Doctor, Writer, Volunteer, Humanist: A conversation on Six Months in Sudan with James Maskalyk

"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 me from my friends. It is not indifference. It is distance. May it fall away."

James Maskaly, Six Months in Sudan

Why did you choose to go Sudan? What were you looking for?

I had my first real experience travelling when I was in medical school. I secured some money to do an international elective in Santiago Chile. I'm from northern Alberta and I'd been to Disneyland once. I didn't know you could do something as simple as get on a plane and be in a new place and really be exposed to a whole new world. I realized that my story is just one of six billion stories and if I fell under the wheels of a bus, the world would just go on. It's an important perspective that many people share for their first big travel experience.

I also had my first exposure to the medicine of poverty at a very formative part of my career. I saw people who were so sick and lacked the necessary care. I felt that if I was being trained to take care of the sick ones, they were definitely in other places than Canada–or so it seemed. From that point, I built myself a career that was leading me directly to a place like Abyei.

The other half of the story is I think I watched a lot of MASH when I was a kid…

If I asked you to describe Abyei to our readers in three words or less, what would you say?

Hot, dusty… and soldiers. Those are the three things that jumped into my head.

Tell me a bit about the Dinka people, who seem to make up most of the population of Abyei. What did you learn about them?

The Dinka are nomads who have lived in that area for hundreds of years and have travelled with the seasons. You know they are Nilotic people, very tall, and they value their tribal system. They solve disputes by mediation–chief to chief. They have an undying adoration of the cow. They value it and they use it as a system of currency, as dowry, and as a muse for their poems. But I think they are a people who are transitioning. I think the harsh geography of South Sudan isolated them from outside influence and this has changed a lot since the war. Now there's an influx of NGO's and hospitals, things like that, and they're facing certain challenges to their way of life. Not just because the concept of being a pastoralist is becoming obsolete due to a shift to borders and land ownerships…

And scarcity of resources…

Yes. It is also difficult to move in times of conflict across borders even though most of the time you can't see them. They are a very proud people but these factors are contributing to the loss of their traditional way of life.

The way you've described them in your book–the word stoic comes to mind. I don't know if that's the right word.

It certainly is the right word. However, my experience is limited in that I was in a very rare setting in Abyei. These are people who just spent years living in refugee camps fleeing from fighting. Was the lack of easy smiles a natural tendency of the Dinka to be more reserved or insular? Or was it just because they were just waiting for the other shoe to drop?

They are certainly not living in their natural environment and under normal circumstances.

I noticed a similar behaviour when I worked in Cambodia. There was a similar sort of glare as if they were assessing and interpreting rather than engaging. Under normal circumstances, the Dinka people–who are easy for me to recognize because they're so tall–are so wonderfully genuine and friendly.

Do you ever get tired of talking about Abyei and your experiences there?

No, not at all. I always feel like I want more experience. I've done this a few times, I always want more, but I don't want to just talk the talk, I want to walk it. It's been about two years since I wrote a book about it but when I talk about Abyei it still seems real. I know it's a real place, I look at pictures of it all the time, but it's difficult to engage with the past. So I don't feel like I'm engaging with it as fully as I might in the future if I ever go back there again, or as I did at the time.

There still are parts of my book that I can't really read. But I have to make it a point to remember because it's a very real place that's really struggling right now. Those people are facing the same challenges today that they did two years ago. And not just in Sudan–people around the world are facing the precariousness of living right on the edge.

After reading your book, and I may be off-base here, but it seemed like you were removed in a way. Obviously not from the work, the patients or your immediate environment. But a lot of the analysis and interpretation of what was going on seemed to happen in your head. Is that just the way you're wired or it was caused by a combination of sleep deprivation, culture shock, stress, and so on?

I think that's kind of the way I'm made. I can't speak to all writers but at some level, there's an observer quality in a writer's personality that makes them reach for a pen in their pocket and to step back. As soon as you retreat to your interior space, you're not in your exterior space and you're not engaged - you're observing or interpreting. So I think that perhaps as time went on, I inhabited a more interior space because I had very few opportunities for easy communication, familiar communication. The people on our mission spoke Italian. There was maybe one person there who spoke good English. And we were so busy, working in a place where you don't share a common language, and seeing so many people die… you become increasingly focused on the existential kind of questions and you start to have this internal dialogue.

That's something that we hear from a lot of people. It is difficult to adapt not only to your host culture but working as a member of a multinational, multicultural team is also challenging. Do you stay in contact with any of your MSF colleagues from Sudan?

Yes I do. Mohamed and I speak on Skype sometimes and we email back and forth. I sent him a copy of my book. I also communicate with Ibrahim, who was our lab tech. I hope I have an opportunity to meet them face to face again.

At one point in your book you described a meeting with local leaders–the community is dissatisfied with the work of MSF and by your own description, you guys basically get chewed out for about an hour. How frustrating is that?

It's really frustrating. You know, I think what was required of me was a proper perspective. It's an example of how I ignored my own advice; do not do this work if you expect to be congratulated for it.

Don't expect a pat on the back?

