Tom Catena is the only surgeon for thousands of square miles in southern Sudan. His hospital, and his life, are constantly under threat. There is no end to the carnage he must treat, and no sign of it letting up. Why does he refuse to leave?

By James Verini

One

As the sun set on a Saturday in early February, Mubarak Angalo, a farmer in Sudan’s Nuba Mountains, was riding in a pickup truck with two friends. They had spent the day at a market, selling vegetables, and were returning to their village when they heard a low droning sound overhead. Instinctively, they knew what it was: the engines of a Soviet-built Antonov bomber. The driver came to a stop, leaned from the window, and looked up. Mubarak listened, hoping to hear the sound diminish.

Nuba is a region of mesa flats, scrubby hills, and escarpments near Sudan’s southernmost border. In the rainy season, its sorghum fields and flowering neem and baobab trees are brilliant greens, and the canopy hides the earthen paths that people travel on between villages. February is the middle of the dry season, however, when the landscape is a milk-coffee brown and the paths are exposed. Antonov pilots scan the horizon easily, looking for dust clouds kicked up by tires.

Nuba has been a war zone for most of the past 25 years, as the government of Sudan has tried to drive Nubans from their land. President Omar al-Bashir, whose regime is dominated by Arab descendants and Islamists, has declared a jihad against the people of Nuba, blacks who practice native religions and Christianity but also Islam. In the past four years, the holy war has been waged largely from the air. The Antonovs strike homes, schools, churches, crop fields, clinics. They drop cluster bombs that send out shrapnel in all directions, inflicting maximum damage on people and livestock. The bombing this year has been the worst in memory. Saturdays, when Nubans set up village markets, are especially lethal.

Every Nuban knows what to do when the drone of the Antonov engines comes: Parents teach children; schools perform drills. If there is a foxhole nearby—and foxholes are ubiquitous, thanks to the constant bombardment—you get in it. If not, you lie facedown where you are. And if you are in a vehicle, you stop, stay inside, and crouch as low as you can. Under no circumstances do you try to run.

As Mubarak and his friends waited in tense silence, the engines grew louder. Mubarak, in his late twenties, knew the rules but panicked. As the plane flew overhead and then released a bomb from the hatch doors in its belly, he jumped from the truck and began running.

About eight hours later, shortly after midnight, the pickup approached a large compound, and the driver honked the horn. A guard unlocked a chain and opened the gate. The driver pulled into a cool courtyard of raked sand and saplings. This was Mother of Mercy Hospital.

A male nurse came outside in the moonlight and looked at Mubarak, who was lying in the flatbed. Shrapnel had torn apart his right arm, left a sucking hole in his left calf, and fractured his skull, exposing brain matter on the right side of his head. The nurse went back inside and unhurriedly returned with a gurney. Mubarak’s friends lifted him onto it and watched as the nurse wheeled the gurney inside. Then they left to begin the long drive home.   

There was no question of where to bring Mubarak. Mother of Mercy is the only fully functional hospital in Nuba, which is about 3,000 square miles. The hospital is overseen by a onetime college nose guard from upstate New York named Tom Catena. Just as there are rules in Nuba for what to do in an Antonov raid, there is a rule for what to do with the victims of the bombing if they are still alive: get them to Doctor Tom as fast as you can.

Near dawn, Catena awoke. He changed into his scrubs, strapped on a Petzl spelunking headlamp, and in long, loping strides descended a slight hill to the hospital. He found Mubarak on the gurney next to a wall in a hallway, alone and untreated. The nurse, assuming Mubarak would die, hadn’t bothered to tell Catena or anyone else about him. The doctor looked at him.

“Ah shit,” he said to himself. “The guy is mangled.”

He rolled the gurney into the operating theater and loosely bandaged Mubarak’s head. He didn’t bother with the arm—it would have to come off. Then he left for Sunday mass.

Carrying a missal and a rosary, Catena walked from the hospital back up the hill, past the cinder-block staff residences, and down a treed bank into a dry riverbed that runs by the hospital’s perimeter fence. A vista of hills came into view, but he kept his eyes on the sand as he gained the far bank and, after passing through a stand of tall bushes, knocked on the metal gate to a compound of small mud-brick huts. A young man, one of Catena’s surgical assistants, came out. Catena told him to be ready for an amputation at eleven.

“Oh, and happy birthday,” Catena said. “It was two days ago, but I forgot to say it then.”

He asked the assistant, Rashid, how old he was. Nubans do not make a habit of noting their birthdays, but he said he was fairly certain he was 21.

“Now you can drink!” Catena said.

Rashid didn’t get the joke, but knew his boss was joking, and laughed.  

Catena arrived at a small brick chapel, about a half-mile from the hospital. A hundred or so people, half of them children, stood in the shade of the boughs of a large neem tree, singing. On the facade above the chapel’s doorway hung an abstract crucifix welded together from pieces of scrap metal. Jesus’s head was a rough-edged triangle. A priest in a batik frock with a green and yellow sunburst pattern led the chorus.

As the congregation sat down, a young man in a tight red T-shirt walked to the podium and read from Paul’s first letter to the Corinthians. “For though I be free from all men, yet have I made myself servant unto all, that I might gain the more,” he said, barely audible. “To the weak became I as weak, that I might gain the weak. I am made all things to all men, that I might by all means save some.” As he spoke, Catena sat, arms folded on crossed knees, staring intently into the dirt by his feet.  

At eleven, in the anteroom of Mother of Mercy’s surgical theater, Catena put on a black rubber smock and white gum boots, then washed his hands and dried them on a not exactly clean towel. The operating room was small, its shelves and scant floor space taken up with boxes of supplies. Mubarak lay on the operating table. Because the shrapnel had hit the right hemisphere of his brain, his left side was paralyzed. His right leg and arm jerked like a manic marionette. Rashid unwrapped scalpels and clamps from bundles of old, shredded scrubs.

“He still has a pulse,” Catena said. “I don’t think he’ll survive, but we gotta see.”

He held up the maimed arm and wagged it.

“Man, look at this.”

Setting to work, Catena murmured a string of instructions and motivational imprecations to himself. As he cleaned dirt and small rocks from what had once been Mubarak’s elbow, he said, “Let’s get this shit out of here. Jesus Christ.” He cut muscle tissue with a scalpel and then burned away bone with a small electric saw. The room filled with smoke and the smell of singed bone and hot metal. “Man, this is a crappy case.”

