In the lead up to World AIDS Day, 2008, on December 1, photographer Brendan Bannon is in Kenya and will be providing images every day of his travels with MSF throughout the region.

Day 8 - WORLD AIDS DAY

Today is World AIDS Day. But there is also Malaria, Meningitus,  opportunistic infections to many to count and of course Tuberculosis.
Outside the hospital as I write this there is a huge public rally to  mark the day. For some it is a day of mourning, for others it is a  celebration and an affirmation of life.

Today is World AIDS Day.

On the wards it is another day of work for the  doctors and  another  day of struggle or reckoning for the patients. Tuberculosis is resurgent in places like Homa Bay-places where people  live in poverty. The living quarters are dark and  cramped with many people sharing  a single room house.

HIV  compromises   immunity and allows TB to take hold. The living conditions contribute to  its  spread. The treatment for TB iscomplex and long.

Lillian, an MSf patient is in the hospital today with a  relapse of  TB. She is  hooked up to a tube that drains the pus from her lungs.  She has  at her bedside table a small purse, a purple plastic cup filled with porridge, a mobile phone charger, many satchets of pills and a small red mirror.

“I want to see my face. So I brought the mirror. In the morning after I wash I look to see myself.3

“I want to see my face. So I brought the mirror. In the morning after I wash I look to see myself. When I loked before I saw some fuzz from the blanket. I brushed them off and  I was amused.”

Her eyes are lively, inquisitive and probing.

“Before when I looked in the mirror I was  fat and more beautiful. Today I see I am thin and not looking like myself.”

Lillian knows that  if the treatment works that  she may  again look like she did before. When she looks in the mirror in the future she may be fat and beautiful once more.

In the lead up to World AIDS Day, 2008, on December 1, photographer Brendan Bannon is in Kenya and will be providing images every day of his travels with MSF throughout the region.

Day 7 - DAILY LIFE

In covering HIV AIDS stories over the last 4 years I am always struck by how much this medical condition is also a social condition.  One way or another the hand  of HIV touches  everybody and everything in a place where  prevalence rates are above  30%.

Weekend rituals include funerals which are usually held on Fridays and Saturdays. For those on ART daily rituals  include  punctuating each day with pill taking and  bi-weekly or monthly doctors appointments.

People adjust. And those that don’t die; or they contribute to the epidemic in ways they may not realize.

Photographing the epidemic is always a challenge. It is vast and  it is everywhere and nowhere  at the same time. The  focus could be the clinics and hospitals where treatment is given. But that is only the most obvious place to look.

There are always opportunities to  make pictures of the  destruction - the destruction of bodies. We know those images well. The  real challenge is to effectively show the way that  the epidemic is infused in daily life. People really do live useful and full lives with HIV. Their continued presence is important to the people they love.

And yet we can not ignore the fact that people are still dying everywhere. Especially in  areas far from clinics. Communities that are not isolated from the spread of the virus are sometimes isolated from the spread of information that may save them.

When they do have the information they may not have the means- emotional or financial- to convert  that  information into treatment or prevention. In order to reach the hospital  some people have to travel 5 Km  just to reach the road and  another 30 Km  on that road to the clinic.

Sometimes you see generational change. I spoke to  a woman  named Jane who  found a way to deal strategically with her life only after she  began ART treatment. She began in the fish business trading her body for the opportunity  to buy fish. “If you didn’t sleep with them  they wouldn’t sell you fish” she told me.

Most of the fishermen and  the fish buyers she knew in  her youth have died.

There is a new generation on the small islands and beach  communities  that has taken its place and will  likely repeat  the mistakes that she made.

“You would need a lot of money to reach these places and organize the women and educate the men” she told me.

Jane’s  story:

“When I started in this business of fish there were so many of us. Competition was strong. Getting fish to sell was a problem. There were men admiring us and  ready to sleep with you in broad daylight. There were women going along and they bought fish very easily. My husband was still alive and had no job. We had children. So it forced me to compromise for the daily bread.”

“If I look for  the lives of my colleagues at that time I cant see them. They have all died.
“When I realized I had the virus I realized I would die if I continued living that way. With the ARVs I knew I would live longer and it gave me a moment to plan.
My husband was dead and I was alone. I needed to respect my children. I had to plan how I was going to live.

