Six Months in Sudan: A Young Doctor in a War-torn Village - Couverture souple

the end.


I decided that this book should start at the end. It is the place I am trying most to understand.

This is it. I am standing in a field watching sparks from a huge bonfire float so high on hot drafts of air that they become stars. It is autumn in upstate New York, and the night is dark and cool. Wedding guests huddle together, white blankets loose over their shoulders. They murmur, point at the fire, then at the sparks.

I am standing by myself, swirling warming wine. A man to whom I had been introduced that night, a friend of the bride, rekindles our conversation. He is talking about an acquaintance, a nurse, who worked during an Ebola outbreak in the Congo years before. He recounts her story of how, after days of watching people die of the incurable virus, she and her team decided that if there was nothing to offer those infected, no treatment, no respite, they would give them a bath. They put on goggles and masks, taped their gloves to their gowns, and cleaned their sick patients.

Before he can go on, I stop him. I can’t talk about this.

“I’m sorry. No, no, it’s okay. It’s nothing you did. I’m going to go inside. Glad to have met you.”

I had been back from Sudan for a month. I had worked there as a physician in a small overwhelmed hospital run by the NGO Médecins Sans Frontières. I returned to Toronto sick and exhausted but convinced I was going to make the great escape. I was working in emergency rooms again, surrounded by friends. Things would be like always.

In this field of cold grass, where hours before my friends had been married, I heard ten seconds of a story, and during them realized there were things I had not reckoned on.

It was the taping of the gloves. The whine of the white tape as it stretched around their wrists, forming a seal between their world and the bleeding one in front of them. I could imagine the grimness with which it was done, could see the flat faces of the doctors and nurses as they stepped into the room.

As he was talking, I cast back to the measles outbreak that was just starting as I arrived in Abyei. One day we had two patients with measles in the hospital, the next day four, the next nine, the next fifteen. The rising tide of the epidemic soon swept over us.

I rewound to a film loop of me kneeling on the dirt floor of the long hut we had built out of wood and grass to accommodate the surge of infected people. I was kneeling beside the bed of an infant who was feverish and had stopped drinking. I was trying, with another doctor, to find a vein. The baby’s mother sat helpless on the bed as we poked holes in her child. She was crying. She wanted us to stop. Small pearls of blood dotted his neck, his groin. We failed, his breathing worsened, and he died. I stood up, threw the needles in the sharps container, and walked away to attend someone else. Behind me his mother wailed. I can see my flat face.

Who was that person? I am not sure if I know him, not sure that I want to.

People who do this type of work talk about the rupture we feel on our return, an irreconcilable invisible distance between us and others. We talk about how difficult it is to assimilate, to assume routine, to sample familiar pleasures. Though I could convince myself that the fissure was narrow enough to be ignored, it only took a glance to see how dizzyingly deep it was.

The rift, of course, is not in the world: it is within us. And the distance is not only ours. We return from the field, from an Ebola outbreak or violent clashes in Sudan, with no mistake about how the world is. It is a hard place — a beautiful place, but so too an urgent one. And we realize that all of us, through our actions or inactions, make it what it is. The people I left behind in Sudan don’t need us to help them towards a health system that can offer immunizations — they need the vaccine. Fucking yesterday. Once that urgency takes hold, it never completely lets go.

Just as our friends wonder at our distance from their familiar world, we marvel at theirs from the real one. We feel inhabited by it. We plan our return.

I have done this work before, but I have never looked back. Now I will. I am going to wear that flat face again, toss and turn in a tangled bed. But I also will feel, for the second time, the cool relief when a child I had bet everything on started to recover, to stand close to the young soldier who volunteered to give blood to a woman he didn’t know, to visit again the members of my small team. Some of the work in repairing the world is grim; much of it is not. Hope not only meets despair in equal measure, it drowns it.

This book started as a blog that I wrote from my hut in Sudan. It was my attempt to communicate with my family and friends, to help bring them closer to my hot, hot days. It was also a chance to tell the story of Abyei, Sudan, a torn, tiny place straddling a contested border in a difficult country. Mostly, though, it was where I told a story about humans: the people from Abyei who suffered its hardships because it was their home, and those of us who left ours with tools to make it easier for them to endure. It is a story that could be told about many places.

The blog became popular. Part of me wants to believe it was because of my writing, but that’s not it. It is because people are hungry to be brought closer to the world, even its hard parts. I went to Sudan, and am writing about it again, because I believe that which separates action from inaction is the same thing that separates my friends from Sudan. It is not indifference. It is distance. May it fall away.

