STOP TB - The Afghanistan Portraits

Marzieh (name changed to protect her identity) did not want her picture to be taken, and only reluctantly gave us permission to work with her. Today the world stands at the precipice of finding new solutions against this disease. Since 2005, global investments have allowed for new vaccines to be developed, to be tested and be distributed. But will Marzieh and her Afghan community benefit from these vaccines depends on the support international organizations like WHO get from wealthier countries and donors.<br>TB Centre, hospital. Herat, 2012

Bibi Gul is completely deaf in her right ear, she only has partial hearing on her left side. Fear framed her every move, she strained to read peoples lips to gain an understanding of her fait. She carried an inner-panic to see her test results. For most Afghans a TB positive result still means a death sentence. She has gotten used to the beatings that rendered her deaf, but she is not willing to let go of life.<br> TB Centre, OPD (outpatient department). Herat, 2012

This family traveled from Khost to Kabul a journey of seven days to save her mother. In Kabul the hospital administrators refused to admit them, because their municipal hospital is in Herat, in the west of the country. They embarked on a ten day journey, after having sold all their farm animals. The day they arrived in Herat, they had no more money to feed themselves. The concerned daughter embroidered fabrics hoping to sell them in the market. We purchased her handicraft so that they had enough money for food the week.<br>TB Centre, hospital. Herat, 2012

We called her endearingly, our magician from Farah. She had just returned from Pakistan with her son back in Afghanistan's southern state Farah. Because she did not continue her TB treatment from Pakistan, the doctors had feared that the microbe had become resistant to the medicines they had available. But after three days at the Herat hospital, she and her son returned to their camp in Farah.<br>TB Centre, hospital. Herat, 2012

Nagainzai had a very high fever fighting Tuberculosis. She was dehydrated and weak. She had been sick for months complaining of a cough. Four days ago she was diagnosed with TB. Her husband Hayatullah, a farmer from Aderskan, stayed with her the whole time encouraging her that she was getting the care she needed. He told her funny stories to humour her. By the morning her fever had broken and she could laugh at his jokes.<br>TB Centre, hospital. Herat, 2012

A new children's hospital had opened in Herat in 2011 and many parents came to get the only vaccine against Tuberculosis for their children. The mothers and grandmothers sit for hours on the cold and dusty hospital floor. Access to vaccines and treatment for children with Tuberculosis remains a great challenge in Afghanistan. Security is not the only concern, but depleted medicine stocks due to political barricades, lack of donor interest in Afghanistan, as the country slips from the news and our consciousness, hinder children to receive the care they need to survive.<br>Baba I Barq Comprehensive Health Centre. Herat, 2012

There is an unusual predominance of Tuberculosis in women persisting in Afghanistan. Women are impacted at 64% of all Tuberculosis patients in Afghanistan. This compromises their reproductivity and thus their social status. This means women are affected during their most productive years, this means that Tuberculosis has enormous impact not just on public health, but also on social and economic development in Afghanistan.<br>Maslakh, IDP camp. Province of Herat, 2012

Access to vaccines and treatment for children with Tuberculosis remains a great challenge in Afghanistan. Security is not the only concern, but depleted medicine stocks due to political barricades, lack of donor interest in Afghanistan, as the country slips from the news and our consciousness, hinder children to receive the care they need to survive.<br>Jibrail Health Centre. Herat, 2012

Gul Ahmad is the guard at the Herat Tuberculosis clinic. He reassured us that he knows when an Afghan is a Tuberculosis positive before the sputum exam and X rays. He can recognize a patient from far away trying to disguise their coughing, sweating and weakness. On average he sees 15-20 patients every day. Half of them end up going home with anti-TB drugs.<br>TB Centre, OPD (outpatient department). Herat, 2012

The Tuberculosis control program in Afghanistan has been successfully integrated in the Basic Package of Health Services provided in the primary health care agenda. Tuberculosis care services are delivered free of charge to all Afghans and supported by donors and international organizations. Looking towards the future, these young doctors will have to face a multi-drug resistant Tuberculosis.<br>Paediatric Hospital, the laboratory. Herat, 2012

Children are particularly a vulnerable group in the future of addressing Tuberculosis. Finding the right doses of combination medicines for children, particularly children dealing with multi-drug resistant TB will make the correct treatment more complicated and almost impossible. Progress on developing appropriate combination medicines for children has been slow.<br>Paediatric Hospital, Herat, 2012

Malika is 20 years old, married and mother of a young child. She had already spent much money to find the right diagnosis for her constant coughing, weakness and body aches. She was just diagnosed as TB positive in the clinic.<br>Guzara District Hospital. Province of Herat, 2012

