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Highlights 2011
Highlights
Highlights 2011 A photograph is an image created when light falls on a light-sensitive surface, and it is with a photograph that this year’s entrants to The Lancet’s third annual Highlights competition hoped to cast light on different areas of health. In July this year we invited readers to submit and share their photographs with us, and we received many emotive and thought-provoking images that
depict issues ranging from conflict to clinical medicine. The winning entries explore various themes, including neonatal care in resource-poor settings, as portrayed in Catherine Matthys’ entry Under the lamplight, which captures the scene at a rural hospital in southwestern Tanzania where “newborn babies are bundled up and placed under a standard reading lamp with a 60-watt lightbulb for warmth”.
Other photographs in Highlights 2011 explore such issues as sanitation in Haiti, health systems in Nigeria, and oncology in Perth and Mexico. We have selected ten photographs that, by capturing a moment in time, tell their own unique stories.
Katherine Rolfe, Zoë Mullan, Joanna Palmer The Lancet, London NW1 7BY, UK
A fragile hold Julia Gunkel, University of Utrecht, Utrecht, Netherlands Last year I went to Cambodia with a charitable organisation from Singapore to visit and offer aid to some of the people who live in underprivileged parts of Cambodia. In the slums on the outskirts of Phnom Penh, people live in cramped, adventurously constructed huts without sanitation or medical facilities. As we wandered through the slum, many families greeted us with curious smiles. I was struck by this woman holding her 2-year-old daughter—the child had extreme muscle wasting, irregular breathing, and was in a lot of pain. This mother and child made an everlasting impression on me.
www.thelancet.com Vol 378 December 17/24/31, 2011
2071
Work in progress Susan Elden and Lindsay Mgbor, UK Department for International Development, DFID Nigeria, Abuja, Nigeria Jigawa State has some of the highest rates of maternal and child deaths in Nigeria and most women give birth at home. Before 2009, there were almost 70 midwives to serve a population of 5 million people. The Nigerian Government responded by increasing the number of midwives and creating a new college of nursing and midwifery. This photograph captures the vision for the future alongside the reality of the present. The state hopes to recruit 500 nurses and midwives. The construction plans for the school will accommodate up to 200 nurses and provide modern classrooms and teaching facilities. Although these efforts have created hope and a renewed feeling of pride, most Nigerians in Jigawa are subsistence farmers with little or no access to clean drinking water, electricity, or basic health services; female literacy in Jigawa is about 20%. These are some of the striking contrasts that I see every day in Nigeria: high hopes in the midst of a bleaker reality.
Highlights
2072
www.thelancet.com Vol 378 December 17/24/31, 2011
Moving on Tom Pepper, King’s College London, London, UK I visited the Medical Centre of the Maritime Wing at Murray Town, Sierra Leone, during deployment as a Royal Navy dental officer. The man pictured was a medical assistant who coped the best he could with the limited resources available; his attitude was representative of the resilience of the Sierra Leonean people and their commitment to improving their future. As part of the medical team from HMS Albion I provided training in casualty handling, basic life support, and first aid to a group of Sierra Leonean recruits. Since 2002, Britain has maintained a small presence in Sierra Leone through the International Military Assistance Training Team that supports the development of the Sierra Leonean Armed Forces into a democratically accountable, effective, and sustainable force. 10 years ago Sierra Leone was receiving assistance from UN peacekeeping troops; now its forces are emerging into a position to provide that same aid to other countries.
Highlights
www.thelancet.com Vol 378 December 17/24/31, 2011
2073
Pump lends a helping hand Ruwan Ratnayake, International Rescue Committee, New York, NY, USA Earlier this year, I worked as an epidemiologist in Haiti in support of the efforts by the Ministry of Health and the Pan American Health Organization/Global Outbreak Alert and Response Network to control the cholera outbreak. During my early morning commute, I took this picture of two young people collecting water from a tap typically found in periurban settings. A national solution to water insecurity is lacking in Haiti, where only 17% of citizens have access to a latrine and 63% to an improved water source. Improvement of public water and sanitation systems would render water safer for the long term and would help to prevent cholera from gaining another foothold in the country.
