MARYKNOLL, N.Y. (CNS) -- As a trained physician, "everything I do has some witness or expression of my faith," Dr. Susan Nagele said.

Nagele has practiced medicine for 31 years under extraordinary conditions in East Africa as a Maryknoll lay missioner.

She visited the organization's headquarters in Maryknoll to deliver the keynote speech at the group's 40th anniversary celebration Aug. 8.

In an interview with Catholic News Service Aug 7, Nagele said she was drawn to short-term volunteer stints during college and medical school at the University of Illinois. Serving in Appalachia, Nicaragua and the Dominican Republic, Nagele said her impact was limited.

"I got a lot more out of it than I gave and I knew I wanted to do something more long-term. I wanted it to be with the Catholic Church," she explained.

"It was coming from my faith and I knew I would need the support of my community," Nagele said.

The Maryknoll Lay Missioners organization was an obvious choice, Nagele said, because it offered good training and a multiyear renewable contract to serve overseas.

Within months of completing her residency, Nagele was in a remote area of Tanzania. Working alongside Maryknoll priests and another lay missioner, Nagele learned the language and culture, while practicing medicine in rural clinics.

Nagele said she added a more pastoral dimension in subsequent postings to South Sudan and Kenya. For example, she instituted popular days of recollection during Lent in an early assignment to Kenya to help medical staff "operate out of some kind of caring faith base. It was really good progress for them and for me."

In wartime conditions in South Sudan in 2003, Nagele said there was remarkable ecclesial cooperation among priests, brothers, sisters and lay people. "The local church was very committed to working together. There were unimaginable needs and an amazing ability to address those needs with what little we had."

Today, Nagele works in the Archdiocese of Mombasa in the southeast corner of Kenya, on the Indian Ocean. It is a vast expanse of 38,000 square miles with almost four million people. Nagele said most of the health care takes place at rural dispensaries and the church does a good job providing care, especially in needy areas. She renovated two ailing clinics and has established five others in the archdiocese.

Among her other responsibilities, Nagele counsels and trains health care workers in palliative care for diseases including cancer and HIV/AIDS.

In 2012, the American Medical Association awarded Nagele its Medal of Valor in recognition of her lifelong work and "courage under extraordinary circumstances."

Sam Stanton, executive director of Maryknoll Lay Missioners, told CNS the organization trains people to fulfill their baptismal call to mission. Since 1975, more than 700 Catholics have served as lay missioners in Africa, Asia and the Americas. They include single men and women, couples and families.

Stanton said the group embodies the "broader sense of what it means to be church." The church needs to support the laity's efforts in mission and ministry around the world, he said.

Maryknoll Lay Missioners builds bridges of understanding within the church here and abroad, Stanton said. "We help people reconnect with what it means to be part of a community," he said.

When missioners joined in 1975, "almost all of their peers were practicing Catholics," he explained. Many people today don't have that experience, but have a need to be part of a group that is on a journey with God, he said.

Stanton said the organization is intentionally more diverse than in the past. It is trying to reflect the growing Hispanic culture in the church and respect Asian influences, as well. The class of missioners that begins in October will include four Vietnamese recruits in a group of 12 to 15 people, he said.

Nagele said there is a slowly growing appreciation for the role of lay ministers in the church in Kenya. "Little by little, people are starting to see it's really important to include laity in planning and evangelizing in more than just a volunteer way."

This understanding is driven by the development of a well-educated middle class, she said. They see things that can be improved and they urge the church to make changes.

"There is a greater ability now than in the past to partner with the laity. And it's a true partnership, where we can challenge each other," she said.

Nagele has worked with other lay missioners and archdiocesan employees, she said, to develop a child protection policy consistent with the guidelines of the Kenya Conference of Catholic Bishops. "A big role I play in the archdiocese is to back up local employees who want to do things right. I pull my doctor strings when I need to," she said, adding she is able to be more vocal in a traditional church setting than other laypeople.

"This is a good ministry as U.S. laity. We can help people develop," she said.

During her tenure in Kenya, Nagele said laity and local groups of religious women have "matured and are much more able to do things on their own. My role is a supportive one, especially when they are frustrated or blocked."

Nagele said she hopes the church in Kenya will focus on challenges to youth, especially those impacted by terrorism. She said boys are taken from government-run schools in Kenya and moved to neighboring Somalia to train as terrorists. "Terrorism is deeply embedded it society, especially among those who don't have jobs," she said.

As a practical step, Nagele said lay missioners offer training in active nonviolence. After recent contested elections, Nagele said she counseled people to "take the long view and be peaceful. Don't riot and respond violently to what you see as an election not carried out transparently and fairly," she recounted.

Nagele said Maryknoll's lay missioners, while working to support local communities over a long period of time, have shown how much the church stands to lose if it does not tap the potential of all of its members.