A snake getting its head smashed in with a rock

Uncategorized

This is one of the more surreal photos I’ve taken. While photographing for a workshop in Cox’s Bazar (the longest unbroken natural beach in the world), I came across a group of boys gathered around something just where the sand meets the sea.

They were clearly excited and slightly afraid of the snake, which was injured and trying to get away. I stopped them from poking it with a stick, and the snake started moving towards the water. As I raised my camera, one of the boys behind me – out of my sight – had thrown a large stone without me realising, and it bounced off the snakes head a split second before my shutter went off. It took me a second to realise what had happened. Needless to say, the snake was dead after that.

Cox's Bazar

Nepal out of a Car Window

Asia, Nepal, street photography

Sometimes you can spend hours trying to get a particular photograph but are never really satisfied with the result. And then you take a couple of single shots out of the window of the moving car that are far more appealing. Both these were taken while driving through Nepal last year.

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A man washes the dust from his body on the busiest road going out of Kathmandu. Nepal 2013

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Evening sun illuminates grasses in the Terai. Nepal 2013

Drive-by in Kathmandu

Asia, Nepal, street photography, travel

So, I’m finally beginning to go through work from Nepal and Bangladesh, while I’m at the end of my stay in Myanmar. I tend to shoot a lot whether I’m with the subjects of my assignment or at the end of a 9-hour drive on the way back from seeing them… like this shot was. I leaned over the guy next to me and stuck my camera out the window of the car. He was used to it by this time.

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Morning shave

Asia, Documentary, Leprosy, travel

So I’ve been travelling for a little over two months now. I’ve photographed in several parts of Nepal, and I’m now in Nilphamari, Bangladesh. I have a lot to show you, but I’ve been too busy taking photographs rather than editing them.

However I quite liked this rather over-exposed image I shot this morning of some patients having a shave in the corridor of the leprosy hospital where I’m currently at. Looks rather surreal.

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Meanwhile, if you’d like to see some more of the places I’ve been, then check out a selection of my best instagram snaps.

Mumbai

India, street photography, travel

I photographed leprosy in a few places in Mumbai, and though I still have yet to edit my general photographs of leprosy in Mumbai, I’ve put up photos I took in Datturnagar which is in Trombay, a suburb of Mumbai. That was very much one of the more positive stories I got from India.

Meanwhile, as I work on the edit of the rest of my India photos I thought I’d post some of my general shots from Mumbai. I loved that city. It’s packed with people, but loses none of that soul and intimacy that is so much easier to find in India than back in the Western World. It is also a haven for making great photographs, and whether I was walking through tight backstreets, cruising in a rickshaw or hanging out of a packed train I had a ball capturing life around me.

Here are a few of my favourites.

Mumbai 2012

Mumbai 2012

Mumbai

Mumbai 2012

Mumbai 2012

Mumbai 2012

Mumbai 2012

Mumbai 2012

Africa’s bullseye: life and leprosy in the DR Congo

Africa, Documentary, General comment, Landscape

This is the Congo.

As I sit down to write this in Dr Jacques Kongawi’s beautiful little guest house (though larger than his own modestly-sized quarters), the rains begin to beat down heavily outside. The corrugated iron roof acts as an amplifier; a huge African drum under a million drops of rain. The volume of noise is incredible. This is the sound of the Republique Democratique du Congo, famed for its mighty river (above), just a few months into the long rainy season.

I am in Gemena, a town in the Sud-Bangui province. On a map of the continent this is the bullseye. The DRC (as English abbreviates it to) is the country that probably has the greatest wealth in terms of natural resources in the world. But instead of becoming a rich, healthy nation it has been plagued by greedy Kings, colonialists ruling with an iron fist, absurd and almost laughably selfish dictators, bloody and complex wars, disease, and everything else that stands in contrast to the great potential it has to becoming a prosperous place to live. Rape is redefined in the Eastern parts of this country and it has been declared to be the worst place in the world to be a woman – in an age obsessed with Al-Quaeda and the Taliban regime that is quite a statement.

But for the month of June I have been documenting a problem that has been around long before the Portuguese explorers first ventured into the mouth of the great river natives called Kongo.

