No Safe Return

Sometimes you start writing one book and end up writing another.  Nowhere is this more apparent than in Six Months in Sudan: a Young Doctor in a War-Torn Village, James Maskalyk’s painfully honest account of his six months as an emergency physician in a remote area of Sudan.  Answering the call for Médecins sans Frontières (MSF), Maskalyk served as a doctor in a town called Abyei, trapped—one might say—at the crossroads of the warring factions within the country.  His account of his duties is often disturbing, particularly in the details of the horrors he encountered virtually every day.  But the real story is the transformative nature of the experience itself, which exposed him to the depths of his self, and packed such an emotional wallop that he will probably never be the same.

In Abyei, Maskalyk says, no one dies from old age.  Life is too hard for that.  The doctors working for MSF are obliged—because of their agreement with the Sudanese government—to take care of the soldiers, who need their help but, perhaps more importantly, serve at an emergency facility for all Sudanese in the area.  These people, because of their limited education, more frequently than not go to the hospital only after their situation has become dire.  Trigger-happy soldiers are everywhere.  Women arrive after botched deliveries of their babies.  Maskalyk encountered virtually every conceivable complication with childbirth.

One woman’s body never ejected the placenta after her child was born.  Another woman bore a child but six days later arrived with part of a second child hanging out of her.  Still other women are rape victims, or have given birth to children with no idea how to care for them.  These details are not for the faint-hearted.  Maskalyk states, “We are here to save lives that would otherwise be lost,” but children, especially, die on his watch all the time.  Of the nights–the few hours when he’s away from the hospital–he says, “I can’t get away…  Not even in my sleep.”  Sometimes, sleep is impossible: “You feel that if you leave the hospital for a moment, let your guard down for one second, someone might die.”   Frequently, he asks himself, “Why am I here?”

Some of his colleagues at the hospital, unable to endure their living conditions, leave before their terms have ended.  It’s hot as hell.  There’s no air-conditioning.  Electricity must be conserved for the refrigerators in the pharmacy or the operating room.  In the dry season, sand gets into everything; in the rainy season, everything turns to mud.  There’s a measles epidemic.  Reflecting on everything that happened to him in Abyei, Maskalyk notes, “I never felt I could get away.”

About Sudan’s bloody on-going civil war, Maskalyk is particularly candid: “Wars no longer take their greatest toll on combatants, but on civilians.”   The international aid workers (especially MSF and the Red Cross) are “increasingly seen as part of the conflict, a political pawn in a larger political game.”  And he adds, “From what we can gleam, the fighting is between opposing militia.  Both armies, the South and the North, find it more politically convenient to use groups of armed civilians to do unofficial fighting to make a point or to raise uncertainty without declaring war.”

The narrative juxtaposes sections from Maskalyk’s recapitulation of his experiences in Sudan with passages from the blog he wrote while he was in the field.  In one brief  section from the blog, the author distills the essence of why the situation is so bleak: “dead body problems.  when someone is sick in a village, they don’t come to the hospital straight away.  there is no road.  transport is too expensive.  often the family calls a traditional healer, and they spend their carefully collected money, likely saved for this exact contingency, for treatments that do not work.  the patient worsens.  there is no choice but to spend what money they have left to hire a donkey, or a car, and bring the patient to abyei.  they don’t have enough, so they sell their only goat, or a piece of their land, to their neighbors.  they use the money to get the patient to the hospital, ten minutes too late.”

Yet for all these profound insights, the real story is not Abyei’s but Maskalyk’s.  Walking into the MFS office in Geneva at the end of his tour in Sudan, Maskalyk suffers acute culture shock.  “Everything is straight, right angles.”   And when he is finally  picked up by a close friend in Toronto—his home before he took off for Abyei–he notes, “I want to go back to my apartment.  Sit in the dark.”   Worse, guilt soon takes over, because he believes he didn’t do enough to help the people of Abyei.

Six Months in Sudan is a classic study of post-traumatic stress syndrome, of survivor guilt.  Maskalyk’s guilt is exacerbated because he understands that most of his friends—and by extension most Westerners—don’t give a damn about what’s going on in Sudan.  They couldn’t care less.  If they think anything about his time in Africa, they believe that Maskalyk has withdrawn into himself because he’s unable to reconcile two different worlds.  But that’s not the situation at all.  “It’s about understanding that there’s only one.”

This is a disturbing and utterly brilliant book.

CHARLES R. LARSON is Professor of Literature at American University, Washington, D.C.

Charles R. Larson is Emeritus Professor of Literature at American University, in Washington, D.C. Email = Twitter @LarsonChuck.