Highlights
2074
www.thelancet.com Vol 378 December 17/24/31, 2011
Highlights
Suddenly mature Bruno Martinez-Leo, Hospital Pediátrico Moctezuma, Secretaría de Salud del Distrito Federal, México I am a paediatric surgery resident and took this picture while making my rounds in the children’s oncology ward. I was perplexed by the look that the little boy gave me—“absent of childhood” I thought. I asked for permission to take his picture, he nodded quietly and kept staring. Despite the success in some treatments for childhood cancer in the past decades, I am always struck how children who live with cancer not only have to endure the disease, but also the devastating effect cancer has on their childhood.
www.thelancet.com Vol 378 December 17/24/31, 2011
2075
Restricted entrance Sibylle Rahlenbeck, University of Hargeisa, Hargeisa, Somaliland I took the photograph earlier this year while teaching at the Medical Faculty of the University of Hargeisa in Somaliland. This sign, posted at the entrance of Hargeisa Group Hospital, asks visitors and patients for proper conduct: “No Batons, Fires, Chewing Drugs, Pistols or Machine Guns allowed in the clinic!” While the picture might suggest the contrary, I always felt safe at the hospital. Indeed, Somaliland has actually stayed calm in the past decade and recovery can be seen everywhere. Two medical universities have been established and the Hargeisa Group Hospital is one of the teaching hospitals. Despite having created a constitution, an administration, and a governmental system, Somaliland lacks international recognition. As such, no development aid can be received and support is restricted to charities and the diaspora community; British colleagues have helped nurture medical education through the Tropical Health and Education Trust.
Highlights
2076
www.thelancet.com Vol 378 December 17/24/31, 2011
Hookwire localisation Jacquie Moran and Christobel Saunders, The University of Western Australia School of Surgery, QEII Medical Centre, Perth, WA, Australia Breast cancer is diagnosed in more than 1·2 million women worldwide each year. Happily, for many women the outcomes will be good—survival has doubled during the past two decades, reflecting both improved treatments and earlier diagnosis. Diagnosis for many women follows an abnormality seen on a mammogram that is too small to detect as a lump. This woman is undergoing a hookwire localisation biopsy of what turns out to be a tiny breast cancer, using a stereotactic prone table technique. She then went to the operating theatre to have the lesion removed. Localising very small breast abnormalities found on mammography can be complex and involve sophisticated imaging and surgical techniques, a team effort, and a rather daunting procedure for the patient.
Highlights
www.thelancet.com Vol 378 December 17/24/31, 2011
2077
Under the lamplight Catherine Matthys, School of Medicine, Georgetown University, Washington, DC, USA Twins are born in a rural hospital in southwestern Tanzania. The hospital has an ancient neonatal incubator, but no one knows how to operate it. It has never been used. Instead, newborn babies are bundled up and placed under a standard reading lamp with a 60-watt lightbulb for warmth. Despite the poor facilities, women walk for days so that they can give birth at the hospital. Other women are brought in on bicycles after spending 2 or 3 days in labour. These twins are lucky to be doing well, since in this setting the low quality of care and poor access to facilities have made childbirth a risky business for both mother and baby.
Highlights
2078
www.thelancet.com Vol 378 December 17/24/31, 2011
Waste nothing Devashish J Anjaria, Department of Surgery, UMDNJ New Jersey Medical School, Newark, NJ, USA During a recent surgical mission with a humanitarian non-profit organisation, International Surgical Health Initiative, to the island of Negros Occidental in the Philippines, I was reminded of how wasteful the western world can be. One day of operating for our mission generated the equivalent trash of 1 week for the entire district hospital in Sagay City. For the staff at this hospital, nothing was “disposable”, and nothing was wasted. An example of this is how they reuse semi-rigid intravenous fluid bags as syringe and sharps receptacles in the operating theatre.
Highlights
www.thelancet.com Vol 378 December 17/24/31, 2011
2079
Lydia’s shoes Catherine Matthys, School of Medicine, Georgetown University, Washington, DC, USA You might ask, “What does a picture of shoes have to do with health?” The answer is: everything. These shoes are worn by Lydia, a 6-year-old orphan. Children in Lydia’s severely underfunded Tanzanian orphanage regularly die from preventable diseases. On my visits to the orphanage each year, I try to make small improvements: getting the children regular doctor visits; documenting their medical histories; simply figuring out their ages. My changes never last long. How can the doctor’s visits continue, when there is no money for transportation to the hospital? The notebooks that I carefully fill with the children’s medical histories are repurposed for more pressing needs, like recording food purchases. Lydia’s orphanage shows how one cannot make lasting improvements in health without also tackling poverty and social inequity. If there is no money for shoes, there certainly isn’t going to be money for medicine either.
