Framework

Capturing the world through photography, video and multimedia

Kolya, 31, an intravenous drug user, spent several years in prison. Already living with HIV, while incarcerated he contracted tuberculosis. He died several weeks later in Ukraine.

PHOTOGRAPH BY: Misha Friedman

The tuberculosis hospital in Togliatti, Samara, Russia.

PHOTOGRAPH BY: Misha Friedman

A nurse cleans a cart used for serving food to TB patients in Russia. It is also used to transport bodies.

PHOTOGRAPH BY: Misha Friedman

A man waits to exchange needles and to be tested for HIV in an outreach bus in Russia. Intravenous drug users have a very high risk of contracting tuberculosis.

PHOTOGRAPH BY: Misha Friedman

A hospital room for five male MDR-TB patients in a TB hospital in Uzbekistan.

PHOTOGRAPH BY: Misha Friedman

A TB patient rests while a bed is prepared for a new patient.

PHOTOGRAPH BY: Misha Friedman

A new patient stares at a hospital worker distributing fish soup while bickering with another patient.

PHOTOGRAPH BY: Misha Friedman

Polina, 37, has just been brought into the hospital severely malnourished and suffering from numerous diseases, including tuberculosis, hepatitis C and HIV.

PHOTOGRAPH BY: Misha Friedman

A destroyed building in Grozny, capital of the Chechen Republic, in 2008.

PHOTOGRAPH BY: Misha Friedman

A Doctors Without Borders (MSF) psychologist holds a group meditation session for MDR-TB patients at Nukus, TB hospital No. 2.

PHOTOGRAPH BY: Misha Friedman

The dilapidated office of the head nurse in Togliatti, Russia, where all equipment is decades old and paint is peeling from the walls.

PHOTOGRAPH BY: Misha Friedman

An 18-year old patient with MDR-TB in the intensive care unit in Nukus, TB hospital No. 2 in Uzbekistan. She takes 22 pills every day.

PHOTOGRAPH BY: Misha Friedman

Stacks of dead patient files in an office in Russia.

PHOTOGRAPH BY: Misha Friedman

Having no relatives and no friends left, Oleg, 41, was left to spend his last days in palliative care by himself in Uzbekistan. His only visitors were nurses and social workers.

PHOTOGRAPH BY: Misha Friedman

In Russia, a nurse checks the weight of TB patients.

PHOTOGRAPH BY: Misha Friedman

A homeless man receives a free consultation in a hospital in St. Petersburg, Russia.

PHOTOGRAPH BY: Misha Friedman

A metal basin in a processing lab in Donetsk, Ukraine, lists names and blood types of TB and HIV-positive patients.

PHOTOGRAPH BY: Misha Friedman

A 34-year-old mother of four was beaten by her husband and her relatives for being sick with TB. She received treatment in Uzbekistan.

PHOTOGRAPH BY: Misha Friedman

Islambek, 19, has XDR-TB. His brother has MDR-TB and is recovering. Their mother died from TB. Doctors just found out Islambek can't be treated.

PHOTOGRAPH BY: Misha Friedman

A man waits to exchange needles and to be tested for HIV in an outreach bus in Russia. Intravenous drug users have a very high risk of contracting tuberculosis.

PHOTOGRAPH BY: Misha Friedman

A doctor prepares a TB patient for an X-ray at a clinic in Donetsk, Ukraine.

PHOTOGRAPH BY: Misha Friedman

A plastic bottle containing used syringes and needles brought in by intravenous drug users for exchange lies on a street in Ukraine.

PHOTOGRAPH BY: Misha Friedman

During the early morning rush hour, a commuter bus stops next to a tuberculosis clinic in a Donetsk, Ukraine, suburb. Most of the passengers on the bus are relatives of patients or sick with tuberculosis themselves. Commuter buses in areas with high tuberculosis rates are hot spots for transmission of the disease.

PHOTOGRAPH BY: Misha Friedman

A lab technician looks through an old microscope at tuberculosis bacteria collected from patients in Ukraine.

PHOTOGRAPH BY: Misha Friedman

An empty hospital stretcher in Ingushetia, Russia.

PHOTOGRAPH BY: Misha Friedman

In Uzbekistan, a 29-year-old patient has just taken her medication. Every day she has to swallow a multitude of pills and fight the side effects of pain and vomiting.

PHOTOGRAPH BY: Misha Friedman

A man walks away from a TB hospital in Ukraine.

PHOTOGRAPH BY: Misha Friedman

At a tuberculosis clinic in a Donetsk, Ukraine, suburb, a doctor checks Andrei for signs of life and finds none. A drug user for many years, he died at 46 from HIV and drug-related tuberculosis. He had checked himself into the hospital three days earlier.

PHOTOGRAPH BY: Misha Friedman

A 29-year-old patient with advanced MDR in the intensive care unit at a hospital in Uzbekistan.

PHOTOGRAPH BY: Misha Friedman

Two younger TB patients guide an elderly patient to her ward. Low salaries and difficult working conditions for health professionals lead to inadequate and limited nursing care in most tuberculosis clinics, like this one in a Donetsk, Ukraine suburb.

PHOTOGRAPH BY: Misha Friedman

Having no relatives and no friends left, Oleg, 41, was left to spend his last days in palliative care by himself.