So, this is where I stand, at the end. In the dewy grass, sparks stretching to the sky. It is cold away from the fire, and I shiver. In the distance I can see light bursting from the farmhouse door. Inside, people are dancing. I thrust my hands into my pockets and walk across the field, away from the end, towards the beginning.
the beginning.
It was my mistake. The beginning was not that clear. It fooled me again and again. It was like preparing for a marathon. You think it starts on the day you decide to do it, when you lace up your shoes for the first time, step outside, and look at your watch. But soon it is the day of the race, and that is the beginning. But no, here you are shuffling to the starting line with a thousand others, high with anticipation. This must be it. Then, the shot.

The real beginning of Sudan, for me, was when I dropped my bags into the dust of compound 1, looked around me, and saw no one. That was the moment, that was the starter’s pistol. Go.

The larger story, the soft bookends to my time in Sudan, began when I was twenty-three years old, a medical student between my first and second year. Most of my friends were taking vacations or were busy in Canadian hospitals, trying to add lines to their CVs, when I stepped onto a flight to Santiago, Chile. I had received money to support a six-week international rotation and was looking to impress my older girlfriend. It was my first time anywhere that was somewhere else.

On my first day of work there, I hung off the back of a bus headed towards a public hospital and reluctantly handed my fare to the person next to me. Minutes later, my change and ticket were returned, passed hand to hand through the crowd. It was at that hospital that I saw a man whose fingers were so heavy with gout, so knotted, that he couldn’t pick up a coffee cup. I was working with a cardiologist who spent his days employed in a public system where families tried to find someone with a credit card to finance their grandfather’s angioplasty. At nights, he travelled to private hospitals to consult on the health of the wealthy so he could send his children to university. I went home convinced that if I was being trained to take care of the sickest, they surely were in other places.

For my residency, I chose emergency medicine because it would give me the widest set of skills, and wouldn’t require me to have a patient practice. I would leave no one in a lurch when I left Canada for weeks at a time.

The story started in rural Cambodia four years after Chile, when I spent a month alone, as a new medical resident, conducting medical clinics in the morning and a needs assessment in the afternoon, trying to understand the health needs in a group of recently surrendered Khmer Rouge. I arrived at the Phnom Penh airport with a backpack full of donated pills, and a letter from the commander of the valley guaranteeing my safety. I drove south with a borrowed translator in a borrowed Land Cruiser and found fourteen thousand people who had exchanged one struggle for another. Instead of fighting the government, they were fighting to carve rice fields from the jungle. It was there I ate my first meal surrounded by starving people, there I saw a woman whose breast cancer had pushed through her skin and to whom I had nothing to give but acetaminophen, there that I walked out of my guest house to find food and stumbled over the feverish body of a woman nearly dead from HIV left at my door, like a cat would a mouse. Overwhelmed and alone, I first discovered my helplessness in a world beyond my control.

I returned to Cambodia two years later to set up a university project that would introduce new doctors to the medicine of poverty. I looked at a heaving shelf stacked with reports on reports of how Cambodians should address their own health and realized that as the one with the resources, it was my privilege to waste them. I set up a meeting with a Cambodian health official and asked what he would have me do.

After I graduated from my specialty training, I heeded the advice of a teacher who told me not to let my lifestyle expand to accommodate my potential income. I rented a small apartment in Toronto and rode my bicycle to the emergency room. I made it six months before leaving for Bolivia, then to southern Africa, to write about the ...

"A rich story that gives a wonderful, raw awareness of what we are as humans. . . . Our hopes and illusions are stripped away, yet we are left not with despair but with a deeper appreciation and a sense of wonder. . . . Brilliant writing. I'm sure Maskalyk is a fine doctor, but he's an even better writer."
— Vancouver Sun

“One of the greatest successes of Six Months in Sudan is that it does not try to be anything more than it is—a moment in time. . . . [It] can be read and enjoyed by those who are interested in the humanitarian movement and in global issues, as well as by those who glance at the headlines and want to know what it is like to be there, responding to world tragedies as they unfold.”
—The Globe and Mail
 
“[Maskalyk’s] empathy is palpable. . . . As he details daily life on the drab compound—the inescapable heat and dust, the terrible food served by their hostile Sudanese cook, the petty bullying of the local militia—and the wrenching demands of the hospital, the book is vivid, and at times even funny.”
—The Walrus
 
