American Tom Catena, the only qualified surgeon living in Sudan's conflict-hit Nuba Mountains has treated more patients than he can remember -- but some cases are etched in his memory.
As medical director, doctor and surgeon at the Mother of Mercy Catholic Hospital, Catena has treated countless patients with horrific wounds from the conflict that has ravaged the rebel-controlled area since 2011.
"The ones that are crushing blows -- and they really are crushing -- are not just the war cases," said Catena.
Last year, a measles epidemic swept the region and the hospital treated 1,400 cases, he said. Some 30 people died.
"You'd come on a Sunday morning and find a kid who's dying from measles, gasping for breath, and the mother is just screaming, crying and rolling on the ground. It can be totally demoralizing and you just want to chuck it in," said Catena.
But, brought to the Nuba Mountains by his Catholic faith, Catena says he is determined to carry on until a doctor from the area can take his place. A lean, shaven-headed 51-year-old, Catena carries out all major surgery, delivers babies and gives check-ups at the 345-bed facility, which he says serves as many as 750,000 people living in the area. There is just one other small hospital, run by a German NGO and staffed by a handful of expatriates and local staff, in the region.
- 'Traumatized by conflict' -
Born in the small town of Amsterdam, New York, Catena was always interested in missionary work. But preferring practical work to preaching, he studied medicine at graduate school on a US Navy scholarship and headed for a two-year stint in Kenya after qualifying.
In 2007, he agreed to travel to work at Mother of Mercy, set up by the then-bishop of Obeid, Macram Gassis, with money from church groups and private donors, who still fund it. It aimed to treat all residents of the underdeveloped Nuba Mountains -- which lies in the restless South Kordofan region near the border with South Sudan -- regardless of religion and free of charge.
Arriving in 2008, Catena's first impressions were of the searing heat and that he was among "people traumatized by years and years of neglect and civil war". The religiously and linguistically diverse Nuba peoples suffered badly during the conflict between Khartoum's Arab-dominated governments and southern rebels in Sudan's 1983-2005 civil war.
The Nuba Mountains plunged back into war in 2011, when the Sudan People's Liberation Movement-North rebelled against the Khartoum government, complaining the region was being marginalized.
Overnight, wounded civilians, soldiers and rebels streamed into the hospital and most of Catena's expatriate colleagues left. His Nuba colleagues replaced them, quickly learning nursing and emergency trauma care on the job, and now form the core of the hospital's team. The hospital has also faced occasional aerial bombing from Khartoum's warplanes, with staff and patients running to nearby trenches at the sound of jets.
"It's the most terrifying thing I've ever heard," Catena said.
Khartoum denies it bombs civilian targets, but in January, the Belgian branch of Doctors Without Borders (MSF) withdrew its staff from the Nuba Mountains after it said warplanes hit a hospital it operated the area.
- Malaria season, HIV testing -
During the rainy season, which lasts from June until November, roads in the region are rendered impassable, largely halting fighting. The flow of civilians wounded by bombings and rebels hurt in fighting slows, but Catena still has plenty of work.
"We're not idle during this time, this is malaria season," Catena said.
He has also started testing in nearby villages for HIV -- the Nuba Mountains has seen a slow rise in the number of cases since 2008. This year the hospital has diagnosed 25-30 cases. After seeing the effects of HIV in Kenya, Catena is determined to prevent the virus from gaining a foothold in the region, and has helped launch an awareness campaign and testing.
With the few moments he has free, Catena reads -- he has just finished Dostoevsky's "The Brothers Karamazov" -- and plans for the hospital's future. The hospital is funding two Nuba through medical schools in Kenya and Uganda, but Catena says his departure is still far off.
"The goal for all of us here is the transition for having all the Nuba run the show. We are feverishly now trying to get people trained, but it will be at least five years," he added.