As 2009 is drawing down, I find myself thinking about some of the books I've read this last year. One of the most moving was "Six Months in Sudan" by Dr. James Maskalyk, an Emergency Medicine physician from Toronto, Canada, who joined Doctors without Borders/Medecins Sans Frontiers after completing his training and spent six months at a hospital in Abyei, southern Sudan. The entire medical staff there consisted of him, a newly minted Sudanese physician, a nurse, and two Sudanese medical technicians.

Dr. Maskalyk describes some of his experiences as well as the frustration at not being able to bring about the positive outcomes that would have been the rule in Toronto, but which were beyond his abilities in Abyei because of a simple lack of means. Recounting the time he was summoned to the hospital late one night to treat a soldier with a gunshot wound to the chest, he recalls reviewing in his head what he would do if he were in his ER in Canada. "Trauma-room ultrasound and x-ray, chest tube, cross and type four units of blood, CT scan chest and abdomen. Call the surgeon for possible explorative laparotomy to look for diaphragmatic injury". In Abyei, all he can do is place a chest tube, give antibiotics, and a tetanus shot. On another occasion, he describes his ultimately futile efforts to save a 5 month old girl brought in with diarrhea, high fever and dehydration, which culminate in his listening, through his stethoscope, to the final beats of her heart slowly coming to a stop, sounding "like the silence must be, after a train wreck deep in the forest, once all the metal has stopped creaking, like all this activity and then this final vacuum in place of all the sound".