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Six Months in Sudan

Canadian Medicine is pleased to republish the first chapter of Dr James Maskalyk's new book, Six Months in Sudan, about the time he spent working for Doctors Without Borders in Abyei.


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.


Excerpted from Six Months in Sudan by James Maskalyk Copyright © 2009 by James Maskalyk. Excerpted by permission of Doubleday Canada a division of Random House of Canada Limited. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.

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1 comments:

  1. sharon21 April, 2009 7:50 AM

    Keeping aware of the human condition:

    This is an interesting chapter. This is a revealing chapter. I would not recommend reading this book in isolation from other written works describing the " journey of man".

    The ones that spring to mind are "The Great Divorce" by C.S.Lewis. The character in that book that springs to mind is "the tragedian".

    The other is Pilgrim's Progress by Bunyan.

    "Whole" people never discount or dismiss the experience of another as they recount details and recall impressions.

    "Whole" people have a "sense of other" more profoundly than a "sense of self".

    You cannot travel beyond the context of the "tourist world" in any country without seeing the impact of "man's inhumanity to man".

    You do not even need to leave your own house or neighborhood to feel it's sting and it's sorrow.

    I do not intend to dismiss the reality of this doctor's experience.
    I simply challenge that a "changed" life makes sure that the new road it walks upon leads to the "celestial city" not back to the "slough of despond".

    For every man In the 'here and now'... the closest look into depravity as well as potential for good....is as close as the bathroom mirror.

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