The first Ebola case in Rosanda was reported on March 11th, 2014, but the story of Rosanda’s Ebola outbreak began with a fisherman living in Aberdeen, Freetown, 300 Kilomiters away. Feverish and scared, the fisherman called his mother who suggested that he see a trusted traditional healer in their hometown of Rosanda. Unable to make the trip alone, his mother came to Aberdeen and returned with him to Rosanda. Within two days of retuning, her son passed away. Shortly thereafter, 58 cases were confirmed positive for Ebola, 41 of which did not survive.
For a village of 900 people, 41 deaths in less than two weeks was a devastating blow to the community. Several compounds were immediately quarantined, and many families fled. The outbreak also brought confusion and distrust. Community members that were admitted to the Ebola Treatment Unit received phone calls from family and friends advising them to deny all food, water and treatment from the ETU. Unsure what to do and who to believe, many of the positive cases in the ETU followed the misleading advice and refused all treatment, food, and water.
Survivors returning from the ETU played an integral role in debunking the community rumors that had prevented people from trusting the ETU and Ebola prevention protocol. Survivors advocated for the support and trust of the ETU, utilizing there own stories as living proof. Attitudes in the community quickly began to shift as Rosanda regained control over the outbreak. The survivors, Chief Bangura and other community leaders have played an crucial role in implementing the prevention protocol.
The photographs in this section were taken in Rosanda during the implementation period of a photovoice research project in July of 2015
Daniel Jack Lyons was commissioned by International Medical Corps to conduct a photovoice research and documentary photography project with Ebola survivors from Rosanda. The project took place in the district of Makeni with 10 participants from the community of Rosanda. Community members were recruited through three Health Promotion staff members who were based in and near to Rosanda. The same three Health Promotion staff were given an in-depth field-based training on how to conduct photvoice methodology, by shadowing each step of the process for the duration of the project. In addition to the Health Promotion staff, an IMC staff member from Guinea joined the ten-day field-based training with the intention to replicate a similar photovoice project with communities impacted by Ebola in Guinea.
The project produced a collection of photos, taken by participants with narratives that answered questions such as; How did I survive Ebola? Can we stop Ebola? What is the role of survivors, and community leaders? The participants of the photovoice project insisted that neighboring communities, who are facing similar challenges with new positive cases, should have access to these photos and narratives. They discussed how effective some of the prevention messages were, and agreed that messages were taken more seriously when delivered through other community members, particularly survivors.
The participants felt that their photos and narratives should be incorporated into prevention materials to be used in neighboring communities. One idea was to select key photos and narratives and make posters that can be hung in other community centers. Another participant suggested making small books with the photos and narratives that could be distributed in other communities. The overall sentiment among participants was that the most effective prevention messages came from other Sierra Leoneans that had lived through and experienced Ebola. Therefore, as a community that has survived a lethal outbreak, their stories of survival and prevention will be effective in preventing outbreaks in other communities in similar settings.
Currently International Medical Corps is using the data collected from this project to inform the design of new Ebola prevention materials to be used throughout Sierra Leone.
Examples of participant photos and narratives from this project can be seen in the photovoice section of this website.
Up until September 2014, Liberia had been the country most impacted by the Ebola epidemic. As of late January 2015, more than 22,000 people have been infected with the disease, resulting in a devastating loss of life for more than 8,800. Shortly after the first cases in Liberia were detected in March 2014, Ebola infection spread unabated across the country, affecting all of the 15 counties, resulting in thousands of deaths. Consequently, Ebola was declared a national emergency in Liberia on August 6, 2014.
With a slow emergency response rate in rural areas, communities like Gbolaka-Ta had little choice but to respond to the Ebola Virus on their own terms. As a result, the disease was largely treated in these communities with local remedies created by traditional healers. Bark from a local tree was shaved from their trunks, pillared into a pulp, and mixed with hot water to create a remedy that was widely used in Gbolokai-Ta. Community members that showed signs and symptoms of the Ebola virus were sent, and sometimes lead into the bush surrounding the villages, where they would lay on a mat and drink as much of the remedy as was available. Some people returned from the bush, but most did not. To this day prayer groups meet daily to pray for those that never returned.