I am working with American Leprosy Missions, one of a number of organisations dedicated to dealing with the problem of leprosy worldwide. I spent 4 days south of the capital Kinshasa with their Buruli Ulcer projects – a nasty ulcerous bacteria similar to leprosy but much more painful to its victims – before moving up here one week ago, to the largest concentration of leprosy in the country. I arrived with Bill, president of the American Leprosy Mission, Matt also with ALM and Nikki with The Leprosy Mission Canada. Most of the photographs in this post are from many short visits to patients we did in the first week so the team could collect stories on video and assess how best to direct their funds. Bill is new to ALM, so it was also good for him to see their projects first hand.

Above: the sign on the door of the leprosy office in Karawa hospital a few hours bumpy drive from Gemena.

Photographing leprosy across the world has become somewhat of a personal project of mine, and I’m hoping to document it in other countries next year. It’s a disease that everyone has heard of – everyone knows about Jesus healing the ‘lepers’ whether you are Christian or not – but generally across the world, even in the countries where it’s still present there is very little basic understanding, and sometimes even awareness that it’s still a problem. I’ll give you a very brief rundown…

Leprosy is curable. The culprit is Mycobacterium leprae, a bacteria closely related to tuberculosis. It is thought to be transmitted in water droplets – perhaps through sneezing for example, but it is not that easy to contract. It is clear that you have to spend a long time with people affected by leprosy to stand a chance of getting it. You also need a very poor immune system. Despite spending long periods of time among these people I will almost certainly never get it. When it does manage to survive in a human it takes around 7-10 years before the first signs of leprosy emerge. These are usually skin patches that begin to show signs of anaesthesia. The destruction of areas of the peripheral nervous system is the best know symptom – it means that any cuts obtained in these numb patches don’t get noticed. They therefore aren’t cared for, they don’t heal well and infections develop; flesh rots away or requires amputation or excision. It is this that can lead to the characteristic missing digits or limbs that are associated with leprosy.

But start taking the antibiotics that is provided for free worldwide and within a day 99% of the bacteria is eliminated from your system and you are no longer contagious. To totally rid of it, continuation of the Multi-Drug Therapy (MDT) for a year is usually necessary. However any numbness attained or digits lost will not change and for the rest of one’s life great care must be taken to make sure any cuts suffered do not get infected.

There are many different problems and reasons why leprosy is still present worldwide, despite it being ‘officially eliminated’ from all but three countries (Nepal, Brazil and Timor-Leste if you’ve ever heard of it). I won’t go into those reasons here… I could cheekily refer you to my own website where I have explanations along with photo essays that go further into these problems, or alternatively please click on the brand-spanking new website of the American Leprosy Missions.

But right now I’m in the Congo and in my brief week I’ve had the chance to visit a number of the different people that have at one point suffered this disease. Some of the stories are extraordinary.

Mitano, an elderly man with leprosy sits in the house that ALM built for him. He now keeps a couple of chickens and a rabbit. However every now and then people will steal from him, so Dr Jacques, the Regional representative for ALM, decided to buy him a dog to scare people off. He named the dog Dr Jacques. He has suffered a lot of stigma, and has never been invited to any of the local community gatherings or occasional celebrations. So recently he decided to spend all of his money on hosting his own party to see if people would turn up. He bought meat and fish and was amazed that residents came along to eat the food he’d prepared with his own filed-down hands. He broke into a grin “When I am at last taken away from this life, they will put on my grave ‘he hosted the best party this village has seen!'”.

Above: Gemena, down from the main market. I can’t personally verify Gemena is no different from any other Congolese Town, but I would imagine it works in the same way. When we arrived, Jacques turned to us all and pointed out a few places. “This is the post office” he stated clearly in English, but with a slightly nasal Congolese accent, “it does not work”.

Dr Jacques himself has many interesting stories. He is one of many half-black half-white Congolese whose mothers were the ‘local relief’ Belgians indulged in during colonialsation. He managed to become very well educated without his father who had visited his mother a number of times over the years. When he was in Brussels studying Tropical Medicine on a scholarship he found out his father was not dead like his mother had been informed by a Belgian nun. He found out the address, and when a woman answered the door, left with her a written message explaining he was the son of so-and-so. When he returned he was told to leave immediately before the police were called. He never met his father, and never wanted anything from him other than to see his roots. He has friends with similar stories. He remembers one childhood friend who was taken from his mother to be adopted by a Belgian doctor and his wife who couldn’t have children of their own. The mother was told her son, who was at the doctors for a few days had died in the night. She of course could not even see the body. This was all found out many years later.

