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.
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 Lesotho, 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, but their efficacy in decreasing maternal mortality remains controversial.
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 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.
The photos featured in this selection were taken for The Samburu Project, who’s primary initiative is aimed at providing easy access to clean, safe drinking water to communities throughout the Samburu District of Kenya. This is a community where women and children walk up to 12 miles every day in search of water. Often, this water is contaminated. With clean water, it will become possible The Samburu Project to impact other aspects of community life including education, healthcare, income generation and women’s empowerment. With water, development happens.
Many of those photographed were also interviewed about the barriers that they faced to accessing clean water before their community or village received a well from the Samburu Project. Their stories are also featured here.
Noolkitoip spent many nights lying awake with a sore back, dreading the morning ahead of her. The average woman in the Lbaaonyokie Community fetches water every 3-4 days, however due to a large family of 20 people, in addition to over 50 goats and 10 cows, Nookitoip needed to fetch water on a daily basis. Carting over 30 gallons of water for 7 hours a day had taken a toll on her back. But there were times, as she recalls, when many people in her household had fallen ill and needed more water than usual, and she would arrive to the watering hole only to discover that baboons had bathed in it the night before. This didn’t only happen once, but rather frequently, and always seemed to happen at times when water was most crucial. Now with a sustainable clean water source only 5 minutes from her home, Noolkitoip is incredibly grateful for her healthy family and her equally healthy back.
Like many others in his village, Jelimiah Lekelele and his family suffered countless infections and fevers from contaminated water. And the fact that the closest water source was 30 kilometers away, only added insult to injury. With a large communal garden to tend to and a considerable amount of goats and camels, the people of Mudanda Village consume more water than most. The quality of that water is indicative of the quality of life in the community. Since a clean and sustainable water source was brought to the community, the garden and livestock has flourished. In addition, Jelemiah boasts that he can count on one hand the amount of times that he has been sick since the well was built.
The hardest days, as Nalotuesha recalls, were those when she could not find someone to watch her two infant daughters when she needed to fetch water. This happened often due to where she lives in proximity to others as well as, what was then, the primary water source. In those moments she was forced to take her daughters with her, which greatly limited the amount of water that she could carry back. Other mothers faced similar difficulties in the community. When the well was built, it not only provided a sustainable source of clean water, but it also created a central location for mothers to meet, one that was that relatively close to each of their homes. Together they decided to create a nursery/day care next to the well so that they have a safe place to leave their children while attending to hard labor. The day care has proven to be a huge success and draws large crowds of women from neighboring communities. Nalotuesha jokingly claims that now her greatest hardship related to water access are the long lines of women waiting to pump water at the well each morning.
Like most people in the her community, Seina once collected water for her family by digging holes in the riverbank. This was common practice for the people of Upper Margwe before the Samburu Project provided them with a sustainable source of clean water. And also like many people in the community at that time, Seina had a nearly fatal case of chronic diarrhea. Ingesting harmful bacteria that causes diarrhea, when there is not an available water source, can quickly turn into a public health disaster. If the body cannot replenish and rehydrate then a very curable condition suddenly runs a significant risk of fatality. This is precisely what happened to Seina. At the age of 24 she was found unconscious by one of her children and rushed to a health clinic. At the clinic she received rehydration salts and medication, however she felt weary about returning home knowing that accessing clean water was still an issue. When asked about the well that was built by the Samburu project later that same year, she describes an incredible sense of relief. The well did not only bring clean water, but it also drastically improved the health of the community of Upper Margwe.
John Letapo places a high value on the education of his three children. But four years ago John recalls a time when all of his children missed over a year of school due to an illness caused by contaminated water. Both John and his wife, and many others in the community were also ill. During that time his wife would often return from the watering hole, frustrated that baboons had bathed in the water again. Each time this happened they grew doubtful of returning to good health. This was also a challenging time financially since their livelihood is largely dependent on livestock, which were also suffering due to the scarcity of clean water. When the Samburu Project drilled a sustainable well that pumped clean water into the community, John was beside himself. Him and his wife grew hopeful for their future as well as that of their children. His livestock began to flourish, and this year they have produced more offspring than ever before. Similarly since Johns wife no longer has to spend hours carting water, she has begun to sell her beaded jewelry in the market, adding an extra source of income to the household. And after returning to better health, his children were re-enrolled in school. John is proud to say that since the well was built in 2011, his children have not missed a single class.
To be up at 4AM is a typical morning for Jelesina. Before a well was built in her community, a typical morning also consisted of walking 12 miles to fetch water. During one of these early mornings, Jelesina was walking with 2 of her daughters, on their way to collect water, when they spotted a lion. Aware that Lions feed at dya break, Jelesina was concerned that the lion had also spotted her. She hid with her two daughters until it was safe. Other women in the community had similar run-ins with wild animals, so they decided to gather in the mornings and make the trip together in groups of 20 people or more. However collecting water in large groups from a limited source had its own complications. On top of that, the waster was often polluted and unsanitary. Since 2011, Jelesina’s 12 mile hike to collect water has turned into a 6 minute walk, thanks to a local well built by the samburu project. As the women now pump clean water from this same well, they often joke with another, reminiscing the times when they traveled together in safety against lions.