Highlights
2080
www.thelancet.com Vol 378 December 17/24/31, 2011
Highlights 2011 A photograph is an image created when light falls on a light-sensitive surface, and it is with a photograph that this year’s entrants to The Lancet’s third annual Highlights competition hoped to cast light on different areas of health. In July this year we invited readers to submit and share their photographs with us, and we received many emotive and thought-provoking images that
depict issues ranging from conflict to clinical medicine. The winning entries explore various themes, including neonatal care in resource-poor settings, as portrayed in Catherine Matthys’ entry Under the lamplight, which captures the scene at a rural hospital in southwestern Tanzania where “newborn babies are bundled up and placed under a standard reading lamp with a 60-watt lightbulb for warmth”.
Other photographs in Highlights 2011 explore such issues as sanitation in Haiti, health systems in Nigeria, and oncology in Perth and Mexico. We have selected ten photographs that, by capturing a moment in time, tell their own unique stories.
Katherine Rolfe, Zoë Mullan, Joanna Palmer The Lancet, London NW1 7BY, UK
A fragile hold Julia Gunkel, University of Utrecht, Utrecht, Netherlands Last year I went to Cambodia with a charitable organisation from Singapore to visit and offer aid to some of the people who live in underprivileged parts of Cambodia. In the slums on the outskirts of Phnom Penh, people live in cramped, adventurously constructed huts without sanitation or medical facilities. As we wandered through the slum, many families greeted us with curious smiles. I was struck by this woman holding her 2-year-old daughter—the child had extreme muscle wasting, irregular breathing, and was in a lot of pain. This mother and child made an everlasting impression on me.
www.thelancet.com Vol 378 December 17/24/31, 2011
2071
Work in progress Susan Elden and Lindsay Mgbor, UK Department for International Development, DFID Nigeria, Abuja, Nigeria Jigawa State has some of the highest rates of maternal and child deaths in Nigeria and most women give birth at home. Before 2009, there were almost 70 midwives to serve a population of 5 million people. The Nigerian Government responded by increasing the number of midwives and creating a new college of nursing and midwifery. This photograph captures the vision for the future alongside the reality of the present. The state hopes to recruit 500 nurses and midwives. The construction plans for the school will accommodate up to 200 nurses and provide modern classrooms and teaching facilities. Although these efforts have created hope and a renewed feeling of pride, most Nigerians in Jigawa are subsistence farmers with little or no access to clean drinking water, electricity, or basic health services; female literacy in Jigawa is about 20%. These are some of the striking contrasts that I see every day in Nigeria: high hopes in the midst of a bleaker reality.
Highlights
2072
www.thelancet.com Vol 378 December 17/24/31, 2011
Moving on Tom Pepper, King’s College London, London, UK I visited the Medical Centre of the Maritime Wing at Murray Town, Sierra Leone, during deployment as a Royal Navy dental officer. The man pictured was a medical assistant who coped the best he could with the limited resources available; his attitude was representative of the resilience of the Sierra Leonean people and their commitment to improving their future. As part of the medical team from HMS Albion I provided training in casualty handling, basic life support, and first aid to a group of Sierra Leonean recruits. Since 2002, Britain has maintained a small presence in Sierra Leone through the International Military Assistance Training Team that supports the development of the Sierra Leonean Armed Forces into a democratically accountable, effective, and sustainable force. 10 years ago Sierra Leone was receiving assistance from UN peacekeeping troops; now its forces are emerging into a position to provide that same aid to other countries.
Highlights
www.thelancet.com Vol 378 December 17/24/31, 2011
2073
Pump lends a helping hand Ruwan Ratnayake, International Rescue Committee, New York, NY, USA Earlier this year, I worked as an epidemiologist in Haiti in support of the efforts by the Ministry of Health and the Pan American Health Organization/Global Outbreak Alert and Response Network to control the cholera outbreak. During my early morning commute, I took this picture of two young people collecting water from a tap typically found in periurban settings. A national solution to water insecurity is lacking in Haiti, where only 17% of citizens have access to a latrine and 63% to an improved water source. Improvement of public water and sanitation systems would render water safer for the long term and would help to prevent cholera from gaining another foothold in the country.
