Something to Write Home About: James Maskalyk of Doctors Without Borders On His Work In Sudan

After 50 years of civil wars that have killed 2 million people and turned millions more into refugees, it appears as though the people of southern Sudan will finally have a chance to become independent from their country's Arab north. But as this nation is preparing to split in half, the focus is shifting to Abyei, which straddles the designated northern and southern regions and where a microcosm of the countries' tensions persists. It has been called the most contested, most emotionally-charged and, recently, the most violent piece of land in Sudan.

In fact, the region was due to hold its own referendum to decide whether it will join what will be a newly-independent South Sudan, but it's been delayed over disputes between the north and south over who can take part. As militias continue to clash, more than 75 percent of the population still lack access to basic health care.

It seems like the perfect time to publish this interview with a doctor/writer/activist who spent six months in Abyei with Doctors Without Borders. James Maskalyk managed to work days on end amidst the stultifying heat, the indescribable poverty and the constant desperation and to still find time to write almost daily on a blog to give an unprecedented look at the gruesome reality of third world medicine in one of the poorest countries in the world. Sometimes funny, sometimes heartbreaking but always insightful, it's not what you might expect to read from the frontlines of humanity at its worst.

In the process, Maskalyk is forced to struggle with the toughest of questions: How do you convey what you've seen and what you hope can be done to save the people you've only been able to help for such a short time? How do you combat compassion fatigue and encourage people to see beyond the tragic statistics? What do you DO with the despair and gaping need you've witnessed?

CS: So, when you started the blog, who were you writing for? And what were you thinking you were going to accomplish with that?

JM: More or less I was writing to my mom and to my friends who I'd left behind, I guess. My goal was to help make sense of it. You come away from an experience like that with a heavy weight on you. I'm [wondering] how could I save Sudan, you know? How can I just raise awareness, but [also] give routes to action as well?

CS: Not just let despair take over.

JM: Right, but there's also the little changes. Like one out of 10 women can read in south Sudan. We know enough to know that when women aren't empowered in any society, the society suffers. So, I figure if there's one small change I can make it to find Aweil's father [she is of the young girls he bonded with] and say "When it's time for her to go to school let me know and I'll come back and I'll make sure that she's able to, to attend school and maybe..."

CS: Clearly there is so much symbolism in your care for her and your coming to terms with what your role can and can't be. For some reason, that girl just brought it all out in you.

JM: When you say you're going to do something and then do it. I don't want to be an asshole, like, that's basically rule number one. I feel like it would make me less of an asshole if I followed through on what I wasn't able to do while I was there, just make sure that she was taken care of.

CS: You even considered adopting her. But the advice you were given at the time by a veteran member of the MSF team was simply "it will pass." So is that jaded cynicism or realism or what is that? What happens to you guys when you've really been there, done that?

JM: It's probably the voice of experience, that's speaking there. A friend of mine told me she was just in Haiti and she saw a four-day-old baby who was so dehydrated that took a cup of water and started to try to drink from it. Four days old. Four days old. Used his hands to drink. I've never even heard of... you know... babies don't... even have reflexes. So the human in you identifies with the human in that person. The connection comes from the "I-ness" in me that is the same as the "I-ness" in you and when you identify that in someone who is suffering and you can diminish that, it's a lovely human response, right? And it's a very natural thing. It should be pursued and celebrated and in some ways that's what [organizations] like MSF are about. A very true, natural understanding that exercises a part that's in each of us, that when enunciated, feels completely correct, completely congruent with life's goals and doesn't diminish your own experience. It enhances your own experience. It makes you happier and better.

CS: Another anecdote that sticks out: the little boy with the relatively minor injury yet the disproportionate amount of care and attention that you maybe consciously or unconsciously to give him. Why do you think that was?

JM: I think it was, like a reliable bit of kindness, like I knew he was OK. I got to know his dad. It was a pleasure to have people come back and see me. And more or less, we both had an understanding that the hand was fine and nothing but, this was a chance for him to come and interact with me and for me to see him and to kind of make friends, you know, to be, like, just two men and have whatever kind of relationship. A lot of people were sick there and I didn't really have a chance to see them get better so to see something as simple as this was a pleasure.

CS: It must have been satisfying. And I think you see that a lot in all kinds of relief work and so forth -- you get burned out because you feel like you're not seeing any tangible results.

JM: You know, of all the good that happened in that mission and all the treatment and this and that, the best thing that happened was being able to say "Hey, I'm James and how can I help you?" And if you look at the world that eventually will be created in places like Sudan or south Sudan or Ethiopia... what a great example to have, right? We come from far away and we're not taking anything from you, we're here to give something back. We're here to volunteer our time.