At only 14 years old, Ltoina Letiwa holds a lot of responsibility as the oldest son in his family. He is responsible for tending to the livestock as well as taking care of his two younger brothers and sisters. While his siblings were still too young to help with household responsibilities, Ltoina was responsible for waking up extra early to fetch water in order to make it back in time to attend to the other chores before the evening settled into darkness. He recalls barely having enough time in each day to complete all his responsibilities. He also recalls the day that he saw big trucks with giant machines breaking up the earth’s surface. He watched for 2 days as long pipes and rods were fed into a seemingly endless pit. It was explained to him that water would rise out of the hole dug by machines, but while he listened and watched closely, he still refused believe that it was possible. On the second day the impossible happened; Ltoina was astonished to see water. And while the well has created more time for Ltoina to tend to his chores, he is happiest to report that he now bathes twice a day as opposed to once every three days.
Mr. Loibor is an elder in his community and carries a reputation for being a very successful man. In his household he has 12 children and 3 wives and lives on a large swath of land with 200 goats, 50 cows, 20 camels, 50 sheep, 10 donkeys and a few dogs to help keep them all in line. A lot of water is needed to keep that much livestock healthy. Before the well was built, each of his wives would make a daily trip to the watering hole, 30 kilometers away. During this period typhoid was rampant due to a contaminated water source. During this period Mr. Loibor was forced to make difficult decisions regarding the health of his children and the health of his livestock. Due to illness, his children were unable to attend school, and without clean water they were unable to regain their health. Within a very short period of constructing the well, only a 5-minute walk from his home, Mr. Loibor saw dramatic improvements in the health his children as well as his livestock. All 12 children are currently attending school and healthy enough to also assist him in duties of rearing all those goats, cows, camels, sheep, and donkeys.
During the last drought in Samburu, Namaita Lenareu sadly watched a significant portion of her livestock die of dehydration. During that year her Goats and sheep reproduced in numbers higher than she expected. When this happened she felt blessed with good fortune; however as difficulties accessing clean water ensued, her joy turned to frustration. Namaita found it impossible to carry enough water each day to keep the animals healthy. On top of that, water that year was particularly scarce. Given these harsh conditions, Namaita and her family were faced with difficult decisions on how to prioritize and ration what little water they had. When water is in such short demand, every day choices such as washing clothes, cooking, bathing, washing dishes, and feeding livestock become extremely burdensome. As a result, Namaita found it challenging to maintain good hygene for herself and her four children. The well built by the Samburu Project in 2011, just a seven-minute walk from her home, changed her life forever. Her 20 goats, five sheep, and one cow are well hydrated and healthier than ever. Not to mention, she no longer has to decide between washing clothes and cooking a meal.
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.
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 discourse with conference attendees around issues of representation and authorship of LGBT people in the global media.
Bourne out of this discourse 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 selection 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.
To see the photos and narratives produced by participants of the Subaltern Speak photovoice project, please follow the link in the photovoice section of this site.
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.
Nigerian gay rights activist: Michael Ighodaro
Phototographer: Richard Stuart Perkins:
Artist: Wizard Skull
Adult Film Star/Artist: Colby Keller
Writer and Art Curator: Phillip Miner
Artist/Photo-sculptor: David Meanix
Performance Artist: Saint Dandy
Musician and Performer: AB Soto
Performance Artist: Zondra
Fim Maker: Sarah Daggar
Photographer: Nino Munoz
Artist/Photographer: Felipe Vasquez
Member of The Crystal Ark and Performance Artist: Viva Ruiz
Comedy Duo: Dick & Duane
Sculptor: Mitch Lewis
Feminist Film Maker: Katrina Del Mar
Ayurvedic Healer: Deloris De Costa
During 2012 I made several trips to Liberia while working on the THINK Photovoice Liberia project. I bookended some of these trips with explorations along the coastline of Liberia. What I found were pockets of beach dwellers that lived and relaxed on the shores of these coastal communities. Surfing is becoming more popular in some of these towns, particularly in Robertsport (photos 1-6). In most communities the beaches are used primarily by fishermen, teenagers seeking refuge, and in some cases local artists who scavenge the shores for drift wood and canvases.
Sexual and gender-based violence (SGBV) is not only prevalent in Liberian society; it is unfortunately accepted as an integral part of gender relations. This perception was exacerbated during the war years, as SGBV was used repeatedly as a weapon. For many Liberian women and girls, the appalling violence they experienced during wartime still occurs. Rape continues to be the most frequently reported serious crime in Liberia. In 2007, 46 percent of reported rape cases to the Liberian National Police involved children under age 18. During the conflict, the perpetrators were mainly fighting forces; however, after the conflict the perpetrators include not just ex-combatants, but community or family members, teachers, husbands or partners.
