When you’re just outside Musanze town, the signs to Musanze Cave seem clear: “xx KM MUSANZE CAVE” and an arrow pointing to the right. Don’t turn right. Keep driving. Don’t let the descending distances on multiple, consecutive signs lure you into turning, not until you get to a sign that simply says “MUSANZE CAVE” and an arrow pointing to the right. Those previous signs? The arrows should point straight ahead. Yes, it’s a little confusing, but worth it.
Not that the road leading to Musanze Cave inspires confidence you’re heading to one of Rwanda’s newest tourism sites. There’s a dirt and rock path, and then a soccer pitch with concrete school buildings and a light forest around the perimeter. The day Mr. P and I visited with our friends J and J, we couldn’t see an obvious path to drive on, or a cave entrance. Kids were playing soccer, so Mr. P maneuvered to the far side of the pitch. That’s where we saw the entrance: about 3m of white ticker tape strung between two wooden posts amongst scraggly bushes and uneven ground. A sign laid out caving rules, including “Any caving activity must be guided.” We wondered where we’d find a guide. We needn’t have worried, not when there might be money involved.
After we parked between some trees, a man in a blue jump suit appeared. He didn’t speak English well and he didn’t look like a guide to me. He certainly didn’t have any official identification. But he safely led us through the caves for an hour and made a handsome profit – 5,000 francs for each of us, a total of about $30. Was this a fair price? Should we have been charged at all? And was this man a guide or an entrepreneurial local who knew his way around the cave? No idea.
There are actually two caves, and both were pitch black and completely dry. We all used flashlights and iPhone apps to see around us. The Rwandan government has done a pretty good job clearing walking paths, but I still felt around with my feet to ensure I wasn’t about to tumble over a wall. We saw some breathless sights, including a portion of collapsed roof overgrown with vines reaching toward the sky (see picture below). We also saw one little bat. And some kind of animal teeth. At least we hope it was animal teeth; apparently there was a massacre here during the 1994 genocide, though I could find only one source that said this.
Overall, the lack of artificial lighting made it hard to discern the shape and depth of the caves and their wonders. And since we didn’t speak the same language as our guide, we couldn’t learn much about what little we could see. Still, I enjoyed exploring in the dark and having the caves to ourselves for one hour.
I’d always thought of tetanus as something you could maybe possibly get if you stepped on a rusty nail. That’s what I learned growing up. Nothing else. I never met anyone who had tetanus and so it was one of those things I rarely thought about. I did avoid rusty nails, though.
Then I met Alizeta Sore, a community health worker in Burkina Faso. We sat under a tree, about six of us, just talking about life and work. Alizeta told us how she became passionate about vaccination work. Her first two children died of tetanus. She hadn’t taken them for their immunizations because the health clinic was so far away. Can you imagine walking over 10 miles one way to a hospital, carrying a baby the whole way? That was the scenario that kept Alizeta from immunizing her first two kids. In a way, it’s understandable. It’s also incredibly sad. In many poor countries, living in a rural area means you and your children won’t have access to facts about immunizations and the actual vaccinations. But people like Alizeta — and the organizations they work for — are trying to change that.
Alizeta now shares her story with mothers, urging them to take their children for immunizations no matter the distance or cost. Here’s a story I wrote and photographed about her for Catholic Relief Services, on behalf of the GAVI Alliance, which works worldwide to increase access to immunizations.
ALIZETA SORE hops on her grey bicycle, the tires filled with just enough air to carry her across the sandy paths of Peele (pay-lay) in rural Burkina Faso. She pedals in flip flops from one group of thatched homes to another, carrying only a sheaf of papers, a cell phone, and a ton of health information in her head.
Sore is a community health worker, and this bicycle journey is a weekly ritual. She’s checking on recently-immunized children and reminding mothers, most of them illiterate and unable to read a health record, to inoculate their children during the next morning’s immunization clinic. She volunteers in partnership with Action pour l’Enfant et la Santé, a Burkinabé civil society organization (CSO) that works with other CSOs under a GAVI Alliance grant to strengthen CSO work in immunizations. AES previously focused on other aspects of child health but now integrates immunization education and services into its work.
