prognosis - hope

Prognosis—Hope A PA Brings Hope to South Sudan

BY STEVEN LANE

PA Cathy Hoelzer’s resume reads like a travelogue through some of the world’s most war-torn and inhospitable corners. Three years in Erbil, Iraqi Kurdistan, in the mid-

1990s. Stints in refugee camps in Chad, Darfur, Turkey and Bosnia-Herzegovina. Two months staffing a mobile medical clinic in Afghani-stan. A year learning Arabic in Khartoum. Eight years in Sudan and South Sudan. And occasional trips to the Philippines to work in a midwifery clinic.

In between, there have been periods spent back in the United States, mostly for education—training as a medical assistant in San Diego; a master’s in public health at Tulane University; and two years at the Medical College of Pennsylvania Hahnemann University (now Drexel University), where she completed her education as a PA in 2001.

All of these have been stops on the journey towards a larger goal that has driven Hoelzer all of her adult life: helping people in need. In a profound and sustained way, the 55-year-old PA has committed her life to doing what she can for people in need everywhere.

“I have a heart for reaching those who are suffering and struggling, the downtrodden and marginalized,” she said.

She also admitted to being an “adventure addict.”Watch PA Cathy Hoelzer lead a tour of her clinic in Doro, Mabaan County, South Sudan.

Hoelzer holding a young patient in the Doro clinic.

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A calling to helpHoelzer traced her commitment to helping others back to a three-month church trip she took to Mexico as a teenager. Traveling through poor vil-lages in rural areas, she saw, for the first time, people who had “almost nothing.”

“I realized that this was my calling,” she said. “I felt strongly that God was telling me to go and help the least reached people.”

Hoelzer’s Christian faith is clearly central to her life. She and her hus-band, Brett, have established a ministry, Hope for Every Nation, with the mission “to show God’s love to unreached peoples by meeting their health needs, by providing compassionate medical care, building their capacity for a brighter future through training them in new skill sets in mentoring relationships and sharing the truth from God’s word through evangelism and discipleship.”

But she spoke relatively little about her faith when this AAPA reporter reached her by Skype in her apartment in Nairobi, Kenya. The conversation was all about patients, equipment, writing grants, and all of the other demands on her time, including the energy that her chosen work brings. Hers is an activist faith, and she channels it to effect real change in the world. In 2007, her work was recognized with the AAPA Humanitarian PA of the Year Award.

The world’s newest countryFor the past eight years, the Hoelzers have lived and worked in South Sudan in East Africa. In fact, they have lived there longer than South Sudan has been a country. The nation gained independence from Sudan in July 2011, following years of civil wars between the predominantly Muslim, Arabic-speaking northerners, and the mostly non-Muslim southerners.

For the past two years, they have been based in the village of Doro, Mabaan County. Cathy is program manager of a clinic dedicated to serving the local population and the flood of refugees who have recently entered the area, fleeing continuing violence in the country.

South Sudan is still the world’s newest country, and its continued exis-tence is anything but secure. Since independence, the young nation has been plagued with new fighting between its two largest ethnic groups, the Dinka and the Nuer. And in addition to internally displaced people, tens of thousands of refugees have also flooded over the border from the Blue Nile state of Sudan itself—fleeing attacks allegedly ordered by Sudanese leader, Omar al-Bashir, who has been indicted by the International Criminal Court for war crimes and genocide.



The fighting and large numbers of displaced people are expected to lead to a famine that could be “the worst in years,” Hoelzer said. The Ameri-can non-governmental organization, Fund for Peace, ranks South Sudan as the most fragile nation in the world.

Nevertheless, Hoelzer said, she will stay there “until she’s too old to do this anymore.” The far northeast corner of the country where she lives is considered relatively safe, she said, though her whole team has been evac-uated twice because of the war.

Six weeks on, two weeks offSix weeks out of eight, the Hoelzers work out of a two-room cinderblock house in Doro that they, not infrequently, share with snakes and rats. They are constantly busy, Cathy in her various clinical and administrative roles, and Brett, overseeing construction of the expanding clinic facility and a hundred smaller jobs.

The other two weeks, they spend in an apartment they own in Nairobi. They need this break to replenish themselves for the next period of work.

“Our work schedule is so intense,” Hoelzer said. “We get so worn out. When we go back to Nairobi, we just go to movies, sleep, eat and rest.”

As program manager of the clinic, Cathy oversees a dozen or so employ-ees, handles all the administration and finance, writes grant proposals, manages the flow and storage of donated medical supplies, and writes reports and articles for news organizations.

“On the side,” she sees 15 to 25 patients a day, typically, the most com-plex cases.