Communities such as Gbolakai-Ta have not seen a positive Ebola case since February of 2015. However as the international aid organizations and national health ministries make the transition from emergency response to development programming, those living in Gbolakai-Ta are concerned about being left behind. This is in large part because these communities did not utilize the Ebola Treatment Unit (ETU) during the crisis, which means that they were not issued certificates of survival. For many, the ETU certificates of survival are a ticket to continued benefits. As development programming continues, community members from Gbolokai-Ta want to ensure that they also have access to those same benefits.
The photographs in this section were taken in the village of Gbolakai-Ta during the implementation period of a photovoice research project in August of 2015
Daniel Jack Lyons was commissioned by International Medical Corps (IMC) to conduct a photovoice research and documentary photography project with Ebola survivors from Gbolakai-Ta. The project took place in in Gbolakai-Ta, in the district of Bong, with 8 participants that were divided into two groups; a youth group, and a women's group. The community chief of Gbolakai-Ta, with the help of four IMC staff from the Social and Behavioral Change team, recruited participants for the photovoice project. The same four Social and Behavioral Change staff were given an in-depth field-based training on how to conduct photvoice methodology, by shadowing each step of the process for the duration of the project.
In the final step of the photovoice process, the photos and narratives of the youth group were combined with those of the women's group to create one cohesive collection of photos and narratives. Together, all 8 participants were asked; what should be done with these photos as a collection? Who should see them? And how should they be seen? The first response from several participants was in the interest of publication. They expressed this interest out of a concern that no one knows their story. A sentiment that falls in line with the first framing question that the group collectively wrote; …how does the world know that we survived? All of the participants agreed that there had been few opportunities for them to tell their story to anyone from outside of the community. They unanimously expressed the desire for people to know what happened to their community, how they responded, and how they survived.
When asked if other communities should see these photos and narratives, the response was overwhelmingly affirmative. Discussing it further, participants decided that they would like their photos and narratives to be displayed in two ways. 1, as an exhibit in the community center in Gbolakai-Ta and 2, as a traveling exhibit that can be transported and displayed in various neighboring communities. Overall, participants felt that they had been through a significant and historical experience and are interested in sharing that experience with others, both locally and globally.
Currently International Medical Corps is using the data collected from this project to inform the design of community engagement strategies to provide services to communities like Gbolakai-Ta across Liberia. This provides evidence that using the ETU certificates to access services is a potentially divisive act that is likely to perpetuate stigma and create animosity within communities.
Examples of participant photos and narratives from this project can be seen in the photovoice section of this website.
On March 11th 2011, one of the greatest disasters of modern history hit Japan. A magnitude 9.0 earthquake occurred off the northeastern coast of Japan, triggering a tsunami, which caused catastrophic damage across the Iwate, Miyage and Fukushima prefectures and thousands of deaths and destroying over 100,000 homes. Fukushima Daiichi nuclear plant was among the vital infrastructures that were damaged. This damage trigged a nuclear meltdown in three of the plant’s six nuclear reactors, resulting in the largest nuclear disaster since Chernobyl. This triple disaster had profound effects on residents, particularly on the 300,000 some residents who were evacuated from the areas surrounding Fukushima Daiichi nuclear power plant. Approximately 82,000 individuals remain in the temporary housing today.
The historical context of this nuclear disaster in Japan’s history, which includes the detonation of atomic bombs on Hiroshima and Nagasaki during the end stages of World War II, as well the Tokaimura nuclear power plant accidents of 1997 and 1999, make this disaster particularly emotionally charged for the Japanese people. Exploring research conducted on survivors of previous nuclear disasters in other countries, including those of Three Mile Island (TMI), Pennsylvania and the Chernobyl nuclear power plant disaster, provides some insight into the potential long-term consequences of the Fukushima Daiichi disaster. In both TMI and Chernobyl, research has show that the psychological consequences of the disasters tend to have a much larger long-term impact on both residents and workers, than physical disability or illness does. Often, it is the residents who are removed from their homes for whom it is most difficult to return to a normal life.
