The population of Kibera is estimated at 1.1 million people, up from 700,000 ten years ago. There is no infrastructure, no roads, no safe drinking water, or sewers. Kibera is created from scraps of tin and mud. The photographs presented here were all taken on my way to do work assignments in the AMREF Clinic (for the Novartis Malaria Initiative) and in the Tabitha clinic (for Planned Parenthood). All of the photos are “grab” shots. Some were taken from the vehicle that we used to get to the AMREF clinic. The car I was in had to inch it’s way along narrow muddy streets barely wide enough for our vehicle. Outside my window, people were going about their daily life not more than three feet away.

On my second trip to Kibera we walked to the clinic, and I had to be very mindful of each step to be sure I wouldn’t slip and fall into the mud and refuse. It was rather uncomfortable for me to take photos in these circumstances, as I felt that people really did not want to be photographed. It’s not my normal practice to work under these circumstances, but I felt obligated to document these living conditions and to share them with the outside world.

The poverty in Kibera was overpowering. Any solutions for alleviating or improving the situation here seemed to be beset by incredible complexities. I was recently at a conference on global health and food security at Stanford University, where I asked an expert in this field about dealing with the poverty found in large urban slums such as Kibera. He admitted that they had not discovered any effective strategy to deal with it.

I am hoping that this post will open a forum for ideas that readers may have in improving the living conditions found in places like Kibera. My impression was that whatever was being done was not effective; of course, the healthcare provided in the clinics I visited was very relevant and made a real difference in people’s lives; but when the population of Kibera has grown by 50 percent in 10 years, larger-scale solution are needed.

Below are a small sample of some of the photos and to see the complete portfolio in a larger format, please go to:

http://www.tuschmanphoto.com/kibera_web

The first image is on the outskirts of Kibera.

There are a series of photos at the end of the portfolio on all the “hair salons”. I found it hopeful that even in dire poverty, people try to look their best and dream of a better future.

I also had the privilege  of photographing a library of images for Planned Parenthood Global and here are a few images that were used in their Annual Report:

To see the full Annual Report, here is a link: (All the large double paged photos are mine with the exception of the one taken in the US).

http://www.tuschmanphoto.com/pdf/International_Brochure.pdf

On the local level I photographed an Annual Report for the Palo Alto Medical Foundation focusing on their oldest patients. Despite the stereotypes of old age, these people were very inspirational. The youngest person, in their late 80′s was a ballroom dancer and the oldest- and this was hard for me to believe- was 105 years old, lived in her own home, had just come back from a cruise and wanted me to help her buy a new computer!

Here is a link to a pdf of the PAMF AR.

http://www.tuschmanphoto.com/pdf/PAM035_Annual2011_lowres.pdf

Several of the images from this past year received awards in photography competitions.

The image of the Ecuadorian women below was awarded a fifth place award in the APA Something Personal Exhibit in SF this past January.

One of my portraits was nominated among the best in the portrait category of the

INTERNATIONAL COLOR AWARDS PHOTOGRAPHY MASTERS CUP. Photo is below:

And finally the following image was accepted into the One Life International Photography Competition. It was taken while I was documenting a girl’s education program in Rajasthan.

I also was fortunate to collaborate wit Gayle Peterson, a philanthropic consultant, on her new venture.

Click here to see the full muti-media presentation:

http://tuschmanphoto.com/Partners_for_Change_.mov

I will be posting stories from the work I did for Planned Parenthood and the Novartis Malaria Initiative. My next post, however, will be on the problem of third world urban slums, in particular, the slum of Kibera in Nairobi, which I had the occasion to visit twice this past year.

Here are some statistics:

India is home to one of the largest illiterate populations in the world. In Rajasthan, 44% of females are literate, as compared to 76% of males. For every 100 rural girls, only one reaches 12th grade. Out of 26 districts with the highest gender gap, 9 are in Rajasthan. Educate Girls works in Pali, where the gender gap is particularly high.

One of they key features that attracted me to EGG is that the program is designed to be scaled up. In fact, EGG has plans to educate 5 million girls by working closely with communities and local governments. In 2010, Educate Girls has scaled up from 500 schools to 2,342 schools in the entire Pali district, which covers 1,067 villages.

Our first stop was to a very small community where I had a chance to meet and photograph two young women. One young girl was not able to attend school — instead she had to watch her younger sister and tend to the family goats.

The other young woman, pictured here with her mother, receives her mother’s support and encouragement to do well in her studies. Her mother, who had a chance to travel outside of her local community when she was younger, realized that her lack of education was a major limitation to her quality of life. Due to this realization, the mother intended to ensure that her daughter finished her schooling. Evidently, the mother was very proud of her daughter’s persistence in pursuing her education.

We next visited a girls boarding school system. This system of schools was initiated by M. K. Gandhi’s wife to provide for educationally disadvantaged girls – many of whom have disabled parents, are orphans, or live too far away from schooling facilities. It was evident from my short visit and from the photos below that these girls were also being educated to be empowered; they had a great deal of self-confidence and were very supportive of each other.

