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Highlights 2014: picturing health

2014; Elsevier BV; Volume: 384; Issue: 9961 Linguagem: Inglês

10.1016/s0140-6736(14)62416-8

1474-547X

Joanna Palmer, Zoë Mullan,

Global Public Health Policies and Epidemiology

It was difficult to select only 12 winners from the excellent submissions we received to this year's Highlights photography competition—the many entries were varied and often surprising.The moment captured in a photograph can highlight important health issues and so it is for the winning images we publish here, many of which cast light on access to health care in low-income countries. From neonatal care in Africa to the work of midwives in Afghanistan, from the challenges encountered by sex workers in India to the vital role that community health workers have in bringing health care to homes, the photographs tell us about the lives and health stories of people around the world. The images also demonstrate the engagement of our readers in communicating issues of global concern in innovative ways. We hope you enjoy them.Walls of KiberaShow full captionSpencer Lewis James; Geisel School of Medicine at Dartmouth, Hanover, NH, USAIn the Kibera urban slum in Nairobi, Kenya, residential walls built of mud and refuse line one of the back alleys of the neighbourhood. Looking deeper into the photo, one can see that mud and waste also litter the streets themselves in the background. At first glance, this shows the resourcefulness of such a community in the face of poverty, but it also highlights the importance of clean water, sanitation, and the environment when it comes to health issues. When we research diseases and treat patients, we must also recognise the crumbling socioeconomic foundations that give rise to ill health. Infections can be fought with medicine, but the poverty and inequality that allow diseases to become endemic must also be fought in places such as Kibera.View Large Image Figure ViewerDownload Hi-res image Download (PPT)All hands on deckShow full captionMeaghann Shaw Weaver, John Glen Weaver; St Jude Children's Research Hospital, Memphis, TN, USA (MSW); Children's National Medical Center, Washington, DC, USA (MSW)This photograph of Himba children was taken in the Kunene region in the northwest of Namibia. As the children pat out a rhythm in the sand, they take turns establishing a peer leader and following the rhythm of that designated guide. The children's attentiveness to each other made us think about the importance of cultural humility in watching closely, listening attentively, and honouring the lead of local communities to turn effective interventions into feasible health improvements. The indentations of the children's handprints in the sand bring to mind a message for global health outreach: “impact boldly and yet tread lightly”. Their smiles remind us of the joy of partnership and the cheer of communities in rhythm together.View Large Image Figure ViewerDownload Hi-res image Download (PPT)The weight of waterShow full captionLisa Fitzgerald; The Nossal Institute for Global Health, Melbourne, VIC, AustraliaAccess to water is an important factor that affects the health status of the Maasai and Samburu nomadic pastoralists of the Rift Valley province in Kenya. The seasonal nature of rivers, prolonged droughts, and lack of water storage mean many are only able to access water which is considered unsafe for drinking. Water collection can take some households more than 2 hours. I took this photograph of a woman as she carried her water home. Some communities are working to bring water closer to people by drilling boreholes and constructing subsurface dams.View Large Image Figure ViewerDownload Hi-res image Download (PPT)The importance of maps for public healthShow full captionKebede Deribe, Abebe Kelemework; Brighton and Sussex Medical School, Brighton, UK (KD); International Orthodox Christian Charities, Debre Markos, Ethiopia (AK)2014 marks 160 years since John Snow's cholera map of London. Since then maps have been widely used in public health. We took this photograph in a small health post in East Gojam zone of the regional state of Amhara in northern Ethiopia. For us this hand-drawn map of a village with its boundaries and the available infrastructure by a health extension worker shows the value of maps for health interventions at the local level. Geographic information systems and other technologies have advanced mapping activities, and we hope recent technology platforms will become available to primary health workers, such as the one working in this rural Ethiopian health post, to help with community health planning.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Neonatal care in low-income countriesShow full captionThomas M Berger; Neonatal and Paediatric Intensive Care Unit, Children's Hospital of Lucerne, Lucerne, CH, SwitzerlandI took this photograph of post-resuscitation care of an asphyxiated newborn baby with respiratory distress at the Hôpital Méthodiste de Dabou, a rural hospital in Côte d'Ivoire. The only form of respiratory support at the hospital is free-flow oxygen administered through a plastic cannula inserted into the nose. Oxygen blenders and continuous monitoring of transcutaneous oxygen saturations are not available. The baby died on the second day of life. This level of care is reminiscent of the situation in the USA and Europe during the 1950s. Neonatal deaths account for 44% of all under-5 deaths worldwide, and most of these occur in low-income and middle-income countries. While researchers in high-income countries refine therapies for extremely low gestational age infants, questions about successful implementation of effective and affordable interventions and robust technologies for neonatal care in low-income and middle-income countries remain unanswered.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Signs of educationShow full captionUlrich Mey; Bole, Addis Ababa, EthiopiaThere are more than 130 sign languages around the world, and like spoken languages, they differ from country to country. Worldwide about 360 million people, of whom some 32 million are children, have disabling hearing loss and most affected people live in low-income and middle-income countries. Alongside congenital causes, hearing loss is often the result of infectious diseases in childhood, such as chronic ear infection, meningitis, measles, and mumps. Sadly, about half of all cases of hearing loss could be prevented through primary prevention, including immunisation and improved antenatal and perinatal care. Unfortunately, in low-income countries many children with hearing loss and deafness do not go to school. I was, therefore, heartened to see this mural in Ethiopia's capital, Addis Ababa, in a side alley by a school for children who are deaf.