Rashid asked what Catena was carving into. It was the ulna. Catena spelled it. “And that’s the radial head,” he said, pointing with the saw. “The head of the radius.”

After an hour, with the ulna and radial head, the muscles, and the ligaments and nerves almost all severed, Catena’s mood lightened. He and Rashid shared jokes and discussed Sudanese pop music. A recent and rigorous student of English, Rashid learned new words and expressions by writing them down on a whiteboard mounted on the anteroom wall. Written there at the moment were improvident, piffle, and prescient.

As he handed Catena instruments, Rashid asked for explanations.

“Doctor Tom, what does it mean: ‘An apple a day keeps a doctor away’?”

“If you eat healthy food like apples,” Catena said, not looking up from the forearm, now separated from Mubarak, “you won’t become sick.”

Catena decided not to touch the skull fracture. Rashid wrapped Mubarak’s appendage in old scrub pieces and put it aside. He wheeled the gurney into the male ward, a long corridor with 50-odd beds, all taken. The patients, many of them soldiers, looked on curiously. Rashid put Mubarak in a spot by a doorway facing onto the courtyard that afforded a light breeze.  

At the sink in the surgical theater, Catena rinsed blood from his gum boots. He was still issuing commands to himself, now more blithely.

“Wash these babies up,” he muttered.

Mother of Mercy sits in a shallow ravine in the village of Gidel, in the heart of the Nuba range, which rises like a fable from the baked Sudanese plain. The people of Gidel, like most Nubans, live as their ancestors did, in stone and mud-brick huts that dot the hillsides. There is no power grid, no plumbing. They fetch their water from a borehole and carry it in orange jerricans and hollowed gourds on their shoulders and heads. They travel by foot or donkey or, very occasionally, pickup. They grow sorghum and tend to small herds of lean cows and goats. On Saturdays, they follow the riverbed to the village market, on the far side of a hill, where they call on a smith and a breadmaker, and where the only signs that it is the 21st century are the Chinese batteries and flip-flops for sale in thatch stalls. If they need to make a call, there is a man on a hilltop about 40 miles away who rents out his cell phone.

The hospital was built by the Catholic Church and opened in 2008. Four long rock-walled buildings form a quadrangle around the courtyard. The main buildings contain the wards, a laboratory, a pharmacy, and administrative offices. Small outbuildings serve as the morgue and a laundry; two sets of field tents take the patient overflow during a battle or an outbreak. The wards are a jaundiced green and white, the paint peeling in the corners, and even the corridors that contain light bulbs are dim. They are heavy with the scents of infected wounds, excrement, soiled bandages.

Patients and their families travel for days, sometimes weeks, to get to Gidel. Most walk, often with debilitating injuries or ailments. Along the way, they stop to sleep at the homes of relatives and strangers. Because the trip is so arduous, the families are welcomed to stay at the hospital for as long as treatment lasts. Some remain for months. They camp by the many foxholes and hang their laundry on the perimeter fence. Their straw sleeping mats and jerricans hang from trees. Children make toys out of discarded medicine boxes. In the mornings, the women take pots from a communal shelf and walk up Tuberculosis Hill, as it’s known, to a ring of cook fires. At midday, when the families of patients bring in lunch, the tang of sorghum paste mixes with the odors of suffering. In the afternoons, when the wards become stifling, the sick go outside to lounge with the healthy. They play cards and listen to music. Those with no visiting family often find distant cousins or long-absent friends.

A few days before Mubarak arrived, Catena, who is the only trained surgeon in Nuba, was examining new patients at the intake clinic. A crowd of several dozen sat outside, fanning themselves with their intake cards. (Temperatures in the dry season can reach 120 degrees.) The women, many of them pregnant, wore colorful wraps, the men cheap suit slacks and secondhand T-shirts.

Inside, an examination table, a desk piled with outdated medical journals, and a wooden crucifix left barely enough room for Catena to stand. He had on bronze-frame eyeglasses with large lenses and was wearing scrubs and green Crocs sandals. At 51, Catena owns one pair of non-scrub pants, which he puts on once every other year, when he leaves the hospital to visit the United States. After moving to Nuba, seven years ago, he came to the realization that he needn’t wear socks. This was, he confided to me, “an unbelievable moment of clarity.”

A stethoscope hung from his neck, along with a traditional Nuban bead necklace and the scapular of Our Lady of Mount Carmel, a Catholic amulet. While he was a medical student at Duke University, Catena considered taking vows but decided if he tried to be both a doctor and a priest, “I’d suck at one of them.”

He examined a middle-aged woman, questioning her in the unaccented Arabic of southern Sudan. His tone was efficient, almost terse. When Catena speaks, people listen: He stands just over six feet tall but seems taller, and has the drawn cheeks, stony chin, shaved head, and deep-set, undistractable eyes of a Roman bust. When he played football at Brown University in the eighties he was 230 pounds. Now he’s a bony 160 but still has a doorway-filling frame.

He pressed lightly on the woman’s back. She winced but did not make a sound. She had a tumor below her shoulder blade.

“Where do you live?” Catena asked.

“We live in a cave,” she said.

She calmly explained that government forces had been shelling her village and that she and her children and many of their neighbors had moved into a cave in the hills. This is common. Thousands of Nubans have had to do the same. Hundreds of thousands of others have fled to the sprawling refugee camp in Yida, in South Sudan, just over the border, or to camps in Kenya and Uganda. Most of the manual labor in Nuba is done by women, and for months she’d been carrying water and firewood uphill to the hideout. Sometimes she had only leaves and bark to feed her family.

“They’ll never say they’re under stress,” Catena said, turning to me. “They’ll say everything’s fine. No, it’s not fine. They live in a cave.”

The next patient was pregnant with her ninth child. Her previous three had died. It wasn’t clear how from her intake card. Next to the names of her living children, “fine” had been written; next to the names of the deceased, “die.”

Between patients, Catena went after the squadron of flies in his office. At Brown he was known for both his vicious tackles and his gracious sportsmanship—“He’d hit the snot out of someone and then help them up,” a former teammate told me. But with flies he is merciless, putting back issues of the Journal of the American College of Surgeons to work in his assaults. A nurse set down his lunch, rice and lentils in small metal bowls, and a thermos of red hibiscus tea. I asked Catena if he drank enough water to counter the heat.

“No. I piss gelatin.”

