“From the Town to the Village”: Sustaining Care in a Rural Sudanese Hospital
C. Phifer Nicholson Jr., MD, MTS, University of California, Los Angeles, Los Angeles, CA
Questions of healing and care for those who are sick and dying are central to many religious traditions (Crislip 2005; Larchet 2002; Fox 2019). Although many of these institutions in the U.S. context have long cut official ties with religious or church bodies, or been bought out by large private equity firms (Offodile II et al. 2021), religious communities still play a key role in public health and direct clinical care in Africa—where anywhere from 30-70% of health care is provided by faith-based organizations (Olivier et al. 2015). Further, these faith-based institutions are disproportionately located in “fragile health systems” that care primarily for rural and impoverished patients (Olivier et al. 2015, 1772). Despite historical links to colonialism (Wall 2015; Greene et al. 2013; Richardson 2020), many of these institutions have left lasting marks on long-term health outcomes in remote and resource-limited settings (Calvi and Mantovanelli 2018; Nicholson Jr. et al. 2023).
A paradigmatic example of a religious community building and maintaining a health care institution in a rural/remote setting is the Catholic Mother of Mercy-Gidel Hospital (MMH) in the Nuba Mountains of Sudan. Since the independence of Sudan in 1956, life in the Nuba Mountains has been colored by near-constant conflict with the government centered in Khartoum (Totten 2012; Rahhal 2001). MMH was founded in 2008 by Sudanese Catholic Bishop Gassis Macram, who established American physician Tom Catena as its first medical director. Three years later in 2011, Sudan’s president Omar el-Bashir sent Antonov bombers, tanks, and infantry to root out potential resistance following an unpopular local election that many Nuba largely believed to be rigged. What followed was eight more years of protracted conflict and human rights abuses that have been described as “the worst atrocity you’ve never heard of” (Kristof and Ellick 2015). At the start of the fighting, Dr. Catena, Sister Angelina (the chief nursing officer of MMH), and other expatriate staff were told there would be one secret flight out of Nuba to guarantee their safety. Catena and the sisters chose to stay, weathering the conflict with the community. These years were tumultuous, characterized by multiple bombings of the hospital and a near-constant threat of being overrun by government forces (Verini 2015).
As of spring 2023, it had been six years since the last bombs fell. On the ground in the Nuba Mountains patients come from all regions of Sudan and South Sudan. People who were “enemies” just a few years ago comprise 30% of the hospital’s surgical patients (Mother of Mercy-Gidel Hospital Annual Report 2022). All are offered care. Nuba and Arab patients share beds in the wards, differentiated only by small particularities in Arabic accents, the village listed on their chart, and minor physical features. Ties between Nuba and the north run deep, as does the deep pain of years of war and discrimination.
MMH today finds itself in this intersection of histories, conflicts, fears, fragilities, and hopes. Given the political instability of the region and the recent flare of violence in Sudan in 2023 that persists until today, it has often functioned without research or humanitarian support, yet, remarkably, has persisted in offering tertiary-level care for over fifteen years at the margins. In the face of a globally worsening, “dangerous shortage of [health care] workers,” it is pressing to understand the lived experiences of practitioners in places like Africa—particularly Sudan—where this shortage is most severe (Lancet 2023).
To that end, the author conducted qualitative fieldwork comprised of participant observation as a clinical trainee and sixteen semi-structured interviews at MMH from January to March 2023, seeking to understand what sustains the work this hospital as well as meaning(s) of MMH to the Nuba and greater Sudan. Findings from this qualitative study reveal particular sustaining factors such as deriving a sense of purpose in serving their community, intrinsic satisfaction in and calling towards their work of caring for the sick, religious belief/participation, and desire for learning, education, and empowerment of the Nuba community. These commitments reveal MMH is constituted by a commitment to relocation as articulated by African theologians Emmanuel Katangole and Jean-Marc Éla.
MMH, by offering tertiary-level care in a rural village, goes to the poor and otherwise marginalized who have been neglected in central places of power (Katangole 2011; Éla 2009; 2005). This commitment to relocation is one that offers insights toward nurturing hope in individual and communal pursuits of offering holistic care at the margins.
A paradigmatic example of a religious community building and maintaining a health care institution in a rural/remote setting is the Catholic Mother of Mercy-Gidel Hospital (MMH) in the Nuba Mountains of Sudan. Since the independence of Sudan in 1956, life in the Nuba Mountains has been colored by near-constant conflict with the government centered in Khartoum (Totten 2012; Rahhal 2001). MMH was founded in 2008 by Sudanese Catholic Bishop Gassis Macram, who established American physician Tom Catena as its first medical director. Three years later in 2011, Sudan’s president Omar el-Bashir sent Antonov bombers, tanks, and infantry to root out potential resistance following an unpopular local election that many Nuba largely believed to be rigged. What followed was eight more years of protracted conflict and human rights abuses that have been described as “the worst atrocity you’ve never heard of” (Kristof and Ellick 2015). At the start of the fighting, Dr. Catena, Sister Angelina (the chief nursing officer of MMH), and other expatriate staff were told there would be one secret flight out of Nuba to guarantee their safety. Catena and the sisters chose to stay, weathering the conflict with the community. These years were tumultuous, characterized by multiple bombings of the hospital and a near-constant threat of being overrun by government forces (Verini 2015).
As of spring 2023, it had been six years since the last bombs fell. On the ground in the Nuba Mountains patients come from all regions of Sudan and South Sudan. People who were “enemies” just a few years ago comprise 30% of the hospital’s surgical patients (Mother of Mercy-Gidel Hospital Annual Report 2022). All are offered care. Nuba and Arab patients share beds in the wards, differentiated only by small particularities in Arabic accents, the village listed on their chart, and minor physical features. Ties between Nuba and the north run deep, as does the deep pain of years of war and discrimination.
MMH today finds itself in this intersection of histories, conflicts, fears, fragilities, and hopes. Given the political instability of the region and the recent flare of violence in Sudan in 2023 that persists until today, it has often functioned without research or humanitarian support, yet, remarkably, has persisted in offering tertiary-level care for over fifteen years at the margins. In the face of a globally worsening, “dangerous shortage of [health care] workers,” it is pressing to understand the lived experiences of practitioners in places like Africa—particularly Sudan—where this shortage is most severe (Lancet 2023).
To that end, the author conducted qualitative fieldwork comprised of participant observation as a clinical trainee and sixteen semi-structured interviews at MMH from January to March 2023, seeking to understand what sustains the work this hospital as well as meaning(s) of MMH to the Nuba and greater Sudan. Findings from this qualitative study reveal particular sustaining factors such as deriving a sense of purpose in serving their community, intrinsic satisfaction in and calling towards their work of caring for the sick, religious belief/participation, and desire for learning, education, and empowerment of the Nuba community. These commitments reveal MMH is constituted by a commitment to relocation as articulated by African theologians Emmanuel Katangole and Jean-Marc Éla.
MMH, by offering tertiary-level care in a rural village, goes to the poor and otherwise marginalized who have been neglected in central places of power (Katangole 2011; Éla 2009; 2005). This commitment to relocation is one that offers insights toward nurturing hope in individual and communal pursuits of offering holistic care at the margins.