It's not about congratulations. What it's really about is treating the patients and looking to the community for advice on how to better meet the objectives you set out for yourself and try to work as closely as possible with them. But also to understand that it is likely in their interest to advocate for themselves as much as possible. Why wouldn't they ask us for a helicopter? Why wouldn't we give them one? Why wouldn't they ask us for better referrals or better transportation, or an x-ray machine? Of course they want the best for the people who suffered for so long. So when the laundry list of things that we weren't doing was paraded in front of us, it was a bit tough. I only better understood once I gained perspective.

And if the shoe was on the other foot, we'd be doing the same thing. You people come in and you have lots of money. You can do better and here is our list.

Especially when you look at the UN going around and having access to all these resources. At MSF we had a limited amount of resources but we had enough to do the job we set out to do–but only just enough for that. So when we rightly stated our limitations I can understand how they seemed like refusals, but they weren't.

You wrote in your blog on a regular basis while in Sudan and you stated that originally, it was just a way to keep in touch with family and friends, let them know what was going on. Was that ever your real intention?

In some way it was. Basically it was just to write. There is one truth about writing, and what separates writers from people who want to be writers: writers write.

But you could have written into a journal.

Yeah I could have done that. The second part of it is I always kind of hoped that by getting my writing out there that something would happen. I never imagined a book. I thought that it would be an article in the Globe maybe or the Toronto Star.

I had previously travelled with MSF in 2005, writing the blog as a journalist. I realized that it was an easy-to-publish platform and an opportunity to really get the word out there, to tell a story. It was tremendously important for me.

Was it a form of therapy for you?

I think if anyone does a work of creation, whether it's a poem or work of art or new song or a book or a blog, if it's a public act in some way, I think you're looking for connection with other people, or with yourself in the future or the past. I think in terms of the questions that I was asking myself, it became more than just a story, like "Hey I've arrived in Khartoum and it's hot;" it turned into more of "Why are we here? What are we doing here at all?" By this I mean as a people, why do we care about people far away? I got to ask these questions that were sincere ones that I had for myself that I didn't know if there was an answer to. After the blog became a phenomenon I realized people did connect, people were interested. That really heartened me so much. I wasn't looking for congratulations; it's not like what I did was particularly remarkable–I was surrounded by people doing the same and even more. But I realized that people were really interested and did care. There seemed to be a true worth to human life that we all recognized somehow and I think that it became an opportunity for me to perhaps better connect with the answers to those big questions.

Before you actually landed in Sudan, you were at MSF in Bonn for pre-departure training. You were told there that you should expect to come back different. How different were you on return?

I don't know. It's kinda like the Heisenberg uncertainty principle–there are some things that are unknowable. You can know the position of a particle or you can know the speed, but you can't know both at the same time. If you try to measure it, you change its speed. And so I think that it's tough for me to say what changed in me. I've asked my mom the question and she said "I think you're more serious." And you know I think perhaps that's probably true. There wasn't a lot of room for levity or irreverence in those places–although I love irreverence so much.

There's a certain seriousness to this kind of work that you have to balance out with celebration and a love of the best and most beautiful parts of life because if you don't, you can forget why you're doing it in the first place. So securing and cultivating those things in your day, in your life, I think are valuable. I think that there was a certain tendency towards self-immolation when I came back.

As I wrote in the book it was about six months before I felt joy; feeling I wouldn't want to be anywhere else, this is really great. And I think that dissonance fades somewhat with time. My first experience in Cambodia where, for the first time, I had that overwhelming feeling as a doctor, was perhaps the one that changed me the most. But I look at my life now and I don't own very much – I live in an apartment. I imagine going away again and that's somehow who I am now. I don't have a lot of attachments. Whether that was me before or me after, I don't know. We get back to that Heisenberg uncertainty factor again.

What are you more passionate about: writing or being a doctor?

In a way, I think I'm a writer that became a doctor. I learned to be a doctor but I've always had a fondness for sentences. I love them. I think my future includes more medicine because I've learned that I truly like challenges and I've really learned to love it. I love the opportunity, it's invigorating and it allows you to ask these big questions about not only what is a life well lived, but what is a good death. It's got all these robust ideas in it. But my future has writing in it as well. I've got another book to write for Doubleday and I love the opportunity to sit there and not just try to tell a story but imagine how can I write better dialogue, how can I make it more real. That's really a creative challenge where medicine is very utilitarian.

If you had a few words of advice for people who will be following in your footsteps, first-time volunteers in a high risk area similar to Sudan, what would you tell them?

I tell students that if you are thinking of doing this kind of work, your job is to work yourself out of a job as quickly as possible. Pursue at the most extreme haste your own obsolescence because you are not there to perpetuate your own necessity but rather to give people the tools to allow themselves to be free.

In a perfect world, if you do your job right, they don't need you anymore.

Exactly.

In terms of learning from the mistakes that I've made, I probably was a bit too serious in Sudan. I would interact a little bit more carefully and genuinely with the population that I worked with. I'll borrow the advice of one of my mentors who told me, before I left for Cambodia, of all the things you do, make sure that you enjoy it because if you don't, then you're not going to want to go back. And I think that was sage.

Additional Learning

Six Months in Sudan Website
Doctors Without Borders: Sudan
Canada: Active in Sudan