Canadian physician James Maskalyk on why he left a comfortable teaching job to work for Médecins Sans Frontières in Sudan.

Marco Visscher | June/July 2009 issue

James Maskalyk has been working to improve public health in developing countries ever since he was a medical student at the University of Calgary in the 1990s. He made his first trip to Chile in 1997, to impress his girlfriend, he says. But it was Maskalyk who returned impressed. Angered by the way poverty inevitably seemed to lead to poor health, he became determined to do what he could to make things better. That’s why in 2007, Maskalyk decided to take a break from his position as assistant professor of emergency medicine at the University of Toronto to work for Médecins Sans Frontières (MSF) for six months in Sudan.
Sudan was (and is) plagued by ethnic and religious conflict between Muslim Arabs in the north and Christian Africans in the south. In Darfur, pro-government Arab militias are accused of killing more than 200,000 people as part of an ethnic cleansing campaign against non-Arabs. Maskalyk was posted to Abyei, a town that straddles the northern and southern parts of the country, where tensions were high because the oil-rich area falls under a special administrative status that neither north nor south favors.
Maskalyk wrote a blog while he was in Abyei (msf.ca/blogs/jamesm), which was expanded into a book, Six Months in Sudan: A Young Doctor in a War-Torn Village
(out in May from Spiegel & Grau). He spoke to Ode about his experiences in Sudan and his motivation for volunteering.
“I would have gone anywhere, really. It didn’t matter. Working in Sudan wasn’t far off from what I imagined. I was working in a small hospital. I stayed in a hut. But I do think I had expected a more idyllic kind of existence. I didn’t think it was going to be so crowded. There was so much noise constantly.
“Only days after I arrived in Sudan, there was a measles outbreak. A lot of children were dying and I didn’t know what to do. Or I did, actually, but it wasn’t enough. So I thought, Should I go to bed now and do the same thing again tomorrow? I think I was emotionally and spiritually bankrupt.
“There was a little girl, Aweil (not her real name), whom I became fond of. Her father was a soldier and her mother had died in the hospital. Aweil, 7 months old and abandoned, was brought into the hospital by a neighbor. When I checked her and listened to her heart, I noticed she was so thirsty that she started to suck on my stethoscope. I treated her for dehydration and diarrhea. She got a bit better, but she never fully recovered.

“As she was developing her own personality, I also got interested in her as a human being. There was something unique about her, something that was maybe similar to my spirit. After a month, I started treating her for tuberculosis. I found something to cure her, and I found a woman to feed her and look after her. She started to get better and then learned how to talk and walk. And then I flew away and left her at the hospital. I hope she’s alive; I don’t know.
“It was such a privilege to be able to see Aweil transform from being sick, sad and orphaned to being well, fed and happy. It’s one of the best things I’ve ever seen. I thought about caring for her, but I don’t think I can at this point in my life.
“I care about the people of Sudan. I have developed a fondness for them. That’s why I can’t really say I left Sudan behind. It’s great to be able to see my friends here in Toronto, and be able to sleep again. But I still find that some of my happiness depends on that place. If Sudan goes through a difficult time, my mood gets affected.
“Recently, the situation in Sudan got a lot worse. Some people got kidnapped, [Sudanese President] Omar al-Bashir kicked MSF out of the country. My only compulsion after hearing such news is, How can I get back there? How can I continue doing this work? And rather than finding the answer to the question of how I can fit this kind of work into my life, I realize the real question has become, How can I fit a life into this kind of work?
“I’ve now been asked by the University of Toronto to develop a training program for emergency medicine in Ethiopia. That’s a great endeavor, and very different from the work of MSF. It’s the difference between relief and development. I value MSF’s work because it’s fundamental care, and it’s focused on the immediate relief of suffering of people who might be victims of inequality or injustice. That’s what I’m most passionate about. Yet the project in Ethiopia is purely educational and institutional. The effect will be a lasting one, both for the patients and for the country. The highest level of achievement as a doctor is your own obsolescence. You want to work yourself out of work as soon as you can. What a wonderful thing if Ethiopians don’t need the help of foreign doctors at all.
“Was it dangerous in Sudan? Well, I never really felt unsafe, but that might be my naiveté. If you sign up with MSF, you accept the risk of working in a place with a conflict. There was a shooting at the hospital, and a lot of alcohol and guns. Yet the most dangerous thing in a country like Sudan isn’t that you get shot, but that you get meningitis or tuberculosis. And those in the most danger are the people of Sudan.

“While I was working in Sudan, Elsa Serfass was killed. She was working for MSF in the Central African Republic. When I heard the news about Elsa, it didn’t make me worry so much about myself as much as about her family, and how tragic the circumstances are. It made me more convinced of the injustices of what is happening in this part of Africa that enables these kinds of tragedies. It made me realize how remarkable my colleagues at MSF were that in the pursuit of peace they were willing to risk their own lives. It made me understand that there’s great worth in this work.
“Many times I’ve thought, Why do people want to do this work? I’ve looked into evolutionary biology and genetic explanations of altruism to discover why I do this work. Do I want to impress someone? Do I just like the adventure? Why is it worth our time, worth the life of someone like Elsa? One way to look at it is to see ourselves as a collection of genes, aiming to reproduce. In that view, it makes genetic sense to throw myself at a grenade in a crowded room if I know there will be more copies of my specific genetic code that are likely to be reproduced in my cousins. For a rationalist, this makes sense, but such a mathematical look at reality doesn’t fit in my view of the world—and it surely doesn’t explain why someone like Elsa died, someone who was working for people who could not be more distant cousins. We can’t explain the good work she was doing by reducing our acts of humanity as if they have to do with reproducing. Once you experience doing such work, you can see it goes beyond all rational explanation, and that it’s just what you’re compelled to do.
“Suppose you’re walking the streets of a poor country with a treatment for malaria in your pocket—you don’t have malaria—and you pass someone on the side of the road who has malaria and who’s feverish. Would you give him that treatment? I think for most people the answer is yes. We’re just part of that greater thing that is life, and all life wants is to go on. Life wants to explore this ecological niche on Earth; it wants us to take care of each other; it wants us to make sure life goes on. This is life caring for itself, and that’s why we do it.”
Interview by Marco Visscher, who is too busy as Ode’s managing editor to take six months off.