Six Months in Sudan (2 page)

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 traveled 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 neglected
diseases Médecins Sans Frontières was treating. I found a community of people carrying dusty bags with whom I shared sympathies and space. I learned that the larger question of these diseases, whether HIV or Chagas, was not how best the world could help those affected but whether we would appreciate our capacity to do so. No matter how many hollow zeros were added to the death toll, my family and neighbors could not understand what the numbers measured because they could not feel the consequences. The response to the tsunami was profound because the size of the wave could be measured by the height of the boat in the tree. If I presumed to work on distant problems, and to write about them, that’s what I had to show.

The story started when I was standing in a customs line, waiting to board the plane to Germany for pre-departure training with MSF, when my friend Matt called and asked why I had decided to go. I told him I wanted to see who I was when everything was taken away, when all the insulation between the world and me was removed.

It started when I arrived in Germany and shared my room with three African men. We stayed up late and talked about what we looked for in women and laughed at how different our tastes were. Later that week, we sat and calculated how much plastic sheeting we would need if our team found a hundred thousand refugees on our doorstep. And in a classroom in Bonn, with thirty others bound for different places, I was told for the first time that I could expect to come back different, that my friends wouldn’t want to talk about the things that I would, that I would have less in common with them than ever before.

I was sitting on the hard plastic chair outside my friend’s office in Toronto, waiting for him to get off the phone. My cellphone buzzed in my pocket and I looked at the display. It read “MSF Toronto.” On the other end was the human resources officer asking if I would accept a mission in Darfur, a mission with only men, a mobile one with security risks. I left the building, got on my bicycle, rode through leaf-filled alleys, and asked myself what I was willing to lose. I got home, read the Joan Didion quote that appears at the front of this book, and decided that I might as well risk it all.

Two months after the Darfur mission fell through because of security
concerns, deep in the Canadian winter, about to make other plans, I checked my email during a lull in an evening emergency shift and saw a subject line that said only, “Sudan?” I read the profile:

It started when I sent back the message “yes.”

I stood on the porch of the house where I had been allowed to quietly come and go over my last few uncertain months in Toronto waiting for a mission, and shared an uncomfortable hug with Steve. He was leaving on a vacation, and we wouldn’t see each other until I returned. He walked towards the fence and, before he reached it, spun around and took a few steps back. “It’s like the last days of disco,” he said, turned, and clattered the gate shut.

My final night in Canada, I walked through a skiff of new snow, my arm laced with Sarah’s. Though I’d been home the last few months, my heart was not. I wanted no ties. My departure seemed like a convenient breaking point for us, at least to me. We arrived at a bar full with my friends gathered for a birthday party. “So when are you going?” one of them asked, as uncertain as I was from my flightless holding pattern. “Soon,” I said. I lingered by the bar, sipping a beer, and after a few minutes caught Sarah’s eye. We spent a last night together in my borrowed home.

I woke up alone. I could hear Sarah. In the shower now, now on the stairs. The door creaked open, paused. Creaked shut. Gate clattered. I swung my feet onto the cold hardwood floor. The house was silent. I got dressed and walked downstairs. My packed bags were by the door, and I moved them to the snowy porch. I turned the lock for a final time, then dropped the keys in the mailbox. I had no home. I was free.

The story started when I was sitting on the plane, flying from snowy Canada to snowy Switzerland, my backpack wedged in the luggage hold below me, writing a letter.

12/02: jet plane.

in the airport, finally on my way. i have been waiting for a beginning for some time, not knowing where or when it would come. it’s here.

of the many lessons i thought i might learn with this, i knew one would be: “be careful what you wish. you might get it.”

i said i would go anywhere, that i wasn’t afraid of being isolated, that i had a wide complement of medical skills and could do a little of everything. i could work in a small team with little backup, improvise if necessary. if there was a time in my life where i could go to a place that required close attention to security, it was now. no wife, no kids, no house, no debt, no one waiting for me to get back.

so, i wished, then got it. i am off to sudan. a small town in the middle of the country, right on the border between north and south. for those with a grander memory of the struggle there, you will know that it has been at war for decades. much of it is between the south and the north. it is a conflict about resources. and allegiances. and history.

darfur has become a media story, particularly in the past three years. there the war rages on, and the fighting is vicious. but sudan has rarely been at peace since its independence in 1956. it has more people displaced from their homes, because of conflict, than any other place in the world. most of them are from southern sudan where war still smolders. the people there feel deeply the effects of chronic conflict. for a nation, it is like a chronic disease. one wastes away from thousands of tiny insults.

the place that i am going is called abyei. you can check it out on google earth. it looks like a smudge in the sand. it sits in an area claimed by both sides but owned by neither. tensions, i have been told, are high.

i will be working in a small hospital with a small team. the patients will be regular size. the mission is a new one, and there isn’t much infrastructure. aside from that, i know little else. i will find out more in geneva.

boarding now. i learned something else these past few months: one shouldn’t think with certainty about the future. it has helped see me through.

that’s it for me. boarded. wine service. better take it while i can get it. soon, suddenly, sudan.