The photographs in this section were taken in a Fukushima, including Gankoya Temperary Housing facility during the implementation period of a photovoice research project in June-July of 2015
In June-July of 2015, Daniel Jack Lyons conducted photovoice research to explore the experiences of the Gankoya Temporary Housing residents and associated community members. This study was conducted with the support of Mount Sinai Icahn School of Medicine and Fukushima University. 9 currently displaced residents of Gankoya Temporary Housing Unit in Soma City, Fukushima Prefecture, Japan, participated in the study. The photos and narratives produced by participants provide a unique perspective into how these displaced residents experience life in temporary housing, their anxieties about the past, and their hopes for their future. The core findings of the study are currently being analyzed and prepared for publication in a peer reviewed scholarly journal.
Thousands of eastern Ukrainians are flowing into The capital, Kiev amid the ongoing Russian military operation, in which the cities occupied by anti-government separatists are being shelled and bombarded with heavy artillery and incendiary bombs. Even in large regional centers like Lugansk, people no longer feel safe, as cases of Russian jets launching missiles at central city buildings in broad daylight have been reported. An estimated 70,000 refugees have fled regions such as Crimea and Donetsk to resettle in Kiev.
The widespread diaspora of internal refugees fleeing Eastern Ukraine has left many jobless and often homeless. Adults with previous work experience are the first to get jobs, leaving a drastic increase in youth living on the streets.
In July of 2014 I was commissioned by Health Right International to document various marginalized populations in Ukraine, including HIV positive mothers, drug users, sex workers, street youth, and internally displaced refugees.
The neonatal mortality rate in Nepal has declined more slowly than infant and child mortality in recent years, indicating the need for stronger evidence and interventions. While maternal mortality has declined, it remains unacceptably high, with 229 to 281 deaths per 100,000 live births. Further reduction of these rates presents significant health systems challenges. Safe delivery, newborn care, and postnatal care can reduce morbidity and mortality. The Nepal Government has increased attention to address these issues by implementing different strategies mainly Birth Preparedness Package (BPP) and Free Maternity Health Services throughout the country. However, in Nepal, only 36% of babies are delivered by a skilled provider, and under half of women received postnatal care for their last birth within “the critical first two days following delivery.”
Health Right International has adapted and piloted maternal and neonatal near miss review projects in selected areas of Arghakhanchi, as part of multi-faceted efforts to strengthen maternal and neonatal care (MNC) from the household level reaching throughout the health system. In October of 2014, I was commissioned by HealthRight international to document the work they are currently implementing in the district of Arghankhanchi. Photos in this selection feature young mothers and pregnant women, Female Community Health Volunteers, Health Facility Staff, and health workers.
Each year, thousands of survivors of torture, trafficking, and other human rights abuses flee persecution in their home countries, seeking asylum and other protections in the United States. An estimated 500,000 of whom live in communities across the United States, the largest amount living in New York City.
During the course of 2014, I worked with survivors of torture on three separate projects. In New York City, I interviewed and photographed both beneficiaries and volunteers working with the Human Rights Clinic at HealthRight International. In queens I conducted a photovoice project with beneficiaries of the Libertas Center for Human Rights. Examples of the participant’s photos and narratives from that project can be viewed in the PHOTOVOICE section of this site. And in Kenya I worked with Ugandan refugees, fleeing persecution from the “kill the gays bill”, who were seeking asylum in Kenya. The photos in this selection feature portraits from all three of these projects. Below are descriptions of the operating context in which these projects were conducted.
The Libertas Center provides services for refugees and asylum seekers who fled their home countries due to persecution. Services include medical and mental health care, forensic evaluations and affidavits in support of asylum applications, legal referrals, case management and social support. Using a model of care coordination, the Libertas Center offers survivors of torture access to healthcare, psychological care, medical affidavits, and social and legal services. In addition, the Libertas Center raises awareness about torture survivors to medical providers and physicians-in-training, and has initiated research projects to quantify the scope of their needs in our community.
