heart attack, fatty liver or obesity of note
- •Breast cancer is found late and treatment results are dismal
- 1:58:24 – 2:15:57
Minimalism, Meaning, and What Being a Missionary Means
Tom talks about his marriage and family life, his minimalism, and his belief that detachment from possessions simplifies life. Drawing on Viktor Frankl and a Bible passage about a rich young man, he explains meaning and the idea of preaching by example, and discusses suicide in Nuba versus the US.
- •Tom owns very few clothes and his only suit dates from 1985
- •He believes detachment from possessions makes life easier and that advertising pushes us toward things we don't need
- •Quoting St. Francis, he says to preach always and sometimes use words
- •Suicide is extremely rare in Nuba, which Tom links to the daily struggle for survival
- •Peter points to Sebastian Junger's Tribes on suicide and shared purpose, and Tom ties it to veterans' loss of bonds
- 2:15:57 – 2:25:54
How People Can Help, Food in Nuba, and Annual Malaria
Tom answers how people can help beyond donating: awareness, advocacy and informed pressure on government funding. The conversation turns to the bland sorghum-based diet and his yearly bouts of malaria, including a coma.
- •Donations to trusted groups are essential, and awareness and advocacy also matter
- •Citizens influence government aid policies and administrative requirements
- •The Nuba word for food is Ngumo, and the staple asida is sorghum paste with okra sauce
- •Tom has had malaria every year except 2018 and was once in a coma
- 2:25:54 – 2:39:46
Unforgettable Patients, Resources, and the Starfish Story
Tom recalls patients he will never forget, including children killed by tetanus and burns and a young man shot in the head. He lists where people can learn about or support his work, and Peter closes with the starfish story, with Tom reflecting that medicine is about one person at a time.
- •Tom recalls a traumatized boy who died of tetanus and burned civilians from bombings
- •Resources include amhf.us, Take Heart Foundation and Catholic Medical Mission Board
- •Peter tells the starfish story as defining Tom
- •Tom says in Nuba you don't see a drop in the ocean, you see a person
- •Peter calls the interview the one he feels most privileged to have done
