Significance Addicts

As a member of Nairobi’s press corps, I often used to socialise with aid workers. The Kenyan capital was a perfect base for us. Its air links meant Africa’s various trouble spots, our professional bread and butter, were within easy striking distance: its shopping plazas, cafés and cinemas made it a place where those who had spent too long in the field dreamed of unwinding. Stints were short, so one always seemed to be saying goodbye to a rangy youth or slim blonde from Concern, or Care, or Goal, or World Vision, or Save the Children or any of the countless humanitarian organisations that wore their hearts on their logos. They tended to be rake thin (some wasting African parasite lodged in their intestines that would take years to clear), hairy (beards, ponytails and stubble that had nothing designer about it), and distinctly clubby, with little interest in anyone outside their world of clipboards, airlifts and white SUVs. They gave off a kind of Ready-brek glow, the aura of the consciously high-minded.

I remember talking to a young Spaniard heading home after a spell in Sudan. A couple of sheets to the wind, he joked about the reception he expected. ‘You know, in Spain, I’m a saint.’ With his dark beard and gaunt profile – amoebic dysentery, or a giardiasis, perhaps? – he could have stepped straight from a Goya canvas, but I must have looked sceptical. ‘No, really,’ he insisted, making a sweeping gesture with his frosted beer bottle: ‘Back home, they really think I’m Jesus.’ The T-shirted messiah had captured the mixture of admiration and envy with which so many of us regard foreign aid workers. For the young idealist winding up his university studies, few jobs have more appeal. Travel the globe at someone else’s expense? Tick. Practise your languages? Tick. Live like a native – briefly – in an awe-inspiring landscape, among other young (attractive) enthusiasts? Tick. Plunge into the well of human experience and emerge immeasurably the wiser? Tick. Everything promised by an army recruitment poster or a Club Med brochure, but with that priceless extra: a sense of one’s own virtue.

Six Months in Sudan is the story of one of those who tried out the role. James Maskalyk, a young Canadian doctor, spent six months in 2007 in Abyei, a town in an oil-rich stretch of barren land claimed by both Sudan’s government in Khartoum and the former rebel movement in the south, working in the rudimentary local hospital on behalf of the Canadian branch of Médecins sans frontières. In the world of professional altruism, few score higher than MSF. Set up in 1971, MSF is known for its readiness to slash through the red tape that keeps less light-footed rivals chafing in capital cities. From Turkish Kurdistan to Congo’s Kivus, the MSF flag is usually the first to be spotted flapping bravely over a muddy sea of refugee tents. The group, which won the Nobel Peace Prize in 1999, also prides itself on its readiness to ‘bear witness’ when politics intrude, staging high-profile pullouts when it feels it risks becoming complicit in a larger abuse.

With his youthful introspection, determination to connect with his fellow man and appetite for the kind of experience calculated to leave deep psychological scars, Maskalyk fits the mould of the MSF recruit perfectly. The book takes us from his briefing at MSF’s Geneva headquarters as a jittery first-timer to his homecoming in Toronto, where he struggles to cross the chasm of intense experience now separating him from friends and family. He has lost his virginity when it comes to matters of life and death, and nothing will ever be the same again.

Maskalyk is a natural and fluent writer. Based on a blog – the first by an MSF doctor – his writing is vivid, impressionistic and off-the-cuff. Reading it is rather like sitting through an episode of ER. You marvel at the responsibility placed on these brave volunteers, summoned from their tukuls in the early hours to deal with the victims of a marketplace shooting. You shudder vicariously at the pus and the gore, delivered with a just manageable dose of medical jargon. You share Maskalyk’s sense of defeat as he calls time over the body of yet another emaciated Sudanese mother who has failed to survive childbirth, and his sense of release as he unwinds with his equally exhausted peers, gazing at the stars.

There is sentimentality here, but it would take a heart of stone not to be moved by the swift succession of individual tragedies he depicts, or to share his anguish when confronted by situations in which a permanent shortage of resources and qualified staff mean there can only be difficult answers. Arriving with the Western doctor’s instinct to battle for each and every life, Maskalyk swiftly forms the necessary psychological calluses as exhaustion wreaks its inevitable deadening effect. The working methods of his predecessors suddenly make sense. He changes apparently illogical operating procedures, only to change them back again, registering that what made no sense in Canada has its own rationale in Sudan.