“[A] gripping and humane account of a mission spent working for Medecins Sans Frontieres. . . . The crowded and airless hospital is understaffed, under-equipped and periodically invaded by groups of excitable militia. . . .Despite all this, Maskalyk does not lose faith in the work he and MSF are doing in places such as Sudan. If his initial, bright-eyed enthusiasm is soon buried under blood, dust and sweat . . . he retains enough humanity to find consolation in small acts of kindness.”
—Daily Mail (UK)
 
“Powerful and shocking. . . .We share [Maskalyk’s] immediate, intimate experience as he confronts so much death... and struggles with limited medical resources in often chaotic circumstances. Heartbreaking scenes are recounted with searing honesty and without a trace of self-satisfaction or self-congratulation.”
—The Irish Times
 
“A fresh spin on a familiar story about death, misery, life and survival. . . . This is not the first book to deal with aid work and the perils of war, but it is successful in bringing a blog-style conversation to the reader. Maskalyk's honest monologue depicts frustration, hunger, sickness and longing that any reader can empathize with. It also marks a path of self-discovery, as a young doctor comes to terms with what he wants in life, and a place changes him forever as a doctor and a human being.”
—The Gazette (Montreal)
 
 “The prose in [Maskalyk’s blog] is carefully crafted, often poetic, always deliberate. . . .What matters here is what he does with it—making it the core of a bigger story, a moving reflection written back home after an experience he always knew would be life-changing. . . . You’re there, in the dust with him—and, when the rains come, in the sea of mud. You’re there in the makeshift shelters that act as operating theatre, consulting rooms and isolation unit. . . .Most stirringly, you’re with him as he watches the first of many babies die of malnutrition . . . [and] as he tells grieving relatives that it is not MSF’s job to help them with funeral arrangements.”
—The Scotsman
 
“Six Months in Sudan offers readers . . . an interesting story and hope of understanding such a complex situation. . . . The difference between those who write from the sidelines, and those who write from within is striking. Maskalyk takes the reader there, pulls them into his tukul (hut) and almost smothers with the realities of trying to help.”
—Winnipeg Free Press
 
“Moving.... Honest and fluently written, Maskalyk’s book traces his rapport with his colleagues, his growing affection for his adopted town of Abyei and the readjustment he faces on returning to Canada. It is an absorbing insight into international medicine.”
—Financial Times
 
“Haunting. . . . the kind of book that makes sense of the senseless and builds important connections between those who have seen and felt what he has, those who aspire to do this kind of work, those who want to support the dedicated humanitarian service of others and those who just want to understand.”
—Canadian Medical Association Journal
 
“Maskalyk's soft prose is beautiful and invites with the right intimate details. He offers a rare window on the inner life of an aid worker, on what it means to be a humanitarian around the hard edges of war, and on the certain drive to go on. Why? Because in his words, `hope not only meets despair in equal measure, it drowns it.’”
—James Orbinski, author of An Imperfect Offering: Humanitarian Action in the Twenty-First Century
 
“This journey is beautifully told in sharp beats and lyrical notes. It is the voyage of a young doctor in a hard world and deep within his own heart.”
—Vincent Lam, author of Bloodletting and Miraculous Cures
 
“Six Months in Sudan is a wrenchingly heartbreaking account of distant agonies almost too pointed to grasp. Learning about Maskalyk's work there is stirring, but the real miracle is this book paints a picture so precisely and vividly that it becomes impossible to look away. This is Maskalyk’s accomplishment, and his gift to the Sudanese and to us. The shame of our indifference retreats before his exhortation: ‘learn, and understand,’ and perhaps a more bearable future becomes possible for all of us.”
— Kevin Patterson, author of Consumption

“This is an extraordinary book, a piercingly authentic account of the fear, confusion and hope of a young doctor newly deployed to a humanitarian crisis wrapped around by a war. James Maskalyk's commitment to survival – his own as well as his patients' - illuminates this account of doctoring in the sort of desperate place where it couldn't matter more.”
— Jonathan Kaplan, author of The Dressing Station: A Surgeon’s Chronicle of War and Medicine

“In Six Months in Sudan, James Maskalyk tells of his extraordinary experiences working as a doctor for MSF, without a trace of vanity or self-congratulation. His book serves as a salutary reminder of what it means to be an excellent doctor, and a brave man. For anyone who is interested in a career in medicine, or in courage, this is a book to read.”
— Gabriel Weston, author of Direct Red: A Surgeon's View of Her Life-Or-Death Profession