Above: family in Africa is very important… this elderly woman with leprosy (centre) claimed to have over one hundred grandchildren. We somewhat doubted, but considering you can be Catholic and still have several wives here it is unsurprising that people often have ten children. There is one man in Gemena who has apparently fathered 48 children.

This is Nzalawa Albertine. She is probably in her fifties, but isn’t sure. Her first husband died in the nineties. She has given birth to 17 children in her life. Four of them are still alive. She blames her second husband for the death of the other 13. “My second husband and his family used witchcraft to kill them. I do not know how, but I know it was witchcraft”. They died for various differing but not unusual reasons… mainly from falling sick. Strangely though, she said her husband admitted to killing the children (mostly from her first marriage) through witchcraft. This is a part of the culture that is initially hard to accept as a travelling westerner, but one I’ve know seen in other countries like Togo, Benin, Nigeria and Sierra Leone.

She states their deaths quite matter-of-factly, numbed perhaps from each loss. The numb patches from leprosy on her feet and body add to an already unbearable burden. She got leprosy shortly after she fled her second husband, unable to have any real say in the divorce she wanted. After all, this is Africa, and she is only a woman.

She lives with one of her remaining daughters. She used to shelter in a ramshackle hut until ALM built her a more solid one. She spends all day farming cassava leaves and occasionally manages to sell a few trade goods that ALM loans her… dried cassava, coffee etc. “I eat cassava leaves every day. I have no money for oil or salt, so it doesn’t taste of much.” Dr Jacques furrowed his brow in concern and asked a question he very well knew the answer to. “Do you ever have a chance to eat meat?“. Nzalawa laughed weakly. “Who will buy me meat? Without my daughter here I wouldn’t be able to do anything.”

I sit back and watch as Nzalawa carefully makes and filters freshly made coffee from the local beans. They give her the impetus she needs to get back to working in the field in the afternoon. Smoke fills the small but sturdy hut. She says her daughter is only 17, but she could be mistaken for being in her thirties. She was asked by a family in another village to be a man’s wife, but her mother said she couldn’t go because she depended on her so much.

I was amazed at how good some of the roads around here are (occasionally). Considering the infrastructure in this country is barely in existence I’ve been very impressed by the (occasional) smoothness of some of the roads. It doesn’t stop other areas resembling a particularly choppy sea though. “You know how to tell if a driver is drunk here in the Congo” says Jacques, his eyes smiling behind his tinted glasses. “They are driving in a straight line on the road”. Not that it would make a difference with the reliability of the police in this country. A man driving along the road who has spent all his money on palm wine has nothing to hand over…

The size of the trees and lushness of the vegetation in general around here is incredible. The agricultural potential, even on a small sustainable level, is enormous. Yet I see large factories still capable of producing vast quantities of coffee or maize, lying unused. No-one knows how to use them. They were taken away from foreign hands during Mobutu’s long regime, but there was no hand over and production ceased soon after the ex-pats left.

Above: In reading a bit about the history of the Congo I’d heard about this distinctive hairstyle typical of more central African countries. You see this style of braiding everywhere.

On Friday I visited Bulu hospital a couple of hours away, mainly just to see the state it was in. There were two leprosy patients currently under its care, but all the beds were full, and there were more urgent cases that took priority.

One of the patients visited while we were there so that Jacques could speak to them.

It was just such a poor rural hospital. The sterilised sheets in the operating theatre were tattered from use and stained so thoroughly it gives you goosebumps to think of the operations that caused them. Outside the maternity ward I found a young pregnant mother resting in a chair, her toddler waiting for her to muster the energy needed to pay attention.

Before going out one day a man came to Dr Jacques house, where I am staying and also where the ALM offices are. On average there are usually five visitors per day asking to see the doctor. They all have a patch on their skin and are afraid it is leprosy. We were on the cusp of leaving so Dr Jacques examined him on his drive, his well-kept property our of prying eyes so there was enough privacy still.

Naiya Yembe, 37 showed Dr Jacques the skin patch on his back and and also demonstrated the swollen nerves on his knee. Though he still had feeling on his patches the evidence pointed to early signs of leprosy.