Alizeta is committed to keeping Peele’s children immunized not just for health reasons but for a personal one: her first two children, both girls, were not immunized and died of tetanus as infants. Alizeta was also unimmunized at the time.
“I use my personal experiences to educate the women,” she said. “Most are sensitive to my call. Some are still reluctant, though.”
“Health is everybody’s problem.”
Burkina Faso’s immunization rates are in the 90th percentile for most diseases, according to the World Health Organization. But recent reported cases of measles and meningitis are cause for concern. Just a few unimmunized children can spark a disease outbreak.
To ensure all children are vaccinated, the Secrétariat Permanent des ONG, a local umbrella NGO that coordinates CSO activities in Burkina Faso, is focusing its Health Theme Group on immunizations with funding from the GAVI Alliance grant. The group advocates for a stronger partnership with the government and filling immunization coverage gaps; Peele, is one of the group’s targets.
“Health is everybody’s problem,” said Athanase Fidele Kabore, the program officer at SPONG. “It’s the community’s problem. It’s a civil society organization’s problem. It’s my neighbor’s problem. If there is polio in my house, then my neighbor is not healthy.”
The group is working to convince the government that more CSOs can offer immunizations, which has been the government’s domain. With the government’s OK and GAVI funding, in May 2012 the group surveyed five communities, two where CSOs gave immunizations and three where CSOs did not.
The survey showed overall health was better in places where CSOs offered health services, including immunizations, Kabore said. This data convinced the Ministry of Health that a wider survey should be done and that CSOs should be integrated into and consulted on national immunization issues, though exactly what shape that will take has yet to be definitively decided.
At the same time, the Health Theme Group has encouraged CSOs already working in the health sector to incorporate immunization activities into their work. Kabore said that one year ago, of 58 CSOs working in health, nine were involved in immunization-related activities, which include advocacy, fundraising, and service delivery. Now there are 33 CSOs working on immunization activities.
“If children are immunized, it is for whole their life and we have no expense for buying medicine every time [they get sick],” said Kabore. “We can use this money for another problem in the community.”
An educated community
A chicken wanders into a room where a dozen mothers and their children sit, the buzz of talking moms pierced by the wails of a just-immunized baby. Alizeta picks up the day-old girl she’s been cradling and hands the girl and a blue health record booklet to the girl’s grandmother. Grandma is taking care of the girl – who won’t be named for another week, per Muslim custom – while the mother rests in a clinic bed.
The immunization scene is repeated over and over for close to three hours. Afterward, Alizeta leads a group discussion about immunizations.
“Do you know the immunization schedule for after the baby has been delivered?” Alizeta asks the women. She stands in the middle of the room where just minutes ago she held babies as they were immunized.
Mothers speak: polio and tuberculosis at birth; polio, hepatitis, diphtheria and tetanus at two months. Women recite the immunization schedule all the way up to the baby’s ninth month of life. After a half-hour more, the group disbands, the women walking or bicycling home.
“There used to be diseases like polio, measles and tuberculosis, which always at this time of year – the hot time – brought many people to the health center,” said Alizeta. “But today, this kind of problem is decreasing.”
Above: Haymanot Aimro prepares to feed her nine-month-old son Bokallu Mosfon in Guraghe zone, Sodoo district, Kela kabele, Ethiopia. Earlier in the day, Bokallu received his last of nine mandatory childhood vaccinations, an event memorialized with a certificate from the local health center.
A measles outbreak in the Democratic Republic of Congo (DRC) killed over 2,000 children in 2012. Just 51% of Ethiopian children have been immunized against diptheria, pertussis and tetanus. These diseases are tragedies that people rarely think about in the United States, where I’m from, but they’re a real threat to public health and social stability in many developing countries that lack strong immunization systems.
This past spring I spent three months filming, photographing, writing and editing print and video stories about vaccinations in Burkina Faso, Ghana, Ethiopia and the Democratic Republic of Congo. My client, Catholic Relief Services, wanted to show what local organizations are doing in partnership with the government to increase access to vaccinations in each country.
