September 30, 2009

Courtesy The Random House Group

Dr. James Maskalyk

In his memoir, Six Months in Sudan: A Young Doctor in a War-Torn Village, physician James Maskalyk recounts his first Doctors Without Borders/Médecins Sans Frontières (MSF) assignment in Abyei, Southern Sudan. He and his team provided emergency medical care to the local population in this oil-rich region, which at the time was contentiously disputed. The book began as a popular MSF blog called Suddenly…Sudan.

In this excerpt from Six Months in Sudan, which was recently published in the US, Dr. Maskalyk describes his first emergency call , received on his first morning in Abyei.

Paola and I pass the military compound. Inside, some soldiers are washing their camouflage uniforms. A goat has climbed to the top of a mound of rubble, and another circles him, waiting for his turn to be king. In the corner of the compound, facing the juncture of the road I’m on and the approach to the hospital, sits a howitzer. I duck underneath its barrel, which appears to be aimed towards the great nothingness that surrounds Abyei, and turn left onto the hospital’s driveway.

In it sit three cars. One of them, a white Land Cruiser, is ours. The other two are military green. A crowd is gathered at the small entrance.

Paola pushes past and I follow. Inside the hospital, people are milling, pushing, yelling, straining to see what they can of the action. A little girl sits on the ground between angles of legs, crying.

I don’t know the hospital yet. It seems huge. I don’t know where I am supposed to be. There’s Bev. Her eyes are wide, her thin frame tight with stress. She is hurrying towards me.

“What’s going on?” I ask.

“Bloody rollover. Military truck ran into a car, then turned on its side. Six soldiers in the back. They’re mostly just banged up, but one of ‘em’s got a big gash on his arm. Sandrine is in the tent with a civilian who got run over. I’m crowd control.” She turns away.

I edge through a group of women, babies on their hips, and walk towards the tent. On my way, I glance into the tiny emergency room. It is filled with soldiers.

In the tent, a man is lying on a cholera bed, grimacing. Sandrine is bent over him, listening to his lungs.

“What’s up?”

“Oh, James. Sorry to get you, but there’s just too many people. Mohamed is in the emergency room with one of the others, and this guy, I don’t know. I think he got run over. I started an IV and I’m giving him a bolus. Pressure’s okay.”

His shirt is off, but his pants are still on. Coarse tread marks march over his thighs.

“His lungs are good?” What about his belly?” I ask.

“Seems okay.”

I feel his abdomen. It is soft. I put one hand on each side of his pelvis and push down. He screams.

“He’s probably got a pelvis fracture. We should cut his pants off. You log-rolled him?”

“Not yet,” Sandrine answers.

“Let’s do that. We should give him some morphine first.”

We turn him on his side, one person holding his neck steady, two others pulling him over. I feel along his spine. As I get down lower, he shouts in pain.

“Maybe a lumbar fracture too,” I say. “Seems to be moving his feet okay. That’s good.”

“Transfer?” she asks.

“I don’t know. What do you think?”

“We can.”

“Maybe it’s all from his pelvis, I don’t know. It feels stable, but if not, the guy needs to be in traction or have surgery. Is there an orthopod at that other hospital, whatever it’s called?”

“Heglig,” Sandrine says. “I don’t think so.”

“X-ray?”

“Yes.”

“Well, it’s probably worth a transfer, then,” I say.

“Okay. We’ll do it.”

“Are you cool here, Sandrine? Should I go help Mohamed?”

“Yeah. That’s a good idea.”

She leaves tomorrow. She is an infection-disease specialist and has been here three months. Today she is on call. Yesterday we were both pulled in so many different directions, we had little chance to speak.
On a nearby veranda, two of the rollover victims are lying on the ground, each attended to by soldiers in green fatigues. They are moving. I consider that a positive sign and walk past them to the emergency room.
It is full. I can barely squeeze myself inside. On each of the two beds lies a soldier. One of them has a clean piece of gauze on his head. I pull it aside. An abrasion. I turn to the other bed and see Mohamed holding a cloth firmly down on the upper arm of the second patient. He and I met briefly during my whirlwind day. He is the other doctor in the mission, recently graduated from a medical university in Khartoum. He is young, brown skinned, with a smile full of bright, white teeth.

“Mohamed, you okay?”

“Oh, James. How are you, man?” he says, grinning.

“He takes the cloth away, and blood starts shooting from a large gash in the patient’s upper arm in a thin, red stream.

“Okay, okay. Got it.”

“I think it was the glass from the windshield,” Mohamed says.

I feel the pulse in his wrist. It’s strong. “Hey, can you ask him to wriggle his fingers.”

A flicker.

“Make a fist.”

A bit.

“Thumbs up.”

Nothing.

“Ask him if he can feel me touch his hand.”

No.

“Radial nerve. His arm is fractured?”

“Seems so.”

“Any other injuries?”

“No, I don’t think so,” Mohamed replies.

“Well, I guess we’ll have to wash it out and sew it up. Splint it. I’ll look for the nerve, I guess. We have ketamine, right?”

“Yes.”

“If you get me some, I’ll start. It’s going to take a long time.”

It does. Over an hour. His arm is broken in half. Thin spicules of bone keep snagging my glove, ripping it. I can’t find the nerve, can’t see enough of the bone to trace its route. I am reluctant to cut any farther. Sweat drips down my forehead and into my eyes. My stomach cramps, and it makes me feel nauseated. I wash out the wound, cut away the black pieces of crushed tissue, sew his triceps together, then close the skin. Lastly, with Mohamed’s help, I put him in a long arm-cast.

—Excerpted from Six Months in Sudan: A Young Doctor in a War-Torn Village by James Maskalyk. Copyright © 2009 by Dr. James Maskalyk Reprinted by arrangement with The Random House Publishing Group.