DAVID ROCHKIND PHOTOGRAPHY

Photography: epidemic

According to the World Health Organization, nearly two million people die from TB every year. One third of the world’s population is infected with the bacteria that can cause TB. It is one of the top three killers of women aged 15-44. To be sure, these statistics are horrifying, but they don’t do much to increase our understanding of the disease, its causes or the real toll it takes on not only the individuals that have it, but also on the families and communities where it is found. Reading these statistics may raise our awareness in a superficial way that causes some discomfort, but those feelings will almost surely fade with time.

This project aims to create an emotional understanding of one of the deadliest diseases of our time. The photographs, taken across three continents where the TB problem continues to evolve, impress upon the viewer the humanity behind the victims of TB and that the disease is not something simply to fear, but something to understand. By humanizing the patients and communities where TB is present the pictures create a stronger impact with the viewer and evoke empathy, as opposed to sympathy. This connection allows for the genesis of a deeper dialogue that will ultimately impress upon the viewer that this is a disease that must be reckoned with and that each of us, regardless of where we live, can understand. The images offer entry points into the subject and, in turn, into the lives of those pictured.

It is easy for images of Tuberculosis, or those of any public health topic, to merely illustrate pain and suffering. This project attempts to move beyond a superficial view of the disease, and beyond a single geographic region, to convey that TB affects communities across the globe in a myriad of ways.

Rhemat Shek lies on the floor of her mother’s home in Rafik Nagar, a slum next to a garbage dump in Mumbai. Her son, Sana Jameer, and mother, Husna Bano, sit behind her. Rhemat and her husband came to Mumbai to be closer to a TB treatment center so she could receive medicine, but they say they may soon return home, interrupting Rhemat's treatment, so her husband can continue to work. She is currently so weak that she is often unable to sit up for more than 10 minutes at a time.
   
M.M. worked at a gold mine for 24 years before being released in 2008 when it was found he had TB and HIV. In South Africa TB is the biggest killer among people with HIV. Here, a priest prays for him to get better at the African Gospel Church in his hometown of Bakuba.
   
TB is a preventable and treatable lung disease, but there have been almost no new advances in treatment for 85 years and the infrastructure to deal with the problem doesn’t exist in most of South Africa. In certain communities, like the country’s gold miners, the disease has reached epidemic proportions. This story aims to convey the stress, pressure and effect that the disease inflicts on not just those who carry it, but also on the communities in which they live. Here, miners pray for their safety before beginning a work shift 6500 feet underground at the Great Noligwa mine in Orkney, South Africa. The miners have historically had high rates of TB, due to poor screening and treatment programs, cramped living quarters and high rates of silicosis, an occupational lung disease that increase the likelihood of developing active TB. Miners have a disproportionately high rate of HIV, further complicating the issue.
     
  
Igori Revenco is a former prisoner with MDR-TB. The prison system in Moldova has greatly reduced their TB incidence rate over the past five years, but still have one of the highest rates of any community in the world.
   
A young man stands in Ashok Nagar, a slum neighborhood that is far from the city center. It can be very difficult and costly for TB patients who live in the far away slums to get to a health clinic to receive their daily medicines. Transportation to a clinic may only cost twenty cents a day, but that can represent nearly 10% of a patient’s salary. Some patients will simply stop going to the health clinics in order to save the transportation money, or in order to not miss work.
   
Angela Orlovsky is coinfected with HIV and TB. She is very weak and spends most of her time in bed in her home in Balti, Moldova.
     
  
TB patients take their daily medication at the TB Hospital in Balti, Moldova.
   
Miners and their friends drink and play pool inside a tavern in Khutsong, a poor mining community outside of Johannesburg, South Africa. Miners often have very little understanding of lung disease, referring to any chest problem as “TB”. This lack of education makes it more difficult for them to spot the symptoms of the disease and seek treatment. Even those who know they have TB often have no way to begin, or continue, treatment.
   
Workers at a garbage dump in Mumbai, India, who scavenge for trash that they can sell, try to put out a fire so they can continue working. Local NGOs say that there is a huge problem with TB among the workers in the dumping ground, as well as the families that live near it, owing it poor nutrition and hygiene, which can make them more susceptible to developing active TB.
     
  
Life in these crowded, government subsidized apartment buildings in Mumbai, India presents problems and obstacles to TB patients. Overcrowding is a problem as are the socioeconomic factors that can lead to other risks, like poor nutrition and hygiene. The elevators in these buildings usually are not maintained and do not work, making it difficult for very sick or elderly patients to get up and down the stairs to go to the health clinics and get their medicines.
   
Men rest after a long day working in a tailoring shop in a slum in Mumbai, India. The men are migrants, coming from all over India, and do not have the money to rent rooms to stay in. They work about 16 hours a day sewing clothing and then sleep together in the workshop. Lok Seva Sangam, a local NGO working on TB, gives educational talks to workers like these, teaching them about the potential risk of living together in such a small, cramped space.
   
Jon Curu is coinfected with MDR-TB and HIV and is being treated at the TB hospital in Vorniceni, Moldova. He is very weak and is unable to move or get out of bed.
     
  
Many people in Balti, Moldova use public transportation, which is one of the places where it is possible to get infected with TB by someone who already has it.
  
A patient at the Group of TB Hospitals in Mumbai, India lays on his bed as a crow sits perched next to him. Later that day the patient was moved to a different bed where he could receive oxygen. He died early the next morning.
   
E.M. worked in the South African gold mines for 12 years when he was released after a medical test showed he had TB and HIV. He is now very weak and gets assistance from home health care workers, though he says the workers do not bring him enough medicine for his daily dose. He is unable to get to the health clinic on his own and is totally dependent on the workers. This is the second time he has had TB.
     
  
Women sing during a service at the African Gospel Church in Bakuba, South Africa. Tuberculosis is very contagious and it can be dangerous for miners carrying the disease to go home untreated, as they may pass it on to their family members.
   
Khumbizile Nkisimane was released from his job at a gold mine in South Africa after 19 years when a medical exam revealed he had TB. He is currently unemployed and tries to support his wife and children by working a small plot of land outside of their home in the small village of Mnceba, South Africa.
   
A doctor visits a patient at the Group of TB Hospitals in Mumbai, India during the daily rounds.
     
  
Dumitru Stuplaov was a former prisoner who died of MDR-TB. His mother, Evgenia Stupalov, stands over his body at a wake.
  
Thembinkosi Nodyontylo, 50, worked in the South African gold mines for 30 years when he was released in 2004 after a medical exam showed he had TB. His wife died of TB in 2007 at the age of 31 and he regularly visits her grave to pray.