Paul returned with the police officer, who insisted on being driven to his girlfriend's house. We weren't arguing. After finally dropping him off, I got back in the front seat and started obsessively wiping everything down again. Paul looked over at me, but didn't say a word; neither of us spoke for nearly five minutes. It had been such a strange, intense experience. Then we both started laughing like old friends who knew what each other was thinking. "Why is it, Paul," I asked, "that whenever I'm working with you, policemen and guns are always involved?"
In 2000 I went to Dhaka, Bangladesh, to cover a cholera epidemic. Bangladesh is a water world. During the monsoon season, almost half this country of low-lying deltas is submerged. In the cities, slums sprout where water collects in large ponds. There is no plumbing in these communities. In the same common pond people wash their clothes, bath, and use outhouses. This was where I had to go to get photographs illustrating the cholera epidemic. Concerned about my safety, the organization hosting me arranged for an entourage of doctors and community representatives--a total of five people. I'd worked in Bangladesh before and knew what it was like to attempt photography with an entourage of twenty or thirty people in tow, watching my every move. With just five I almost felt alone.
It was early morning when we got to the slum. People were starting morning routines of washing and cleaning, often with water stolen from municipal pipes. Hanging toilets lined the community pond shore, with waste dropping directly into the water. Keeping my eyes on the ground, I rushed to photograph a child about to enter one. I looked down as I walked to avoid the human waste that lined the walkway, left by those who couldn't wait or didn't have access to the hanging toilet. The waste was hard to spot among the garbage heaps but the smell was unmistakably human.
After I finished photographing, one of the young doctors admitted she nearly fainted from the smell. I was amazed, since this was the community her clinic served. She explained people came to her clinic and she, coming from an upper middle class family, had never set foot in a slum before. Walking through this slum hadn't bothered me at all. I began to wonder if I had been doing this too long. What did cross my mind was that I had traveled half way across the world to take a picture of an outhouse in good light.
Developing countries aren't the only places with water issues. In the United States, people are getting sick in record numbers from swimming in public pools and water parks. Kids and adults have accidents and parents bring babies into community pools. With disturbing regularity, we read about children, playing in pools dying or getting sick from exposure to cryptospormora or e-coli. These diseases are contracted through ingestion of human waste. I think about the hanging toilets of Dhaka and wonder if it's any different from American children dumping their untreated waste directly into a body of water shared by others. Even before doing these stories, I've always been wary of public pools. These days, only the strong smell of chlorine can entice me in.
Clean water is a huge issue. Some say it is the global health issue. But it is hard to photograph in a dramatic and compelling way. I have to make visually interesting images about important but often non-visual points. The hanging toilets of Dhaka are one thing but getting a publishable photograph of an American child having an accident in a public pool is another.
When people learn I freelance for National Geographic, they often seem perplexed when I tell them what I photograph. "You don't do animals?" they ask. No, I don't do animals. Well, actually I do, but not in the way of the wonderful wildlife pictures some of my talented colleagues produce.
I see a deer and I think Lyme Disease. A raccoon isn't cute, it's rabid. Mosquitoes don't just sting--they carry an arsenal of diseases like malaria, yellow fever, West Nile, and encephalitis. The little mouse is a downright bioweapon, a harbinger of rapid, horrible death and carrier of deadly hemorrhagic fevers.
I first learned how dangerous a mouse could be in Sierra Leone when I was looking for Lassa Fever. Lassa, carried by mice, was found only in that part of Africa. During the rainy season, mice come inside looking for food, leaving trails of urine and waste, often on the food people prepare.
One afternoon, I watched a woman pounding flour. Dust was everywhere, highlighted by the sun. It made for an interesting image, and I moved downwind to frame the shot better. Flour settled on hair, clothing, and camera. Later, Peter Jared, the writer, told me how dangerous my actions were. "Do you realize you could have been contaminated by that flour?" he asked. "Breathing is how the virus gets into the human system." Though Lassa Fever has no cure, it can be treated with limited success with an antiviral drug called ribavirin. Unfortunately, the last case of the drug available in the entire region had been delivered to a village near Kenema.
