Imagine a primitive hospital with no plumbing, CT scan or X-ray machines; equipment that is sterilized over coal and steam, donated surgery supplies and one doctor for 450 patients.

It is located in a war zone with daily bombings; the local residents struggle to grow food for fear of being killed.

Brookings resident Mark St. James, who is a registered nurse, lived and worked in such an environment at Mother of Mercy Hospital, located in Sudan, a third-world African country, from March to June.

One night in February, while watching television news, St. James, 52, saw a report on Ryan Boyette, an American who didn't leave the Nuba Mountains when a war broke out between Sudan and South Sudan, as did all of the other humanitarian groups,and was attempting to recruit sponsors for the Nuba people.

The story inspired St. James.

"I just said I want to go over there and help," he said. "I wasn't working. I had all of these skills in 22 years at Sutter (Coast Hospital). I felt it was my calling, and my wife agreed."

However, getting to Sudan was easier said than done: The United States has sanctions against Sudan andndash; no Americans are allowed in.

St. James, a Catholic, did some research, and found a connection with the Catholic Diocese in Nairobi. After Bishop Max Macrum received a letter from Star of the Sea Priest Luan Nyugen verifying St. James is full Catholic,and the resident surgeon, Dr. Tom Catena of New York communicated he wanted St. James for his surgical and emergency experience, Macrum arranged St. James' travel.

"I went over there knowing I would have to sneak in," St. James said. "It was all a secret from the start. My friends didn't even know. I couldn't say goodbye to them."

The trip took 10 days of travel and multiple flights, but eventually St. James arrived.

What he did

While in Sudan, St. James assisted Catena.

The pair performed emergency surgery and made rounds every day, visiting each ward. Each ward held 40-230 patients.

Each day, they worked 10-hour shifts and saw about 400 people.

The two also offered daily clinics to educate the hospital employees; none of them were medically trained. Most only had the equivalent of a sixth-grade education, and were taught on the job.

"The goals were to treat the injured and the sick, and to teach the Nuba people about medicine," St. James said.

St. James learned new skills, too, such as how to diagnose without X-rays and CT scans, using the old-fashioned way of talking and listening.

"It's just amazing how you save so much time not waiting for an X-ray or an MRI," he said. "Straight to the emergency room. With Dr. Tom (Catena) and me, we could diagnose in 20 minutes. At Sutter, you would wait an hour for a CT scan and MRI."

Other differences include minimal charting and no paperwork.

"We didn't do any charting," St. James said. "Just word of mouth. One chart of medicine for the caretakers. That's it."

There also were no politics.

"We're just 100 percent doctors and nurses," St. James said.

Catena, who was a member of the United States military, trained at Duke University. St. James studied at Los Medanos College in Pittsburg, Calif. He also studied at the Naval Medical Center San Diego and trained with the United States Marines at Camp Pendleton. Eventually he became a Navy Corpsman, challenged the Licensed Vocational Nurse (LVN) test and went straight from nursing school to working in the emergency room.

He has worked in the medical field since 1979, first as a Navy Corpsman serving in Beirut from 1979-1983, and then at medical centers such as Sutter Coast.

Cultural differences

During his stay, St. James experienced a completely different lifestyle.

Sugar and salt are like gold; they are very difficult to attain.

An assortment of beans and rice are the staples of the Sudanese diet.

Eggs are not eaten; they are left to hatch.

When it rains, burrows are filled with snakes and scorpions.

Children wear clothes with holes, and go without shoes.

Amputations are done with a hand saw. Anaesthesia doesn't exist.

Even though Sudan and South Sudan are desert wastelands, leprosy, rabies, malaria, yellow fever, TB and cancer are rampant.

St. James also witnessed medical miracles.

He saw a boy with a piece of shrapnel the size of a quarter removed from his head live. Brain surgery wasn't an option, so St. James was sure the boy would die. After going into a coma, the boy woke up talking the next day, was discharged a month later, and is only left with a slight limp.

