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NEAL CONAN, Host:

In 2007, James Maskalyk - excuse me, Maskalyk - arrived in the Sudanese border town of Abyei to work as a field doctor with Doctors Without Borders. Normally based in an emergency room in downtown Toronto, Abyei was a different world, where he coped with a measles epidemic, malnutrition, tuberculosis and, of course, minimal resources.

W: A Young Doctor in a War-Torn Village."

I: 800-989-8255. Or send us an email: talk@npr.org.

And Dr. James Maskalyk joins us now from the studios of the CBC in Toronto. Nice to have you with us today.

D: Glad to be here, Neal.

CONAN: And you could have remained an emergency room doctor in Toronto, or I guess gone to any big city hospital anywhere. What made you choose a small village in the Sudan?

D: Well, I think it was an early experience I had in medical school. You know, I grew up in northern Alberta, in rural Canada and I - until I was in, you know, in my early 20s, I didn't really even know you could travel and get a ticket and arrive somewhere in a different country where people speak, you know, a different language.

And like many people, my first traveling experience kind of opened my mind to the world. And it happened at a time early on in my medical career when I got the chance to work in a public health system in Santiago, Chile. And I had this, you know, understanding, you know, I guess, for the first time seeing poverty and the sicknesses that are kind of inherent to it that, you know, if I was being trained to take care of the sick ones, they certainly seemed to be in other places.

So, I started to focus my career from that point towards one that would lead me to places like it did to Abyei, Sudan.

CONAN: And where is that village, exactly?

D: It's on the border between - you know what? In 2005, there was a peace agreement that ended this long civil conflict in Sudan. It was one that lasted for, you know, 20 years, until 2005.

CONAN: This was the north-south conflict, as it was often called. Yeah.

D: Oh, correct. Yeah. And the - as you perhaps know, it was - displaced several, you know, million people. And this place, Abyei, was a contested town. And when that line was made in 2005 dividing north and south into semi-autonomous regions, Abyei sat on that border in this kind of crucible, and as such held that latent tension for all those years.

CONAN: And I know that you prepared yourself when you were headed there and studied up on some of the things that you would encounter there. But nevertheless, you must have encountered a lot of surprises, too.

D: Yeah. You know, in the Western medical education, you know, you're given some exposure but mostly through, you know, reading, etc., to the diseases - you know, tropical diseases are the ones that you're likely to encounter in places like Abyei.

So for me it was, you know, my first exposure to absolute starvation for the very first time. And no matter how much you read about something like that, clinically managing it as a physician and also kind of dealing with it as a human is - was a new experience, and at times a difficult one.

CONAN: Because I assume even in Santiago, in Chile, and certainly in Toronto, you had the background of - you assume if you can provide some corrective to whatever condition the person has, their background condition is going be fine. They're going to be okay. Not necessarily true.

D: Yeah, unfortunately. You know, I think that what happens as a physician, when you work in a place like Toronto is - or many hospitals in the West, you know, you can honestly to say to a patient that you see, I can offer you the best health care in the world.

When you're in Sudan or places like that, you can kind of just say, well, I'll do the best that I can. And sometimes it's not enough. And then, you know, as a physician or as a person, I feel like I haven't really lived up to my end of the bargain. And it eventually kind of, you know, takes its toll.

CONAN: There's a point where you're talking to your nurse about a malnourished child and you say this kid is probably going to die, and that while you don't get used to it, you learn to accept it. Is that the case, that you come to accept preventable death after a while?

D: In ways that you can make sense of it somehow. I don't think that it's something that you really ever get used to. But in - when you're faced with, you know, such overwhelming needs with few resources, it's something that despite your best attempts, you can't really avoid.

CONAN: No. And feeling badly about it is not going to help, is it?

D: Yeah. You know, I think that you never really distance yourself - or I didn't - from that, you know, the emotional response of - or that feeling of being helpless and overwhelmed. But you realize that you're - need to go on to continue to do your job, and as fully as you can with the resources that you have at hand.

CONAN: We're talking with Dr. James Maskalyk, the author of "Six Months in Sudan: A Young Doctor in a War-Torn Village." 800-989-8255. Email us - talk@npr.org - if you've gone overseas to a very different place to provide health-care coverage. And let's go to Steve(ph). Steve with us from Penn Yan in New York.

STEVE: Hi. I was in Somalia three different times in the early 1990s, working in the northeast part of the country as an administrator, trying to restart maternal and child-health programs and primary care health programs in the area where there were none.

CONAN: And what proved challenging, and what proved satisfying, about that?

STEVE: Everything proved challenging because there were - the only resources, for the most part, were resources that we were bringing in ourselves and were working with very, very willing to work Somalis who had no resources.

So there was a lot of challenge just in terms of trying to develop programs in an area where everything had been destroyed. I think what proved most satisfying was the fact that we trained a lot of people who were local people who had no health background, but we trained them in very basic caregiving.

And they provided local resources. And I was also there - I mentioned three different times, so I was able to see the program continue and grow over the course of two years.

CONAN: And do you think it's still doing good?

STEVE: I have a - well, I don't know, but I have a feeling it's probably not there anymore. Somalia, as you know, is a very chaotic, very difficult place. And I have a feeling that unless there is continued - or unless there was continued outside support, programs probably disappeared.

