It may sound odd, but working with public health people in the field is an amazingly enjoyable experience. These are big-picture thinkers. They are committed to communities and the people they are trying to help. They are willing to make major sacrifices in their lives to do what they think needs to be done.
When I'm working with these people, every day is an amazing adventure. We never know what we will come across, what barriers will need to be crossed. They work under conditions that would intimidate the less committed, and they do it day after day after day until the work is completed.
I also have a desire to make right what I see as wrong. I have lived this philosophy all my life. Even as a child, if I felt a teacher was treating me unfairly, I would speak up. Not the fast track to being the teacher's pet, but it developed out of self-defense; coming from an ethnic background, I encountered prejudice and racial slurs growing up. I quickly found I had to stand up for myself. If I didn't, who would? I'm not a scientist or doctor, but I am a natural observer. I can report what I see and it's always with the hope that what I do will move those who can make a difference to act.
Several years ago, the Society created a program called "Contributing Photographer in Residence." I was one of five photographers asked to participate. The idea was to support photographers who, in the course of working with National Geographic, showed consistent interest in a specific area, like wildlife, conservation, the oceans, or in my case, global health and change. When I was interviewed for the position, I said I was going to use it to advocate.
The position allowed me to begin a yearlong project to start a Global Health Initiative at National Geographic. I offered global health as an innovative way to teach geography. It seemed a powerful tool to bring home how changes in environment, social structures, and political systems affect us personally. Why should we care that the breakdown of the former Soviet Union gave rise to drug-resistant tuberculosis in their penal system? Because Russian immigrants bring the strain to this country. Why worry about destruction of the rainforest? Because exotic diseases, some without cures, are moving out of those once isolated regions in growing numbers. And in an ever more connected world, no place on the planet is more than a day away.
I got the Global Health Division of the Centers for Disease Control to partner with National Geographic. I evangelized the initiative to people in many divisions of National Geographic and interest mounted. A proposal for funding was prepared and submitted to a major foundation. Unfortunately, after a very long wait, the proposal wasn't funded, dealing a major setback to the initiative.
Before the momentum I'd built dissipated, I decided to try and get a book on my work about global health published. Through it, perhaps I could keep the interest alive. I spoke with Lisa Lytton, project manager with National Geographic books. She was interested and took the idea to her bosses. They were intrigued, but this was not a typical National Geographic book topic. It wouldn't be an easy sell. Lisa created a sample layout or blad, so we could sell the idea. I showed the blad to Terry Garcia, the head of National Geographic Missions, who oversees the CPIR program. He was enthusiastic, and with his support, the case for the book got much stronger. Finally the book division told me if I could find the money to publish, they would produce the book. We got a ballpark figure for what we'd need and started looking.
In mid-January, 2003, funding finally came through and we got the go-ahead. The book had to appear in fall, 2003. All materials had to be at the printers by May. We had less than four months to pull everything together. A writer, designer, and picture editor had to be hired. An outline had to be compiled, images selected and scanned, text written, a layout created. With the backing of her bosses, Kevin Mulroy and Nina Hoffman, Lisa got started.
In the hands of less-qualified people this could have been a nightmare. Instead, it was one of the most enjoyable projects of my professional career. Lisa, formerly a designer for National Geographic Magazine, had worked on several of the stories that contributed to the book and knew my material. In a stroke of brilliance, she hired Dave Griffin to design the book. Dave used to work with Lytton as a designer for National Geographic Magazine. He left the magazine to head up design for National Geographic books, then moved on to U.S. News and World Report where he now manages design and photography. An excellent journalist and talented designer, Dave also knew my work well. His clarity and decisiveness moved us along with amazing speed. My husband, Bill Douthitt, who edited many of my global health stories and is known for handling large complex projects, organized the photographs. Writer Peter Jaret, who worked with me on the virus story ten years before and whom I consider a friend, agreed to write the text. This was no small commitment. He had only two months to pull it all together. Thanks to the efforts of National Geographic's chief counsel, Terry Adamson, President Jimmy Carter agreed to write the forward. Dr. Donald Hopkins, one of the executive directors of the Carter Center wrote the introduction. Karen Kostyal, a compassionate and talented editor, oversaw the text editing. Charlene Valeri, the CPRI manager, made sure we were all communicating with each other.
Thanks to this team of seasoned professionals, the book was ready for the printers on schedule. I felt like I was part of a ballet where everyone performed his or her part flawlessly. By the end of August, I held the first edition of the book in my hands. People still express amazement that such a project could be pulled together so quickly. I have to remind them that production of the editorial material took over a decade, and could only have been done with major support from National Geographic Magazine and editor Bill Allen, who approved most of the stories that made up the book.
People sometimes comment on how difficult it must have been to photograph many of the subjects in this book. How did I get permission? How did I handle such emotional situations? The permissions usually result from a great deal of advance research and planning. You don't just walk into these situations. I work with organizations like the Centers for Disease Control, Family Health International, Doctors without Borders, and others to focus and develop my plans. When I start working, what I'm thinking and feeling can be intense at times. My emotional state sometimes interferes with my professional focus.
Shortly after I arrived in Uganda to cover AIDS, I walked into a room just as I heard the last gurgles of a dying baby. There was a moment of cold silence, then the mother and the grandmother started to wail. I stood there, paralyzed. I had never seen a child die. I couldn't even touch my camera. Then I started to sob. I had to sit down. I thought of Katie, the infant I left at home, and of my son, Will. This child was gone, no longer to be held by its loving mother. The nun escorting me didn't know what to do. I was mourning as if it was my child lying there. It took me several hours to recover enough to continue working. Over time, I saw many more children die. I couldn't take some of those pictures, dramatic though they sometimes were. I wanted to keep my humanity and preserve the dignity of sorrow for parents who suffered the unimaginable loss of their children.
Years earlier, while working at The Virginian-Pilot newspaper in Norfolk, I covered a car accident. An elderly driver ran into a beauty salon. A middle-aged patron, her hair in curlers, had been pinned between a car and the wall. As I lifted my camera to shoot, she started wailing, "Please don't take my picture!" I became that woman. I imagined a picture of myself undignified, pinned under a car with curlers in my hair. I put my camera down. She had already suffered enough pain. I couldn't see why I should cause her more by splashing her photograph across the front page of the paper. Before I could finish that thought, I found a TV cameraman standing beside me, filming. The woman continued wailing, begging him to stop. "She really doesn't want her picture taken," I told him. His only response was "I'm just doing my job."
I eventually made a picture of firemen taking this woman out of a window on a stretcher. She wasn't identifiable. It was an acceptable picture, but not as dramatic as the one I decided not to shoot. I felt I had to tell my boss, Bob Lynn, what had happened. He was going to see the TV coverage. I knew he would wonder why I hadn't gotten the same image of the woman in curlers, crying, pinned under a car. I was sure he would be furious at me for not doing my job. Bob's reaction will always stay with me. He said, "You have to be a human being first. If taking that picture made you feel less human, then don't take it." That philosophy has guided me on my long journey through the frontlines of global health.