HealthRight International provides forensic and case management services to immigrants fleeing torture and other severe human rights abuses. Founded in 1993, HRC recruits and trains volunteer clinicians who conduct forensic evaluations to document physical and psychological signs of torture for survivors in immigration proceedings
When the “kill the gays” bill was passed in Uganda, thousands of lesbian, gay men, bisexuals and transgendered people crossed the broader seeking refuge in Kenya. Many turned to a life on the streets before coming into contact with one of several LGBT Organizations. One in particular, GALCK was providing a safe house for LGBT refugees to live in. However when neighbors began to enquire about the new community residents, rumors began to spread. Before long the police knocked down the doors of the safe house hauled the men staying there to the station. Upon realizing that they were Ugandan refugees, they relocated them to a refugee camp on the outskirts of the city.
Inside the refugee camps, however, Kenya might as well be Uganda. Other refugees began to despise any association with LGBT people and resorted to assaulting them and eventually poisoning them. A group of men escaped the camp, and with the help of AMFAR were awaiting legal assistance to declare them unfit to live in the camps. This is when I met them in March of 2014. The gay men featured in these portraits are all from Uganda and were awaiting further news regarding their pending refugee status from the Kenyan government.
The floods of 2013 displaced over 150,000 people in the Gaza province of Mozambique. In the immediate aftermath, mass evacuations to temporary camps and relocation sites resulted in large-scale humanitarian needs. The International Organization for Migration (IOM) and partners in the UN and NGO community immediately reacted to support emergency life-saving measures. Having given legal and material protection to Internally Displaced Populations (IDP’s) from the flood, IOM still saw a need to continue working with the communities.
In December of 2014, I conducted a participatory photo documentary project with flood survivors in three of the relocation sites. The project utilized a community based participatory research method known as photovoice, which combines photography with grassroots social action and is commonly used in the fields of community development, public health, and human rights. Seventeen participants were given cameras and asked to represent their community or point of view by taking photos, discussing them together, and developing narratives to go with the photos. An assessment of these photos and narratives provided evidence of the reach and impact that durable solutions can have on communities in resettlement sites. This project served to evaluate the IOM resources that have been most effective in preventing people from returning to live in the flood zone. In addition, it measured the astounding resilience of Mozambicans to make radical life adjustments in the face of a natural disaster. Examples of participant's photos and narratives can be seen in the PHOTOVOICE section of this site.
This selection of photos features portraits of some of the the participant's from this praject, as well reportage images that were taken while spending a considerable amount of time in the camps. In addition to conducting photovoice, which entails numerous in-depth interviews and focus groups, I also incorporates my own photography into the methodology. By working closely with participants, I am able to build trusting rapport and gain access into the communities that I work with. The end result is a combination of perspectives that, in this case, include those of internally displaced flood survivors as well as observations made by myself as a public health professional and photographer working in the resettlement sites.
Barrouleit is a small fishing village on the island of Saint Vincent's, and is the location of a photovoice project currently being conducted in partnership with Mount Sinai Icahn School of Medicine. The purpose of the project is to look at how alcoholism, as a byproduct of the rum industry left behind by british colonialism, has deteriorated local communities. The goal of the project is to help communities such as Barrouleit determine and design culturally appropriate treatment options for alcoholism and substance use. Currently the few options available to people are adopted from abstinence models designed in Europe and North America. Based on the photos and narratives of participants so far, it seems that a truly Vincentian approach to treating alcohol and and substance use will require a more nuanced model, one that takes into account cultural sources of pride and tradition. It is likely that the Saint Vincent's model of treatment will align itself closer to a harm reduction approaches, as opposed to abstinence only models.
This collection of photographs features both some of the participants of the photovoice project, as well as the local context in which they live. Not everyone that appears in these photos are participants of the project, but all photos were taken in and around Barrouleit.
