Suddenly…Sudan.

bio: James Maskalyk is an emergency physician and, when not in the field, lives and works in Toronto.  He was stationed with MSF in Abyei, in a small hospital that sits on the contested border between North and South Sudan.  This was his first field mission with MSF.

feb 14. the doctor’s appointment went well. it was just as i imagined, very secret, lots of lasers. they couldn’t (or refused) to make me taller, and all they had in cybernetic enhancements was super taste. so i got it. i am tasting things that i had three months ago. jack, i had forgotten how delicious that stew you made for thanksgiving was. amazing.

still waiting to find out if my visa will be ready by friday. apparently it requires one more signature. if it is ready, i will travel to khartoum very early on saturday morning. since the day of rest in sudan is friday, it will be the equivalent of arriving at the beginning of the week. i am hoping to get to the field as quickly as possible so that i might get handover in abyei.

the midwife had her visa refused. she is on her way back to italy. apparently the government is happy with the quality of deliveries and feel that there is no need for any further expertise. wait until they get a load of me. the red carpet will stretch all the way to italy. i do have a few tricks up my sleeve. one of them is that trick with the fake hand, where you greet the woman and say “hi, i’m doctor maskalyk” then turn away leaving her holding the hand. i use it to try to scare them out of labour. it rarely works, but is worth a shot.

i have delivered about 30 babies in my time, and will be delivering a few more in abyei. it has been a while, though. a straightforward delivery is as easy as falling down. the biggest issue is how to deal with obstructed labour, when a woman needs an urgent c-section, or continues to hemorrhage after delivery. luckily, there is a surgeon a few hours away. to this point, the field has orchestrated a few transfers a month for maternal problems during delivery.

i had hoped i would get to khartoum every six weeks or so, for a couple of days of R & R, and to send some pictures of abyei, but i have been told it is too far. i will see what i can do.

a friend sent me a link describing canada’s recent pledge to begin the repair necessary in south sudan. sweet.

feb 13 day 2 of briefings in geneva. my passport sits with the Sudanese embassy. there is a 90% chance I will have permission to travel by Friday. a midwife from italy, destined for the same mission, has had her visa with the embassy for weeks and still has no approval. it is important for me to get to sudan as quickly as possible. the doctor I am replacing is due to leave soon, and our paths must cross. she needs to give me the crib shit for abyei, about how to make things work.

I have learned some more about abyei. 60,000 people. it sits neatly on the border between north and south sudan, and is one of the areas where tensions are highest. a peace agreement signed in 2005, the Comprehensive Peace Agreement (CPA) has allowed this area to be governed under “joint” rule by the two signatories, the Sudanese People’s Liberation Army (SPLA) and the ruling National Congress Party (NCP). some claim that the CPA’s Achilles heel is that it focuses to squarely on the division of resources between two groups. there is a referendum in the future that will determine whether areas like abyei will be governed by the north or the south. some suspect the peace will not hold until then.

there is much more, but I want to try and keep these short. the situation in this area of sudan, like in darfur, is very complex. it is msf’s policy to be completely independent. already there is some concern that we are being perceived as partisan. to ensure access, and for safety, it must be clear that we side only with the sick.

to the sick. I saw an outline of the hospital. and a breakdown of patients seen. lots of malaria. some malnutrition. no meningitis yet, but an outbreak is consuming the south. kits have been ordered but haven’t arrived. there was some wounded brought into the hospital a couple of weeks ago, and I have been asked to make sure there are contingencies to treat a large number at the same time, if necessary.

though I saw the outline of the hospital, i still can’t see it in mind. when I try to imagine what my day will be like a week from now, I don’t succeed. every time I try to stare at it, I ricochet off to after the mission to those familiar feelings of return. about how straight everything in geneva will seem. and square. and clean.

I have a few briefings tomorrow, and have to visit the hospital to get a final check up. I’m anticipating that it will be done in some type of amazing hi-tech 007 medical lab where anything is possible. i am going to ask to be made taller. if they refuse, I am going to ask for super hearing.

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. it starts now.

in my mind, i thought it would start three months ago. i went to germany to train with médecins sans frontières (msf) last october, and during that time, colleagues were getting phone calls: “can you do nine months in northern sri lanka? immediately?” many of them had missions coming into the training session. i assumed that i would be off like a shot, the day i said i was available.

i wasn’t. i have been waiting. for the beginning. i packed up all my things, and without a place to live, took myself to brazil for november. no word. came back to toronto, convinced close friends to take me in, and worked in the ER over christmas. still no word. two weeks into the cold canadian january, just as i was reconsidering both my plan and my sanity: word. word up.

i knew as i was waiting that i would realize at least two important things. first, that the time would be fonder in my memory than it was to experience. true. and it will become even more so. i have spent hours with people i care about most in the world and fully participated in every moment because i never knew when the next one would come. i am grateful for each. thank you.

second thing. “be careful what you wish for because you just might get it”. wise words. i said i would go anywhere, that i wasn’t afraid of being isolated, that i had a wide complement of medical skills and can do a little of everything. i could work in a small team with little back up, and improvise if necessary. that if there was any time in my life where i could go to a place what required close attention to security, now was that time. no wife, no kids, no debt. no one waiting for me to get back.

so, i wished, and 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 many years. 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 two years. and 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. many of them are from southern sudan where war still smolders. they feel deeply the effects of chronic conflict. it’s 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 at the troubled crossroads between south and north, 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. aside from that, i know little else. i will find out more this week, in geneva.

boarding now. i learned something else these past few months. that one shouldn’t think with certainty about the future. it has helped. right now i don’t know how long i will be away, nor what my days will be like. i will let you know as i do and send word when I can.

change can only happen, in the world as in ourselves, with some amount of insight. i hope that during these next six months that i am afforded some about sudan, as a part of our world that is happening right now this very second even now. if I am lucky, maybe i can explain it well enough that i might understand.

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

james.maskalyk.md@gmail.com