Highlights
2074
www.thelancet.com Vol 378 December 17/24/31, 2011
Highlights
Suddenly mature Bruno Martinez-Leo, Hospital Pediátrico Moctezuma, Secretaría de Salud del Distrito Federal, México I am a paediatric surgery resident and took this picture while making my rounds in the children’s oncology ward. I was perplexed by the look that the little boy gave me—“absent of childhood” I thought. I asked for permission to take his picture, he nodded quietly and kept staring. Despite the success in some treatments for childhood cancer in the past decades, I am always struck how children who live with cancer not only have to endure the disease, but also the devastating effect cancer has on their childhood.
www.thelancet.com Vol 378 December 17/24/31, 2011
2075
Restricted entrance Sibylle Rahlenbeck, University of Hargeisa, Hargeisa, Somaliland I took the photograph earlier this year while teaching at the Medical Faculty of the University of Hargeisa in Somaliland. This sign, posted at the entrance of Hargeisa Group Hospital, asks visitors and patients for proper conduct: “No Batons, Fires, Chewing Drugs, Pistols or Machine Guns allowed in the clinic!” While the picture might suggest the contrary, I always felt safe at the hospital. Indeed, Somaliland has actually stayed calm in the past decade and recovery can be seen everywhere. Two medical universities have been established and the Hargeisa Group Hospital is one of the teaching hospitals. Despite having created a constitution, an administration, and a governmental system, Somaliland lacks international recognition. As such, no development aid can be received and support is restricted to charities and the diaspora community; British colleagues have helped nurture medical education through the Tropical Health and Education Trust.
Highlights
2076
www.thelancet.com Vol 378 December 17/24/31, 2011
Hookwire localisation Jacquie Moran and Christobel Saunders, The University of Western Australia School of Surgery, QEII Medical Centre, Perth, WA, Australia Breast cancer is diagnosed in more than 1·2 million women worldwide each year. Happily, for many women the outcomes will be good—survival has doubled during the past two decades, reflecting both improved treatments and earlier diagnosis. Diagnosis for many women follows an abnormality seen on a mammogram that is too small to detect as a lump. This woman is undergoing a hookwire localisation biopsy of what turns out to be a tiny breast cancer, using a stereotactic prone table technique. She then went to the operating theatre to have the lesion removed. Localising very small breast abnormalities found on mammography can be complex and involve sophisticated imaging and surgical techniques, a team effort, and a rather daunting procedure for the patient.
Highlights
www.thelancet.com Vol 378 December 17/24/31, 2011
2077
Under the lamplight Catherine Matthys, School of Medicine, Georgetown University, Washington, DC, USA Twins are born in a rural hospital in southwestern Tanzania. The hospital has an ancient neonatal incubator, but no one knows how to operate it. It has never been used. Instead, newborn babies are bundled up and placed under a standard reading lamp with a 60-watt lightbulb for warmth. Despite the poor facilities, women walk for days so that they can give birth at the hospital. Other women are brought in on bicycles after spending 2 or 3 days in labour. These twins are lucky to be doing well, since in this setting the low quality of care and poor access to facilities have made childbirth a risky business for both mother and baby.
Highlights
2078
www.thelancet.com Vol 378 December 17/24/31, 2011
Waste nothing Devashish J Anjaria, Department of Surgery, UMDNJ New Jersey Medical School, Newark, NJ, USA During a recent surgical mission with a humanitarian non-profit organisation, International Surgical Health Initiative, to the island of Negros Occidental in the Philippines, I was reminded of how wasteful the western world can be. One day of operating for our mission generated the equivalent trash of 1 week for the entire district hospital in Sagay City. For the staff at this hospital, nothing was “disposable”, and nothing was wasted. An example of this is how they reuse semi-rigid intravenous fluid bags as syringe and sharps receptacles in the operating theatre.
Highlights
www.thelancet.com Vol 378 December 17/24/31, 2011
2079
Lydia’s shoes Catherine Matthys, School of Medicine, Georgetown University, Washington, DC, USA You might ask, “What does a picture of shoes have to do with health?” The answer is: everything. These shoes are worn by Lydia, a 6-year-old orphan. Children in Lydia’s severely underfunded Tanzanian orphanage regularly die from preventable diseases. On my visits to the orphanage each year, I try to make small improvements: getting the children regular doctor visits; documenting their medical histories; simply figuring out their ages. My changes never last long. How can the doctor’s visits continue, when there is no money for transportation to the hospital? The notebooks that I carefully fill with the children’s medical histories are repurposed for more pressing needs, like recording food purchases. Lydia’s orphanage shows how one cannot make lasting improvements in health without also tackling poverty and social inequity. If there is no money for shoes, there certainly isn’t going to be money for medicine either.
Highlights
2080
www.thelancet.com Vol 378 December 17/24/31, 2011