questions? answers? – from the Globe and Mail

Joyce Smith from Canada Given the harsh conditions you worked under, have you had to have any counselling or psychological help since your return from the Sudan?

James Maskalyk I did not receive any counselling, or psychological support, since my return. MSF makes such support available, but it is not mandatory. Further, there is a system of “peer counselling” where volunteers call those of us who have just returned from the field, to see if we’re OK. I received the calls, but never called back. I didn’t want to talk, I wanted to forget. Of course, as I come to the book, you solve suffering not by turning away from it, but by facing it.

Telling the stories in the book helped. It allowed me to take the memories, the good ones and the hard ones, and put them in front of me, flat on the page. There are many I can’t read without having their emotion thrown forward, but by sharing it with others, their weight has been diffused.

Jim Terrets, Vancouver Congratulations on your book. Since you used to be a “professional shoplifter,” I take it you won’t mind if I steal a copy of your book from the local bookstore?

More seriously, on an ethical level, how do you deal with the question that by publishing this book you are exploiting these people’s misery and misfortune? It may be a tough question but unfortunately in today’s world, there’s a number of people making money off of the suffering of others. Is this something that you have considered or talked over with your publisher?

James Maskalyk Thanks for your question, Jim. It is an important one. I was very careful while making this book to be mindful of the stories I tell throughout it, to provide anonymity to its characters, to use truth as its most important guiding principle. I believe that bringing it to an audience does not exploit those who suffer, but is one way of doing them justice.

I don’t know many people who do this type of work, or tell this type of story, for the money, because there isn’t much of it. What there is from Six Months… I am giving some to MSF and to Abyei. One of my publishers has made a similar contribution. I broached the idea, last year, of making this freely available online after the softcover comes out, so we’ll see. In the meantime, I take significant satisfaction, as the editor of an open-access journal, that a large part of the book (my blog) is available for free on the internet.

So don’t shoplift! Unless you’re a paid professional. Instead, if you are interested in reading the blog, donating to MSF, or finding routes to action, visit www.sixmonthsinsudan.com.

Julie Toronto from Canada Are you willing to discuss your religious views? Did they change after your mission? Were/are you able to reconcile your beliefs with the injustices you witnessed?

James Maskalyk It’s a good question, Julie. When I was a kid, I went with my parents to the United Church in Spruce Grove, Alberta. I remember one Sunday, when I was 12 years old or so, watching a member of our congregation, a dentist, accept a small donation from our Sunday school class that was meant to help buy supplies for his upcoming trip to China to do free dental work. He was deeply touched and had tears in his eyes. I thought, “Well, whether God exists or not, if the church allows for this type of action, it doesn’t matter.”

I stopped going to church when, as a teenager, I became too big for my parents to drag out of bed. I go on occasion now, with my family, if I am home in Alberta around important holidays. I still see that it attracts good people.

I have no particular theistic beliefs. I believe that god and nature and love and the soul and truth are parts of the same thing. I do, however, believe that, if there is a heaven, this is it. It must be. Right now, I am looking out my window in Kensington Market, and a black storm has blown quickly in. A woman is walking quickly through the rain and a bird, in the tree outside, is singing. Of course, many of us suffer, you and me included. But for me, it wouldn’t be paradise if there wasn’t something worthwhile to do. Even I would get tired of playing Frisbee for eternity. Well, maybe.

Rather than challenging my faith in god, working in places in Sudan forces me to question my belief in the human. What is our nature? What are we capable of? Love, yes. War, yes. Acts of beauty, of grace, yes. Letting children starve, yes. Change? I think so.

Thom Kingston, Toronto James, your MSF blog was an incredible journey, and the book is equally engaging. Couple of questions: How did writing the book help you process what you experienced while you were in Sudan, and did any part of the writing process provide reconciliation or new understandings of the things you witnessed? I understand that much of Abeyi is now sadly gone due to the conflict, and I wonder how one makes sense of it all? I knew nothing of that part of the world before I read your blog, and I have to tell you that I was thoroughly captured by your writing and descriptions of this place, the hospital, the ethical dilemmas you faced, the people you touched and were touched by, and MSF’s work — all of which you told so candidly. I felt like I was there, and I think your blog closed the distance in a world that can seem, well, worlds apart.

James Maskalyk When I first started to write the book, I regretted that I had agreed to. The door that I had so carefully shut, the one to Abyei, the one that held back all those feelings of helplessness, the deep questions about the nature of human beings and myself as one of them, about life and its worth, as soon as I opened it a crack, it all came tumbling out. I was left trying to go through my experience, one that I had difficulty explaining to my closest friends, and condense it into 300 readable pages. It felt impossible. It felt as big as a blue whale; there’s no way it would fit on a page.