When I signed on for this project, I realized I knew very little about immunizations. Sure, I’d received a bunch of shots when I was young and before I first traveled to Africa a few years ago. Maybe it’s because I don’t have children, but before March I couldn’t have told you with any certainty what vaccinations kids usually receive (this is what the World Health Organization recommends.)
Obviously, I had a lot to learn. So I studied policy papers about immunizations in each country and read every news story I could find on the topic. Once I got in-country, I spent hours interviewing and talking with people who advocate for policy changes and implement immunization programs. Thanks to all the people who shared their time with me, I now know more about immunization policies and programs in four African countries than in my home country (though this project did lead to my dad sharing his memories of receiving one of the first polio vaccines in rural Missouri in the 1950s).
Oh, the challenges and adventures on this assignment!
In Ethiopia I wasn’t allowed to photograph or film in or around health facilities. So instead I spent time with recently-immunized kids and their moms at home. Those are some of my favorite photographs and video clips because they’re sweet everyday moments, like the picture above.
In Ghana, I was documenting a community health meeting under the shade of a huge tree when a thick limb right above me cracked off and crashed to the ground. Everyone scrambled to safety just in time, thank goodness. The next day, I was filming under the shade of another huge tree in another community when everyone started sprinting past me. I followed — was another tree branch breaking? — and saw a thatched house ablaze about 50 feet away. Everyone was running to extinguish the fire, which they quickly did.
In Burkina Faso, where daytime temps were 100+ every day, my temperature soared to 104 Farenheit (40 Celsius) twice in one week. I’m pretty sure I had heat stroke. The doctor at the private clinic where I spent an afternoon thought I had malaria (I didn’t), and I ended up on an IV drip, learning French medical vocabulary and talking Obamacare and the American health insurance system with my two Burkinabé hosts. My clinic bill totaled just under $100 for everything — clinic fee, doctor’s fee, medicine. I thought that was cheap but my hosts didn’t. Then they were stunned to find out what I might have paid for similar healthcare in America: I estimated at least $250 out of my pocket, even with insurance.
In the DRC, a mother named Sunda Lina (second-to-last picture below), patiently sat in a sweltering car, all the windows and doors shut tight, so I could record an interview with her without distracting background noises. She’d never been interviewed before and I’m sure she didn’t completely understand why I needed silence. And yet she obliged. I’m always amazed when people open themselves up to me this way.
Of all the interesting people I met who are working to increase vaccination access in these four countries, my favorite was a community health worker in rural Burkina Faso. Alizeta Sore, a quiet and kind Muslim woman, was nominated by her village to work at the local government health center when it was finally built six years ago; before then, people walked or biked 15 miles to the closest health facility. Everyone trusted Alizeta because she’d been the community’s unofficial midwife for years. Alizeta is especially passionate about immunization education and access because her first two children died of tetanus as infants. I’ll share more of her story in a later post.
Alizeta Sore, a community health worker, holds the yet-to-be-named child of Kadidia Sawadago before the baby receives a vaccination at the Peele Health Center in Peele, Bogodogo Health District, Burkina Faso on Friday, April 5, 2013.
Alizeta Sore, a community health worker at the Peele Health Center in Peele, Bogodogo Health District, Burkina Faso, walks home after leading a pre-natal health class that includes information about the importance of vaccinations for pregnant women.
Hannah Essel holds her daughter, Christabel, after a nurse immunized the girl during a monthly health services day in Praagave, Ghana, a rural community near the Cape Coast. If a child misses being vaccinated on this day, the only other healthcare option is a clinic about three miles down a rock-filled, red dirt road.
Children are weighed before receiving vaccinations in Ghana (left) and the Democratic Republic of the Congo (left). (Most kids cry and scream like crazy when getting weighed. The boy on the left just took it all in stride. A lot of us were chuckling about how relaxed he looked. )
Messelu Tamire holds her son Yop, 1, as she prepares coffee at their home in Guraghe zone, Sodoo district, Kela kabele, Ethiopia. “These days everyone in the neighborhood knows about vaccination and whenever I have the chance I will tell those mothers that don’t – those mothers who don’t do it due to a lack of awareness and ignorance – who change the day on which their child is vaccinated, they will either go to the markets or do some other business,” said Tamire. “So I keep telling them about the importance and advantage of vaccination and advise them it’s better for them to lose one day market rather than losing a lifetime opportunity for their child.”
