Quotes from Six Months in Sudan, by James Maskalyk

- ‘I was kneeling besides 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 to 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.’ (4)

- ‘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.’ (4-5)

- ‘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.’ (5)

- ‘This book started as a blog that I wrote from my hut in Sudan.’ (5)
- ‘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.’ (8)

- ‘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.’ (9)

- ‘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 ids, no house, no debt, no one waiting for me to get back.’ (12)

- ‘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 was that I would.’ (15)

- ‘After two days of briefings, they were nearly done. My last meeting was with a woman in the communications department. I explained to her my intention to write a blog, and my hope that it would allow a different exposition of life in the field. It would be insistent, rough, and fresh. It would fit our mandate of témoignage, of bearing witness. MSF Canada was fully supportive, had set up space on their web page that could be updated by text email, even by SMS. I was going to be the first to try it out. The communication liaison was reluctant. She explained to me that an MSF worker, the year before, had kept a blog in Sudan. In it, she had come out heavily in favor of the Darfurians, and labeled the Khartoum government complicit in the tragedy playing out there. It was an unwise public declaration when our presence depended on the permission of the northern Sudanese government. All of our visas, all of our supplies, most of our national staff were passed under Khartoum’s watchful eye. It was an administration known for its attention to details. Anything I posted would be read not only by my family and friends but by Khartoum. That was certain. And if they perceived we were interfering in their activities, they might begin to interfere with ours. I said I would take great care. I had been briefed in Canada by the communications department, and was aware of the risks for my team as well as for MSF in a country known for its resistance to outsiders. My interest was not in telling the political story, not exactly. It was detailing the medicine of poverty. Readers could draw what conclusions they wanted. I passed her the URL of the few posts I had written so far. She promised to read them.’ (17-18)

- ‘From the center of Sudan, a lonely mark arced out past the edge of the paper and stopped at a label that read “Abyei.” Surrounding it were five small faces. The team. A field coordinator, a logistician, an administrator, a nurse, and the doctor I was due to replace.’ (18)

- ‘It was obvious who was on their way to the field and who was coming from it. Those who were leaving were well dressed and curious, their eyes full of questions. Those coming home wore their months on drawn faces, curiosity stamped out.’ (19)

- ‘I would be responsible for all of the inpatients in the hospital, and all emergencies. I would be supervising one Sudanese MD, newly graduated, and two Sudanese medical technicians, both of whom had done a short training course and could diagnose and treat simple things, like dehydration and malaria. Second, there was the therapeutic feeding center…I would be responsible for collecting statistics and monitoring epidemics. There had been some deaths from meningitis in a nearby military camp, and Abyei was cinched, with much of Sudan, by Africa’s meningitis belt. Further, a couple of cases of measles had been diagnosed nearby. The last vaccination campaign in the area had been years before. Finally, I should be prepared to handle several wounded at one time. There wasn’t just the threat of multiple casualties from an outbreak of war, but a week ago a vehicle collision had sent thirty people to the hospital.’ (30-31)

- ‘Like in most MSF missions, national staff make up the vast majority of employees. Nurses, cleaners, cooks, drivers, guards. Of the forty or so people who work for MSF in Abyei, only five of us are expats.’ (50)

- ‘When I ask people in the hospital where they are from, they answer in days. ‘Three days away.’ ’ (62)

- ‘I visited compound 2 on my first day, with Bev. Haven’t been back since. I don’t go to the market anymore. Nor anywhere else. I talked with patients through a translator, or Mohamed when he is around, and only some of the Sudanese nurses speak English. Most of the time I walk around in a bubble.’ (69)

- ‘If there is any ethical imperative for a central administration to assume some responsibility for the health of its people, it is tempered by our presence. The people here are getting free care. Why hurry?’ (79)

- ‘I asked a first-mission nurse, disheartened midway through her nine-month mission, what she found most difficult about the job. ‘No feedback.’ This work is not what one does if he is interested in being told that he is doing the right thing. We are expected to know. The work is not easy, not for anyone, and it never ends. If you keep on looking over your shoulder, waiting for a pat on the back, you’ve missed the point. It’s not about you. If you are expecting it to be, better you stay at home. Still, at the end of a long day, it is an easy thing to miss. My blog is good for that. I’m lucky.’ (102)

