Why Nuba?

I’ve been to the Nuba Mountains in central Sudan three times over the past 15 years, staying a month or so each time and working with Dr. Tom Catena, one of the most amazing people I’ve ever met.

Dr. Catena is world-famous for his humanitarian work serving the Nuba people in a region where there is no other access to medical care. Born in New York, Dr. Catena served in the US Navy and boarded in Family Medicine. After completing his service, Tom immediately moved to Kenya and has lived and worked in Africa ever since.

In 2008, Dr. Catena opened Mother of Mercy Hospital in the Nuba Mountains, effectively becoming the first and only physician for hundreds of miles. He single-handedly created and manned the hospital’s inpatient, outpatient and surgical wards.

When I first traveled there, in 2008, the hospital had just opened. Tom began his day around 4 am, eating a quick breakfast and going for a brisk walk in the early morning dark. After that, he rounded on a hundred or more inpatient adult and pediatric cases, many with diseases and infirmities no longer seen in the developed world: rabies, tetanus, leprosy, tuberculosis, advanced cancers, even dental issues. Following inpatient rounds, he moved to the operating room, where he used surgical skills he had acquired in Kenya to remove goiters, perform bowel resections, and amputate limbs. Several hours later, he moved to the outpatient clinic, where sometimes 200 people or more waited patiently in the hospital’s courtyard to have their UTIs, pneumonia, and countless other issues evaluated and treated.

I couldn’t believe this was Tom’s daily routine, seven days a week, all year long.

Other physicians and specialists, like myself, did come and go to help Tom, but ultimately he was the one constant: the physician, administrator, logistician, and maintenance man. His evenings were spent dealing with staff issues, rationing generator fuel, and troubleshooting the hospital’s one satellite internet linkup, among many other responsibilities.

Things took a turn for the worse in 2011, when Sudan split into two countries and the government in Khartoum decided to force the Nuba Mountains to stay with the north through a vicious bombing campaign carried out on the Nuba people. Tom suddenly became a war surgeon, treating patients with severed limbs, head trauma and other ghastly injuries inflicted by barrel bombs dropped by the Sudanese army onto peaceful men, women and children.

Dr. Catena is easily searchable on the internet, and I recommend you look him up. He is the recipient of the 2017 Aurora Humanitarian award, the proceeds of which he donated to other humantiarian causes. There is also a film about him, titled The Heart of Nuba, which you can learn about here.

I worked with Tom at the beginning and also subsequently during the war years, my one month there being the scariest of my life. Hiding in a hole in the ground while a bomber drones overhead is pure terror. Fortunately, the war in Nuba is over (for now) and Dr. Catena is happily married to a Nuba nurse, and they are raising two children near the hospital he almost never leaves.

Tom’s example has guided my entire medical career and my philosophy when it comes to providing healthcare. The majority of my work in the US has been with underserved communities and FQHCs. And despite the wonderful, caring organizations I’ve worked for, I’ve witnessed the relentless monopolization of healthcare by huge corporations whose “patient first” branding masks one goal: profit.

I opened Nuba Health to see patients on my terms and provide the kind of care I believe people need: relationship-based, transparent, simple and affordable. An alternative to marketed medicine. I’m not brave enough to move my family to central Sudan and devote the rest of my life to healing the neediest of us. But Dr. Tom Catena’s example is at the heart of everything I do.

Refills, refills, refills.

Recently an elderly patient of mine (let’s call him AB) needed refills for multiple medications for various serious health issues. Because of his limited insurance, he can only fill the meds at one particularly bad pharmacy (I won’t name the corporation, but it’s easy to guess).

AP contacted me by email and gave me his full name and address, but no phone number, and a list of his nine medications. I sent everything electronically and figured that was that.

Two days later, he emailed me in a panic. He had been to the pharmacy and they had “no record” of any prescriptions being sent for him. Unfortunately, this happens all the time — especially if the doctor leaves a voicemail, which is rarely checked promptly, if at all.

I confirmed in my EMR the meds had been transmitted. I called the pharmacy and spoke to the pharmacist, gave the patient’s name and date of birth. Yes, all the medications had been filled and were waiting for him. However, the pharmacy (like me) didn’t have a phone number for AB. I emailed him back, telling him the medications were definitely there. I also urged AB to please, please give me a phone number. No response.

Another two days went by. Another email from AB. He had gone there again, no medications, and he suggested it was my fault, that I had “pressed the wrong button”.

I immediately emailed back: “What is your phone number?” And, thankfully, he responded.

I called AP, conferenced in the pharmacy, and asked for help. The harried pharmacist asked the patient for his date of birth and full name. AB is from Afghanistan. When he gave his full name to the pharmacist, he added an additional surname he had not given me: ABC.

So. Even though the pharmacy had his birth date and address on record — and the name AB (so close!) — they neither had the time nor cared enough to realize that ABC was the same person needing critical medications. And they sent him away. Twice.

The pharmacist’s solution on the phone? “When you come in here, just say you’re AB.”

Life is often busy, stressful and downright irritating. People like AB — older, confused at times, from another culture — tend to be nearly invisible to our profit-based health care system. But I often find if you take a deep breath and empathize, most problems are solvable by just caring.

Nuba Health is Here.

Quite a dramatic headline but for me it is a big deal. I started this practice to form real relationships with patients and not worry about all the nonsense that serves to make so much of U.S. healthcare a tragic mess: EMRs, bureaucracy, mammoth corporations that care more about their branding than people.

Health care in America is expensive, impersonal and profit-based, which is a lucrative but unsustainable model. You shouldn’t put a price on someone’s life; they’ll always pay. But that’s precisely the situation we are in. Moreover, the vast profits made by health care companies come from treating chronic illnesses rather than preventing them. In America, there’s no money in prevention.

As a result, most primary care physicians are burned-out clinicians who have little to no control over their relationships with patients. Volume and billings, not compassion and service, dictate their daily work. And they are trapped: after years of education and sacrifice, many cannot take the risk of working for themselves. Even less so nowadays, as small practice after small practice is gobbled up by health care conglomerates, and the independent doctor who is also a friend becomes a thing of the past.

My practice is an attempt to give patients a meaningful alternative to corporate medicine. I focus on prevention and improvement rather than a different pill or additional surgery. Human beings are inherently healthy. The body and mind are exquisite organisms that in general need very little intervention to heal and thrive. Stress, isolation and lack of knowledge underlie most of the health problems in America today. My mission is to change that, one patient at a time.