He is refreshingly honest about the hard-hearted mathematics that come to apply in remote hospitals such as Abyei’s. If a child can only be kept alive by pumping oxygen manually into his lungs, the doctor will have to stay up all night to pump, and a sleep-deprived doctor will not remain functional for long. The baby Maskalyk and his colleague spend three days feeding from a syringe dies ‘because, at some point, we went home to feed ourselves’. Sometimes, it makes better sense to let people die.

MSF staff operate a strict policy of not allowing their vehicles to be used to drive the sick to hospital or bodies to their places of burial. Agree to these requests, staff explain, and the vehicles risk being marooned in danger zones or become de facto public hearses. Yet the policy violates every compassionate instinct, as Maskalyk acknowledges: ‘You want to drive each patient where they need to go until you run out of gas, use every last dose of rabies vaccine … to give the starving family money even if it will only feed them for a day, drip all of the blood into this patient, the human (someone’s father, brother, son, best friend) bleeding in front of you even though it means there might be none for the next ten, but today you have it, and today is his lucky day, and tomorrow you will worry about tomorrow.’ He recounts an anecdote that must still make him wince: how he curtly refused a ride to a young man who wanted to bury his wife, only to realise later the man is a colleague, whom he failed to recognise in the shadows.

Maskalyk is touchingly aware of his own failings, but less adept at sketching the larger backdrop against which these stories play out. He happened to parachute into one of modern Africa’s potential flashpoints, the place where a carefully negotiated deal ending two decades of civil war between Khartoum and the Sudanese People’s Liberation Movement risked collapse. As in so many parts of Africa, Abyei’s hidden assets – its oil reserves – have proved more curse than blessing. The district accounts for around a quarter of Sudan’s total crude output and hence is worth fighting and dying for. An international boundary commission was set up to define Abyei’s borders, but the government rejected its findings in 2005. It is this fact that explains the presence in Abyei of the troops who repeatedly threaten to set up camp in the local hospital.

One gets only a tangential sense of all this here. Maskalyk may go on long cross-country jogs to keep fit, but the town and region remain a blur. Like the other Western volunteers, stretched by fatigue, he rarely holds a conversation with a Sudanese who is not a patient. He notes the ritual markings on the faces of those he treats and the sewn-up vaginas of the women who have undergone female circumcision, but cannot grasp their full significance. On the rare occasion that he ventures into Compound 2, where the project’s Sudanese support staff live, the short burst of camaraderie he finds there comes as a revelation. For most of the time he falls prey to precisely the clubbiness that characterises at those Nairobi parties. The cataclysmic outburst of fighting between the army and the SPLA that ends the book comes across as a convenient closing device instead of an explosion that left analysts debating whether Sudan’s Comprehensive Peace Agreement was already history.

To demand a broader canvas from those whose focus is necessarily fixed on the here and now is unfair. But it does seem that Maskalyk’s real interest lies in what is going on inside his own discombobulated brain. He writes with most insight when exploring the profound sense of alienation that grips the visa-spattered wanderer – war correspondent, refugee camp organiser or frontline doctor – who has stared death and privation in the face and then finds drinks by the pool and the gossip of schoolfriends back home unbearably strange.

The theme was explored at greater length in Emergency Sex and Other Desperate Measures (2006), written by three increasingly fraught humanitarian workers – Kenneth Cain, Heidi Postlewait and Andrew Thomson – as they bounced from one world crisis to another. ‘I will never go back to being the person I was before I left,’ Maskalyk writes, but wasn’t that one of the aims of the exercise? I have spent my professional career in the company of young adventurers who riff about the Easter lunch they are missing with mum in the Home Counties, yet rush to sign up for the next posting when presented with that Home Counties reality. The unsympathetic dismiss them as adrenalin junkies, but ‘significance addicts’ is perhaps the more appropriate term.