In January of 2012 I began traveling to Liberia to work with a group of 25 young women, all survivors of gender based sexual violence. The 25 young women are in a rehabilitation school called Project THINK. They offer education and skills training as well as counseling and support services to female ex-child soldiers and survivors of SGBV. I was hired as a consultant in collaboration with New York-based nonprofit, PCI Media Impact to document the girls’ stories of survival.
For four years Mozambique was home to me. The first two years were spent living on a small rural island that was reachable by a 6-hour boat ride from the capitol, Maputo. The island, known as Inhaca, had 5,000 residents, two cars, and no paved roads to speak of. Most of the population lived without electricity or running water, including myself.
Initially I was hired by Habitat for Humanity to identify orphan-led households and facilitate the process of building them a home. Apart from a Portuguese diamond smuggler who was hiding out there, I was the only foreigner living on the island and certainly the only one to be considered a member of the community. Based solely on the color of my skin, I was assumed to be a doctor and as a result was asked into many homes to visit with people who were bed ridden with illness. Although I was by no means a doctor, I could easily identify the physical symptoms of later stages of AIDS. In fact, in the 8 months before moving to Mozambique I had been living with and caring for a very close friend who was HIV+ and in a similar state. Perhaps for this reason I was deeply affected by these visits and moved to take action.
At the time there were no HIV services or testing center on the island. In order for an Inhacan to get tested they would have to travel by boat to the central hospital in the capital, Maputo. This would require setting aside three days minimum, and a significant portion of their income. If they tested positive, then they would be expected to make this trip once a month in order to receive treatment. Many people, for good reason, preferred not to get tested. I spoke to the director of the clinic who allowed me to gather a group of volunteers to be trained as home based care activists. I contacted an NGO in Maputo to send someone out to train the group. And within a month we had 12 activists visiting the homes of those who were sick, but still no way to provide testing and treatment.
I traveled to Maputo once a month to stock up on groceries and during these trips would stay with an older expat who often hosted lavish brunches at her roof-top apartment on Sunday mornings. During one of these brunches I became quite vocal about the state of Inhaca. To which a USAID worker assured me that she would bring this to the attention of the Ministry of Health. These types of promises were made often and so I thought nothing of it. However a week later, while working with my Home Based Care volunteers, I received a call informing me that Inhaca was about to change. As it turned out the first lady of Mozambique was planning a political visit to Inhaca in support of the upcoming elections. The USAID worker seized the moment to point out how embarrassing it would be to the Ministry if the first lady arrived to Inhaca and was greeted by a protest regarding the dire state of HIV services. I hung up the phone and within days everything changed.
A barge arrived packed with construction materials, medical equipment, and a 4-wheel drive off-road ambulance. I helped supervise the construction of the clinic and within a week we were up and running with HIV testing and treatment services. Eventually my home based care activists were trained to be HIV counselors and the Ministry sent over an additional clinician to supervise the services. I spent the rest of my days on the island split between working in the HIV clinic and continuing to facilitate the construction of homes for orphan-led households. In the quieter moments I camped on the other side of the island and surfed waves that had previously been uncharted. This lasted for 2 years until I was recruited by Vanderbilt University’s Friends in Global Health to help build their community health program in the rural North of Mozambique.
The following two years were spent living in a province called Zambezia. I was hired to essentially replicate what I had done on Inhaca, but in 6 rural districts all across the province. I spent more time on the dusty dirt roads than I did in my own home. The environmental shift from the sea breezes of Inhaca to the dusty potholes of Zambezia was drastic and shocking. But I loved my work. In many of these districts people had never heard of HIV. Friends in Global Health was setting up testing units in places where no one had ever been tested. It was my job to immediately set up People Living with HIV (PLWH) groups in each district in an attempt to preemptively combat inevitable HIV stigma. Each group, mostly made up of women, was trained on how to design and implement an income generation project of their choice.
Given the nature of this work, and being a source of information and counseling for people who had recently tested positive, I developed very close bonds with those that I worked with. The same could be said for my experience on the island of Inhaca. The photos in this series document the people that I shared these experiences with, and the places where many friendships were formed.
Fisher boy, on the island of Inhaca pt.1
Early morning fog, heading into rural Zambezia for weeks on end
Dona Ines, washing clothes in Masaka
Dona Luisa and her adopted children
Hangin around Pt.1
Hangin around Pt.2
Victor, of Gurue
Fishermen waiting for the tide to come in on the island of Inhaca
Dona Gebuza, returning from PMTCT counseling in Mocuba
Long days on dusty roads
Rosaria, taking the boat from Inhaca to Maputo to get the results from her HIV test
Francisca, HIV activist of Ile
Hernanda, HIV activist of Ile
Renaldo, HIV activist of Ile
Rosa, HIV activist of Ile
Dona Luisa, of Quilimane
Fisher boy Pt.2
Wima and Alcinda, nurses of Lugela
Catholic church in Quilimane Pt.1
Catholic church in Quilimane Pt.2
Rest stop, outside of Alto Molocue
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.