At the heart of the problem
An MSF writer turned doctor
Biography—James Maskalyk graduated from the University of Calgary’s MD programme in 1999 and qualified as an emergency specialist from the University of Toronto in 2004. He practises emergency medicine at St Michael’s Hospital, Toronto, and is an assistant professor at the University of Toronto. He is an associate and founding editor of the open access journal Open Medicine (openmedicine.ca), and director of the Toronto-Addis Ababa Academic Collaboration in Emergency Medicine (missbdesign.com/clients/TAAAC/programs EmergencyMedicine). He has worked with Médecins Sans Frontières (MSF) since 2005 as a writer and doctor. His experience of working for MSF formed the basis of his book Six Months in Sudan. He has recently returned from working for MSF in the Dadaab refugee camp in Kenya, where he wrote a blog about his experiences. He is currently writing a book about the intersection between medicine and humanity.
What first attracted you to humanitarian work? 1
When I was a medical student, I went to South America to work in the public health system. I saw how sick people seemed to be compared with patients in Calgary, Canada where I was training. I knew that medicine could be a tool to working towards understanding and embracing an unfamiliar world. I found it challenging to make sense of how in Canada I could get a computed tomography scan in two hours, but if I got on a plane somewhere else, people had to live with a lack of essential hygiene and were dying from diseases at a young age. I’m a medical professional—how could I not address that if I was aware of it? If you get too distant from the weight of that suffering you risk losing your moral compass.
Do you have any particular memories from working for MSF?
A young girl, probably 9 months old was abandoned early after I arrived in Abyei, Sudan. She was brought in by a neighbour who had found her in the grass, dehydrated. I admitted her to hospital, and as I attempted to auscultate her lungs she tried to suck on my stethoscope because no one had given her any water. The man who brought her in said he couldn’t stay so she was more or less mine to take care of. I became very fond of her; she was one patient to focus on amid the chaos. By the time I’d left, she’d learnt how to walk and talk. I left considering whether she needed me to care for her further—to take her to a doctor in Canada. I decided that it wasn’t in her best interests. Instead I found out how she could be cared for in her own community. Then the war came and I lost track of her. I tried to make peace with that decision. I’m not sure if it was good. [When I was] in Ethiopia last year I tried to find her, but I couldn’t get a visa into the country [Sudan]. I will find her one day. I’ve just got to figure out what my actions will be when I do.
What was your daily routine in Dadaab?
Woken up by the call to prayer: Kenya is a Muslim country. I would go to work at 7.30 am until noon and do my patient rounds. In the afternoon I’d see new patients and check on critically ill patients. Then the car would come at 5 pm and my day was done. Because of security, you weren’t allowed to go back and forth at night so the challenge began at 5 pm when you had to amuse yourself. That led to my throwing parties—looking for some excuse to kill a goat or two, drink some beers, and dance. One of the nurses told me, “I think we’ve had a party every Saturday since you arrived.”
How do you find the process of writing?
It is challenging as an academic, practising physician, and humanitarian to find the space to write. I like writing sentences; I’d probably be a writer who’s become a doctor rather than a doctor who’s become a writer. Writing in general is boring and painful a lot of the time with limited successes, but once you’ve written a great paragraph it feels as if you are about two inches off the ground: “That’s exactly what I wanted to say.”
What was your first book about?
Six Months in Sudan is a memoir of my experience as a young doctor working with MSF in the contested border region of Abyei. It still is contested. It was heavily militarised. We had a small field hospital for treating thousands of people returning for the first time in years. It was safe. We were there to treat those returning and to watch for signs of war, which unfortunately came. It was overwhelming returning to Canada to resume my life where I left it with the knowledge that in another part of the world a war is about to happen. I wanted to tell everyone. The book focuses on that experience: the excitement of leaving, the intensity of being a physician overwhelmed with [people’s] need, and coming back home, which didn’t feel the same. The suffering of the people is contagious, and I was infected.
What advice would you give to medical students with humanitarian ambitions?
You should do it. If you don’t, it would be a missed opportunity. I don’t think people need to devote their career to it, but volunteering some of your time and skills is your responsibility. Doctors are interested in diminishing an individual’s suffering; that’s the unit with which we work. By diminishing the suffering for somebody it lessens the burden on us all. Action is emancipation of some kind. This is what it’s all about—once you’re doing it, you know it.
You can step over the homeless person on the street, but you saw them, and it’s likely that you wondered whether there was something you should do. I think that’s why in this age, in spite of all the conveniences and freedoms, we suffer—because we don’t feel as if we’re engaging in the right thing. There’s one way to deal with it, and that’s to act.James Andrew Barclay, third year medical student
Correspondence to: email@example.com
Competing interests: None declared.
Provenance and peer review: Not commissioned; not externally peer reviewed
Cite this as: Student BMJ 2011;19:d6429