Pre­scribed read­ing

One aim is to put him­self out of a job. But de­vel­op­ing world medic and author James Maska­lyk knows that day is a long way off. By Tim Corn­well

The Scotsman - - Bookfestival -

‘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.” So, on Fe­bru­ary 12 2007, be­gan the blog that launched James Maska­lyk’s writ­ing ca­reer, as he flew on his first mis­sion for char­ity Médecins San Fron­tières.

From be­ing as­sis­tant pro­fes­sor of emer­gency medicine at the Uni­ver­sity of Toronto, Maska­lyk was posted to Abyei, work­ing with poverty-stricken pa­tients in an oil-rich town in a coun­try torn by war. The blog led to a book, Six Months in Su­dan, which be­came a best­seller last year, but he’s proud that you can still read his orig­i­nal ac­count for free.

As a doc­tor-turned-writer, now work­ing on a sec­ond book of “es­says from the emer­gency room”, but eye­ing a “tran­si­tion to fic­tion” in his third, Maska­lyk marches in a rich tra­di­tion. Sir Arthur Co­nan Doyle trained in medicine at the Uni­ver­sity of Ed­in­burgh, as did John Collee, doc­tor-turned-news­pa­per-news­pa­per colum­nist-turned screen­writer of Hollywood films, from Mas­ter and

Com­man­der to Happy Feet. A young W Som­er­set Maugham treat­ing the poor in London slums trans­lated the ex­pe­ri­ence into his first novel, Lisa of Lam­beth – “I saw how men died,” he said, and per­haps de­vel­oped the clin­i­cal eye he showed in his clas­sic short sto­ries.

Maska­lyk saw plenty of death and dis­ease in Abyei, near Dar­fur, with chil­dren dy­ing in his arms or adults slip­ping into co­mas. Next month he trav­els to Ethiopia on a train­ing mis­sion be­fore an­other six-month stint with MSF in Jan­uary, des­ti­na­tion un­known. On a re­turn trip to the Su­dan planned later this year, he aims to meet again with some of those he de­scribed in his book.

In Fe­bru­ary he could re­port the “bright­est” news on his web­site, that a lit­tle girl, Aweil – not her real name, who he treated for de­hy­dra­tion, di­ar­rhoea and tu­ber­cu­lo­sis – was alive, ap­par­ently in south­ern Su­dan with her fa­ther. “She is the girl for whom I wrote my book,” he wrote. “I vis­ited her ev­ery day, got to watch her change from a dwin­dling in­fant to a strong, smil­ing, laugh­ing, grasp­ing girl with bright eyes. The war came, af­ter I’d left, and I lost her. She’s been found. Or at least word has been.”

In a year when sev­eral ses­sions at the Ed­in­burgh In­ter­na­tional Book Fes­ti­val have tried to probe the fu­ture of the book, printed and elec­tronic, Maska­lyk is a case study of new technology. His book has sold 10,000 copies in Canada, but “I prob­a­bly had thou-thou­sands more read­ers for the blog,” he said. “For me it rep­re­sented a pub­lish­ing model I could par­tic­i­pate in. I didn’t have the priv­i­lege of any­one I knew, in my fam­ily, who knew to write books, or find an agent. There is a sur­plus of in­for­ma­tion [on the in­ter­net]. You can’t sift through it, but it does level the play­ing field so you get your voice out there.” We may be fac­ing “a bit of a cri­sis” on what the book is ac­tu­ally be­com­ing, but pub­lish­ing is no longer some­thing for the “priv­i­leged few”.

Maska­lyk worked in Chile as a med­i­cal stu­dent, but his first se­ri­ous brush with the medicine of poverty came in Su­dan. He is only blog­ging in­ter­mit­tently at the moment, at six­monthsin­su­dan.com, but the pace will pick up when trav­els to Ethiopia to lead a train­ing project at Ad­dis Ababa Uni­ver­sity, said to be the first of its kind in east­ern Africa. Head­ing a teach­ing team of two other uni­ver­sity pro­fes­sors, the goal is to train about ten emer­gency medicine spe­cial­ists on the ground.

“As soon as they send some­one out of the coun­try to train, they are al­most guar­an­teed never to come back,” he said. “Out of 4,000 peo­ple sent to train out­side Ethiopia, 62 have come back, be cause they stay for greater fi­nan­cial gain, in places like the Mid­dle East, Amer­ica, to some ex­tent Canada, and they send money back home.”

The money sent to their fam­i­lies is said to be greater world­wide than the amount of for­eign aid, but what is lack­ing is a com­mit­ment in the coun­try it­self: “The so­lu­tion is to get peo­ple in­spired in work­ing in academia, train­ing them in the coun­try, and hop­ing those will form the back­bone of pro­fes­sion­als and ad­vo­cates for their coun­try as well. Your pri­or­ity is to work your­self out of a job. It shouldn’t be per­pet­u­at­ing ne­ces­sity.”

In emer­gency medicine, he said, there is the first “golden hour” when early at­ten­tion is vi­tal. That con­cept barely ex­ists in places such as Ad­dis Ababa, with lit­tle mech­a­nism to get peo­ple to hos­pi­tal or treat them on ar­rival. “You maybe can get an X-ray or CT scan if you have the money at an out­pa­tient fa­cil­ity, but there’re no neu­ro­sur­geons to op­er­ate on the haem­or­rhage in­side your head.”

The project is about build­ing lo­cal ca­pac­ity, not im­port­ing scan­ners or sec­ond-hand elec­tro­car­dio­gram ma­chines that won’t be­mended by com­pa­nies that no longer re­pair them, so “it sits there like a piece of junk”. By spread­ing knowl­edge, he said, you “cre­ate the pos­si­bil­i­ties”, that an Ethiopian en­gi­neer may come up with a more mod­est ma­chine, sourced and main­tained lo­cally.

The work in Ethiopia, un­der the aus­pices of the Uni­ver­sity of Toronto, won’t be as iso­lated or rough as front-line work; he will prob­a­bly get to go home at the end of the day, have a beer and sleep in a bed. But it is still the medicine of poverty, and low re­sources.

“You want to give peo­ple their own free­dom, the tools of their own eman­ci­pa­tion. When I was

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