PHOTOGRAPH BY: Misha Friedman

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reFramed: In conversation with Misha Friedman

“reFramed” is a feature showcasing fine art photography and vision-forward photojournalism. It is curated by Los Angeles Times staff photographer Barbara Davidson. twitter@photospice

Misha Friedman is a documentary photographer who has worked for various NGOs, including Médecins Sans Frontières, documenting the humanitarian crisis in Northern Uganda, urban violence in Nigeria, Kala Azar in India, and civil war in Darfur. His recent projects deal with the tuberculosis epidemic in the former Soviet Union, and corruption in Russia. Friedman’s work has received awards from Pictures of the Year International, PDN’s 30, Critical Mass Top 50 and he was also named Forward Thinking Museum Artist of the Year. Friedman’s portfolio of images on tuberculosis received an ANI-PixPalace award during the Visa Pour L´Image festival taking place this month in Perpignan, France. His work will be exhibited at the 2012 “Visas de I’ANI” exhibition at the Galerie du Bar Floréal in Paris.

Tuberculosis is still a very deadly disease – especially in the former Soviet Union. The number of patients with very difficult to treat forms of tuberculosis is growing steadily in that part of the world. Officials from health organizations say it is an epidemic and it is not slowing down. More and more patients are found to have the non-treatable form of tuberculosis – XDR (extensively drug-resistant). Though Ukraine, Russia and Central Asia are very different, they have one thing in common – people are not treated properly, and people are not aware that tuberculosis does not have to be so deadly. If only more time would be spent on educating the population, thus preventing the disease from spreading. Instead, those who become sick also become stigmatized, relatives turn away, and neighbors stopspeaking. They spend months in prison-like clinics, where equipment is outdated and medical and nursing staffs are just as poor as their patients. Many leave without finishing their treatment and many come back and back and back. In that part of the world, unemployment levels are high, most young people are left jobless and spend their time taking drugs, using the same needles, having unprotected sex. Many end up HIV positive. But they do not die from developing AIDS; they die much quicker – from tuberculosis. Most of them do not even know they are sick, till it is too late. I have been working on this story since 2008. It first started as an assignment from Doctors Without Borders in Chechnya, and quickly grew into a much larger project, involving several countries, dozens of hospitals and clinics, and hundreds of doctors and patients. I have seen very little change in the past few years, but I hope that now, when my project is complete, any attention it receives will bring some change at least to the people involved. By Misha Friedman

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Q: You have spent the past four years photographing “Tuberculosis in the Former Soviet Union.”  It’s certain that this issue is close to your heart. Tell me what you hope to achieve with this intimate body of work?

A: I hope to raise awareness to the problem, to reach decision-makers. As more attention is paid to my project, there is more hope that these decision-makers will be reminded of how desperate the situation is, but also, of how easy it is to change things.

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Q: Did working with Doctors without Borders (MSF) help shape your desire to photograph under-reported social issue stories?

A: Yes, working in medical NGOs taught me to look at such stories from a position different to the standard journalistic one. I learned a lot about various social/medical problems which are of the utmost concern in the world today. With such NGOs as MSF one works with the most vulnerable people, and by knowing how to approach them, what problems they face every day, helps me to focus on shooting pictures, which I hope, will help to correct the unfairness they live with.

Q: Why is the deadly form of tuberculosis – called XDR (extensively drug-resistant) – spreading so fast in the former Soviet Union.

A: The multidrug resistant form (MDR) is being mistreated for various reasons in these countries, and so new forms of the disease are developing.

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Q: Generally speaking, tuberculosis is a treatable disease. Does knowing this, yet seeing so many die from the disease, drive you to continue to tell this story?

A: Yes. But at the same time, this also discourages: I see that very little changes, no matter how much is done by NGOs, U.N., journalists, etc.

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Q: Can you speak to the personal price that you as a photographer pay covering difficult social issues like this project?

A: It’s not “normal” for any human being to witness such things happening. I do try to separate work from my personal life.

Q: How do you earn trust and gain access to these patients? Do you think a similar story logistically would be able to be told in the United States?

A: Depending on the situation. I have always worked together with people who see/help/treat these patients daily and that’s how I gained their trust. I think people, in general, in the United States are more trusting of journalists, and do not fear to share their stories. I do plan to look into a story on TB in the States this summer.

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Q: I like the way you have presented your work. Can you tell me about your postproduction work on your images?  I’ve seen a few of your same images published in both black and white and color. The color images are sharp and clear and the black and white versions have a unique ghost-like appearance as if you were shooting film at 3200. You shot these in digital, yes? So how do you create the effect?

A: Shot in digital. It’s a long-term project, and I have shared some of the photos (in color) with various NGOs so they could use them in their work. As for the black and white, as this project involves pictures from various countries, shot in different conditions, in different light, I had to make them look as similar as possible in black and white. Also, I have an older (2006) digital camera, and one of its perks is that when I convert photos into black and white, they start to look as if shot with grainy film.

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Q: How are you able to self-finance these projects – as I know most major media outlets are not paying for this important work anymore?

A: Grants and funds. I was lucky, overall. First, I started the project while still being employed in a different capacity (logistician) by MSF, and after I focused all of my attention on photography, I was able to secure a few small grants.

barbara.davidson@latimes.com

twitter@photospice

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