Mr. P and I have been working like crazy recently. He’s always up late or analyzing Excel sheets on the weekends. I’ve been filming and photographing all over Africa and barely been home since March. We needed a vacation — a totally relaxing, unplug-from-the-world getaway.
So between two stories I shot in Malawi, Mr. P met me for an escape on the southern shore of Lake Malawi. We splurged and stayed at Norman Carr Cottage, a cozy guesthouse run by a South African couple: Taffy, a talkative and opinionated man who will have you laughing at most everything he says, and Jenny, an equally opinionated, funny and warm woman. We slept in a huge room with a huge mosquito net (the small nets, like we have at our house, make me feel like I’m sleeping in a delicate jail cell), ate delicious breakfasts every morning (our other meals were tasty, too) and snorkeled, swam and read. And slept. A lot.
Also, we barely used the Internet because the connection was terribly slow. Bonus.
Right: Waiting for a wedding reception to start at a hotel in Accra, Ghana.
Left: This snazzy chicken’s “Hello!” and upbeat attitude in the face of becoming the “tasty Chicken that you love!!” totally endeared me to this bird flu awareness poster in Accra, Ghana.
Right: Looks like Rwanda just got a huge shipment of Nutella and jam! Sometimes grocery stores in Kigali will be overflowing with one item and devoid of others. Last week Mr. P and I searched three stores for shampoo and finally found several bottles of just one brand in one store. This is life in a landlocked country that imports everything. (Not such a bad life, actually.)
The rain started during the Friday evening commute, the worst possible time for a storm no matter where you are in the world. There appeared to be little or no drainage system, so the streets quickly become flooded, with cars and people wading through hip-high water in some places. I snapped these iPhone photos from the shared van taking me and a man to the Kinshasa airport. He was taking pictures as were a lot of people in the street. Is this kind of flooding normal for Kinshasa? I have no idea. But it looked like a lot of people with very little sustained considerable damage to their homes and businesses.
My friend Aude Guerrucci and I were setting up for a video interview when we found out a reflector, some tripods and a set of headphones got locked into a room for which no one around had the key. You hear about these things happening but you never think it will happen to you – until it does! We scanned the office we were working in and got creative. Our setup wasn’t elegant, but it worked. Here’s what we did:
• We put a 5D Mark III atop three cardboard boxes, but then the lens pointed too low on our interview subject. Aude scrunched up a small, drawstring bag and propped it under the lens. After that improvisation, the lens pointed too high. I grabbed a few credit cards and slid them under the back of the camera. Perfect.
• Though we used a wireless Sennheiser lavalier microphone on our interview subject, we wanted clean backup audio, just in case. I stacked up four cardboard boxes (two medium, two small) and positioned my Zoom H4n recorder and Sennheiser ME 66 shotgun mic atop it, the mic pointing at the interview subject.I set my audio levels at the beginning of the interview.
Then I did what I always tell people not to do: I monitored the audio without headphones. I didn’t have a choice since Aude needed our one available set of headphones to listen to the lav audio. But I also felt OK monitoring without headphones because I know my recorder well. Throughout the interview I adjusted the shotgun mic, recorder and audio levels from my perch behind the cameras and boxes.
• We had four mics receiving audio: the Sennheiser shotgun, the 5D Mark III onboard mic, the Rode mic plugged directly into a 5D Mark II, and the wireless Sennheiser lav plugged into a second Zoom H4n. Overkill perhaps, but audio is super important and I’m pretty crazy about recording clean audio.That said, I don’t consider the Rode mic an ideal audio backup for interviews unless there’s no other choice. In my experience, the Rode picks up too much noise. However, it’s a great microphone for ambient sound. I love recording with it out in the field.
As for the on-board camera mic, I would rather cut an interview from the final video edit or – preferably – reschedule the interview than rely on the low-quality sound from that mic.
• Very luckily, there was a large flipchart and stand in this office. We moved it to the left of our interview subject for fill light.
The results were good. I know we’re not the first professionals to have to improvise an interview setup like this. I’d love to hear what others have done in a pinch.