It did. At least some of it, glimpses, like through the cars of a passing train. I spent time with those feelings, those people who suffered so much, and told accounts that would have remained buried. If the story is the unit of human understanding, I understand the world better because of the book. So too my place in it. My sincere hope is people who read it feel the same.

As for Abyei’s destruction… I can’t think of it without feeling like a door as wide as the world opens up. I feel small, and lost, and like I didn’t do enough. So I guess there is more to be done.

Jim Rigby, from Spruce Grove, Alta. Jim, congratulations on the publishing of your book! Given the moving and compelling nature of your blog while you were in Sudan, I can’t wait to read your compilation and sharing of your observations and experiences there. I could truly sense the deep humanity that emanated from your compassionate relationship and treatment of the Sudanese people who were so displaces and suffering. I am wondering: Were you able to come away from that intense experience with a sense of hope and were you able to bring that out in your book? Or were you left with a sense of desperation for the destiny of the people with whom you had come to know?

James Maskalyk Glad to hear from my hometown! And you, Jim. Thanks for your question.

I left Sudan, as I had left Cambodia years before, with a similar conviction. They are the most hopeful places in the world. If hope is quantifiable, if you can measure in its depth or breadth the distance from ones current situation to an ideal one, then those places have the largest amount of hope in the world. In Toronto, I can hope to get a good night’s sleep for a change, or to have some time to cook. In Abyei, one hears gunfire and the sound of footsteps, and hopes that his child makes it through the night.

I think the book is full of that hope. You can read it in the stories of the people I worked beside, and the patients we tried to help. I get asked often if I felt like we made a difference. I know we did. I know because there was that boy that came in, the one that in his three years on the planet had never taken a single step, the one with a fever that wouldn’t go away. A month after I started him on TB treatment, he pulled himself to a shaky stand and two weeks later, he took his first step. There were many stories like that. And one can think that to the world it doesn’t matter that much until he remembers that it means the world to that patient. One exact world, bright, and full of sounds. And with each of them, the world is changed.

Calvin White, Salmon Arm, B.C. You have had so much experience with dying. And your book and blog are all about truly living. What would you say to a young person — say someone between 18 and 30 — if they genuinely wanted to better understand what it means to truly live, and what it means to die?

James Maskalyk I remember once, not long ago, I was working in a Toronto hospital with a medical student when a very sick woman came in. She was alone, had no family, and her wish was not be resuscitated. I could tell by her breathing that she her death was close, and told my student, “Don’t see any new patients. Go into that room, and be with that woman. She’ll die soon. You should be there.” I wanted him to see the changes that happen in the body, how the heart counts down, how the breathing stutters, then fails, how their eyes lose their focus and then… life is gone. I thought it important for him as a doctor to see those things so he could know, when the time came, that death was in the room, and if appropriate, that he should intervene. I also thought it was important, as a human, to understand that one day, that will be us. To see that the body is not life, but is a place where it manifests. Once it leaves, all the cells are still there, all the electrolytes and chemicals, all the machinery, but the life is gone. It is something much greater than its parts.

He never stayed in that room. After a minute or two, he left, picked up a chart, and went to see a new patient. I went into the room instead.

I’ve watched dozens of people die. In Sudan, many were children. They often seemed too tired to breathe. It’s different when I see people at the end of their natural life, as adults, face their own mortality. For them, it usually in one of two ways: fear, or acceptance. I knew that if there was one thing I wanted to figure out in my life, it was how to leave it with grace.

When I was writing the book, I remember thinking, “I hope I live long enough to finish my first draft” and the relief I felt when I sent it in, knowing that even if I wasn’t there to see it published, it would be. I am not sure if it is the best way to live, but I feel like, in being alive, that I have been given a giant gift that I have done nothing to deserve.

As for advice to young people trying to make their way, I would want them to remember, we create reality. In the chemical reactions to light at the backs of our eyes, and the electrical impulses that carry touch on our nerves, but so to with our actions and intentions. We don’t always create the circumstances we live in, or suffer through, but we can change how we respond to them. To figure out how best to do that, travel, live widely, strive and love and fail. Seek out the truth like nothing else will do and don’t care so much about what other people think of you, because most of the time, they don’t. Feed your imagination so it grows, because the limits are there, not in the world. Most of all, be assured, no one, including me, has any idea what it’s all about. It’s your job to live that question. Do it like your hair’s on fire.

Anna Haine, Toronto I started reading your blog in 2007 on a recommendation from a friend and was completely captivated by your writing style. Your ability to remove the “white noise” from an experience, place, or situation and deliver only a simple and true observation is magical.

