The first thing I noticed about the boy was his skin--the color of aged parchment. He wore a tattered T-shirt and shorts, and he lay very still on the cot. His face, pale from fever, seemed to fade into the mattress stained by the sweat of hundreds of patients.
A yellow fever epidemic was consuming the region around Mirador, Brazil. More than 50 people had died--enough, in the complex math of developing world public health to justify intervention. A Brazilian vaccination team was sent in. I went with them, photographing a story on viruses for National Geographic Magazine.
The team made a courtesy call at the clinic of the local health officer. My presence caused a stir. No one had heard of the magazine I worked for, but I was an American and few foreigners come to Mirador, a small town six hours by car from the Amazon River city of Belem.
The boy's father stood off to the side, obviously upset. Dr. Nicolas Degallia, leader of the vaccination team, explained to me the boy had yellow fever and was very sick. His brother had died the week before of the same disease. The father, not wanting to lose another son, had brought him in by foot. The father was poor and couldn't pay for the IV bags needed for the severely dehydrated boy.
I started to photograph the scene, which caused a flurry of conversation with Dr. Degallia, followed by activity. A pole with an IV bag appeared and the boy was soon receiving fluid and vitamins. Dr. Degallia had told the clinic staff it might be better if I photographed them helping the boy rather than letting him die.
We returned to the clinic the next day. The boy was sitting up, tired but alive. His father grabbed the hand of Dr. Degallia, grateful to have his son back. Later, Degallia, whose life's work was studying yellow fever, expressed amazement to me at what he had seen. "Yesterday, I would have never guessed the boy would walk out of that clinic alive."
None of the pictures I took that day in 1993 would have won a contest. The yellow fever epidemic was not part of major press coverage. There were no famines killing thousands, no ethnic cleansing, no drama big enough to capture international media attention. Over several months, fifty people in a very remote part of Brazil died of yellow fever. A few viruses like Ebola grab media attention when they appear because they act in spectacular ways. But yellow fever victims fade quietly away as that boy almost did.
This was the first time in my career as a photojournalist that I directly saw the difference my presence made. I saw how simple intervention could have an impact. And I saw how powerful the presence of the press could be. I was a foreign journalist. What I observed was important enough to the workers in that clinic that they broke their own rules and gave medicine to someone who couldn't afford it. This chance interaction saved the boy's life and changed mine, setting me on what became a decade-long journey. I started out to cover viruses. Over time, that grew into a mission to tell the story of the global health issues we face at a remarkable time in history.
I didn't plan to be a photographer. I majored in anthropology and religion at the University of Michigan. After graduation, I got a grant to collect oral histories in Tennessee and took up photography to document my subjects. I found I liked it and worked my way up to a staff photographer position at The Virginian-Pilot in Norfolk. After five years there I began freelancing. I proposed stories to National Geographic about areas I knew. My first story for the magazine was on my hometown, the Hampton Roads area of Virginia. I followed up with ideas on other regions I knew--the state of Tennessee, San Diego, and the Gullah culture of the Sea Islands. In the wake of the Chernobyl disaster, Tom Kennedy, then Director of Photography handed me my first international story, on the global effects of radiation. I thought my first overseas story would be on a much smaller scale. This was a trial by fire. I had never worked outside the United States before, nor had I done a science story. But in photographing "Living with Radiation," I found I liked big, complicated global stories, and I liked putting a human face on science issues.
After "Radiation," I worked on stories in Asia, had my son Will, and was expecting my daughter Katie. About three months before she was born, Kennedy offered me the viruses story. He wanted me to give it the same human treatment I'd used on radiation. It put me on the spot. I wanted to do the story but while I was pregnant I wouldn't want to get near most of the situations I would have to photograph. And, as anyone who has freelanced knows, the greatest fear is turning down assignments--it could be the last one offered.
I asked to think about it. My obstetrician was astonished that I was even considering such a story. Finally, Kennedy agreed that before doing international travel, I could wait until my daughter was born and weaned.
It was a tough assignment. I went to some of the poorest, most unstable countries in the world. I was arrested in Sierra Leone, had AK-47's pointed at me, walked through human waste in the worst poverty imaginable, and become dangerously ill while covering brothels in Bombay. In Ivory Coast, I worked in a hospital housing people dying of AIDS. They lay on blue rubber cots; many were naked. No medicines were handed out--people came there to die. I began to understand how many people die every day because no one really cares. People die of diseases no longer found in the developed world--malaria, yellow fever, and measles. Undernourished children die quickly from common childhood aliments; colds become pneumonia, diarrhea deteriorates into severe dehydration.
In hindsight, I'm grateful to Kennedy for giving me that assignment. "Viruses: On the Edge of Life, On the Edge of Death" changed my professional life. Before this story, my interest in global health was limited to what I read in the papers. "Viruses" threw me into experiences I'd never imagined and forced me to look closely at the extreme poverty under which much of the world lives.
After "Viruses," I became very focused on global health and social change. I asked for or proposed stories in those areas, including aging, genetics, women, and population and human migration. I often found one story sprang from the seeds of another. During "Viruses," I began to think about why so many areas I visited were in economic, social, or environmental distress. I researched this and developed a proposal for a story I called the "Ecology of Disease." I wanted to show how changes in physical and social geography contribute to the rise in disease.
I came up with that idea back in 1994. SARS, West Nile and mad cow weren't part of our vocabulary back then, but after my experience with viruses, I could see them coming. Still, it took a while to get the idea approved. I kept proposing it to National Geographic, and in 2000 it finally got through. Sometimes it pays to be tenacious.
"Ecology of Disease," an accompanying coverage of HIV/AIDS, and the virus story became the heart of a book National Geographic recently published called Impact: from the Frontlines of Global Health. I've taken a very personal approach in photographing these issues, looking for intimate moments that can symbolize larger situations and connect with readers.
On January 1, 1993, two days after weaning my three-month-old daughter Katie, I got on a plane to Puerto Rico. The next day I was in one of the worst slums in San Juan photographing HIV-positive drug addicts shooting heroin. My presence was accepted, but my worry was a badly done injection would spray infected blood in my face. I was photographing the addicts close and personal. The walls were already splattered with blood of previous users.
Working on AIDS took me to worlds I could never have imagined. In every part of the planet I met people coping with this horrible disease. I spent time with bar girls in Cambodia, drug addicts in Moscow, transvestites in Puerto Rico, gay bathhouse patrons in San Francisco, and middle class housewives in Georgia. I saw African women struggling to live as long as they could for their children. I witnessed the pain of elderly grandparents losing their adult children. I marveled at the bravery of children holding homes together after both parents died. I photographed a mother who wanted me to adopt her children after she died.
In San Francisco I covered the infamous gay bathhouses. One gracious owner was anxious for me to show his work. He ran an erotic workshop, teaching young men to express their feelings and closeness to one another without exchanging bodily fluids. He wanted them to learn how to love and live. This was a new experience for me; I was raised as a good Catholic girl, and when I'm not on the road, I'm a suburban housewife with two kids in a Catholic school run by nuns. But here, I was in a room filled with naked men and I was the only one clothed. The men wore rings on body parts I didn't even know could hold a ring. Yet I felt completely at ease. The facilitator gave instructions and told the men to imagine this or that. I photographed them stroking, holding, kissing each other. I tried to make tasteful pictures. Though National Geographic has the reputation for giving many men their first glimpse of female breasts, there are limits to what the magazine will run and I knew I was pushing the envelope. But the odd thing was, the actions I was watching didn't feel erotic at all. It was almost sweet, like watching chaste young people trying to kiss each other for the first time.
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