In the afternoon, his lunch untouched, Catena made rounds in the wards. He kept everyone giggling with a light slapstick patter. He backed into nurses, mock-slapped patients. The staff was in the middle of a weekly cleaning, and as a short nurse passed by, carrying a mattress over her head, Catena snuck up behind her and hinged it down. She twirled in confusion. He lifted his arms, and she looked up at him and blushed as her colleagues laughed.

He washed his hands and picked up a filthy towel. He scowled at a nurse. “Raila, come on,” he said, holding up the towel. Raila didn’t look concerned.

“Don’t dry your hands on that thing,” he told me. “Your hands were cleaner before.”

I offered him my hand sanitizer.

“Wow! Thanks, man.”

Necessities at other hospitals are luxuries at Mother of Mercy, where almost everything—towels, instruments, medicines, uniforms, bed frames, pencils—must be flown on cargo planes from Kenya to the refugee camp in Yida and then driven to the hospital in cargo trucks. (The roof was brought in piece-by-piece from Italy over the course of a year.) The drive can take several hours or several days, depending on the state of the roads and the whims of the Antonov pilots. Other things the staff improvises.

Catena started Mother of Mercy with a small group of foreigners. He took on Nuban employees gradually. “There was nobody who could do anything,” he said. The war had closed most schools, and many of the local hires had no formal education. Others had grown up in refugee camps. They had never seen a sponge, much less a syringe. Now there are 200 people on staff, almost all Nuban. Some, like Rashid, are naturally talented. Catena’s anesthetist, who never got past the third grade, trained on the job. Others struggle to catch on. During the cleaning of the ward, he found a nurse—not for the first time—pouring water over an electrical socket.

Late in the day, a nurse asked Catena to look at a woman with an abscess. The nurse was learning English and could remember only that the body part where the abscess had formed began with a b.

“Is it a brain abscess or a breast abscess?” Catena asked.

She thought.

“Breast.”

“Good, that’s better,” he said. “Between a brain abscess and a breast abscess, take the breast abscess.”

Examining the woman, he stuck a gloved pinky into the small hole in the underside of her breast. She looked on expressionless.

“That’s not much of an abscess,” Catena said. “That’s disappointing.”

In the children’s ward, the rafters were decorated with stuffed animals and doilies made by nurses. Catena checked on a ten-year-old girl, Toma, who was too shy to talk. Her mother, Afaf, explained that the area around their village was bombed constantly. Toma had been at home with her brothers two weeks earlier when they heard an Antonov and made for a foxhole.

Afaf was returning from the market when neighbors rushed up and told her that Toma had been hit. Afaf ran home and found her daughter on the ground. Her left calf had been sheared off by a piece of shrapnel. Toma’s eldest brother went to notify the local army commander. The commander knew of a truck in another village and went to get it. Four hours later he returned. It took another six hours to drive to Gidel. Before they left, Toma’s mother looked for the missing appendage but couldn’t find it.

When Toma arrived at the hospital, Catena examined her leg with some relief. Shrapnel often leaves messy wounds, as with Mubarak’s arm, but hers was clean. She would be a good candidate for a prosthesis.

Until recently, between a million and a million and a half people, from 50 different tribal and language groups, called the Nuba Mountains home. For most of their history, Nubans lived isolated from the world and the rest of Sudan. In precolonial times, the mountains were a refuge from the Arab slave trade. In the 1920s, in an effort to stem the spread of Islamism and Arab nationalism coming from Khartoum, the capital, the British administration closed Nuba off.

In 1955, as Sudan approached independence, a civil war broke out between northerners and southerners. It would persist for nearly half a century. At first, Nubans stayed impartial, but when the southern rebellion coalesced into a real army, in the 1980s, Nuban fighters joined up. In 1989, when Omar al-Bashir took power in a coup, government forces set upon Nuba. They torched villages and crop fields, assassinated leaders, mined roads, separated men and women to prevent breeding, and blocked humanitarian aid. They put the population into so-called peace camps, where non-Muslim Nubans were made to practice Islam and abandon their native tongues. Mass rapes were committed. Some called it a policy of genocide. “The aim was nothing less than the complete relocation of the Nuba and the eradication of their traditional identities,” writes historian Alex de Waal.

In 2003, when the civil war finally ended, Bashir shifted his wrath to the western part of the country, supporting a campaign of ethnic cleansing against non-Arabs in Darfur. For this he was indicted by the International Criminal Court, though the case against him was recently shelved. In 2011, Bashir resumed the assault on Nuba. By then, however, the Nubans had an army of their own, and they fought back. So Bashir began the air war. The military converted its fleet of Antonovs—slow, clumsy transport planes—into crude bombers and stocked up on Russian-made Sukhoi jets. Since 2011, the government has dropped nearly 4,000 bombs on civilian targets, according to Nuba Reports, a local online news agency.

At first the ordnance dropped by the Antonovs were so inaccurate, locals called them “dumb bombs.” Recently, the government has improved its technology and introduced surveillance drones. The bombing has become more precise. At the same time, Bashir’s troops have stepped up the shelling. Villages have been inundated with fire from mortars, artillery guns, tanks, and rocket launchers. “The shelling has been just unbelievable,” Ryan Boyette, the editor of Nuba Reports, told me.

Toma’s father was not at Mother of Mercy. Like many Nuban men, during the brief peace of the 2000s, he had moved to Khartoum to find work. The government forbids these migrant workers from returning. Toma had not seen her father, a road cleaner in the capital, in seven years. “If he tries to come out, they will kill him,” Afaf said.

In the hospital, Afaf had become friendly with an uncle and a grandmother of a group of five young cousins. The cousins lay in the beds around Toma’s, naked, their limbs daubed with burn cream and loosely wrapped in gauze. They breathed unsteadily and twitched with pain. The outer layers of their skin had been burned away from their bodies.

The uncle told me that their village had been shelled for months. “They bomb during the day and shell at night,” he said. Most of the children in the village had moved into caves in the hills, but the cousins, who were needed to tend to the family’s goats, stayed. At night they slept in a foxhole. One night the week before, the shelling had started at 10 p.m. Before dawn a shell hit a home, setting it ablaze. The burning branches and grassstraw fell into the foxhole in which the cousins slept. Four of them burned to death. The youngest, a two-year-old girl, died in Mother of Mercy.