Another child who suffered a skull fracture after falling out of a tree survived.

And a third, lived after suffering burns covering more than 60 percent of his body from an incendiary bomb.

St. James also learned how different life in a third-world country really is.

He learned how to survive in triple digit temperatures and heavy humidity without a fan.

He learned to live in an area that did not receive direct mail; mail was transported to and from Nairobi.

And he learned just how valuable he is.

One day, St. James was bored, so he packed a backpack with supplies, walked outside of the compound and went on a 14-mile hike to the next village. Later, he was yelled at because he could have been killed or kidnapped.

When he wasn't working, St. James enjoyed spending time with the local children.

"The kids gravitated to me," he said. "They would follow me like puppy dogs on my days off."

He attributed their fascination with him to his blonde hair.

"They've never seen anybody like me before; that's how primitive this area is," St. James said.

Keeping in touch

Although St. James couldn't receive mail, he did have limited Internet access, (56 Kb andndash; so slow that when four people were online pages crashed). This allowed him to post pictures and videos on his Facebook page, and to send emails to family and friends, such as his wife, Linda St. James.

Linda admired his decision, but admitted it wasn't easy having him so far away.

"It was very, very hard," she said. "Will he come home alive, or dead?

"It was hard for our marriage. But then I thought it was a good thing that he did. It's always hard; it's a sacrifice you have to make, but the best feeling is, you're able to help and make a difference.

"He did what he did, and felt like part of his mission in life is fulfilled andndash; to be able to help the needy, and the people who are struggling."

To cope with Mark being away, Linda would visit with friends, and keep herself busy around the house.

Through email and Facebook, Margo Ivey, an RN who worked with Mark for many years at Sutter, was able to follow Mark's adventures.

"He brought that part of the world to me, and I had no idea what was going on over there," Ivey said. "For him to go to someplace that remote, Third World, to be able to see that firsthand and bring that back, oh my gosh, that's pretty impressive. I can only imagine the challenge that must have been for him."

Marjorie Towers, a friend who used to go to church with Mark and Linda, would share Mark's pictures with her Bible study group.

"Here's Mark, and here's what he's doing," she would tell her fellow group members. "We could see it firsthand."

What he's like:

Neither Linda St. James, Ivey or Towers were surprised with Mark's decision.

Linda described him as a very hard worker.

"He doesn't just sit around; he wants to do something," Linda said. "He always wants to make a difference."

Towers said he is helpful, compassionate and a very committed Christian.

"Mark is a very pleasant gentleman," Ivey said. "He has a good heart. He's a risk-taker. He has been quite a traveler all of his life. He and Linda traveled significantly."

He also isn't afraid to try new things.

On one trip he and Linda took, starfish was a delicacy. Mark ate the starfish, but didn't eat the right part, Ivey said. He became paralyzed, couldn't breathe and almost died.

"That was really something," she said. That's just one of the types of things that he would do. It didn't surprise me then when he was going to go on this trip to this place that I would never even consider going alone, let alone on missionary work."

When asked, Ivey said her work in the emergency room doesn't even come close to what Mark experienced and dealt with on a daily basis.

"We see people who are healthy to start with," she said. "Then (they're) in car accident or have things that happen to them because of the way we live like diabetes and congestive heart failure because we don't take care of ourselves. But over in Sudan, they don't have a chance to take care of themselves. They're already malnourished and dehydrated. To see people also blown apart by war, we don't see that. We see a gunshot wound every once in awhile, but not a leg ripped off. And then to not have the capabilities to treat people like we do. ... It's like something you'd see in the movies. It just didn't even register to me when he told me the story of the no anaesthesia. It brought me back to "Gone with the Wind." andhellip; I couldn't relate to it at all."

Towers said Sudan was a perfect opportunity for Mark.

"That was just something that he's always wanted to do," she said.

Now that Mark has returned to Brookings, he hopes to work as an RN at Coastal Home Health and Hospice.

One day, after the war is over, he would consider going back.