“People understand things differently, they perceive things differently. I understood my life differently  than others and decided to live it in my own way.

“What I am trying to say to whoever will listen is that you must think strategically- especially if you are HIV positive. You have to think, take care and not poison other people. There is no reason to die early. Life is how you take it.”

Treatment has changed my life and  replaced despair with hope.”

In the lead up to World AIDS Day, 2008, on December 1, photographer Brendan Bannon is in Kenya and will be providing images every day of his travels with MSF throughout the region.

Day 6 - MILKA’s DREAM

Milka Anyango Odondi wants to be a grandmother someday. Today she gave birth this morning to a healthy baby boy. They are both HIV negative.

“When I was pregnant I wanted to know  my status- I wanted to take every precaution to protect the life of my child. This is my third child and  we are all Negative.
I have been taking care of myself well. I don’t move around with other men and I believe my husband is the same. We stick to each other.

My husband tests every three months and is not going around with other women. We sat together and spoke about our lives and  pledged to concentrate our love in our family.

I encourage  my friends to take care good care and to not move around with other men.
If they stay  healthy they can take care of their children for a long time. If they move around they  might die and  leave their children  at too young of an age.

I want to be a grandmother; I am dreaming of it. I want the pleasure of  seeing my children grow and I  figure that  by old age I’ll have a lot to teach the younger ones.

I have known some wise women and I want  to be among them someday.  I have seen their homes grow well through their wisdom. I wish to be the same.”

Hours after the birth, Milka hadn’t chosen a name for the boy. She hadn’t talked to her husband yet. He works on a tea plantation in another district. In the rush to the hospital she  forgot to bring his phone number. When she speaks to him she will ask if he likes the name Ian Anyango.

In the lead up to World AIDS Day, 2008, on December 1, photographer Brendan Bannon is in Kenya and will be providing images every day of his travels with MSF throughout the region.

Day 5 - 11,622 HUMAN STORIES

Until today single themes or powerful stories emerged organically  giving me something to explore, photograph and write about. This day was different and I was left with several scattered moments that reveal the scope of what is happening  here in Homa Bay.

I visited Pamela, the head nurse, who sits at a large table in a big room lined chest high with filing cabinets.

As  we were talking people pulled out and returned stacks of files and  I became curious.

The cabinets were  numbered and the numbers climbed from left to right in a circle around the room.

The last number is saw was 11,622. “There are more files in another room” she told me. “11,622 human stories.” I thought. And Pamela said “ These are the lucky ones. They can come in for treatment. There are so many more out there in rural areas that don’t ever make it here.”

Earlier in the day Eric Aghan the MSF doctor brought me to see Henry. On Monday  we saw him unconscious- comatose from Meningitus.

Everyone was afraid and half expected that he would die. He had tubes in his nose and   hand.

“Here, when the family sees the tubes go in it’s like watching the  child  being taken to St. Peter’s Gate” Eric told me.

Yesterday Henry showed strong signs of recovery and Dr. Wanjala, the ministry of Health doctor removed  the tubes. “The patient does his part, we do ours and God does his” he told me.The boys mother found Eric on the ward and called him over. “She said ‘look Henry can eat on his own again!” and when she said it she was smiling all the way through. When parents see a child turn back from death they are very happy- it is a remarkable thing that she said.”

“Without proper care,  and if you are in a place where treatment is not  available, you would not be looking at a three year old child- you would be looking at another statistic.”

“There is no better way to thank the strangers who help MSF  here than to show them a child  that is still alive. People have hope not only for living but for living useful lives- going to school, farming, raising families, working. As doctors we have  a way toward happiness- we can properly treat  our patients and help our colleagues” Eric Aghan added.

The work continues. In Henry’s old bed there are two new patients with feeding tubes in.

In the maternity ward Azel was sleeping in the incubator. She was born 17 days ago to Dorothy, 26 years old, HIV positive.

Azel, sleeping in the incubator.

When she was born she weighed 1.92 kg.Now She is eating and gaining weight.

Dorothy found out that she was HIV positive when she was  3 months pregnant.
She told her husband after a few days. “He accepted the news. He told me it was normal. I told him to go and get tested. He didn’t bother.”