Then the regional nurse walked in and he recognised Naiya as a leprosy patient that had been put on the MDT medication 7 years ago. He had taken the medication, but only for three months. Why? We told you to take the full course, what made you stop?

“I was running from the rebels. They came and we had to leave quickly so the medication got left behind”.

Naiya, his wife and his four children lived in the bush for two months waiting until they could safely return home. During that time his two youngest children got malaria and died. The skin patches had subsided and until recently the leprosy was forgotten about. He will start up the treatment once again after a laboratory test confirms it is leprosy.

An brief outing at sunset showed us a few of the areas around Jacques house. A beautiful lake provides the ideal dusk wash down for locals, their antics once overlooked by ex-pats enjoying a beer at a well-known Belgian restaurant. Abandoned during the Mobutu years, it still has in its grounds the majestic statue of Nzomba, a heroic local warrior, now only admired by boys who enjoy the view from the top. Even if the restaurant could get up and running, there are few around that could afford even reasonable prices.

More sinister territory lies near by Jacques house. This is the home (or one of them) of Jean-Pierre Bemba, one of the Democratic Republic of Congo’s more bloodthirsty politicians/warlords. He owns an enormous plantation next to Jacques house, just one small source of a wealth thought to be in the hundreds of millions of dollars. If he wasn’t currently awaiting trial at the International Criminal Court in the Hague for crimes against humanity and war crimes, we may have given quadbiking through his plantation a second thought.

We were eyed somewhat suspiciously by a semi-alert guard when we viewed his father’s mausoleum however. The concrete hexagon closer resembling an unfinished miniature silo than a grand tribute to is father, and surrounded by rust-red termite hills, it was a rather strange resting place for Jeannot Bemba Saolona, the wealthy Zairean businessman who profited hugely during the Mobutu era.

Clearly without Bemba’s presence, locals aren’t averse to messing around in the irrigation pools.

One of the ways ALM has been exploring in helping make the leprosy affected live sustainable lives is loaning goods for people to sell at a profit. These are usually along the lines of palm oil, salt, sugar, coffee and soap.

This is often done quite successfully. During the first week I saw two people repay recent loans from ALM.

However it doesn’t always work that way… one of the many challenges Dr Jacques must cope with.The pastor preaching to the crowd (above) had leprosy. ALM loaned him money to start a small trade, and enough to send his son to school. However, as I’ve noticed is increasingly (perhaps?) common across Africa, the money was spent on local brews. He is an alcoholic, and Jacques has had no choice to cut off money until he can see the man is attempting to make changes for himself. He says he needs money to send his son to school, but Jacques knows that there’s only one place that money will go if he is loaned it. The boy is, quite bluntly, collateral damage.

Expecting an alcoholic, much less one who still suffers after affects from leprosy, and who, as a given lives below the international poverty line to suddenly become sober, even for the sake of his son’s education would take nothing less than a miracle.

Above: strips of leaves used for roofing are laid out to dry in the sun.

Below: A man takes plantain and cassava leaves on the back of his bicycle to sell at a market 10km away.

Witch doctors, the local herbalists and traditional medicine practitioners have often posed problems, as locals usually approach them first if not out of preference, out of proximity. However some have been asked to refer patients that look like likely leprosy cases to Dr Jacques. It’s an approach that respects and works with the local culture, not against it.

I generally don’t hand out any money when I work. For a start I’m usually photographing people who are being encouraged by an organisation to find sustainable solutions for living. You don’t want people to rely on the next white man to provide their food. Also if I gave out money to everyone I felt really needed it, I wouldn’t be able to fund half of these projects (the self-funded half naturally). I’m hoping I can be more useful in an indirect, long-term role.

However this next lady really moved me into giving the pathetic 3800 Congolese francs (around four US dollars) I had in my pocket.

It’s not that Tapita Pugbale has a particularly sad story. Granted, her husband died in the late nineties, but that is hardly unusual, and in this culture it seems, barely worth mentioning. She lives in one of the huts built from a collaboration between ALM and Habitat for Humanity.

And ALM loans her the aforementioned soap, coffee etc to sell to make a living. She is not particularly good at it – she is unable to walk to market, so sells it from in front of her hut, hardly the busiest place in Gemena.