CS: Do you feel like you've conveyed that message?

JM: I think so. I mean, I don't know how it's interpreted, but the way we do medicine now is different that it was 50 years ago. Like, I don't stand about the patient and talk about them. I sit down and I talk to them, I tell them my first name and that's new millennial kind of doctoring. As much as MSF does treatment on malaria and TB and HIV some of the best of that is saying we're here to help because it seems like you're suffering. That's such a great enunciation of what it means to be a human being, you know?

CS: I know that relief organizations are constantly struggling for ways to creatively get the same message out because, unfortunately, the tendency now is for the eyes glaze over. How do you tell the same story? Why is there still hunger and suffering?

JM: You get countries that have less than us, people who have been dealing with water and sanitation problems like India or Bangladesh and you give them the ability to respond to them and we will benefit from it. You know, we're not the arbiters of the world even though we think that that's the truth. I don't know if I'll live long enough to see the day but I've noticed that... we're not saviors or anything, that's not what it's about. When I talk to groups of students I say, you know, the 50 of you here... two of you are going to do this no matter what I say. You know, I could chain you to your chairs and you're still going to find a way to get on that plane and live that life because it's that path that you're on. So, I'm going to try to reach the rest, the 48 of you. I've found that doing this kind of work is some of the best enunciations of my medical knowledge, and my hope is to reach more like four or five out of 50.

CS: Are you saying all medical students should do a rotation in a third world country? Would you say that it's for everyone?

JM: I think that getting the picture is for everyone. I think having an understanding of the world you live in is for everyone and I think understanding that you shouldn't let your lifestyle expand to accommodate your potential income is for everyone. The more that you are able to live selflessly rather that selfishly is how you find your true self. [But also] I think it's not realistic for people to go away like I do for ten months regularly to pursue that type of work.

CS: So back to the question: once we know, what do we do?

JM: I think with time and experience you approximate more and more that true enunciation of how to answer that call about what to do with what you know and what I figured out is... have a bit of a longer view. While it would be easier for me to forget Sudan and jump into whatever my next mission happens to be, I think that [it's about] continuing to practice what you preach. So not just sitting there and talking about Sudan, but being able to engage again in that world is important. I always encourage young doctors to keep your hands dirty, you know, keep on engaging in that world because that contact, that human-to-human contact is where the real relationship lies and you can build something on that stable ground but the more distance you get from that the more quickly you are able to lose the plot, so continue to work and engage on the ground. And then I think it's really about giving people the tools for their own emancipation.

CS: The perfect sedgeway for me to ask you about your latest project in Ethiopia.

JM: [The goal is] to train Ethiopian doctors in emergency medicine. They will be the first in their country, and the first in Africa, outside of South Africa. in a few years, they will form the first cohort of specialist emergency physicians at Addis Ababa university, and assume the responsibilities of educating the young doctors below them. from there, the hope is that emergency medicine will spread throughout Africa, and with that, we will learn better how to perform in under-resourced settings, even in Canada and the U.S. we will only ever be asked to do more with less.

CS: What's your advice for people who are struggling with what we were just talking about? What do you leave behind? How do you do it?

JM: I think, you know, everyone's got different tools, right? I'm lucky in that, at the end of the day, I can go to places like Sudan and treat people and feel like that's my job. That's what I'm going to do and it may not be everything. It may not be a route to peace, but it's the least I can do. But I think the mistake people make is looking at all these huge problems and they look so massive. But the reduction of it is that the truth is the solution is the same. It's one person. What starts with one person, multiply that by six billion times. It's the same unit, right? Same unit as the problems is the solution. And so it starts with the level of the individual.

CS: So start small?

JM: If you try to take on peace in Sudan and you're up against not just adversaries, but history that you have very little control over. So, identifying in that large problem a small piece of the puzzle that you can affect is the first step. And then, actually, taking concrete steps to work towards it. You know, no one's going to lead you by the hand, unfortunately. No one can give you a road map. People ask that all the time of me "Tell me what to do. Just tell me where to go, what to do." I don't know. I don't know you. You know you. But start with something that is the level of the individual. That's the first step on the path. I would say also, too, give 10 percent of your time or your money. It doesn't matter which. Just 10 percent. And however you chose to do that is up to you.

CS: Sounds like a road map.

UPDATE: Maskalyk wrote to me recently: "I've been giving pause to your question 'once we know, what do we do?' for it is the essential one. I think an answer is: start and never give up."

The blog is now also a book.

This blog is part two of the series "Profiles in Nonconformity."