As the uncle talked, the grandmother propped up the one surviving boy in the group. She tried to pour water from a cup into his mouth, but his lips were too damaged for him to drink. The water dribbled down his chin. She climbed into the bed and lay down next to him, copying the curve of his raw little body but unable to touch him.

The boy was “probably going to die,” Catena told me flatly, out of earshot from the family. The chances of the other cousins were “halfway decent.” Lately, he had seen more and more children burned beyond repair by shelling. They don’t have enough skin to allow proper grafts, and their bodies are too weak to fight the infections. “You just watch them die,” he said. “There’s not much you can do.”

Nearby were a brother and sister who’d been hit with shrapnel in a jet attack. I asked their mother if she knew why the Sudanese government had targeted their village.

“We don’t know why,” she said. “We know that it’s Bashir who’s doing this, but we don’t know why.”

Next to the children’s ward was the male ward, where Mubarak lay, unconscious and snoring. His wounded leg and the stump of his right arm were cleanly bandaged, and his head wound was healing. A feeding tube was taped to his cheek, his right leg and right arm bent and relaxed in gentle rhythm.

Standing by the bed was Mubarak’s cousin, a soldier who happened to be at Mother of Mercy visiting a wounded friend when Mubarak was brought in. Other patients stood around as well, enjoying the breeze coming off the courtyard. They took turns fanning Mubarak with a T-shirt.

His cousin told me that Mubarak had three sons and was an industrious man, not just a farmer but a trader of small goods. He was the only one of his brothers who hadn’t gone into the army. “He is just an honest guy,” he said. Word had gotten back to Mubarak’s wife, and she was on her way to the hospital, on foot. Their village was several days’ walk away. Catena, who hadn’t expected Mubarak to survive, was faintly optimistic.

Rashid went to check on Mubarak occasionally, but only occasionally. He’d seen “so many amputations,” he said, “too many amputations.” When he wasn’t working, Rashid spent his time in the anteroom of the surgical theater practicing English. He picked out words from a Collins pocket dictionary and wrote them first on the whiteboard and then in a small notebook that had begun life, apparently, with a different purpose: its cover read URINE SPECIMEN.

Rashid first came to the hospital as a schoolboy, soon after it opened in 2008. He walked there from his village, in the throes of malarial fever. Like many schools in Nuba, where there are few trained teachers, his had Kenyan instructors. He’d learned a lot about Kenya’s past, he told me, but almost nothing of Sudan’s. He knew little about the history of Nuba or the origins of the war he was living through. When the school closed, he took a job to support his mother and six younger siblings.

He was proud to be at Mother of Mercy, as were his colleagues. In the first days I stayed at the hospital, following Catena’s every step, it was easy to see the hospital as his creation, and his and its presence in Nuba as fabulous, almost miraculous. And in a way, he is and it is, and indeed many Nubans, including many who work at Mother of Mercy, see them that way. A surgical assistant told me, “I’d heard about Doctor Tom before I’d seen him. I heard about there is a doctor here in Nuba Mountains. He is the one saving us from the Antonov bombs.” But the more time I spent with Rashid and his colleagues , and the more I saw of Nuba, the more I realized that what Mother of Mercy offers is not apart from the place. On the contrary, it is distinctly native, only forgotten. The hospital allows for the expression of qualities of Nuban character and culture—solicitude, compassion, endless reserves of resilience and dignity—that have been buried under the rubble of years of bombardment. At Mother of Mercy, Nubans gather and mend and talk and—for all the horror of its wards, in the midst of its foxholes—think of a time before, and after, war. The hospital may not exist without Catena, but Nubans make it work. A nurse told me that being there was “the best way to help Nuba, because we have no skills.”

Rashid asked me one day, “Is there a war in the U.S.?”

I told him that the U.S. had gone to war recently, but that there hadn’t been a war on U.S. soil in some time. We were lucky.

“Yes, you’re very lucky,” he said. “Us, we’re very unlucky.”

In the surgical theater, near Rashid’s whiteboard, sat a large bound ledger containing a record of every trauma case Catena had treated since 2011. I counted over 1,700 entries, written in careful blue and black ballpoint by him and the other surgical assistants. Alongside the names of victims were the names of their villages. The entries were chronological, and the same villages appeared again and again as ground was taken by the government and then won back by the Nuban army, year after year. Where the injuries were caused by an Antonov bomb, an “A” was written. There were hundreds of A’s.

Catena lives in a cinder-block house with a pitched aluminum roof and a dirt yard, where hornbills and shrikes congregate in the mango and mahogany saplings. On the unadorned poured-concrete porch are two pairs of broken sandals he has been meaning to get fixed for years and a permanently inert broom. Inside, the floors are covered with scrubs, back issues of Time and Sports Illustrated, and well-worn books. Recently, he’d finished G.K. Chesterton’s biography of St. Francis and Marilynne Robinson’s Gilead. (“How does a woman get into an old man’s head like that?”) They came in care packages sent by his father. Catena hasn’t gotten around to throwing out the cardboard boxes, which are all around the floor, too.

His father includes jumbo bars of Hershey’s chocolate, which Catena keeps in a sputtering deep-freezer, the only appliance in a communal staff kitchen. Outside the kitchen is a hand pump where he washes his scrubs. The cleaning women would do this, but he doesn’t like to bother them. The pump basin has been taken over by a family of ducks, a gift to Catena from the supreme general of the Nuban army. A constant assassination target, the general lives mostly in undisclosed locations, traveling with, among other keepsakes, the cockpit seat of a downed Antonov. Very fond of the doctor, he occasionally shows up at Mother of Mercy unannounced, bearing unexplained gifts like an extravagant uncle. Recently, he gave Catena 25 pounds of honey.

Catena attends mass every morning at 6:30 and then works for 12 to 14 hours, six or seven days a week, more if there has been a battle or bombing. On Fridays, he performs a dozen or more surgeries. For his work, the Catholic Medical Mission Board, which employs 1,200 volunteers in 27 countries, pays him $350 a month.

He appears never to tire. When he has visitors, he talks with them enthusiastically into the night, listening intently, always looking them in the eyes. When asked questions he speaks expansively, his conversation full of references to old Saturday Night Live skits and college and professional sports. He recalls not just the scores of decades-old football, baseball, and basketball games, but also jersey numbers, the details of plays.