She’s wearing a clean white top that Jacques gave her as a present (she is genuinely pleased and excited to see him when we arrive), and wandering into her hut sunlit through thin orange sheets, she has the expected curiosities on the wall… I wonder how often her tie collection gets put to use? Or perhaps it’s a part of her husband she won’t let go of.

She is unable to pound cassava or do much of the house-labour women here are brought up to do the moment they can be pulled out of school (on the occasion they ever went to school). She still has reactions to the bacteria inside her, even though it is now dead and she is no longer considered (at least by definition courtesy of the World Health Organisation) a leprosy-sufferer. In fact I’ve seen many many cases like hers. From a Leprosy Mission’s standpoint she is an average elderly woman who still carries a few marks of leprosy. Better than average perhaps, as she has suffered no stigma throughout her time, and her church group has come to pray with her when she has been unable to walk to the Sunday service.

But she still struggles to make a living. She has rarely been able to repay the loan from ALM that Dr Jacques has provided. But he says she doesn’t spend it wildly… aside from once spending it on a grandsons funeral she spends it on food for herself. She has no family around to look after her, and when I visited she was lying on her bed, weak, having only eaten a small bowl of cassava leaves that morning. She was hungry, and clearly life’s lot has made her weary and very emotional. She started crying mid-sentence and said, “I’m hungry, but what reason do I have to live? I just wish my husband could come back and take me to heaven with him.”

There’s not much you can say to that. I looked at Jacques and said I’d like to give her these francs. He nodded, his face still and solemn, despite being used to hearing these things everyday since he started his job. “Yes, that would be good”.

When I left Tapita’s, Jacques turned to me and said “you know, without ALM Tapita really would be dead. We provide the medication she needs from the reactions to the dead bacteria. If she wasn’t so close to where I live she would have died a long time ago”.

I read an article recently called “Hiding the Real Africa“; about NGO’s faking facts and figures to make the need seem greater than it really is in order to get donations flowing in and to sustain their organisation/business. But I haven’t sensationalised anything in this post. The DRC has a long way to go to bringing it’s people towards the standard of living reflective of it’s natural wealth. Probably far beyond my life time. I hope not. But at the moment it’s the efforts and encouragement from ALM and the likes of Dr Jacques that are what gives thousands of people affected by leprosy a chance. People like Tapita cannot afford to wait for their government to play catch-up with the rest of the world.

Leprosy Eliminated? Togo

Documentary, Photojournalism

MAHAMADOU KEFAS

Mahamadou was 20 when he got leprosy. I spoke to him at Koloware’s Centre de Sante, formally Centre de Lepreserie, a Catholic Mission near Sokode in Togo, West Africa. He was born in neighbouring Benin, and was working on a farm in Anie with his father when he noticed a cut on his arm that he hadn’t felt. He realised that his entire body was going numb. I spoke to him as he sat in his wheelchair outside the wound care room where Tchedre the nurse was doing dressing changes for several patients at 7.30am on a Friday morning. Most of the patients who were due to have their wounds looked at had not turned up due to heavy rains that morning. This is not uncommon, but unchecked wounds do get worse. Stones often turn up in foot wounds and infection sets in very quickly. It is these infections that result in rotting flesh that drops off or requires amputation, leading to loss of digits and limbs.

Mahamadou told his father about the symptoms and was taken to a hospital where a doctor correctly diagnosed it as leprosy. He was due to go into the local clinic near where he lived in southern Togo three times a week for injections. However continuing to work on the farm he suffered more cuts which started to get infected. Word spread that he had leprosy. No-one would hang around with him anymore. If he went out people would shy away from him. He told me that his friends would see him then simply turn around and run away. He lived with his father who stuck by him, but the rest of his relatives did not visit or speak to him. Eventually he stopped going out completely. The only people he spoke to for several years were his father and the doctor. His Uncle heard about Koloware and his father brought him up to the Leprosy Centre. His father visited him every Saturday for 4 years before he died.

He now lives in a small room in a compound with a total of five rooms, each housing a patient. He is the only one of them that does not have family. The leprosy bacterium (Mycobacterium leprae – closely related to tuberculosis) that causes the numbness is no longer active in him. He has no right foot, no digits on his left hand, cannot feel any part of his body, is blind and according to the World Health Organisation does not have leprosy. He has lived in Koloware like this, relying on food and support from the sisters of the Catholic Mission since the 1960’s.