Even though the treatment of TB is free in the public hospitals, Shabaneh (name changed) and her family spent an entire week of income just to come up with the transportation money to make it to the clinic. Today initiatives have been implemented to go out to more villages and increase detection and reach more women affected by Tuberculosis. House to house visits have been organized to improve detection and referral of patients. Over 300 women members of the Shuras were trained in detecting signs and symptoms of Tuberculosis.<br>TB Centre, hospital. Herat, 2012

Thirteen-year-old Najiba was diagnosed with Tuberculosis two months ago. Her weekly walk to the clinic for her medication is motivated by knowing that when she is healthy again, she will be able to play with her brothers and sisters again. Her five siblings are avoiding her because they are afraid of being infected. She has promised herself that she does not want another person to be excluded like her. "If they cough, I will bring them to the clinic to be checked for TB."<br>TB Centre, OPD (outpatient department). Herat, 2012

Despite the weak economy and security threats in Afghanistan, the National Tuberculosis Program has provided life saving services through 600 health centres and laboratories, training health care workers to deal with difficult patients and keep them on the regimen of medicines to cure the disease.<br>TB Centre, OPD (outpatient department). Herat, 2012

The camps of returning refugees or internally displaced populations become very quickly breeding grounds of sorrow. Diseases take hold faster in these impoverished, small temporary quarters, rife with violence, unemployment and children forced to labour and early marriage. This old man is sick with TB.<br>Maslakh, IDP camp. Province of Herat, 2012

There is always hope when you meet men like Hemat (courage), his name has been changed to protect his identity. When they returned from Iran, he felt very weak and coughed all day. He self diagnosed himself as missing his son who he had left behind. "I can't put into words how depressed, worried and ashamed I was." But after weeks of his persistent cough, he found the courage to run down to the van with the visiting doctors. The strangers convinced him he needed to come to the clinic for the sputum and X ray test. He was diagnosed with TB. He had heard that it was a death sentence. The thought of never seeing his beloved son again, broke his heart. He decided to follow the doctors’ orders and finish the long regimen of exams and medicines. Today, as the leader of his camp, he is the number one recruiter to bring the kids and neighbours to the doctors to get examined." I decided this is my mission now, to get everybody tested and advocate for health in my community." Many in his clan have been saved.<br>Maslakh, IDP (internally displaced persons) camp. In the photo, his son refugee in Iran. Province of Herat, 2012

Solutions, tests, laboratories, medications have to be built on a sustainable model to be a viable solution for Afghans in the long term. Too many promises have been made to the Afghans that have not been kept. Engaging women in its public outreach to educate women and empowering them to be able to get the assistance they need is key. Allowing the patients to create an information network that will teach all Afghans that Tuberculosis is not a death sentence is key to our success; especially in hard to reach rural Afghanistan and with minority groups.<br>TB Centre, OPD (outpatient department). Herat, 2012

Here we have the modern, cool, young Afghan, taking his medication with an American soft drink. Regardless of the challenges Afghans face, they remain hopeful and are moving forward to improve their lives. By listening to Afghan voices and engagement by the community we are able to develop sustainable solutions for all Afghans. So we all have to listen to our Afghans as they call out: "Stop TB, now and forever!"<br>TB Centre, the treatment. Herat, 2012

Travelling exhibition for the World Health Organization's “Stop Tuberculosis” campaign: 25 portraits and stories of TB patients in Herat, Afghanistan.

Tuberculosis is a disease of poverty. In Europe, the infectious disease was eredictaed by medical advances and improved living conditions since the middle of last century. However, annually around 9 million people fall ill with TB and 1.3 million are dying from TB.

Malnutrition, poor living conditions, war, and displacement favor the spread of the disease. Especially in Afghanistan, a country that experienced war and during the last thirty years, tuberculosis is a major health problem. Around eighty percent of the victims of the disease are women. The causative agent of the disease is the bacterium Mycobacterium tuberculosis that is transmitted through coughing and sneezing. Although the disease is curable, the treatment becomes more complicated by the emergence of resistant variants of the pathogen. In the photo exhibition "STOP TB - The Afghanistan Portraits" Portrait photographs of people who are affected by the disease are shown. The photos were taken by the international humanitarian photographer Laura Salvinelli in western Afghanistan. The photographies were produced by the National Stop TB Partnership in Afghanistan and the WHO. Salvinelli is representative of the positive photography. With her impressive portraits Salvinelli does not show victims of the disease, but human beings with individuality and dignity. The exhibition contains detailed text researched and written by representants of National Stop TB Partnership in Afghanistan and the WHO and the Geman microbiologist Matthias Stehr, the exhibition´s curator in Germany. The exhibition explains the historic background of the country, the living conditions of the Afghan people and the strategies for the fight against tuberculosis in Afghanistan.

Photo captions by Ahmad Azadi