I
ARRIVED IN GENEVA
on an overnight flight and stood sleepless, blinking under bright lights. I hefted my two bags from the circular parade of black cases and looked at the clock. I was overdue at the MSF office with still a train to catch.

This is the way it works in MSF as a volunteer: you are either in or you’re not, you buy it or you don’t. You take public transit and stay in hostels. You brief sleepless and fly economy. An unnecessary dollar spent on you is one less for the field.

I put my backpack on and tightened the straps until it felt snug and weightless, then stopped at a kiosk to get a train schedule. Minutes later, the Swiss countryside was blurring beside me.

I walked from the train station, with my backpack on and my suitcase rolling behind. The office was twenty minutes away by foot. Geneva was temperate, its streets bare of snow. Taxicabs slowed beside me and honked. I waved them on.

On a final corner sat a building draped in scaffolding, and behind bright metal bones a banner shouted: “Malaria!” I pushed through the glass doors and into a hallway lined with posters. One showed a pill set like a jewel into a gold ring; another decried rape in the Congo. People walked past them, talking loudly, papers under their arms. A woman with a large backpack on edged past me and out the door. I walked to the front desk. The woman behind it hung up the phone to have it ring again. I smiled and waited.

On a whiteboard beside her was written a list of names and countries: people leaving on mission, people coming home. Mine sat misspelled in the “Out” column and, beside it in brackets, “MD North Sudan.” When she was done, I pointed at it.

“That’s me.”

She looked down at her busy desk. On it was a piece of paper with names and times: my briefing schedule. She handed it to me. At the top was: “James Maskalyk MD (Sudan) Stay in Geneva: 12.02.07 to ????”

She showed me to a room where I could store my things. It was full
of luggage. People leaving, people coming home. The walls were lined with rows and rows of gray plastic boxes, on their mouths written “DRC” or “Mozambique” or “Myanmar.” Inside some were letters, or small bound parcels making their way to the field. They were grouped together geographically. I traced my finger from Asia to Africa, from South to North, and next to “Tschad” sat a box labeled “Northern Sudan.” I shook it. It was empty. I stepped from the room and closed the door.

I sat in meeting after meeting, sleep headache bunched behind my eyes, and tried to concentrate. Facts that were meant to illuminate my days, the course of my months, were laid out before me. I was told about life on mission, how one should behave around alcohol, around drugs, about the perils of sleeping with one’s team members. I was given the layout of the hospital, the pattern of pathology, the hierarchy of responsibility. I was told about the diseases I would see, ones that my medical training rarely touched, ones I had encountered mostly in textbooks. Malaria, tuberculosis, guinea worm. In my satchel was a sheaf of papers I had already printed off, some on leishmaniasis, some on leprosy.

I would have no access to x-rays in Abyei, no basic lab tests. The nearest surgeon was three hours away, and the road to him was not always safe. I would be expected to birth babies and handle trauma. I was asked if I would perform an abortion if it was medically necessary. I said that I would.

I was responsible for the Sudanese people in the hospital, but so too the expatriates on my team. I was told that the doctor I was replacing was leaving after only three months to pursue a master’s. I wondered how many master’s started in March.

During my last meeting of the day, I learned more about Abyei. The project was the crucible where North meets South. In a peace agreement signed two years before, the one that ended Africa’s longest, bloodiest war, it was agreed that the Abyei question would be settled later. Soldiers from each side faced each other across an invisible divide and between them sat the hospital. And our compound. And soon, me.

Everything around Abyei was a vacuum built by twenty years of guns. One that both sides, South and North, were trying to get people from all over Sudan to fill in preparation for a referendum that was to determine Abyei’s fate, and with it the destiny of Sudan.

There were a few other NGOs in the area, and a large UN mission. Together we were in the middle of nowhere. Us and thousands of Sudanese people returning to make a home where there was none; canaries in a coal mine.

I shook my head clear. I was in the security briefing with the operational director. This was important. I should write this down.

Where’s a pen?

“All right. Well, I guess the biggest risk is full-scale war. Not very likely at the moment, but it can change quickly. Okay?”