In the depths of Sudan, Africa lies the war-torn Nuba Mountains. This region has been in a state of war since the Sudan genocide in 2011. It can take upwards of two days to travel 20 miles from the capital city to the mountainous village of Gidel because there are no traffic lights or paved roads. The dirt roads are filled with large potholes caused by water and rain damage. The area is so remote that COVID-19 — the virus that was everywhere — did not make it to the people of the Nuba Mountains.

Within Gidel and the Nuba Mountains is the Mother of Mercy Hospital. This is the only hospital for a 300-mile radius and serves a population of more than 1.3 million people in a place that is the size of West Virginia. It is led by one doctor, Tom Catena, MD, who has made it his life’s mission to serve the needs of these forgotten people. And for two months of fall 2023, Rose-Hulman alumnus Gary Ulrich, MD (2017, biology) worked alongside Catena to practice medicine in this once-in-a-lifetime opportunity.

“It’s like doing a year of medical school in a month … everything and anything is possible,” said Ulrich, describing his experience working in the Nuba Mountains.

Ulrich first heard of Mother of Mercy Hospital when Catena gave a presentation in Rose-Hulman’s Hatfield Hall in 2019. Catena, who completed his family medicine residency training with Terre Haute’s Union Hospital in 1999, was in the United States receiving an award from Union. Ulrich attended the doctor’s presentation and vowed he would one day work with him.

“Hearing his selfless life work inspired me,” said Ulrich. “And I think it’s important to challenge yourself and put yourself in uncomfortable situations to grow and become more well-rounded.”

Ulrich always knew he wanted to be a physician. His father is a retired orthopedist with Union Health, and he grew up seeing the impact one can have on a community. He chose Rose-Hulman and a biology major because of the school’s reputation and the fact that the college’s rigorous education would prepare him for medical school. Upon graduation, he attended Indiana University School of Medicine.

During medical school, Ulrich spent a research summer in Leeds, England, a city which played a pivotal role in the development of the modern total hip replacement and where in nearby Wrightington, England, Sir John Charnley performed the first modern total hip replacement in 1962. As part of his collaborative program with University of Oxford and University of Leeds, Ulrich met a patient with hip arthritis that couldn’t walk. He was part of a surgical team that replaced the patient’s hip and the day after surgery, she was up and walking pain free.  

“That experience is when it clicked for me that our craft can change lives,” said Ulrich. “Seeing that impact on my own really convinced me to be an orthopedic surgeon.”

In October 2023, Ulrich was headed to the Nuba Mountains to begin his work with Catena.

His two months in Sudan were not only filled with hands-on physician work, but also learning how special it is to be a doctor and master a craft that can give and provide outwardly to people. He also experienced first-hand how different medical problems are in these remote areas of the world compared to the United States.

“These patients present late in their disease course because they’re traveling so far to get to the hospital,” said Ulrich. He described the typical distance as a comparison from going from St. Louis to Terre Haute to obtain care. 

“If [the patients] have cancer, they don’t know they have cancer until it presents late and has grown extensively. So, they present with huge masses, spleens the size of watermelons, or thyroid goiters the size of grapefruit. … Dr. Catena and I would say it’s sometimes easier to be a physician in Nuba because some pathologies are so bluntly obvious to diagnose.”

The way in which diagnoses are made is indeed limited. There are no CT scans or MRI machines at the Mother of Mercy Hospital. Catena and Ulrich relied heavily on physical examinations, as well as a mobile x-ray machine and ultrasound equipment. Ulrich also saw his diagnostic skills improve tenfold and was able to practice his orthopedic craft in a new way.

“The orthopedic breadth of what we can do over there is very limited,” said Ulrich. “The sterilization techniques are not up to par; so, if someone needs orthopedic work, we can use plates and screws for fractures. But replacement surgery is not something that’s been tackled. The most common viable option is amputation.”

That, however, did not stop Ulrich for finding a way to help a Sudanese People’s Liberation Army (SPLA) soldier save his leg after sustaining a gunshot wound fighting for his Nuba homeland.

“This soldier came to us with an open gunshot wound that occurred two to three months prior,” said Ulrich. “In the United States, with an open gunshot wound, the protocol is that antibiotics and a tetanus shot are given within three hours. … Dr. Catena’s breadth of what he can do is below the knee amputation, which is what this soldier was ultimately facing. But I had some experience with orthopedic rotations, and I offered to do a primitive orthopedic surgery to save the leg.” 

What Ulrich proposed was an external fixation procedure. During this procedure, metal pins are inserted into the bone above and below the injury site. The pins are then attached to a metal bar outside the body, and the external fixator frame keeps the injured bone stable and aligned so it can heal. Additionally, Bill Rhodes, MD, a visiting plastic surgeon from Kenya, performed a cross-leg flap, which involved taking healthy tissue from the uninjured leg and bringing it over to the injured leg, to cover the open gunshot wound defect. This was the first external fixation procedure ever done at Mother of Mercy Hospital. The soldier has since healed and as a result, he was able to keep his leg.

Ulrich left his experience in the Nuba Mountains a changed physician — not only in his diagnostic abilities, but in the way he views the region and its people, as well as life in general.

“The Nuba people live every day in rebel territory,” he said, “There are SPLA soldiers with AK-47s protecting the village paths. There are mounted machine gun vehicles guarding the market. There is the theoretical threat of the Antonov bomber jets returning … Families live in tukul huts smaller than the typical American office. Children have one pair of clothes. The day’s meal is not guaranteed. … And yet the Nuba are happy, joyful, hardworking people. Seeing the sense of community, togetherness, and positivity these people have in such a difficult situation speaks to what you need to achieve happiness in life. It’s not the tangible things, but the intangible.”

Ulrich, who volunteered his time in the Nuba Mountains, will soon begin his surgical internship year at the University of Toledo. He feels Rose-Hulman ingrained in him qualities that prepared him for his career as a physician, as well as life — perseverance, integrity and a strong work ethic. Eventually Ulrich would like to incorporate global outreach and service into his practice. 

“Sometimes people view service work primarily from the perspective that you are doing a good deed for the people you are helping. … But for me, it’s the opposite,” said Ulrich. “Being in the presence of the Nuba people has taught me so much. I have undoubtedly become more grateful and humble with what I have been given in my life … to witness the perseverance of the Nuba people and the selfless life work of Dr. Catena has been an honor.”