We then had an opportunity to visit Pipla, a small rural tribal community. It is geographically isolated and consequently cut-off from many state resources. Here, Educate Girls has been the only organization attempting to educate these children to a level where they can commence mainstream schooling. The Non-Residential Bridging Camp (NRBC) program here has been very effective. The number of tribal girls participating in the program is quite high, particularly when taken as a percentage of the total number of girls living in the area. There is a local school nearby (~1km from where we visited) where students who successfully complete the NRBC can continue their education.

I would like to thank Matt Withers,  a volunteer with EGG, who accompanied me on this trip and provided me with much of the background information.

I will be leading an Eastern India photo tour starting December 31, 2011 exploring the River Ganga (Ganges) from Kolkata (Calcutta) to Agra and Delhi ending January 15th. This tour will be designed to allow time for you to understand and record the exotic culture, sights and sounds of the real India.

If you are a photographer, writer, artist or any traveler who hates being rushed from one site to another then this tour is for you.

I am teaming up with the finest tour operator I have ever met. Louise Nicholson wrote the book on India. Her National Geographic Traveler: India is one of the best-selling guides to India. She is a true expert having visited the sub-continent more than 200 times. Also, because she has made TV documentaries on India, she knows the meaning of a ‘good view’ and she understands photographers’ requirements.

Louise has had years to find and develop relationships with the finest local guides to make sure our trip goes smoothly. We will be touring in comfort at the best time of year for photographic light and reasonable temperature to see India at its most spectacular.

My previous experience traveling on a Louise Nicholson organized tour in India is what convinced me to work with her to put together this trip. I know that this trip is going to be a wonderful experience for all.

If this tour sounds like anything you would be interested in then I highly encourage you to click through to my professional site to learn more about this India photo tour and to contact Louise directly for details on indianicholson@nyc.rr.com

To see photos from last trip to India, please go to:

http://www.tuschmanphoto.com/india_1

“In a world that is more interconnected than ever before, challenges such as poverty, inequality, women’s rights, aging and the environment belong to all of us.”

“These are problems that can, and must be solved. Thankfully, significant strides are being made by committed organizations and impassioned individuals all over the world. Working together, incremental actions will create exponential results.”

I am very proud that many of my images are being used to highlight this call to action. Below are ten posters featuring the campaign. Other photographs will also be used in a National Geographic insert, a multi-media web presentation and an exhibit in Copenhagen.

For those not familiar with UNFPA, the “United Nations Population Fund is an international development agency that promotes the right of every woman, man and child to enjoy a life of health and equal opportunity. UNFPA supports countries in using population data for policies and programmes to reduce poverty and to ensure that every pregnancy is wanted, every birth is safe, every young person is free of HIV/AIDS, and every girl and woman is treated with dignity and respect. UNFPA – because everyone counts.”

For the remainder of the year I will be posting stories on some of the issues that I have documented this past year, including a girl’s education project in Rajasthan, India and family planning programs in Latin America for Planned Parenthood. I also will be working in Kenya and Ethiopia, documenting malaria treatment and prevention and women’s reproductive healthcare.

This six page article on my photography is being published this month by Rangefinder Magazine. Here is the link to the complete story:

http://www.tuschmanphoto.com/pdf/MTP_rangefinder.pdf

The NKST reproductive-health project recently upgraded a center for educating midwives and nurses on reproductive-health issues, particularly basic family planning, contraceptive technology, and post-abortion-care services. The NKST education course produces a large pool of skilled family-planning attendants, whose outreach provides basic healthcare services to the wider community. Below is a series of photos taken in the classrooms.

This next series are photos taken in an AIDS clinic at the NKST facilities.

In my last night in Nigeria, I met with Dr. Mairo Mandara, director of the Packard Foundation programs, to go through a debriefing session on my experiences during the previous 10 days. She is a very bright, energetic, determined and outspoken woman, someone whom I greatly admire. I consider her, Thank-God Okosun, and some of the doctors I met to be true heroes. It would be easy for them to move to Europe or the U.S. and have a much easier life, but they are completely devoted to improving the quality of healthcare for so many of their fellow citizens; their hard-work and dedication is truly admirable.

I told Dr. Mandaro that Packard had indeed made progress in bringing family planning and post-abortion-care services to many communities, and that this changing cultural norms represented no small task . Apparently, I had only visited 20% of the projects that Packard had instituted in northern Nigeria, so the work that they had undertaken was even more widespread and extensive than what I was able to document. Yet, I told Dr. Mandara, there is so much work that remains to be done. The birth rate had been reduced to approximately 6 in the communities where they were working (as opposed to 10 or 12 before), which is definitley a big step in the right direction; nevertheless, without further reductions and better educational opportunities for children, it will be difficult for these communities to attain an improvement in their quality of life, and they will continue to struggle with poverty.

I asked Dr. Mandaro how much the Nigerian government contributes to women’s reproductive healthcare programs, and her answer left me quite speechless — it was precisely zero. To make really lasting changes in a country the size of Nigeria, these successful programs must be scaled up; however, without government support, it will be difficult to deliver the necessary education and family-planning programs to the millions of people who need them.