Have you seen the Everyday Africa photo blog? I like it. A lot. It aims to show mundane, normal moments in Africa, not just the poverty, disease and strife that seem to dominate much visual imagery of Africa in the West. So, inspired by “Everyday Africa,” I’ve been looking for those mundane, normal moments here in Rwanda and in my travels. I shot all these photos with my iPhone, except for the first one, which I shot with Mr. P’s point-and-shoot.
If I had to know only two French phrases (and really, I know only about five), then I’m glad I know these:
- Ou se trouve _____ ? — Where does one find _____ ?
- C’est bon. — That’s good./It’s OK.
They’ve come in quite handy, these two phrases, in my first 48 hours in Burkina Faso. I’ve asked people where to find the bathroom, the ATM, the church, water and tennis balls. How do I know all that French vocabulary? I don’t! Well, except bathroom and water. I’ve been looking up words on Google Translate and picking up other words as I go about my day. For everything else, I take a Spanish word and “Frenchify” it by dropping the last syllable and trying on a French accent. I sound horrible, I know I do, but I’m trying. And the kind Burkinabé who encounter me and my weird Spanish-French mix have all listened politely and helped decipher what I need.
I’ve wanted to learn French since I was 10. Back then, my family was living in Jeddah, which had a sizable expat French community. I somehow found a free French class near my house, and excitedly walked to my first lesson one evening, my notebook and red plastic pencil case in hand. I was the youngest student by far. The teacher handed out worksheets with pictures and vocabulary words: work, office, children, cooking. Boring. I wanted to learn how to talk about my favorite colors and playing tag with my friends. I hung on for a couple more classes before dropping out.
We moved back to the U.S. when I was 12, and I thought this would be my chance to learn French. Nope. My school offered only Spanish. Crazy American school system. So I took Spanish, enjoyed it and minored in it in college. I should be a fluent Spanish speaker by now, but I’m just conversational.
I wish I could be even slightly conversational in French. I feel bad for being in Francophone Africa and not speaking the main language. I feel I’ve got to explain to the smattering of English-speaking Burkinabé I meet, “I really do speak languages other than English! Just not your language. Don’t judge!” This urge to explain is my own insecurity, of course.
Anyway, I still want to learn French. The French Cultural Institute in Kigali offers classes that I’ll be signing up for when I’m back in Rwanda. For now, I’ll continue picking up what French I can and I’ll stumble along in my Spanish-French mishmash. C’est bon.
I had just arrived home from my morning run today when I heard an air raid siren. I knew bombs couldn’t be imminent. But it sounded just like it does in movies about World War II in London. It sounded just like when I lived in Seoul and sirens blared occasionally in drills meant to remind citizens of the North Korean threat. Was this a drill, too? If so, for what? As the second siren went off, I looked out the apartment window. Hordes of energetic kids ran into the neighboring schoolyard, jumping all over the playground. The air raid siren is the school’s bell. Of course.
One of the most popular songs in Rwanda right now is a catchy tune about EDPRS sung by Knowless and Riderman Jay Polly. EDPRS stands for Economic Development and Poverty Reduction Strategy. Can you imagine a top American pop song about TARP or Obamacare? Me neither. My husband has seen the EDPRS music video a couple times. We’re hoping to catch a live performance of the song at a concert tomorrow. Be sure to watch the video below (in Kinyarwanda). My favorite part is the construction workers holding hands and raising their arms as they sway to the music. There’s a story here that I may dig into once I’m more settled.
Here in Rwanda (and much of Africa), you pay for Internet access based on how much data you consume. Since that’s not how we pay for Internet in the U.S., I’ve never given a thought to my consumption numbers. I know they’re probably high. Before arriving in Kigali, I worried that the cost of Internet access here would gobble much of our expendable income. So I was thrilled to find that MTN, a national telecom company, offers a 30-day unlimited data plan for just RWF 21,000, or about $33. That’s less than I paid in Washington, D.C.