Death of women from complications of childbirth remains a major global health problem. In 2010, nearly 300,000 women died in childbirth, the vast majority in developing countries. The maternal mortality ratio—deaths associated with pregnancy or childbirth per 100,000 live births—has proven to be one of the most intractable health indicators in the developing world. Few resource-limited countries have made significant progress toward the Millennium Development Goal 5 target to reduce the maternal mortality ratio by 75% between 1990 and 2015. Lesotho, for example, has one of the highest maternal mortality ratios in the world—in fact, the maternal mortality ratio increased from 237 to 1155 per 100,000 live births between 1990 and 2009.1,2 In contrast, almost all resource-rich countries have less than 10 maternal deaths per 100,000 live births.
Common causes of maternal death in resource-limited settings include obstetrical hemorrhage, peripartum infections, eclampsia, and obstructed labor.3 The majority of these deaths can be prevented with timely access to emergency obstetrical care. However, in resource-limited settings, many deliveries occur at home, often aided by a traditional birth attendant or family member without the skills or the equipment to respond effectively to obstetric emergencies.
The geographic distance between women’s homes and the nearest health facility can also magnify the problem. In a setting like rural parts of the North Rift Valley, Kenya, where women must traverse mountainous terrain to reach a facility with obstetric services, the delay can be significant. If a woman experiences a complication with rapid onset, even a delay of several hours can be fatal. Such emergencies often cannot be easily predicted.
Maternity waiting homes are built near a facility with essential obstetric services and allow pregnant women to travel thereseveral weeks before delivery, wait for the onset of labor, and be quickly transferred to the facility for safe delivery. Waiting homes have been introduced in many developing countries, and their efficacy in decreasing maternal mortality continues to be proven.
Since 2005, HealthRight International has been working in the economically and geographically isolated communities of Kenya’s North Rift Valley responding to three areas of critical need: maternal and neonatal health, malaria, and HIV/AIDS.HealthRight supported multiple health facilities in the NorthRift Valley district of Kitale to construct maternity waiting homes where women can come and stay for free prior to the onset of labor. Since their construction, these maternity waiting homes have helped to reduce deaths by getting pregnant women to facilities for close monitoring in the days and weeks before delivery. The number of women using the three MWHs increased in 2013 by 54% and 100% of those women say that they would recommend the facility to a friend.
n July of 2014, I was commissioned by HealthRight to interview and photograph the women who are, and have accessed the services related to the maternity waiting homes, as well as the community health workers who promote such services.
Clean water is a luxury that not everyone has the privilege to enjoy. As the politics around water tighten their grip in the west, it is becoming increasingly relevant to take a closer look at the politics and impact of water in the global south. Worldwide, approximately 20 percent of the global population does not have access to clean drinking water. The photos featured in this series were taken in a rural district of Kenya called Samburu, an area plagued by water shortages. Recent droughts have intensified already-existing water shortages, a crisis that now impacts 3.5 million Kenyans living in arid and semi-arid areas of the country. These photos of Samburu people were initially taken for the Samburu Project, and feature members of the Samburu community utilizing clean water that has been made available to them by the Samburu Project.
Gorongosa is a beautiful game park that suffered a precipitous fall from grace. Three years after Mozambique won its independence from Portugal in 1975, a civil war broke out and raged for 17 years. The park, which had been established by the colonial government in 1960, became a battleground. Its headquarters and tourist facilities were destroyed. Roving soldiers, hungry for food as well as for ivory they could trade for weapons in South Africa, killed many of the large animals. After peace accords were signed, but before order could be restored at Gorongosa, commercial poachers killed an even larger number of animals, peddling the meat at nearby markets. In the end, nearly all the big game species were gone or nearly gone. Only the crocodiles, quick to slide down muddy banks into the safety of the rivers, escaped with little harm.
Currently, the Gorongosa National Park, in Mozambique, is thought to be one of Africa’s greatest wildlife restoration story: a 20-year Public-Private Partnership between the Government of Mozambique and the Gorongosa Restoration Project, a U.S. non-profit organization. By adopting a 21st Century conservation model of balancing the needs of wildlife and people, The Gorongosa Restoration Project are protecting and savingthe beautiful wilderness, returning it to its rightful place as one of Africa’s greatest parks.