Abyei seems a place where life has been pared down to reveal its truest necessities. When you left that place and returned to Canada where life’s necessities are so taken for granted that they appear to have been forgotten, how did you cope without feeling angry and resentful of our privileged society?

Also, in a place such as Abyei, the need is obvious and the opportunities to help are clear. Without doubt, there is also opportunity to make a difference here in Canada but it is not so clear where and how to offer assistance. Do you have any specific suggestions as to where one’s efforts should be directed locally?

James Maskalyk Hi Anna. Thanks so much for reading and, even more, for getting it. Though the book might be more widely read than the blog was, I think there was a unique power in the original’s immediacy. Further, it was alive, kept that way by those who read it or commented. Like yourself.

I never felt angry or resentful about the society that I returned to, only somewhat distanced from its priorities. I remember going for a run shortly after I was back and, as I neared Toronto’s waterfront, noticed a plane dragging a sign behind it, advertising a major bank. Rather than making me want to open an account, it had the opposite effect. Why on would I give my money to someone who thought that was a good use of it? Or of gasoline? I think with the contrast, one loses a film of familiarity that can cloud our vision of the world around us. Only once in the emergency department, to a man with a cut finger who came up to complain about his two hour wait, did I say “Do you know how lucky you are?” Of course he didn’t, and after saying it I realized that the better response would have been (and still is), “I’ll see you as soon as I can. Thank you for being patient.”

As I come to in the book, the feelings on return weren’t one of anger, but of urgency. How could I make people understand: my friends, my family, the wider world? People were suffering unnecessarily RIGHT NOW. It wasn’t about the distance, it was about us sharing a common moment. I knew that if I took 10 strangers from a Toronto street to Sudan and showed them a floor covered with starving kids, seven of them would turn to me with eyes as big as moons and say, “We can never let this happen again.” So, in my blog, and in my book, I try to remove that from the equation. With time, the ache of that truth fades somewhat. You begin to sleep again, find happiness in its usual places. But it never goes away completely.

When people talk about assisting, I have started to ask them what exactly they mean. Do they mean in Sudan? Or to engage in an activity that pushes the world, somehow, for someone, to an easier place?

The suffering in the world is the same kind that is inside of us and, similarly, can be addressed. And it’s worth it to do it even in small ways, in yourself and the world, because they work just as well. You can affect suffering by noticing a person with a lost look and helping them find where to go, or by volunteering at your library, or at a palliative-care hospice, or getting the tools to take your intention to Sudan.

If you are interested in continuing your engagement with Abyei, check out www.sixmonthsinsudan.com. There are some small ways there. If you are looking for something closer to home, something that will allow you to act in your own community, there are volunteer resources where you can find something worthwhile that will fit you well. Toronto’s here.

Greg Sacks, Toronto Congratulations on a page-turner of a book, James. You did a brilliant job of presenting the hard decisions humanitarian field work presents, and the struggle we humans face having to make them. Working with MSF, you had to enforce strict rules to insure your role was clear and your presence effective. Not being able to drive the sick to the hospital, not being able to drive the dead out — it seems you constantly had to put up walls and say, “It’s not my problem.” When trying to make a difference in the world, is it best that we each pick one problem and make it ours, rather than get paralyzed by the sea of problems we could choose from?

James Maskalyk Yours is a good question, Greg, because I think it is in the weight of the largest tasks that one’s momentum can feel so small as to be useless. The thing is, the problems seem large because we see their breadth rather than the unit from which they are made: the individual. The best part about this, of course, is recognizing a similar truth about large solutions. Same unit. Because we all have limits on our time and attention, choosing something that fits our capabilities is an important first step. The second is sticking to it. One person can’t solve all the problems, but we can each identify ones that matter the most to us, and begin to work in small ways to address it.

France Kirilow, Burlington, ON Your book was amazing. I couldn’t put it down! I have a lot of questions but don’t want to bombard you so could you simply tell me why Alex of MSF was upset with your blog? I read it and didn’t see anything wrong with it. Were you obligated to edit it?

James Maskalyk I think that there was an early fear throughout some of MSF that, once opened, public lines of communication like blogs would be difficult to close. With that, I am sure there was some fear of losing control of the delivered message, something that can be very important when working in politically sensitive settings.

There have been instances where field workers have publicly declared opinions that were better kept to their company of friends. I was careful not to make political declarations, because more than anything, even more than telling the story, I wanted MSF to stay in that hospital and work. I did feel, however, that if I was conscious of both security and neutrality, it was possible to tell a story that people would want to hear, one that was rough, and raw, and from the field.