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Questioning violence against womenShow full captionK V Balasubramanya, Srinath Maddur; Karnataka Health Promotion Trust, Bengaluru, Karnataka, IndiaSex workers can face marginalisation and violence, including from intimate partners, family, and clients. Young women like the one shown in this photograph have begun to question the violence they are exposed to. She is a member of a non-profit community-based organisation that works with a project called Samvedana, in Karnataka, southern India. The project, which receives funding from the United Nations Trust Fund, seeks to raise awareness of gender-based violence and its interface with HIV among sex workers. It supports sex workers through education to question violence against women, and aims to improve their access to health, legal, police, and justice services. Almost 30 000 sex workers have attended training across 15 project districts and women have set up their own Crisis Management Teams. The project also provides training and sensitisation about these issues to journalists, police, judiciary, and health service providers.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Preventing polioShow full captionMichael L Washington; Health Economics and Modeling Unit, Centers for Disease Control and Prevention, Atlanta, GA, USAI took this photograph during National Immunisation Week for polio in Ondunu, Namibia. In this rural area Namibian health workers came across a mother and her young child who had not been vaccinated and were able to administer the vaccine. On the polio vaccine vial, the square box in the blue circle is white, which is an indication that the vaccine is still good. My favourite thing about this photograph is that it shows the important contribution of boots on the ground epidemiology: finding unvaccinated children with a public health intervention in hard to reach rural communities.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Stitches to save livesShow full captionGijs Walraven; Aga Khan Development Network, Geneva, SwitzerlandThis photograph of an appliqué wall hanging tells the story of Lailoma, who died after obstructed labour and a uterine rupture. Without access to a skilled birth attendant, she endured a long journey with poor transport and road infrastructure from her home to a health facility. The wall hanging was made in 2008 by the third group of students to attend Bamyan Community Midwifery School in central Afghanistan. 3 years later, the fifth group of students at the school made another wall hanging to tell the story of Sherbano, a Bamyan trained community midwife, and Fatima, who had severe pre-eclampsia. Fatima was successfully treated at the local health centre as a result of a health education session by Sherbano in her village. The Bamyan Community Midwifery School is linked to the provincial hospital and was established in 2004. Since then 132 community midwives have graduated. Deliveries attended by skilled birth attendants in Bamyan province have increased from 37·2% in 2007 to 64·0% in 2013.View Large Image Figure ViewerDownload Hi-res image Download (PPT)A Sierra Leone first aid post in the evening sunShow full captionSunil Singh Bhopal; Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UKFreetown, Sierra Leone: even a decade after the end of a bloody civil war, signs of the country's violent past are all around. Whilst walking on one of Freetown's beautiful beaches, I noticed a first aid post painted with the familiar emblem of a red cross flanked by a picture of a Kalashnikov with the clear message “No Arms Allowed”. The juxtaposition of these two symbols created a feeling of discomfort for me as a health professional. The red cross symbolises neutrality and protection, whereas the gun symbolises pain and violence. Health care is of great importance in times of war, yet in many places health professionals find themselves under threat in conflict zones. The recent Ebola outbreak has refocused the world's attention on this country in west Africa. As a global community we must help to ensure that disease-induced instability does not lead to further violence in Sierra Leone.View Large Image Figure ViewerDownload Hi-res image Download (PPT)A link to lifesaving treatmentShow full captionRobert John Flick; Baylor College of Medicine Children's Foundation—Malawi, Tingathe Outreach Programme, Lilongwe, MalawiA community health worker with the USAID-funded Tingathe programme, Frank, prepares to provide HIV testing and counselling for couples attending Kawale Health Centre in Lilongwe, Malawi. Frank and his colleagues offer HIV testing services to couples—many expecting their first child—and drive efforts to ensure the timely diagnosis of HIV and initiation of antiretroviral therapy. Since it began in 2008, community health workers for Tingathe—“we can” in the local Chichewa language—have undertaken more than 50 000 HIV tests and have helped link more than 17 000 HIV-positive patients with lifesaving services in Malawi.View Large Image Figure ViewerDownload Hi-res image Download (PPT) It was difficult to select only 12 winners from the excellent submissions we received to this year's Highlights photography competition—the many entries were varied and often surprising. The moment captured in a photograph can highlight important health issues and so it is for the winning images we publish here, many of which cast light on access to health care in low-income countries. From neonatal care in Africa to the work of midwives in Afghanistan, from the challenges encountered by sex workers in India to the vital role that community health workers have in bringing health care to homes, the photographs tell us about the lives and health stories of people around the world. The images also demonstrate the engagement of our readers in communicating issues of global concern in innovative ways. We hope you enjoy them.