Health photographer : photo reportage / by Paul Almasy

Health photographer Photo reportage by Paul Almasy "Good morning, Mr Director." "Welcome, Mr Almasy." I walked into the office of Senor Ramirez, Director of Public Relations at the Health Ministry of a Latin American country. He greeted me warmly. "We've prepared quite a heavy programme for you," he said. "Early tomorrow morning a car will collect you from your hotel and take you to the new central hospital. We inaugurated it a year ago; it's a very modem hospital and I'm sure you'll admire it. Later you'll visit our big laboratory where we're getting very good results in our work on Chagas' disease. On Thursday you will have an opportunity to witness an operation by Surgeon-Professor Diaz, and you'll be able to take some photographs." Hungarian-born Paul Almasy has been taking photographs for WHO - and for other in- stitutions - for 38 years. He looks back at some of the notes he took over the years while on missions to Latin America . Today he is th e Doyen of the Ph o t a- Journalists of France. I suppressed a smile. "Senor Rami- rez, I'm very sorry, but I have to ask you to cancel this programme. It does not fit my assignment. Your country has very serious health problems and in many places people do not have enough drinking water. In the country- side there is a shortage of dispensaries. Tuberculosis is still killing thousands of people every year. I would like to see for myself and photograph the difficult conditions in which a large part of your population has to live. We do not need photographs of the clinical aspects of diseases. I have to show pictures of the causes of the diseases your people are suffering from. I have to get pictures of the situations that are begging for solutions. Your government has asked for a lot of money to help you solve those problems and our people in 16 Poor? Yes. Dirty? Yes. But happy! Right: "/ have to show pictures of the causes of the diseases your people are suffering from., Geneva will soon be considering your request. If I do a reportage showing how wonderful everything is in your country, your government won't get a cent." Senor Ramirez was surprised and a little embarrassed. After a few minutes' r~flection he nodded agreement. Early the following day I went into the countryside with a doctor to visit a district with a very high mortality rate. I would be able to carry out my mission. I have reported that conversation because it has recurred many times over the years, during my travels, and at many levels, in ministerial offices, and in provincial town halls. Cancelling and replanning a programme scheduled for my work has sometimes been the biggest problem I have had to face, and one that had to be solved with a certain amount of tactful diplomacy. Another country, another date. At Manzanares, a little village in Peru, the inhabitants had only the water from a stream polluted by the drains of a neighbouring mining town. I arrived after three days of rain and saw two little girls bailing out water from pud- dles in the road into a large drum. "This way Mummy won't need to walk for an hour to get water." "But you'll have to boil that water before you drink it." They stared at me. "Why?" Their question shows a terrible ignor- ance and the answer can be found in the health report on that district: 32 per cent of deaths are caused by diarrhoea! diseases and paratyphoid fevers. I have kept a note I made in March 1964. It reads "water-borne diseases kill five million babies each year and WORLD HEALTH. March 1990 spread disease to 500 million people. This situation will get worse in the years to come (!) especially in urban areas." Another misunderstanding at Qui- pas, again in Peru. There, a group of women of all ages had taken on the task of building water conduits to collect water from a spring a few kilometres away. It was very pure water. When I took my camera out of its bag, I sparked off angry shouting: "Tourist! Gringo! Dollar! No photo! Vayase!" One of the women had already picked up a large stone. I retreated to the town hall where the mayor received me very courteously; we went back to the construction site and the mayor explained to the women who I was and why I was taking photographs. "That's why WHO is helping us; this gentleman is doing us a favour!" After that they were all smiles. Indeed everything went so well that one of the women invited me home to taste the cake she had made for her son's 18th birthday. I leafed through my travel notebook for 1973. The first page was headed 'Venezuela - Medicatura." As I read the notes I relived the events in Ciudad Ojeda, near Maracaibo, at a rural dispensary called a Medicatura. It was the health unit for a zone covering Top: This market-woman in Peru made no objection to being photographed. Centre: With infinite patience, a woman waits for her sick child to be treated at the health centre. Below: Poverty breeds malnutrition - and malnutrition kills children. 17 Health photographer "Today we are going to eat meat.'' six villages, and it had four beds for patients. It was staffed by an auxiliary doctor, Senorita Larreal, who was born at La Laguna, a village of 1,600 inhabitants. The regulations required that the person in charge of a medica- tura should come from one of the six villages in the zone, so that all the inhabitants of the region would have known him or her since childhood. The people trusted her and she spoke the local dialect. It was a tried and tested system. The dispensary was never idle; there was a phone call every ten minutes from someone asking for a piece of advice or a visit. Acting on the first call, we took a canoe to visit the home of a young woman who had delivered an infant and felt unwell. When we found she had a fever we returned quickly with an urgent warning for Or Ferrer, head of the health centre of the region. Another call came from a nearby village and for that we went on a bicycle. A farmer had received a visit from his sister-in-law who lived in a region where there had recently been a smallpox epidemic. He wanted vacci- nations for himself and his family. We received a friendly welcome every- where and I was always asked what I intended to do with the photographs. Of course, I had to promise to send them one. I usually tried to keep my promise. In the favelas of Rio de Janeiro I took photographs of dwellings that were so insanitary as to be almost unbearable, humanly speaking. In the suburb of Callao, a little girl called Luisa, aged eight, showed me a rat that her brother had killed. She said: "Today we are going to eat meat." • 18 EQUATORIAL GUINEA Hope~rthefuture by Patricio Rojas n emergency situation - this is how the national authorities have described the present state of health and health services in Equatorial Guinea, a small country with a popu- lation of 340,000 situated on the Gulf of Guinea, in Central Africa. A decade under a repressive regime ( 1969-1979) left the public services virtually derelict and brought about the collapse of internal and external communications, a drastic drop in agricultural production (cocoa, wood, coffee), the drying up of foreign invest- ment and a steady exodus of the few nationals who had been trained for the production, service and administration sectors. Violations of human rights forced nearly one-third of the country's population into exile. The end of the dictatorial regime in 1979 afforded a chance to draw up plans for demo- cratic rule and national recovery aimed essentially at ending the social and economic chaos, revitalising national development and improving the living standard. But in spite of tremendous efforts and the sustained support of friendly countries and international agencies, the country's situation remains critical. Thus for instance there has been no significant improvement in indicators of health and the quality of life in WHO/P. Rojas recent years. Indeed, some of these indicators remain alarmingly low: infant mortality is estimated at 145 per 1,000 and no more than four per cent of the population has access to drinking water. Dr Patricio Rojas is the WHO Representative in Malabo. Equatorial Guinea. Equatorial Guinea is confronted by a whole range of health problems, from the virtual ruin of most of the physical infrastructure in the health sector to acute shortage of all types of resources. The absence of any inte- grated health development strategy has also prevented more rational use of technical and financial assistance from bilateral and international agen- cies. So the real challenge is to define objectives, establish priorities and draw up realistic action plans at a point where the country's needs are press- ingly urgent. Drastic problems call for bold measures. In Equatorial Guinea, gen- eral mobilisation is under way to A health volunteer in Equatorial Guinea numbers each household during a malaria case-finding campaign. Facing page: Street scene in the capital, Malabo.