When a mother is HIV positive the child  will not necessarily contract the virus.
All protocols have been followed to help prevent the transmission of the virus to Azel. But  Dorothy won’t know for sure wether the baby has the virus for another 18 months.

In the lead up to World AIDS Day, 2008, on December 1, photographer Brendan Bannon is in Kenya and will be providing images every day of his travels with MSF throughout the region.

Day 4 - INVISIBLE CHILDREN

Walter is 12 and Charles is 10. They are alone and they are invisible.

“Nobody comes from the community to visit us here. They just look at us from the outside,” Walter said looking out the door of the house he shares with his younger brother.
They never knew their father. Their mother died in 2002 and  this April thier grandmother died.

“We dig the earth and plant and we go to school. No one is telling is to go. We go because we need more knowledge. I want to be a doctor- that’s why I go,” said Walter.

“Doctors help people and  I want to help people” he continued.

“Do you know any doctors?” I asked him.

“I heard of doctor Chula but he died 3 years ago. People were always talking good about him” he said.

Walter is 12 and Charles is 10. “Nobody comes from the community to visit us here.

I wondered if  during the time his two closest relatives were dying if they  received any medical treatment.

There is a cost recovery system at the public hospitals so people in Kenya who  are sick and poor often go without care believing it to be out of reach.

The boys  told me that when they get sick they wait for it to finish because they can’t afford to go to the hospital.

The brothers live in a 2 room mud and stick house on their grandmothers  200×200 meter plot.

Scattered around the land are signs of industry and initiative. There are the rows of maize, smaller plots for green vegetables and next to the house Charles has made a small nursery for tree seedlings. “this is my experiment,” he told me.

Walter is 2nd of 49 in his class  at school. Charles the younger brother is 5th out  of thirty.
In the face of an incredible tragedy these kids have and incredible resolve. And they have each other.

Charles said “My older brother is always  giving me advice. He tells me ‘We should love each other and not destroy the things we have.”

Walter added “ we still have a few problems- Sometimes  there is not enough food so we go to sleep hungry; The other problem is clothes- we don’t have clothes to wear to church.. or shoes. And sometimes we can’t afford the fees for our exams at school.”

After we face all of these problems and if we are able to succeed I hope the community  will see that we are people too.”

In the lead up to World AIDS Day, 2008, on December 1, photographer Brendan Bannon is in Kenya and will be providing images every day of his travels with MSF throughout the region.

Day 3 - LOVE MEDICINE

“Sometimes what you need to give a patient is love. For two months little Steve was our fuel. He kept us going“, Dr Rodrigo told me.

I think  that In medicine, as in life, there are ordinary  relationships and extraordinary ones. Extraordinary ones teach us about our selves and connect us deeply to other people. They  change us as they remind us of each others humanity. It sounded to me like the relationship that was fused between young Steve, his family  and his team of doctors was  extraordinary.

Steve, at 12 years old, was facing death.

When steve came to the hospital he was sick. His first line ARV treatment had failed. Whatever medical interventions were tried seemed to be failing as well. Steve, at 12 years old, was facing death.

Dr. Rodrigo:
“For two months he was our fuel’, said Dr.Rodrigo. “He kept us going and now the medical me doesn’t understand what happened! When I look back, I ask myself : what did we do to make him better?”

“At the time I was trying to Phase into the stage where you let him die peacefully- then we started to get closer to him. We talked to him about his dreams…
The emotional me wants to believe that love was the treatment. The medical me dstill wonders what was that got him through and made him recover.

“I remember a couple of days  being fed up with work. T

hings weren’t working and I went and saw little Steve who is dying and he would give you a smile and everything was better.

“One day Helen, Steve’s tuberculosis doctor, told me  tshe was having a tough day but after seeing little Stevie’s smile, things looked completely different, somehow better. I felt jealous for not being there.”

Eventually he started to recover. We  saw he gained  a Kilo of weight, then three and so on. Every little weight gain was like a grain of hope. Helen would come and check him very early and then she wouldn’t be able to keep the good news. It kept us going like fuel for our souls.”

In here you need to win some battles from time to time, little Stevie is one of those.