If I ran a large foundation, I would insist that the government match my annual budget by at least 5-10 times. Of course, this is my personal blog and opinion and in no way reflects the policies of the Packard Foundation or the realities that they may contend with. But I find it shameful that the government of Nigeria does not contribute any funds or programs in family planning. Despite the handicap of working without government support, Packard has made a significant contribution to the well-being of many communities in northern Nigeria.

The highly restrictive religious bias against reproductive health issues is a serious cause for concern in Nigeria. Most religious organizations view issues of reproductive health, particularly issues of sexuality and family planning, as immoral. Seven years ago PPFA was able to partner with the NKST church in altering this cultural and religious perception. Family planning, sex education and post abortion care are now accepted throughout the church and the fact that the church has a well established network of hospitals and clinics has made this PPFA project an effective one for reaching a large number of potential clients.

We arrived at the church headquarters as a large thunderstorm was brewing. The church compound is quite large, encompassing schools for both primary and secondary education, as well as those that train nurses and midwives and support several clinics.

As is the custom, we paid an honorary visit to the head pastor of the church upon our arrival. I photographed him by dim window light as there was no electricity in the building.

PPFA and Packard also made an advocacy visit to the leadership of NKST church to honor Rev. Inyonogie in appreciation for his contribution to the achievements of the family planning project. Here he is pointing to a painting of the founder of the NKST church.

A recess at the primary school in the church compound.

In the church. congregants are singing hymns before the start of the official PPFA program.

Church officer organizing PPFA donated contraceptive commodities. The materials also include MVA kits and Misoprostol. Manual vacuum aspiration (MVA) is a fast and safe way to empty the womb using a large syringe and cannula. It can be used to help a woman who has had a miscarriage or abortion that was not complete. Misoprostol is also used for incomplete abortions or miscarriages.

Prophylactics that will be distributed to the congregants.

Since the community is rather self contained ample opportunities for reproductive health care counseling exist.

The program takes advantage of normal everyday activities to distribute condoms. Go to the seamstress to get a dress made or an alteration and you also get a lecture on birth control and some prophylactics.

Similarly, go to the hairdresser, get counseling and free prophylactics.

A couple obviously anticipating using their new contraceptives.

Patients waiting to see health care worker at family planning clinic.

At the clinic, a couple receives counseling on family planning and they choose a method.

The introduction of family planning into a conservative religious community is no small achievement; changing cultural perceptions is a formidable task and we have to look no further than our own country to see how difficult it is to make lasting change. Packard and PPFA have successfully partnered in having family planning become a totally accepted way of life in the NKST communities.

Two experienced TBA’s from CEDPA ( Center for Development and Population Activities) were among the first guests.

Gathering of guests in the courtyard.

Traditional Birth Attendants gathered in one of the rooms adjacent to the courtyard. Frankly, I did not see much interaction between them and the guests. Perhaps they were planning their strategy, or more likely  just resting before the guests arrived.

A few scenes from the courtyard:

A retired birth attendant.

A retired birth attendant, her colleague ( also retired) and her granddaughter.

Male Peer Counselors visit the marketplace to counsel males on the importance of  family planning.

Finally, Pathfinder volunteers at a university in Kano dispensing information on AIDS prevention.

I will be completing this series of  with two new posts on PPFA’s work in a Christian community in northern Nigeria.

MMSH is the only large scale hospital whose work in maternal health care that I documented. There were 3 very large hospitals where I was scheduled to work but was unable to do so for reasons that will become apparent at the end of this post.

Women waiting to be seen at MMSH

Health care worker recording patient information.

Patients and nurses in the ward for post-abortion care.

A patient undergoing Manual Vacuum Aspiration in the procedure room.

We also had the opportunity to visit the FOMWAN (Federation of Muslim Women’s Associations of Nigeria) Maternity Hospital in Kaduna. FOMWAN originally established the clinic in an area very close to an urban slum with the intent of treating women and children from this community. For religious reasons FOMWAN did not provide any family planning services. Pathfinder worked with community leaders to change this policy.  Pathfinder’s programs are focused on reproductive health and family planning–specifically healthy timing and spacing of children for improved maternal and child health outcomes. As mentioned in previous posts, the fertility rate and the maternal mortality rate is extremely high in Northern Nigeria. Increased birth spacing plays a critical role in reducing maternal mortality.

The hospital is a maternal and child health facility and at least half the patients in these small wards were very young children. With the help of Pathfinder, the hospital was able to increase their capacity and treat a larger number of clients.

Maternal Health Care Coordinators in front of hospital.

Organizing patient records

The pharmacist.

Women and childrens wards.

As I mentioned, we visited three very large regional hospitals only to discover that there were no patients, only senior administrators. The wards were completely empty, no nurses, health care workers, just empty beds. The reason for this was shocking; the government refused to pay the employees, including all the doctors and nurses, a reasonable wage for their services. Consequently, all hospital employees were out on strike and the hospitals had shut down. This was quite unbelievable and it doesn’t take much imagination to picture the serious consequences. I have to say I find this situation quite incomprehensible. Here are two photos from a hospital showing the empty wards.