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Six Months in Sudan Rating: 8 on a scale of 10 Review This is a complex book. At first glance it seems straight forward, but it is somewhat deceptive in its quality. You should read this book from cover to cover to get the fullest understanding of what happens. The doctor who wrote this book is an emergency room physician by training. Based on what he writes about himself I would suspect his personality style is an unusual one for physicians in general. I can imagine that Doctors Without Borders might not have been happy about him writing this work. To me, the book says more about the people who decide to do this kind of work than it says about the work itself. In many ways the book is about him trying to recover himself after this experience. Writing about the experience is certainly a way to accomplish a catharsis with regard to his time in Sudan. He does a superb job at capturing the disconnect that occurs for people who go off to do relief work, go to war, serve in a disaster settings or other similar events. As a person who responded to the Katrina-Rita hurricane disaster with the US Public Health Service for 30 days, I could identify with all his feelings of disorientation, disconnection, and loss of grounding that occurs both upon arrival and upon return home after the deployment or service. This is a quite real phenomenon. It is a dissociative sort of state. It is remarkably common for folks who respond to these sorts of events. He was aware that it would occur, but none the less, he was effected by it rather remarkably just as most people are. This sort of dissociative state may be thought of as a sort of loss of consciousness. When you go from all that is familiar, drop into a completely foreign environment, lose touch with all your usual cues such as food, sleep, bed, friends, family, etc., your conscious brain gets overwhelmed. The unconscious brain then begins to pick up the slack which creates a sense of things all being a bit unreal. There are so many new situations with so many decisions that it is very difficult for the conscious brain to keep up. The unconscious brain begins to react and direct, which is very strange. I remember well the day I arrived at the Bossier City Special needs shelter in Louisiana during Katrina-Rita. Our team had five providers, and we all had a similar sort of experience. For about two or three days we felt like we had forgotten how to practice medicine. It was a very strange experience. I knew intellectually that I should know what I was doing, but everything was so strange and different, it felt like I was in another world. Gradually, things came back into focus for us all, and we began to "grasp" what was going on. He captures this experience well in the book. I can only imagine that it is magnified in an environment such as Sudan where things are even more unusual and strange compared to what we are used to. I don't think he understood this process psychologically. I have only understood it years later in my own experience and ongoing learning. Though many of aspire to go do this sort of work, and even though we may have heard about these kinds of effects, it is not until we experience it that we really appreciate the seriousness of the effect. In a disaster like Katrina-Rita when you are expected to be mobile and "change" is the order for the day, it takes a lot of energy to make this work, and it also requires grounding one's self, some friends, and a lot of good sleep. The book is written for a general audience. I found myself as a physician wanting to know more than he wrote. It sounded like he was very busy, but it was hard to really tell. I wanted to understand better what he was going through. I wanted to know more about how he was busy. He spent time telling us about the team from Doctors Without Borders and I appreciated what he told us. However, his relationship to others working in this clinic seemed quite minimal. This seems to have been the nature of his personality. We learn toward the end of the book that he really never spent much time getting to know the people he was working with except for his team. This would seem to be the experience of a young man. This is a western cultural perspective. I would like to believe that if I were working in this environment that I would get to know the whole team not just a few folks. A friend of mine went to Mexico for a sabbatical sort of trip for a year. Specifically, he wanted to improve his Spanish. He went to work in a clinic. At the start, he came in each morning and did his usual American style thing. He would come in, get to his desk, do some charts, etc. After a couple of weeks they sat him down and wanted to know why he was so angry at them? He had no idea what they were talking about. They told him they surmised he was angry because he never came around to talk to any of the secretaries, nurses, lab people, other doctors, etc. To them, making social rounds in the morning was just a part of doing work in their culture. He seemed to be breaking this unwritten rule and they interpreted it as anger. I wonder how the people this doctor worked with interpreted his lack of involvement with them after six months. We can learn much by what this fellow does and by what he does not do. It is hard to escape from one's cultural perspective, even in a foreign land. He did do a good job telling a story. I appreciated this about the book. I did not want to put it down. But, about half way through the book I was quite angry with him. I wanted to grab him and shake him and yell at him about working better as a team. I wanted to grab him and talk to him about relationships. I wanted to understand better the rules Doctors Without Borders has for people to follow. Eventually, by the end I began to comprehend things better. His return home was about what I would expect. It is very strange to hop on a plane and go from extreme intensity back to the regular world. There is this chasm you cross that seems to defy understanding. Partially, I believe it is the gap between the conscious and the unconscious. I know that sounds very strange, but the experience is very strange. When I got home from Katrina-Rita I remember clearly the realization of how tired I was. I remember the sense of being disconnected in reverse, disconnected from all that should have been familiar. This lasted many days. My wife would say it lasted for many weeks to months, and some friends think it has never gone away. You are changed by experiences like this. Just how I was changed is not always so obvious. I did thoroughly enjoy the ending of this book. I loved the house keeper who the gentle threads of time, life and God brought to him to help him get back on track. I liked his final sentence at the end of the epilogue, "...it's not about trying to reconcile two different worlds, it's about understanding that there's only one." But, once again, I disagree with him. It is about reconciling two different worlds. The problem is, the two different worlds are not so obvious. There are the two worlds that exist on this little planet spinning around the sun, the two different cultures. And, there are two worlds within himself, one conscious and the other mostly unconscious. As I watch him through his words I see both worlds in a way he cannot yet see them. It was truly an act of the conscious ego to say that it is not about trying to reconcile two worlds. It is clearly about trying to reconcile two worlds. To reconcile is to bring accounts into balance in a literal sense. He, like all of us, is trying to find the balance. He has not found the balance yet, and neither have I. This entire little planet of spiritual beings is trying to find this same balance. His journey ultimately is a spiritual journey. He is only beginning to discover this. I look forward to more of his writing. All opinions are mine and only mine, Curtis Climer, MD Copyright 2010
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