Dickson Kaburu, one of the clinical officers at the clinic, described Cathy as “a go- getter. She is very motivated and hard-working. She helps us to

keep going. She likes having objectives, which helps us all understand that we have achieved something.”

She also empowers the local staff, said Kaburu. Hoelzer also oversees a nine-month training program for local commu-

nity health workers at the clinic, setting up a basic curriculum and having the students sit for exams and get a certificate at the end of it.

These workers are “the hope of the future for healthcare in South Sudan,” said her collaborating physician, Rob Congdon, MD, an American family practice doctor who works at the nearby county hospital. “They only

Take a look inside Cathy and Brett Hoelzer’s home in South Sudan.

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Hoelzer meeting with Falata elders in South Sudan.



grow in ability to diagnose and effectively care for patients with the sort of daily on-the-job teaching that a person like Cathy is able to provide.”

The staff also includes Kenyan clinical officers, who are somewhat simi-lar to PAs in their training; local midwifery assistants; and nurses from Ger-many, Canada and the U.S.

The clinic includes an outpatient clinic, a busy maternity ward and a leprosy program. The nearby refugee camp of more than 50,000 people, as well as occasional outbreaks of cholera or tuberculosis, generate a lot of new patients.

Brett Hoelzer keeps himself busy as well. He manages construction of the new buildings that are constantly going up to extend the clinic or pro-vide housing for new employees, and is generally the clinic handyman, in a place where supplies can be scarce, and ingenuity is often in demand. Cathy calls him “MacGyver.” Recently, he helped Cathy make a prosthesis by filling a glove with foam and pinning it to the patient.

The clinic has a solar power inverter installation that provides electricity, and a borehole pump that supplies clean water.

The Doro clinic is fortunate to have the new and fairly well-equipped Bunj County Hospital a few miles away, to which they can send very sick patients. The hospital was built by Samaritan’s Purse, a U.S.-based mission-ary organization headed by Franklin Graham, son of the late evangelist preacher Billy Graham. Congdon spends much of his time at Bunj, where he works with Evan Atar, MD, a locally famous physician who has stayed in the area throughout all of its wars and troubles, and has been the subject of several articles in the international media.

Congdon is “always available by phone and email,” Hoelzer said. “South Sudan is the newest country in the world; there’s not much regulation here. But I try to follow the rules as I would back in the U.S.”

The Hoelzers are formally employed by SIM International, a missionary outreach organization with offices on every continent and more than 60 hospitals and community health centers around the world. SIM helps pro-cess their funding (the organization survives entirely on grants and on private donations) and provides some financial and administrative services.

Humble and beautiful peopleLife in Doro is simple, and almost completely devoid of Western comforts. The Hoelzers can get some staples at the open market near the clinic, and there are a couple of Ethiopian and Darfurian restaurants. But they live mostly on rice and beans, Hoelzer said, and a few items they bring from Kenya on their bimonthly R&R trips. Care packages from friends (ideally, containing chocolate) and responses to Facebook posts provide a comfort-ing connection to the outside world.

Cathy acknowledged that there are times when she thinks she just can’t do it anymore. But her days are also full of countless small triumphs, and her deep desire to help keeps her going, as well as the people she works with and for.

“The Sudanese are some of the most humble and beautiful people,” she said. “They are generous, warm, kind, loving people. I was just given a job offer to go back to the U.S. but declined.”

Kaburu, one of the Kenyan clinical officers, agreed, acknowledging that there is still much to be done. “It’s a blessing to be here and work around needy people who are very lovely and warm. They all need our help in terms of healthcare. It’s my dream that 10 years from now we will have all these things in place. If we had 10 Cathys, that would be great.”



STEVEN LANE is a communications professional who has written about PAs, PA education and healthcare issues for many years. He is a regular contributor to PA Professional. Contact him at [email protected].

PAs neededCathy is a big believer in the PA profession and has been surprisingly active in AAPA despite her peripatetic life. She has spoken at AAPA conferences since 2006, on topics like cross-cultural competency and tropical medicine, and is a member of the Fellowship of Christian PAs and PAs for Global Health.

Being a PA, she feels, has allowed her to bring so much to the people she works with.

“My training got me so well prepared,” she said. “We were told that we should be 80 percent sure of our diagnosis even without labs and tests. That really honed my physical skills.”

And she is passionate about the need for more PAs to spend a little time helping those in dire need.

“We have so much to give,” she said. “We need to think about others. Take a month sabbatical and go work somewhere. Look on medical volun-teer websites. If you don’t want to work for a faith-based organization, there are plenty of secular organizations. Just do it!”

Find out more about conditions in South Sudan.

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