I sent all of my posts to both Canada and the Geneva office, and I can’t remember a single instance when they told me to change something. Similarly, I sent a copy of my book their way, and pointed out controversial chapters for them to review. I received some suggestions, but no censor. I felt obligated in the writing of the blog, and the book, to be mindful of consequences of the words. A recent reviewer of my book, while overwhelmingly positive, said that I “frustrated” in my “apolitical stance”. This, of course, is even more frustrating for me and my colleagues. However, it is right to remember our place, to show solidarity for alleviation of suffering rather than a particular side. Particularly now, in Sudan, it has never been more important to demonstrate that we are neutral and impartial.

France Kirilow I noted that you wrote all your blogs in lower ase form. However, you took the time to write your last blog with the appropriate upper case letters. Why?

James Maskalyk At the beginning, I posted like I was writing letters to my friends and family. My audience was familiar, and the posts were intimate, and informal. I had that feeling throughout the blog. I rarely got to see a post go live. I would type it into an e-mail, then send it to the satellite, close the plastic computer lid, and step out of the logistics tukul into the beating sun.

When I left Sudan, there was no rhythm, no routine. I was once again immersed in a world full of freedom, and choices, and movement, and newness. Nothing felt familiar, not my home, not the blog. I guess I forgot to forget the capitals.

France Kirilow Why did it irritate you to be called Kywyja (white person) by the Sudanese?

James Maskalyk It irritated me to be called Kywyja because my name was James.

Perhaps it was also because we live in a culture where most ethnic generalizations are pejorative. And untrue. I talked to my translator about it. I told him that I couldn’t avoid thinking of Kywyja as an epithet. He was startled.

I understood, after talking with him, that Kywyja was not informed by the terrible history that the Western world shares, of slavery and conquest, where people with visible differences were only either commodities or obstacles, not quite human. For many in Sudan, their knowledge of us was from dropping food from planes, or travelling from place to place in a Land Cruiser spending money without appearing to have a job. We seemed irreconcilably different, more different than we were the same.

No matter how it made me feel, of course Kywyja was not a slur, nor was it a term of endearment. It was a measure of distance. A distance of approximately 50 cm, the clearance of a Land Cruiser from the ground.

I wrote more about it in my original blog. You can find it here.

France Kirilow Your diet in Abyei appears to have been rather austere and not always the most sanitary. Did this cause medical problems for you and your team?

James Maskalyk Yes, it did, at least for me. I was sick often. It was a difficult part of it. I never adjusted to the water. Most often, when one gets sick from “the water” or “the food,” it is because of its contamination with human feces. The cause of diarrhea is, in effect, diarrhea. That is the state of much of the world’s water. Despite taking many precautions (boiling, filtering), some of us would still get sick. It was not unique to expatriates and our stomachs. Our guards, our nurses, dozens of my patients. So many people in Sudan have no choice but drink the water that their waste runs into. One of the coming shocks, perhaps in my lifetime, will be a realization that this phenomenon will not be limited to places like Abyei, but will be ours to share.

France Kirilow What compels you to work in places like Sudan and Cambodia? Is it a need to make the world a better place? To bring more awareness of the plight of the Third World? An altruistic nature? A challenge? Or to try and understand your place in the world?

James Maskalyk It is a combination of all of those things, France. I think it first started as an adventure, into the world and myself at the same time, to see what we were made of. With time, I discovered that we were made of the same things.

It has been a while since I have been in the field; two years this August, the longest time in almost a decade. I want to return, and I am not sure I can enunciate the reasons any more, because after finding so many along the way, it has just become who I am.

Jodi Buker, Calgary I haven’t read your book yet but I have put it on hold at the library here (Calgary Public Library). I think I’m # 42 on the waitlist and it’s not even in the library yet — it’s just on-order. Anyway, I can’t wait to read it. I know it’s not going to be a “light read” but even so, I really enjoyed reading your blog. I thought your prose on your blog was beautiful and evocative and I’m sure it will be the same in your book. My sister sent me the clipping of the article about you in the Globe and Mail (sorry, I don’t know the date) and I see you have a trip to Ethiopia and hopefully another mission with MSF planned. Do you have plans to write more books in the future about your experiences?

James Maskalyk Thanks for reading, and for writing, Jodi. I do plan to write more books in the future, though I am not sure they will be about my medical experiences. Recounting this book was an exacting task. I think the next time I head to the field, instead of ducking into my hot tukul after a long day’s work in the hospital to write for an hour, I will stay in the gazebo and wait for my Arabic teacher to show up. After so many months of trying to tease the emotion of important, and sometimes difficult moments, onto the page, I look forward to inhabiting my imagination for the next book. You know, less diarrhea, more heists. Everyone loves heists. I betcha even the Sudanese.