Steve was put on second line ARV treatment and, after a short while, he started correcting a nurse who delivered his medicine.

“When a patient is correcting his nurse by telling her she is  not giving the right amount of drugs.

That is the sign that the patient is ready to take his medications alone !” Dr. Rodrigo said.

“In the end ,the magic was Steve. He found the will to follow his treatment.”

The point of Dr. Rodrigo’s story to me  is not that love will conquer all or that on it’s own a miracle. But I do believe, because I have seen it in my own life, that when love, compassion and curiosity are shared with a patient the patient can see a world that is bigger than the disease.
And they can summon the will  to live in the world that they see.
My mother was sick for years with Multiple Sclerosis. I took her to hundreds of doctors appointments.  Most of the time the news was grim. She would be told: “you are worse off than  the last time I saw you and  it’s likely continue to get worse.” Then she was told that it was vaguely possible that the steady March of  disease could be stalled at its current stage for a short period.
There was  one doctor, Dr. Phillips, who made the time to listen to her. He asked about her work and her family. Then he would tell her that he admired her courage and that if he could  ask God for  one miracle he would ask for her  recovery.
By then she couldnt walk. So I couldnt see her quicken her step…. But  I did notice that she would push  the wheelchair out of his office herself.

In the lead up to World AIDS Day, 2008, on December 1, photographer Brendan Bannon is in Kenya and will be providing images every day of his travels with MSF throughout the region.
Day 2 - A DAY OF CONTRASTS
Today was  a day of stark contrasts. It is incredible to see two  sides of a disease so seemingly different. One  harrowing and horrible the other colored by hope in the face of tragedy.

3 years old and HIV positive, suffering from menengitis. (Photo by Brendan Bannon)

In the district hospital I watched doctors and families gather around desperately sick children. Henry, 3 years old and HIV positive, was suffering at the moment from menengitis which left him unconscious. His mother, father and aunt were bedside  and consumed with  concern and anxiety.

Doctors and nurses rushed around him tending to other children equally sick. There were at least 2 children to  a bed- all with tubes inserted for feeding or breathing or intravenous fluids.

Eric an MSF doctor examined Henry’s eyes to see what damage the meningitis  had caused to his nervous system. The boys pupils responded  equally to the light, meaning that  the brain infection had not permanently compromised his nervous system. Chances for a good recovery were still high.

The eye exam showed that chances of good recovery from meninigitis were high (Photo by Brendan Bannon)

This news brought a brief moment of relief,  the family gathered  in  vigil around him.

In the afternoon I visited Clinton, a 12 year old HIV positive orphan who lives with his grandparents. After walking 5 km home from the hospital Clinton effortlessly climbed a few hundred meters of steep hill to his grandparents home.

Clinton walking home to his grandparents house (Photo by Brendan Bannon)

Clinton began treatment in 2003- 2 years before Henry was born. Five years later he is still strong enough not to need ART.

Clinton’s parents died within six months of each other from AIDS. They refused to be tested and never sought medical help. “My own son and his wife would not have died- but they refused to acknowledge this disease.” his grandfather said. Clinton contracted the virus from his mother. At the first signs of illness he agreed to be tested.

Although he is HIV positive, regular checkups and  treatment at the first signs of opportunistic infection have kept him strong. “ Now there is nothing I can’t do,” he told me.

Clinton sorting a collection of rusted nails. He wants to be an engineer when he grows up. (Photo by Brendan Bannon)

He also told me that he wants to be an aeronautical engineer. He sees planes flying overhead and  now he wants to build them. At one point he pulled a collection of bent and rusted nails from his pocket and began to sort and organize them.

“He is very practical and he does things practically. I think he could build airplanes someday,” his grandfather said.

His grandmother, understanding that these pictures would be seen around the world, had a message to share:

The first one (Clinton’s father) died because he did not go for the test.  Clinton agreed to go and he is surviving. So I think everyone should go for the  test. There  is goodness in testing… and the goodness is that I am still seeing Clinton. And I am happy!”

Clinton and his grandmother. (Photo by Brendan Bannon)

Clinton, the future engineer wanted to “ thank the people who design the drugs and deliver them. Without them I wouldn’t be here.”

“Without the drugs  this district would be almost empty now.” his grandmother added.