However, where the park has succeeded in restoration they have failed in community health initiatives. In 2007, a staggering 27% of park employees who were tested for HIV, tested positive. The restoration project responded by partnering with Mount Sinai Hospital to create a community health program, and since then have implemented several programs to improve the health of employees and create linkages to surrounding communities. Though, HIV rates and stigma among employees continued to soar.
In August of 2014, Daniel Jack Lyons was hired as a qualitative research consultant to conduct a community based needs assessment with the employees of Gorongosa National Park in order to design an HIV prevention strategy to be implemented among park employees.
The photographs in this section were taken in Gorongosa National Park, and with Employees and Community Health workers during the data collection period of the community based needs assessment.
Given the wide breadth of work that the park employs, the key findings of the assessment were based on the notion that there is not one particular approach to HIV prevention that could possibly benefit all employees of the park equally. Rather, a more nuanced strategy, with various types of activities will be necessary to engage the various types of employees working in the park. This is particularly true for certain sectors of the park, such as park rangers who are hardest to reach as well as most vulnerable to HIV transmission due to the context of their working conditions. Fortunately, the park has a number of resources already in place that will be essential to implementing the recommended programs and activities. Some of these resources include onsite nurses, one of whom has over 15 years of experience in HIV prevention outreach, treatment and counseling. Moreover there is a motivated and eager group young male peer educators who have been formed, in addition several young women have expressed interest in also becoming peer educators. Once both of the groups are formally trained they will be an integral resource to the park’s workplace HIV prevention outreach program. The implementation strategy that I designed proposed eight programmatic recommendations that are based on data gathered while conducting the community health needs assessment, and are representative of the assessments key findings.
This selection of portraits was taken at the conference on Same Sex Sexuality and Gender Diversity in Nairobi, Kenya in March of 2014. 5 of the people featured here were participants of a photovoice project titled Subaltern Speak. The participants of this project documented the struggles they face based on sexual orientation and identity politics within conservative local contexts.
The most prevalent theme of the participant’s narratives and photos related to issues of safety. Many of the photos and narratives submitted by participants documented spaces that were unsafe to reveal their sexual identity, such as public spaces, as well as those where it was safe to be known as gay or lesbian, usually in private settings such as parties. Each participant selected two photos that touched on this theme to be included in the final presentation that was held on the second day of the conference. When presented, the photos and narratives provoked a discussion among conference attendees around issues of representation and authorship of LGBT people in the global media.
Born out of this discussion was an interest to collaborate on a series of portraits that confronted the notion that for people in African countries, ones safety as it relates to identity is out of the hands of the individual. In countries like Uganda, Nigeria, Malawi, and others, newspapers and publications are printing the names and photos of LGBT people, and consequently endangering their lives. The portraits featured in this seeries respond to this act of endangerment by reclaiming the right to choose when and how an individual identifies. Each person that sat to be photographed came up with their own unique way to de-identify themselves.
This series was exhibited from May 8th to June 2nd 2015 in the Netherlands Ministry of Foreign Affairs, and in July of 2015 at Gallery 315 in New York City, under the title Who Can Tell. They were also published in the book Boldly Queer: African Perspectives on Same-sex Sexuality and Gender Diversity.
Examples of participant photos and narratives from the Subaltern Speak photovoice project can be seen in the photovoice section of this website.
Crimes of the Future
This collection of photographs puts emphasis on the act of travel and the silence found in foreign settings. These photos feature bodies, spaces, and lifeless structures, each displayed with evident placidity, but with no direct narrative.
I have found a dream of beauty at which one might look all one's life and sigh. A strictly North American beauty—snow-splotched mountains, huge pines, red-woods, sugar pines, silver spruce; a crystalline atmosphere, waves of the richest color; and pine-hung lakes which mirrors all beauty on their surface. The Rockies are before me. The air is keen and elastic. There is no sound but the distant and slightly musical ring of the lumberer's axe.
-Isabella L. Bird
The majority of the portraits featured in this section were originally published in the Huffington Post as accompaniment to interviews authored by either Philip Miner or myself. Each interview and portrait focuses on an individual who is pushing the boundaries of identity politics through artistic expression and/or political activism.