“I miss the contact,” he told me of playing football. “People think I’m crazy when I tell them that, but I say, ‘You haven’t tried it.’ I mean, running full speed at someone and just slamming into them! It’s, it’s—” he tensed his shoulders and raised his arms and grimaced with pain and joy. “But I worry about what’s happening to my head,” he said.

At night the cleaners, who double as cooks, set out pots of rice, lentils, and noodles on a side table in a small dining room. The nurses are responsible for bringing in the flatware and jerricans of water from the kitchen but never do, because they know Catena will. He also clears up after everyone has eaten.

One night he arrived late for dinner because he’d been delivering a child.

“Do you mind if I shower?” he asked. “I’m covered in amniotic fluid and urine.”

When he returned and sat down, he told me how he got to Nuba. He grew up with five brothers and a sister—now a priest, a former Army Ranger, a judge, a marine biologist, a hospital administrator, and a part-time teacher—in Amsterdam, New York, a hollowed-out industrial city between Syracuse and Albany that is home to the Professional Wrestling Hall of Fame. “There was just nothing there,” Catena said. “Nothing to do.” He was a diligent if not brilliant student and an exceptional and fearless athlete. At Brown, his teammates called him Catman for the relentless way he went after blockers and quarterbacks. Off the field, he was timorous, aghast at and amused by the famously permissive atmosphere of the university. One Saturday night , when he was in his dorm room studying, a young woman he didn’t know, fresh from a costume party and wearing a tinfoil hat, knocked on his door.

“I want to go to bed with you,” she said.

“No! What?” he replied. “I won’t do that. I don’t even know you.”

He majored in mechanical engineering, joined Campus Crusade for Christ, and, as one of his ex-teammates told me, “pretended to drink at parties.” After graduating in 1986, he turned down a job to work at a plant that made nuclear submarines.

The idea to become a doctor arrived as a kind of portent. He was driving through a storm with his brother when lighting struck near the car. They were both momentarily stunned by how close it came, and then Catena turned to his brother and said, “I should go to medical school.” “I don’t know why,” Catena told me. “I just suddenly knew I needed to go.”

To pay for the Duke School of Medicine, Catena joined the Navy and trained as a flight surgeon. He went to dive school in Panama City, Florida, with future SEALs and was later stationed at the naval base in Diego Garcia. He thought he might settle down, have a family, become a small-town doctor—the “Norman Rockwell idea”—but the idea didn’t take. In the late 1990s, he read an article in a Catholic magazine about a man who was both an ordained priest and a physician practicing in East Africa. He was captivated. When I asked him why, he said, “I just wanted something more, something deeper out of life.” Catena wrote the doctor-priest, Bill Fryda, asking if he had need of a volunteer. Fryda called back, inviting Catena to assist him for a couple of months at a hospital in Kenya. “That was 15 years ago,” Catena said, his eyebrows arching in surprise.

In Nairobi, Catena met a Sudanese bishop, Macram Gassis, who was in the process of building Mother of Mercy. Catena had never been to Sudan and knew of the Nuba only through the photography of Leni Riefenstahl, who in the sixties and seventies lived among and documented them. He didn’t labor over the decision. When the bishop said the hospital was complete, in March of 2008, Catena moved to Gidel, sight unseen.   

In fact, the hospital hadn’t been completed. He had to share a toilet and shower with patients. At first there was no mortuary, and the newly deceased were left on gurneys in the hallways until they could be buried. The staff complained that the dead roamed the hospital at night. Word got out that an American doctor had come, and soon he was out of beds. Patients lay on the floors, patiently. They suffered from malaria, pneumonia, gastrointestinal disorders, viral and bacterial infections, rheumatic fever, cancers, heart ailments, hernias, birth complications, venereal diseases. Women came in with bones broken from beatings administered with sticks by their husbands, brothers, and fathers. (“It’s way too common here,” he told me, referring to domestic violence. “Our staff have been beaten by their husbands. Some of our male staff beat their wives.”)

As we spoke, nurses and technicians came into the dining room, ate quickly in silence, and left. Catena likes his staff but doesn’t socialize with them much. He does share the contents of his father’s care packages, though. As each finished, he held up a chocolate block.

“Julius, don’t forget your chocolate,” he said to one nurse. Julius chuckled and left, uninterested.  

I noticed on Catena’s wrist a black rubber bracelet engraved with John 3:30. (“He must become greater,” John the Baptist said of Jesus, “and I must become less.”) It’s not his favorite Biblical passage. That is Matthew 19:16, the parable of the rich young lawyer, as it’s known, in which Jesus recommends that the interlocutor in question abandon his wealth and become a disciple.

“I don’t think Christ was kidding,” Catena told me. “He wasn’t saying that to bust the guy’s balls. No. Sell all this shit and come and follow me.”

At first, Catena wasn’t welcomed in Nuba. Old beliefs persisted, and there was a deep suspicion of Catholicism. Protestant missionaries had been around since the 19th century, but the Catholics didn’t arrive until the 1980s. Word spread that a Sudanese doctor working with Catena had been sent to Nuba from Khartoum to poison them; the doctor had to leave before he was thrown in jail. When a local woman working at the hospital found some human tissue on the floor, she brought it to the authorities. Catena was accused of performing abortions. His plea that he was adamantly pro-life, which he is, didn’t translate. Nor did his English idioms.

“I think a lot of it was, these people have been crapped on for so long,” Catena said. “They’re not going to trust you. You’ve got to prove yourself.”

Slowly, he did so. When a local administrator who had been hostile brought in his pregnant wife, Catena discovered the fetus had died in utero. The mother was hemorrhaging badly and required a transfusion, but Catena had no blood on hand. He noticed he was the same type as her. He put a tube in his arm and pumped out two liters. She lived. The administrator never thanked him but was less hostile after that.

For his part, Catena came upon a profound respect for Nubans. He admired their willingness to “put up with crap, with hardship, day after day after day.” He was taken aback by the generosity some showed him. Kenyans, he’d found, still lived with the insecurities of colonialism. Because he was white, even Kenyan colleagues asked him for money. When they went out, he was expected to pay. After arriving in Gidel, he went to the Saturday market for coffee. A Nuban cleaner at the hospital greeted him briefly and then disappeared. When Catena went to pay, he found that the cleaner had bought the coffee for him. “This was one of our staff who was making peanuts. I was totally dumbfounded.”  

