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
‘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