CONAN: I wonder, Dr. Maskalyk, if you feel the same way?

D: About the progress, where it's...

CONAN: Well...

D: ...there's something sustainable or...

CONAN: Was there lasting benefit?

D: You know, I guess I'm lucky in the way that when I think about that question, I can measure the success in the unit of the patient. And now in terms of whether that brought Sudan towards an easier future as a nation or tipped the balance towards, you know, a more TB-free future, I can't say. But I can say that I remember instances of people who otherwise wouldn't be alive if it wasn't for the free care that we were able to give.

There was a child that came in, you know, 3 years old, had never walked in his entire life and came in feverish, and I was having a tough time trying to diagnose him.

And actually, I put a picture of him up in a blog that I was writing that you mentioned earlier at the time, you know, preserving his anonymity, and I got a response back from someone who said, I've seen something like this, and when I - it was tuberculosis, in that case.

And even though I was considering TB, I never - wasn't considering it highly enough, but I put it, you know, I started the child on tuberculosis treatment. And two weeks after I did, he stood for the first time.

So, you know, whether it made the world a better place, it certainly did for that boy. And there are many cases like that, whether it was measles or meningitis, you know?

For every failure, there were three cases of people who succeeded and who went on to live. And so I think just like Steve's school or - maternal health, I mean, I'm sure that there's mothers who have healthy children that would've not have lived without it. So I think...

CONAN: Difference it made, yeah.

D: Yeah.

CONAN: Yeah. Steve, thanks very much for the call. Appreciate it.

STEVE: Thanks. Thank you.

CONAN: Bye-bye. Let's see if we can go next to Janet(ph). Janet calling us from Cape May in New Jersey.

JANET: Yes. Good afternoon.

CONAN: Afternoon.

JANET: Thanks for taking my call. I really can identify, and I appreciate the work that the doctor was saying. I had the occasion to spend two years in Guatemala.

And I'm a nurse, and I had visions of - having been there previously, very briefly - of what I thought they needed. And I found out, as I went around, the two things that I was most unprepared for - and I will never forget it - is, wherever I went, I was constantly asked, did I have any Pepto-Bismol, Pepto- Bismol. And that was the one thing I didn't pack, thinking of shoes and clothes and all these other - everything under the sun.

And I came to learn that that would've stopped diarrhea, and consequently a lot of the children down there get very ill because of the diarrhea and eventually die, and - which I unfortunately witnessed early on. And that was one of the things I didn't have on hand. And the second thing that was shocking to me was I didn't realize when you're in a Third World country, if you're an amputee - your legs, in this case of children - there were no wheelchairs.

And that threw me. And the infections, once again, that can - one can encounter when you have to kind of use your elbows to more or less, you know, move from point A to point B.

And so I went down, thinking I was so prepared - 30 boxes of this and that - and I found out those few things. And so, you know, the Pepto-Bismol I couldn't get, and when I came home I did start, kind of, a minor program where now to this day, I still send wheelchairs down there, so...

CONAN: Well, Janet, thank you very - that's a great story. Thank you very much for the call. Appreciate it.

JANET: Thank you very much.

CONAN: Bye-bye. Dr. Maskalyk, I don't know if you had a Pepto-Bismol moment, but what did you learn in six months in Sudan?

D: Well, the list is a long one. You know, it's tough to condense it even into book length. I think that there are things that I, you know, I learned as a physician, you know, whether it's from, you know, tuberculosis or how to deal with a malnourished child. But I think also from, you know, just the experience as a human being about working with other people - and many members of my team were from all over the world, you know, from Italy, and many were obviously Sudanese.

And coming together over that kind of unifying solidarity of, you know, respect for the human spirit, to that we're all gathered around that idea that, you know, people should suffer as little as possible no matter were they live.

CONAN: Mm-hmm.

D: It was a really important thing, I think, for me personally, to be a part of. You know, it changed, I think, my focus of my days, and not just as a physician, but as a person as well, too.

CONAN: And briefly, I wonder what it was like that first day back in Toronto in that gleaming, bright, scrubbed emergency room?

D: You know, I left Sudan - and I think this is probably a common story for people who do similar work - with that world was still living inside of you. You come away with an urgency. You can't quite enunciate to your friends. You can't quite enunciate to people who haven't shared it, you know, people who don't need a better health system - they need the measles vaccine but yesterday. And it takes some time before that urgency starts to fade.

And when you, you know, you come back - three days before, you were in Abyei, Sudan, you were with a team of doctors that, you know, with nurses and another doctor walking over a floor with, you know, malnourished or starving children on it, and then three days later you're in Toronto standing on a street corner, you're like, well, what am I supposed to do now?

Go see a movie or, you know, go to the grocery store? And it takes some time before you somehow make peace with that.

CONAN: Dr. Maskalyk, thank you very much for your time today. Appreciate it.

D: My pleasure. Thanks for talking to me.

CONAN: Dr. James Maskalyk. His book is "Six Months in Sudan: A Young Doctor in a War-Torn Village." You can read his blog through a link at our Web site at npr.org click on TALK OF THE NATION.

And this is TALK OF THE NATION from NPR News.

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