Nubans, who had never been colonized, refused to prostrate themselves. They had to swallow their pride to tell him they were in pain. Many of his patients suffer from the psychological effects of war, and Catena once considered offering counseling services, until he realized it would be impossible to get Nubans to speak about their feelings.  

Everything changed in 2011, with the return of war. Catena had never seen a gunshot wound. Suddenly, he was faced with hundreds of them, and not just any gunshot wounds, but the devastating gashes of 7.62-millimeter rounds shot from Kalashnikovs in close-quarters combat. Within days the floors of the wards were covered over in blood. Few of the wounded soldiers moaned or wept or begged for assistance. One of the first men he treated had been shot in the jaw. The bullet had gone through his throat and out the back of his neck. He was sitting placidly, awaiting his turn with the doctor. “He was pretty friggin’ stoic for a guy that was choking on his own blood.”  

He still doesn’t understand how some of his patients survive. Catena, who trained with commandos in the Navy, described one Nuban general as “the toughest guy I’ve ever seen.” The general had been to Mother of Mercy twice, once after his collarbone was shattered by a bullet, and once after he was shot through the head. Both times the general walked out of the hospital. “He’s a friggin’ warrior, that dude! He’s like a classical Spartan.”

In the past four years, Catena has become a vocal critic of the Sudanese government. In interviews with journalists, he calls Omar al-Bashir a war criminal. He feeds information on attacks to reporters and posts pictures of maimed patients on his Facebook page. I’d brought a box of cheap red wine for Catena from Nairobi, and one night he suggested we “crack that baby open.” As we sat on plastic chairs in his yard drinking, his anger rose. “This country is a joke!” he said. “The only thing the army is good for is killing its own people. Can you imagine if they had to fight a real war? Anyone could come here and destroy them. San Marino could invade Sudan and take it over!” He described a recent government attack on civilians. Like almost all such attacks, it had not been mentioned in any media anywhere. “If your own government bombs a place and kills nine people and puts twelve in the hospital, that would normally get mentioned, right?” he asked, earnestly. “I don’t even know which end is up anymore. Is that normal? If you’re on the outside, is that something normal?”

He sank back in his chair and shook his head. “You kind of get beaten down by it,” Catena said. “You’re like, Yeah, whatever, no one gives a shit. Maybe every government does this. I don’t know. I used to think, Why don’t they get worked up, the people who live here? Why don’t they get furious and worked up? Then, when you’re here for a while, you understand. Nothing really changes.”

Bishop Macram, who manages Mother of Mercy from Nairobi, frequently reprimands Catena for his outspokenness. When I sought permission to go to the hospital, Macram advised me: “Don’t talk to Doctor Tom too much. He’s too angry. He doesn’t know what he’s saying sometimes.” Though the cargo trucks that bring supplies to Gidel from the refugee camp in Yida bear Macram’s name in large white block lettering, Macram himself is too frightened to travel there. He fears he’ll be assassinated.

Catena, however, rarely leaves Mother of Mercy. He hasn’t been to the Saturday market, a ten-minute walk away, in five years. One day a colleague who manages the hospital’s outreach clinics asked if he’d accompany her to a nearby village. “No way,” he told her. Every time he goes away, someone arrives who won’t survive without him. “That’s what I’m afraid of.”

He makes his biennial visits to the U.S. reluctantly. Last year he received an award from the National Football Foundation. It entailed giving a speech before a crowd of hundreds at the Waldorf Astoria in Manhattan. Catena dreads speaking in front of groups—he doesn’t even address his staff en masse. “I was hoping the government would attack and close the road and I couldn’t get out,” he said. He eventually consented and found himself in New York in a borrowed tuxedo, the jacket several sizes too large, and a loose clip-on tie. For all his anxiety, he is a forceful orator and enjoyed delivering the speech.

In 2011, when the assault on Nuba began, humanitarian organizations closed their offices and expatriates fled. Macram instructed Catena to evacuate. He refused. Macram threatened to fire him. He still refused. “Terminate me,” he told the bishop, “I’m not leaving.” In the speech at the Waldorf, he recounted the episode with visible annoyance. “What they were in a sense saying was, ‘Tom, your life is worth more than these people here.’ And I said that’s a bunch of, a bunch of’”—he wanted to say bullshit but caught himself—“‘nonsense. Their lives are as equal as my life is. In the eyes of God, we’re all created equal. So Tom’s life is the same as Joe Blow in the Nuba Mountains. There’s no difference.” He told the audience, which included professional football players and socialites, that while in New York he’d received an email from Mother of Mercy. Thirty casualties had come in from a battle. “It killed me to not be there and help out. I felt like an injured football player on the sidelines.”  

During the trip, he visited his family in Amsterdam. He went to the church where his parents and sister were married and he was baptized. It had closed. Posters on the doors suggested it was being converted into a New Age Buddhist temple. He was chagrined. Hatching a scheme to salvage the statuary, he tried to knock the door open, but it wouldn’t give.

For many Nubans, Catena now carries the aura of a saint or deity. Patients will refuse to accept medicine from nurses, imagining it will work only if it comes from him. Some ask him to put a hand on them, believing he can cure by touch. (The ultrasound machine in his office, which Catena occasionally turns on for no other reason than to make patients believe he’s using every modern tool to cure them, adds to the mystique.) In certain villages he is known, only half jokingly, as the Second God. When he leaves, people weep openly and pray for his return. I mentioned this to Catena, and he frowned.

“These people kind of look at me as being an equal. I don’t think they look at me as being a white person or a foreigner, as being superior, at all. I hope to God that doesn’t change,” he said.

In December 2014, Bashir announced that victory in Nuba was close at hand and ordered a multifront assault. That month saw more bombs dropped on the region—over 300—than any on record. By January of 2015, Mother of Mercy was full of wounded soldiers.

When I was there in February, about 50 were left. Most had come from a nearby area, Angartu, the site of the deadliest and most bitter fighting. They were missing fingers, arms, legs. One man had on stylish wrap-around sunglasses, the sole intact lens covering his good eye, while the other socket, blasted out, was filled with wadded gauze. The soldiers wore uniforms in various patterns and shades of camouflage, listened to American country music on a radio, and drank from old, boxy metal canteens.

A soldier in his thirties, with a neatly trimmed mustache, had been shot in the knee. He told me that when he was a boy his village was attacked. His elder brother and father were killed. “I grew up with anger,” he said. He and most of his friends joined the army. Only a few have survived. “The government says they don’t need black skin. They hate black skin. They want to get rid of it in Sudan, especially the Nuba. But black skin was offered by God. It is a gift.”

