Six Months in Sudan: A Young Doctor in a War-Torn Village

In 2006 James Maskalyk, a young, single ER physician, gave up a successful practice at one of Toronto's finest hospitals to join Doctors Without Borders. Armed with a wide set of medical skills and unburdened by a family of his own, he volunteered to serve in the world's most dangerous places. After months of waiting, he received his assignment: a small village called Abyei, sandwiched in between two military compounds on the border of northern and southern Sudan.

Six Months in Sudan is the riveting memoir of a young doctor trying to heal a village on the brink of devastation. With tribal factions at war all around him, Maskalyk tries to keep the peace in his makeshift hospital while waging his own battle against war's terrible offspring--disease, starvation, and, perhaps most frightening, the numbness and hardening that threatens his resolve. In spite of the many losses he endures, there are victories great and small, medical and political, personal and communal, which buoy his spirits. And there are lighter moments, too--nights listening to the village jazz band and morning jogs across the African desert.

A memoir of volunteerism that recalls Three Cups of Tea, Six Months in Sudan is written with humanity, conviction, and piercing insight. Maskalyk chronicles the unthinkable cost of war for one community, and one man's courageous effort to bring about lasting change.

"When he signed up to do a stint with Mdecins Sans Frontires in 2006, Maskalyk, currently assistant professor of emergency medicine at the University of Toronto, volunteered to go anywhere the organization wanted to send him, writing, 'No wife, no kids, no house, no debt, no one waiting for me to get back.' He was posted in Abyei, an oil-rich region set squarely on the demarcation between north and south Sudan, where one of the bloodiest civil wars in Africa had recently ended. In a makeshift hospital, he saw dozens of sick people, most suffering — even dying — from treatable illnesses. In his six months of service, Maskalyk oversaw a measles outbreak and treated tuberculosis patients, mothers fatally injured during childbirth and countless malnourished children. Even if Maskalyk frustrates in his apolitical stance, refusing to ask why so many are suffering and merely lamenting the fact, he provides a raw and deeply felt account of his time in Sudan. (June)" Publishers Weekly (Copyright Reed Business Information, Inc.)

Given the malign reality of relief fatigue, even those of noble intentions have difficulty dealing with more than one disaster at a time. Mention Sudan and instantly Darfur comes to mind, while the rest of the country, along with the rest of the continent, recedes into obscurity. Yet when presented with an opportunity to serve in the tiny village of Abyei on the fractious line between north and south... Washington Post Book Review (read the entire Washington Post review) Sudan, James Maskalyk left an emergency-room post in Toronto and volunteered for Doctors Without Borders. For six months, he delivered babies, did his best with limited resources to comfort the dying, fought a measles epidemic, offered basic maintenance to TB and AIDS victims, and tended to soldiers and civilians wounded by grenades and gunfire. The work, heat, dust and discomfort were relentless, and the dedication of Maskalyk and his staff often went unthanked, even resented. But as he put it, "If you keep looking over your shoulder, waiting for a pat on the back, you've missed the point. It's not about you."

That there was something Sisyphean about the task goes without saying. Day after day, the grind continued, broken only by gruesome episodes and rare moments of joy. Maskalyk's roster of patients would have overwhelmed anyone less committed and less capable of compartmentalizing his emotions. Pregnant women dying of sepsis, babies dying in breech positions, kids dying of shrapnel wounds, adults dying for want of care that the primitive conditions in Abyei didn't permit — these constituted the existential conditions of life in a war-torn tribal village.

Maskalyk did what he could to cope. When not too exhausted, he went for a morning run. He paused to admire a sunrise or visit a little girl he fell in love with and considered adopting. He wrote a blog. But this caused controversy. His superiors at Doctors Without Borders feared he would upset the government in Khartoum and get the mission expelled. To his credit, the author never complains, doesn't despair and never melodramatizes his personal predicament or the overall situation in an area seething with armed militias. Just as he was determined to provide for his patients' needs, never aggrandizing his role or hinting at heroism, he presents the reader with an unvarnished reality.

This is not to suggest that Maskalyk ever became numb to experience, or that despite the suffering and harshness that he witnessed he wasn't sensitive to the dilemma of the people and the paradoxes of his job. He explains why Doctors Without Borders sticks resolutely to its mission and works within limits, but he concedes that "when a family comes kilometers over broken roads, carrying their dying daughter, and they arrive ten minutes too late, when you tell them that no, you cannot help them bury her ... the knowledge that you are being wise is poor comfort."

Considering Maskalyk's generosity of spirit, his courage and frequent astuteness of expression, it's unfortunate to have to quibble with some of his narrative choices. In an author's note, he acknowledges that "the conversations are from my memory and though their words are conjured, the content is not." But whatever its truthfulness, far too much dialogue sounds stilted or downright silly. To cite just one of example, Maskalyk reports a phone conversation with his girlfriend.

"'Yeah, I totally suck. But it's like ... a kid dies or whatever, and you're like, Hmm, what should I do now? I guess I'll just wait around for the next one.'

"'Oh baby.'

"'Yeah. Whatever. It's cool.'

"'Doesn't sound like it.'

"'It's OK. Sorry. Didn't mean to harsh you out.'"

Maskalyk's writing, like his medical treatment, improves when it depends on close observation and detailed description. "This is what happens if you are a Dinka child (dead at the age of 13 months.) Your father takes a small piece of string and binds your large toes together, to keep your legs closed, then wraps your feet. Your hands are placed grasping each other, and your thumbs are bound. Your fingers are then concealed in gauze. Last, he lifts you onto a piece of colored cloth and wraps you a final time." Austere as the Sudanese landscape, plangent as a ballad, this book has poetry in it along with pain.

Michael Mewshaw's new novel, "Lying With the Dead," comes out in October. He's finishing a book about Africa.

Reviewed by Michael Mewshaw, Washington Post Book World (Copyright 2006 Washington Post Book World Service/Washington Post Writers Group)
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An inspiring story of one doctors struggle in a war-torn village in the heart of Sudan

In 2007, James Maskalyk, newly recruited by Doctors Without Borders, set out for the contested border town of Abyei, Sudan. An emergency physician drawn to the ravaged parts of the world, Maskalyk spent six months treating malnourished children, coping with a measles epidemic, watching for war, and struggling to meet overwhelming needs with few resources.

Six Months in Sudan began as a blog that Maskalyk wrote from his hut in Sudan in an attempt to bring his family and friends closer to his experiences on the medical front line of one of the poorest and most fragile places on earth. It is the story of the doctors, nurses, and countless volunteers who leave their homes behind to ease the suffering of others, and it is the story of the people of Abyei, who endure its hardship because it is the only home they have.

A memoir of volunteerism that recalls Three Cups of Tea, Six Months in Sudan is written with humanity, conviction, great hope, and piercing insight. It introduces us to a world beyond our own imagining and demonstrates how we all can make a difference.

Dr. James Maskalyk is an assistant professor in the University of Torontos Faculty of Medicine and a founding editor of the medical journal Open Medicine. He lives in Toronto.