It takes fourteen days for Lassa Fever symptoms to show. Peter and I started counting. We'd be in Uganda then. If I got sick, we'd have to radio the hospital and hope they could get ribavirin to me. That all depended on us getting through on the radio and the hospital messenger making it past the maze of roadblocks and checkpoints for which Sierra Leone was notorious. Fortunately, I stayed healthy.
As I was concluding work on the virus story in 1993, Peter and I heard about a virus emerging in the Four Corners area of New Mexico. It appeared on the Navaho reservation, where doctors began noticing young people dying rapidly from what seemed like a strain of pneumonia. I didn't encounter this disease, eventually named Hanta Virus, until nearly a decade later.
For the "Ecology of Disease" story I arranged to work with a team of researchers in New Mexico collecting deer mice, the carriers of the Hanta Virus. Like Ebola, Hanta is labeled a "Class Four" virus, approached with extreme care. But something seemed amiss the morning I met the team. Everyone was dressed in biohazard suits and putting on air filters to work in the contaminated environment where the mice lived. It became clear to me that no one had arranged a suit or air filter for me. I spoke to the lead researcher through his plastic space helmet. "Will I be safe?" I said. "Should I worry about contamination?" He looked at me for a moment, and said, "You're probably okay."
I thought about this when I traveled with a team of Navaho Indians who were going into homes where someone had gotten ill or had died from the virus. They were there to clear out the mice. They jokingly called themselves "mouse busters." But they took their jobs very seriously. Everyone was clad in white biohazard suits. My hair was tucked into the hood and I wore goggles, a facemask, and booties. The team said a short prayer before we began our rounds. Areas where mice were found or caught were sprayed with bleach. When we left the homes, we bleached the bottoms of our feet.
These kinds of stories involve a range of decisions, big and small. I always think about my cameras when I'm in a disease situation. They are not covered and there is a potential risk every time I take a picture. The oils from my hands trap particles that are carried to my face each time I lift the camera. What are the possibilities of being contaminated by my cameras?
Photographing large global stories has its own special challenges. World events can undo well-laid plans in an instant. When I started the "Ecology of Disease" story, I didn't plan much emphasis on bioterrorism. But after the events of 9/11, my work at Fort Detrick, the Army's biological warfare center became the lead to the story. I spent a lot of time covering food safety issues, but that was sacrificed to make more room for security issues. Now of course, with the discovery of mad cow disease in the United States, world events have made food safety a huge concern.
No less challenging, but perhaps more controllable is the problem of taking big themes and narrowing them down to a coverage plan I can do in the allocated time and budget. How much time do I spend on AIDS? What about malaria, which kills four million people every year, most of them under five? Should I be driven by statistics about the impact of different diseases, or focus on the most visually loaded possibilities? What is the right balance?
I freelance for a magazine with demanding editors who require beautiful pictures, even if the subject is about disease and public health. News magazines often employ black and white to convey a serious edge to weighty subjects. I love the graphic immediacy of black and white. But National Geographic requires color. So I try to seduce the reader with my images, through graphic composition, lush color, and rich light. If the reader is drawn into the photograph and engaged, then a message can be delivered; the reader will see the faces I have seen and feel connected to the situation I saw. Maybe they'll be moved. I want my subjects to seem so familiar that the readers feel they are looking into the face of someone they might have known--a neighbor.
I've run into people who have questioned if global health is an appropriate topic for National Geographic. But every picture in Impact has come from stories I've done for the magazine. They're really all parts of one story, and doing the book allowed me to bring them all together.
I've done all kinds of stories for the magazine--a news story on an earthquake, a look at my own roots with a story on Japanese women, environmental stories like the impact of oil in Alaska, and many others. But in between those, I sought out or proposed stories about global health issues.