The most talkative soldier, a hulking young man named Abdul, had taken a bullet to the abdomen. He was usually outside playing cards or eating sorghum paste with his mother. He spoke clear, blunt English, and the wound didn’t seem to bother him.

“I love war,” he said, holding up his bowl and insisting I have some paste. “I want to kill them all.” All who? “Just my enemies.”

Bashir is adept at turning the Sudanese minorities he victimizes against one another. For years he enlisted Darfuris to attack Nuba. At Angartu, as at other battles this year, the government deployed a paramilitary detachment, the Rapid Support Forces, made of up Nuban soldiers: Nubans were now fighting each other. Though some of those fighting for the government were doing it for money, or the promise of it, most appeared to be forced conscripts. I mentioned this to Abdul.

“Yes, I know that,” he said. “But still I want to kill them all. Why do they leave the Nuba Mountains? And then they’ll go join Omar? They must be punished, here and in the eyes of God.” He wouldn’t return to the army once he recovered, however—he planned to go to the refugee camp in Yida and enroll in school. He wanted to become a politician. “I want to kill enemies,” he said, “and then I want to travel to school.”

---

On a hot afternoon, I traveled to Angartu in a Land Cruiser. To get to the frontlines in Nuba, you must carry a handwritten permission note from an army administrator. In every village are checkpoints, which consist of lengths of string run between slim branches held up by rusted truck rims. The guards rarely ask for the notes; they almost never see people they don’t know. Families hoping to find rides to Yida congregate at the checkpoints, their possessions in frayed suitcases and plastic grain sacks. When vehicles pull up, they rush to the windows and beg to be taken on.  

The Nuban army has no bomb-disposal operation, so undetonated ordnance is often left where it lands. Along the road, we passed at least three unexploded bombs that I noticed, their noses buried in the soil and drab olive green tails pointing in the air. One had been shrouded in thornbush by locals to keep children from playing with it. The bombing and shelling had left Angartu with the annihilated appearance of a wildfire zone. For miles, craters pocked the ground, fields were blackened, trees dismembered and pulped.

A few days earlier, near the village of Mendi, the Nuban army had knocked the government forces from their position at the foot of a hill. Dug around the hill were trenches, along their edges the tableaux of hasty retreat: cigarette packets, plastic mouth tips for hookahs, half-used tubes of toothpaste. The stamps and labels on the shell casings and unused rockets and mines left behind were in Persian, Russian, Chinese. The corpse of a government soldier lay crumpled in a latrine well, a tank shell on top of him. On the hillside was a patch of rocks, about 30 feet wide, where the Nubans had buried enemy dead. “So they don’t smell,” a soldier explained.

In the 1990s, Mendi had been a government-run peace camp, which in reality meant it was the site of unnumbered murders and rapes. A stately but neglected mosque still stood in the village center. During the recent fighting, homes and market stalls had burned down, leaving perfect squares of black on the ground. Residents had fled into the hills and were only now returning. Already new straw roofs and fences were up. An elderly leper slowly hammered in a fencepost with defingered hands. The village had been destroyed and rebuilt many times, he told me, but he would never leave. I asked an old woman about the bombings. “You can’t even count,” she said. “We’re just patient.”

In a hut, the Nuban sector commander sat in plaid cargo shorts, playing cards with his lieutenants. Outside was the truck he’d been going around in since the victory, a retrofitted pickup, one of many vehicles left by the government troops. A Russian-made recoilless rifle was mounted in the bed, and on the cab, in thick yellow Arabic lettering, was painted Glorious is Allah.

The sector commander estimated that almost 100 of his men who’d fought at Angartu had gone to Mother of Mercy afterward. A lieutenant stood up and showed me a shrapnel scar on his arm that Catena had stitched. Half the men in the hut, it turned out, had been treated by Catena over the years, not just for war wounds, but also for stomach ailments, heart conditions, infections.

“I thank God I’m close to Doctor Tom,” said the commander, whose rheumatic knee Catena had fixed. “Somebody needs to think for others.”

The battle for Angartu could be heard at Mother of Mercy. On some days, the accompanying lamentation could be heard, too, the collective wailing of wives and mothers reverberating through the hills. The war had never come so close to the hospital, and as it approached, Catena told me, he began to have “heinous dreams.” In one, jets and helicopters landed near the hospital, and government soldiers rushed inside and grabbed him. A man took an audio recorder from his pocket and played back recordings of insulting statements Catena had made about Bashir.

“I was like, Shit, they got me!”

This was more troubling even than his usual nightmare: It’s two weeks before the beginning of the football season, and he looks down at himself to see not the 20-year-old Catena, but the concave-chested current version. He gets onto a bench press but can’t lift the bar. He’ll never survive on the field, he realizes.

As the battle went on, Catena made plans to evacuate patients and staff. If the hospital was overrun, he decided, he would try to set up a mobile clinic, and if that didn’t work, he would move into the hills with locals and care for them the best he could. He suspected the latter option was more likely. Often, Catena worries that Nubans have been so brutalized by endless war, they’ve forgotten how to care about each other. Last year an Antonov and a Sukhoi jet bombed the hospital. Catena was in the operating room, a patient with an opened abdomen on the table. (He finished the operation.) No one was seriously injured, though one bomb landed near Catena’s house, dislodging the roof and sending the doors flying from their hinges. He hoped the attack would bring everyone together. Instead, about half the staff left work without a word. A few never returned. “Some were scared. Some saw it as an opportunity to take a few days off, which kind of annoyed me,” he said. “I was like, Come on, man. Everybody’s in the same boat.”

I asked Catena if he would ever consider leaving Nuba. There was a very real chance that he would someday be killed. He shook his head without having to think. “If you can’t stand with the persecuted people, then what are you doing? You should just become an atheist.”

There are aspects of life in Nuba that still drive him to distraction. Patients refuse to give blood, believing it will kill them. He has watched parents refuse to give blood to dying children. It’s rare that he sees a patient who hasn’t already been to a traditional healer, who offer cures for everything from malaria to Antonovs. Nubans arrive comatose from supposedly medicinal roots or with gangrenous limbs that have been set improperly. One day, in the female ward, Catena turned over an unconscious young woman to find a line of fresh burn scars along her spine—a popular and expensive folk remedy offered by healers for “yellow fever,” which can mean anything.