Above and below: Mahamadou eats alone in his room. He is blind and can’t feel what he’s touching, so makes sure his food bowl is always in the same place between his legs so he knows he’s picking up food. He has no fingers on his left hand, mainly from burning his fingers while cooking during early years at Koloware.

Above: Mahamadou gets a check up every few days at the health post about 40 metres from his house. Missed appointments in the past have lead to the types of infections that took his right leg away from him.

Above: Mahamadou is numb over almost his entire body.

TCHEDRE WALLAKASONA AND THE KOLOWARE LEPROSY CENTRE

Tchedre’s Uncle was a nurse at the Leprosy Centre and encouraged him at 17 to come and work here. He soon learned that despite much help being needed for the 300 ‘lepers’ (at the time) at Koloware there were very few doctors who would even go near them for fear of contracting the disease. The sister who was in charge of the mission at the time saw potential in him and with the private funding that the centre gets from European (primarily German these days) individuals sent him to the nearest town, Sokode to get trained as a nurse.

Despite retiring 5 years ago, he still comes in three times a week to check and clean the wounds on many of the patients. He described the attitude of many of his patients as like that of children: “Every day you must bring them in to take their medicine, or get dressing changes. But they can’t feel the pain, and I see them handle red hot pans with their hands. If they have work to be doing at home (such as cooking, or even farming for the few that are able) they choose that over coming in for their check-up. When they do come in I sometimes see stones lodged in their wounds (causing infections) because they haven’t been checked in several days. I even tell them not to go into the field to work after I’ve changed their dressings, yet they do and get dirt all over them”.

He is dealing for the most part with the very poorest people that have received no education. Sometimes it is hard to have sympathy for those that don’t seem to want to help themselves, but in the cases of these men and women their priorities are always going to be food, water and whatever family is still around them above a cut that does not affect them at present and that does not feel painful. Such is their way of life. Tchedre obviously cares enough to carry on having retired.

He told me that in the central region (where Koloware is located) about 50 people get diagnosed with leprosy each year. It’s not exactly a ground breaking figure, but such a feared disease also means that many will be hiding their symptoms – like almost all of those that attend Koloware Health Centre once did. Women especially suffer from this – if the husband doesn’t throw them out outright they’ll almost certainly be hidden away for fear of bringing shame on the family. Leprosy is not a fast acting disease, developing over many years. But with most of the people that get it ignoring the patches and numbness out of ignorance or fear, the later stages are often reached even in these current days when the Multi-Drug Therapy (MDT) cure is readily available worldwide.

They are able to take the drugs at home, only coming in to Sokode (where the central region’s leprosy advisor is) to pick them up and for the occasional check up. But too many times have professional, trained nurses in Sokode hospital refused to touch those with the disease, helping fuel the stigma. Many patients are sent to Koloware for these dressing changes. With the exception of the foreign missionaries (like the director – Sister Antonietta from Italy), all the staff in the health post have been born in Koloware and grown up around those with leprosy. However even in Koloware there’s fear about the disease, despite being educated in how easy it is to cure if caught early.

Just a few weeks before I arrived some farm-hands had seen patches on a sixteen year old co-worker. They suggested it was leprosy, but the boy covered them up with his shirt insisting it was from a voodoo curse that was put on him – the more bearable burden. Fortunately they confronted him later and he agreed to go for a diagnosis at the health post, where they confirmed it was leprosy. Within two weeks he was no longer contagious; however he will need to make sure he continues taking the MDT for at least a year before the bacteria has completely been eliminated. His colleagues had caught the disease before any nerves had been killed, but if they hadn’t the numbness would remain for the rest of his life, and he would have to be extremely careful as a farmer that those areas of anaesthetised skin don’t get damaged.

There are only a couple of the ‘lepers’ that attend the markets – when people from all around the village come to sell, buy and trade in Koloware. They fear being shunned and rejected. Those that have small businesses rarely attend their own stalls, knowing people will not buy from them. They instead get family to sell for them. Others have little choice, hoping the busyness of the market will pull attention away from them they go about buying the food they must have to survive. Since the leprosy post was founded here 63 years ago there has been only one marriage between a ‘leper’ and a ‘non-leper’. Social mixing is relatively uncommon.