- ‘This is not my country. I can’t meet someone in the market and make a friend, I can’t make a joke with my patients. So when I seem frustrated, it is not with what you are doing. I promise. It is because I feel helpless. Okay?’ (127)

- ‘I don’t think that I will end up ruined, but there are certain things that are going to be tough to share. Things that would make poor dinner conversation (Hey, have you ever heard an infant’s heart stop? Don’t you think it is like the silence must be after a train wreck, deep in the forest? Once the metal has stopped creaking? Like all this activity, and then this final vacuum in place of all the sound?” I can imagine meeting people on the street, and being asked how my ‘trip’ was. (…you know the feeling when you and your friends are cleaning up after some young mother dies and you can hear her baby cry and you’re all praying to yourselves, please don’t let anyone look me in the eye? You know that feeling?)’ (170-171)

- ‘As a doctor at home, it is rare to have one of these experiences, but when you do, you often bear it with others. Another doctor, or nurses whom you know. You sit and talk about it. It doesn’t make it go away, but it diffuses some of the weight. I don’t do that here.’ (171)

- ‘The damage done by bullets designed to kill humans is different than ones we use to hunt animals. When we fire a bullet towards an animal, we hope to kill and eat it, not destroy it. The ones made to shoot people are designed to tumble and fragment after they penetrate the tissue, transferring as much energy as possible to the body, creating as large a hole as possible.’ (174)

- ‘As the MOH designate, it is Sylvester’s job to act as coroner. The arriving soldiers were not satisfied and demanding their own inspection of the body. They charged past, ignoring Marco’s request to leave their weapons at the gate. Soon a swarm of armed soldiers was milling among our patient beds, asking questions. At least three of the families in the feeding center left. We evacuated all MSF staff from the hospital. It was Marco’s only card to play, to withdraw activities. If such impositions continue, we close the mission. They lose the free care for their soldiers and their families, and gain the ill will of a community.’ (181)

- ‘We could easily take one of our cars, the pickup for instance, and offer the family some relief from a cruel day. But we don’t. We cannot be a hospital and a hearse service. Nor when someone knocks on our compound door, his eyes as big as moons, and says ‘My wife, she is delivering at home, but the baby is stuck, can you take her to the hospital,’ can we be an ambulance service. No, we say, you need to find a way, and quietly close the gate. These are impossible decisions because their wisdom is easy to see, but they are contrary to one’s spirit.’ (188)

- ‘Everyone in our mission smokes furiously. MSF. Part of the reason is the isolation, the idle minutes. As it has been said in many languages, when you have a cigarette, you always have a friend. The other part is that in the face of all the sickness and early death, one’s health falls from constant focus. You look around at the other passengers, and from all accounts, if it looks like the plane is going down, smoke ‘em if you got ‘em.’ (195)

- ‘I remember talking with friends about how I could manage to work, during my residency, 30 sleepless hours in the hospital, leave it to sleep, then return. I explained that the last thing to go was my capacity to perform medical duties. I could sort out a high potassium at five in the morning. What I lost was my ability to offer the patient something beyond the task. I would walk in, inject the proper drugs in the correct amounts into their IV, mumble something neither of us understood, then stumble out to do something else. The tiredness I feel now is different. It has been a slow erosion.’ (208-209)

- ‘One of my friends told me once that, when she was having a personally difficult time (someone in her family was sick and her relationship was crumbling), she poured herself into her general practice. The more she worked, the more patients would stop on the street and say ‘Hello, Doctor Soandso,’ the more they would send flowers. Not only was she caring, she was being cared for. Of course, in the end, this was not an equitable relationship, not the true contact someone needs to feed their bruised spirit, and after several months, she burned out.’ (209)
- ‘ ‘This is the maternity ward,’ I say, standing at the doorway. ‘Basically, I have no idea what is going on in there. We had a midwife, but she split.’ Angela’s eyes are wide. Around us, children cry, mothers mill about, forty outpatients are queued at the front, some holding babies, others with their heads in their hands. One of our cleaners starts our gas water pump, and it roars to life. He puts one end in a blue barrel, filling it. As he pulls it into the next, it sprays loudly, splashing us in the transition. Chaos. ‘Don’t worry,’ I say. ‘It gets smaller.’ ‘I wasn’t expecting this,’ she says. ‘Where do you start?’ ’ (229)