Still, I’m watching my numbers. When I connect to the Internet, a little MTN window pops up that shows how much data I’ve used each day. On Wednesday, it was 22.5 MB. Yesterday it was 852.3 MB. Today it’s likely to be even more than yesterday. The reason? We’ve had to download a 4.7 GB file to fix an issue on my husband’s computer. So far the file’s been downloading for 17 hours. We’ve got another 14 hours to go. I hope MTN doesn’t cancel our unlimited data plan after this.
I shot this picture not knowing what was happening. Sometimes you do that: photograph first, ask questions later in the interest of capturing the moment. These young women staying at the Nutrition Rehabilitation Home in Dhangadhi, Nepal, weren’t sure what they were looking at either. Then they found out: A dying person being carried into the hospital next door. Heartbreaking.
My colleague Molly and I walked among the thatched homes in Char Baria, talking to people about their lives – one of my favorite things to do, ever.
We had come to this small village in southern Bangladesh looking for a good person to profile for a story about maternal and child nutrition. When looking for the right person, the idea is to find someone who’s active, will be comfortable with the camera and is a good storyteller. That last detail is crucial. It’s hard to create a compelling film from someone who can’t talk about his or her life in a relatable manner, i.e., stories.
That first evening, as a curious crowd gathered around us, I asked our translator to ask everyone, “Who do you think tells the best stories in this village?” I’ll never forget the sight of about 25 people, mostly women and most of them shorter than I, simultaneously nodding their heads and looking toward Tohomina and saying her name.
“OK, then,” I said to Molly. “Looks like it’s unanimous!”
From a recent outing with friends in California: Good friends like Amelie and Cora are always happy to see each other.
Sometimes I like to think purely artistically when I’m photographing — you know, forget about moment and photojournalism and emotion. What are the things around me? How beautiful does the world look? From top to bottom: outside Alewife Station in Arlington, Mass.; sunset on Block Island, Rhode Island; the Atlantic Ocean, Block Island, Rhode Island; and somewhere above New England. Thanks to my dear friend Abby for help with this edit.
Lawrence (right) is one of those charming kids who knows he’s charming and uses his powers for good. He’s always making people laugh with his silly faces and funny gestures. One evening when I was photographing at Omoana House, a child health rehabilitation center in Jinja, Uganda, Helen (left) sat alone on a back stoop, looking a little lonely. Lawrence sauntered over with a water hose. He stuck it in his mouth and stood a few feet from Helen. “What’s he doing?” I wondered. Helen looked perplexed, too. Lawrence pretended he wasn’t doing anything strange. He looped the hose over his head, not looking at Helen, who cracked a teeny smile. Grass crunched under Lawrence’s feet as he walked closer to Helen. He sprawled out on the stoop next to her, hose in mouth, eyes fixed on her to see her reaction. He got it: A genuine smile. Helen was charmed, as was I.
Neelum Chand carries her son, Shuvam, 1, through the Nutrition Rehabilitation Home (NRH) in Dhangadhi, Nepal, after lunch on Sunday, April 29, 2012. The NRH, a project of the Rural Women’s Development and Unity Centre, a Nepali NGO, works to restore malnourished children to health. Forty-one percent of Nepali children under age 5 are short for their age (stunted), according to the preliminary 2011 Nepal Demographic and Health Survey. Stunting is an indicator of malnutrition, and ensuring children are properly nourished in the 1,000 days between pregnancy and age 2 are vital to a child’s development.
Photo by Laura Elizabeth Pohl/Bread for the World
Swayambunath, a grand Buddhist temple overlooking the Kathmandu Valley, is a wonderful place to contemplate life. I was lucky enough to visit two weeks ago while on a reporting trip to Asia for Bread for the World. My colleague and friend Molly and I spent one morning here during our brief sojourn in Kathmandu before heading out west.
I visited the temple when I lived in Kathmandu five years ago. As I walked around Swayambunath this time, I thought about how to photograph the scene differently than before. Did I succeed? (Apologies for the strange formatting of the archived post.)
I’m glad we detoured through the Kasha-Katuwe Tent Rocks on our way to Santa Fe. I’d seen pictures of these before but I couldn’t have imagined the beauty and wonder of hiking through the rocks myself. We hadn’t planned to hike to the top. I hadn’t planned on taking hundreds of pictures. Afterwards I wished we’d brought a picnic and I’d taken more photographs.