“Don’t do that!” he reprimanded her parents, pointing at the burns. “It can’t help.”

They looked at him blankly.

He no longer tries to use the argument that he is a doctor and understands things patients do not. Nubans call half the people who work at Mother of Mercy “doctor,” he has learned.

“Everything is a pain in the ass here, for everyone,” he told me one day. “Nothing’s been really developed or adapted. There’s just friggin’ nothing. If something spills in my office, there’s no mop anywhere. There’s just a rag, and no water.” Children routinely excrete on the hospital floors. Adults, including his staff, spit constantly. He used to put up signs explaining that spitting spread tuberculosis. They made no difference. “We’re fighting a million years of people spitting,” he said. Recently, he found a patient wiping his snot on the wall. “I was like, Come on—what are you doing?”

Still, Catena stays. Will and stubborn faith are not the only anchors. He admits that he suffers from a disorder known as founder’s syndrome. It’s a self-diagnosis. His aim, his fondest hope, is to leave Mother of Mercy in Nuban hands. But for seven years he has invested every moment, every emotion, every ambition, into the hospital, and now he can’t bear the thought of turning it over to someone else. Bishop Macram has sent other doctors. Some have left at Catena’s insistence, others at their own. One American got so frustrated with Catena he tried to walk to South Sudan.

Catena has an increasingly hard time imagining his place in the outside world. Some aspects of modernity have left him behind. One night I found him in his office, trying to type a document in Microsoft Word. He asked if I could change the font and spacing—he didn’t know how. I asked if he was joking. “No, man, this isn’t what I do. I cut off arms!”

But mostly he stays because he admires and loves Nubans. Sometimes he is so touched by their understanding and gratitude, he believes he could live with them for the rest of his life. Recently, American friends of his organized a shoe drive. A shipping container of donated sneakers and boots and wingtips arrived in Gidel. Catena made a rare trip away from the hospital to personally deliver some of them to villages. A few weeks later, in the middle of a downpour, he was at home, enjoying a rare moment of rest, reading, when he heard singing. He went outside to find a procession approaching. It was the population of one of the villages he’d brought shoes to. They were carrying firewood and chickens and sorghum beer. They had walked for hours in the rain in order to thank him in song and feast.

“That blew me away.”

One evening, I watched him playing with a baby boy outside the intake clinic. Catena, who has never been married and has no children—he hasn’t had a girlfriend since leaving Kenya—can’t resist Nuban children.

“Mashallah!” he said (an Arabic expression of elation) as he squeezed the boy’s chubby arm. “Look at this kid. My God! Two months? Look at this!”

Catena asked the mother where they were from. She said they were from the refugee camp in Yida, South Sudan. They had walked for days to be treated by him. (The border between the two countries is porous.) Catena can’t stand it when Nubans say they are from Yida; he sees at as an admission of defeat.

“You’re not from Yida!” he said to her. “No one’s from Yida. Where are you really from?”

She named her village. Government forces occupied it, so she and her children had lived in the camp for three years.

“We want to be back in our real home,” she told him.

While he waited for Catena in the surgical theater one morning, a few days before I left Gidel, Rashid wrote new words on the whiteboard: puerile, lethal, robust, poverty, soiree. It was nearly the beginning of the school term, and Rashid had decided to go to high school. At 21, he’d be a freshman. His goal, he told me, was to become a surgeon and a writer: “I want to write about what is happening in Nuba.”

The Catholic diocese runs a high school in Gidel, and students were arriving from around Nuba. Most were in their twenties and thirties; some were former soldiers. On the hillsides around the hospital, they were building the small mud huts that would serve as their homes throughout the term.

Catena came into the operating room, followed by one of the burned cousins, who was on a gurney pushed by a nurse. To keep the cousins alive, every few days Catena had to slice the dead and dying skin from their bodies and smother them in burn cream. As Rashid stripped the soiled gauze from the girl’s body, she trembled and moaned.

“Khalas, khalas,” the anesthetist said to her. (“Enough, enough.”)

Rashid told Catena that he couldn’t find the definition for prosthetic excretion in his dictionary, and Catena nodded sympathetically. As he cut away, he cursed to himself and then calculated that 20 percent of her body was burned.

“The body has percentage?” Rashid asked.

“Yeah. It’s called the rule of nines,” Catena said. Each side of each appendage that was burned counted for nine percent. “The total is 100 percent.”

Rashid quickly did the math, figuring out that 100 isn’t divisible by nine. “What about 99 percent?” he asked.

“Well, the kuka area is one percent,” Catena shot back. Kuka is Arabic slang for the scrotum. Rashid laughed. “But on some dudes it’s way more than one percent!” Catena added.

Rashid didn’t get it, but laughed along with his boss.

The next cousin was brought in, and Rashid studied her.

“This is 20-something percent,” he said.

Earlier some of the cousins had gotten out of bed for the first time. They could not put on clothing, and were obviously still in great pain, but felt well enough to walk. The grandmother held their hands and led them in a small circle around the courtyard. Soon after, Mubarak’s wife arrived, having walked for three days. Mubarak began moving his eyes soon after she appeared at his bedside. He seemed to be nearing consciousness. Late the next afternoon, however, his eyes stopped moving. Within moments he was dead.

Catena found out hours later, when a nurse mentioned it to him offhandedly. “Ain’t nothing easy,” he said afterward. He was standing on his porch, shaking his head. “Anyway, you can’t change it. That’s the way it is.”

It was dark when Mubarak’s body was brought to the morgue. Outside, his wife crouched in the dirt. She was not crying but wore a slight frown as she stared intently at nothing. She had found some men who would help her dig a grave. Now she was waiting to claim her husband. There was only one stretcher at the morgue, and there were people ahead of her in line, also waiting to bury their dead.

The next morning, I got a ride with a convoy going to Yida. At a checkpoint, a young man with a backpack ran up to the truck and asked to be taken on. He’d been waiting there for days, he explained. The truck was full, the driver told him.  

When he learned I had come from Mother of Mercy, the young man asked if I’d met Toma, the girl who’d lost her foot in an Antonov bombing. He was her cousin. I told him that I had and that she was doing well—she was being fitted for a prosthesis. She would be able to go back to school. It would take her longer to walk there now, but that wouldn’t stop her.

“That’s good,” he said.

He waved as we pulled away, and the dust from the truck’s tires enveloped him.