Above: Patients wait outside the Health Centre for dressing changes and check-ups.

Above: Assistants from Koloware help patients clean out infected wounds under the tap before they are looked at by the nurse.

Above: When you can’t feel your feet you can’t tell when your feet get too big for your shoes or when they are crushed. Permanent disfigurement can make walking extremely difficult.

Above: Tchedre Wallakasona, who has worked at Koloware since 1967 and despite retiring five years ago still comes in three times a week.

Above: Tchedre examines a regular patient while a child looks through the curtain from the room next door. The Health Centre now attends other diseases and injuries as well as leprosy, it’s main purpose when it was founded over 60 years ago.

Above: A ‘leper’ makes twine to sell to bind straw onto roofs. I saw a few patients doing this job even though few have fingers, and some are entirely blind.

Above: A patient passes the time with a rolled up cigarette.

Above: This man has been blind for over thirty years. He also spends much of his time making twine for roofs.

Above: Leprosy affects the eyes in a number of ways that can result in blindness. In this case it has prevented the eyelids from closing and protecting her eyes from dust and dirt. Tchedre is reaching out to her and berating her for missing her dressing change the previous morning due to the rain.

Above: A ‘leper’ buys vegetables from the Saturday market.

Above: Outside the Mosque at lunchtime on market day, a faithful patient must remove his prosthesis as well as his footwear before entering.

AISSATOU ASSOUMANOU

Aissa was brought up in Sokode, red patches started appearing on her face and she was diagnosed with leprosy. She was 12 at the time. She started the treatment, but stopped going when she was married at 13. Her husband told her it brought shame to the family, so she pretended she had never had it. In the next few years she gave birth to a boy and girl by him, but patches started to appear again in her late teens and her husband left her. “I was sad” she recounted wistfully, “but not because he left me, because the leprosy had come back again”.

Her parents took her to Koloware where treatment began. After four years of living in Koloware and taking the treatment she got married again, to a fellow ‘leper’.

While I was with my second husband, my first one came to visit me. He saw I had built a life around me and was happy. He was jealous and angry. But I wasn’t going to go back to him, even after my second husband died from leprosy.” Her second husband had built a home for her and their two new children, but after his death a storm destroyed it while they were sleeping. She managed to get her children out before the roof collapsed in on them. The director at the time helped rebuild her house with the funds from private donors. Of her four children three are living in Cotonou in Benin, and one in Sokode. She sees them once a year after the Islamic festival of Tabasci.

She is lucky in that her leprosy injuries are easier to hide than others, and she sells a few things on market day; ground nuts, cigarettes etc. “I used to sell much more, biscuits and sweet snacks. However over the years my custom has got worse. If the director didn’t provide me with ingredients to cook with I wouldn’t have enough to feed myself”. Last week the patient living in the room next to her died. She will use the room to house her chickens until somebody comes to fill it up.

Above: Aissa thinks back through her life as my questions brought up past memories.

Above: The courtyard where Aissa lives. Her room is one of those on the block on the right.

Above: Aissa cooks in the light of her doorway, away from the spitting rain outside.

Above: Aissa emerges from the doorway of the room next to hers. It was vacated last week by its owner who died of infections from leprosy. She keeps chickens in it now.

Above: The infection on the bottom of Aissa’s foot. She is glad that it is easily concealable.

Above: Aissa sells groundnuts and other snacks at her stall outside the yard where her room is. She used to sell much more, but business has not been good in recent years.

I only had two days to photograph in this small village. I wish I had been able to spend more time and properly got to know the lives of these social outcasts. I am trying to document leprosy in several different countries worldwide, to show that such an ancient, well-known and easily curable disease has not been eradicated because of the vastly disproportionate wealth distribution across the globe. It can only survive in people with poorest immune systems where poverty is rife, and will continue to destroy the lives of those it inhabits due to the lack of education and stigma that surrounds it. The project is entirely self-funded, and I plan to fund my own exhibition to raise awareness. If you can help in any way, with finance or advice, then please do not hesitate to contact me – info@tom-bradley.com. My leprosy work from Nepal and Nigeria is on my website – www.tom-bradley.com.