PHOTOGRAPH BY AURÉLIE MARRIER D'UNIENVILLE. ALL RIGHTS RESERVED.
Nana Camara, 48, waits to see the nurse at La Clinic Cabinet Medical in the Nongo neighbourhood of Guinea’s capital, Conakry. Camara has been suffering from malaria for four days, but had been unable to come to the clinic sooner due to lack of funds.
Instead, she endured the fever at home, relying only on Paracetamol from her local pharmacy, until one of her nine children was able to borrow enough money from his employer to cover the medical costs.
Many Guineans simply cannot afford to pay for medicines or treatment, as well as the costs of transportation to access their local clinics, leaving many of the country’s health centers largely empty most of the time.
It is a problem Camara understands all too well. Just two months ago she lost her husband to a heart attack, after doctors at one of the city’s main hospitals refused to treat him without being first paid a sum of money the family could never afford.
The clinic is also struggling in the aftermath of the Ebola outbreak. In particular, malaria symptoms like Camara's are very similar to Ebola symptoms. One patient at this clinic didn't respond to malaria treatment and later tested positive for Ebola. The clinic never had full protective gear.
PHOTOGRAPH BY TOMAS MUNITA. ALL RIGHTS RESERVED.
Muzammil, 37, is comforted from his pains by his stepmother while waiting outside a pharmacy for the pharmacist to arrive. Incredibly poor sanitation in the area make deaths from diarrhea and stomach infections all too common.
Others watch them, early in the morning in an internally displaced persons camp for Rohingya people on the outskirts of Sittwe, Rakhine State, Myanmar. With virtually no doctors around, pharmacists are the only people treating diseases and injuries. There is a government-run hospital, but it is semi-operational and the Rohingya don't trust it.
PHOTOGRAPH BY SAM REINDERS. ALL RIGHTS RESERVED.
A young girl waits in one of several seemingly endless queues at a clinic in Sindhuli district in Nepal. This specific clinic, set up by an international NGO for the day, was one of many of its kind operational after April 25th’s devastating earthquake in the country.
After a long walk to the clinic the queuing starts; first to register and receive their patient form, then to see the doctor, then to get any medication prescribed. The outing can last a full day, and despite tarps being erected to shade the crowds, the excessive heat still took its toll. These were the lucky few.
Patients are meant to keep their form for future doctor's visits, which theoretically would help the doctors to see the patient's history and track progress. In reality, without duplicate copies of patients' forms on file, the system doesn't always work.
Especially since the earthquake, people in Nepal wait incredible amounts of time for healthcare, which often comes in the form of volunteer doctors. Villages routinely wait for medical care for days, because of how difficult it is to get there by road.
PHOTOGRAPH BY MARTINA BACIGALUPO FOR MEDECINS SANS FRONTIERES BURUNDI. ALL RIGHTS RESERVED.
Mama Fidès sits beside her son, who is 11 months old and suffering from high fever and anemia caused by severe malaria. The child needs a blood transfusion that is not available at Kirundo Hospital. Mama Fidès waits and hopes it will come soon enough.
In this case, they were lucky: the blood transfusion arrived during the night. The following day, the doctors told Mama Fidès that her son was almost ready to go home.
Many other children are not as lucky, either because they arrive too late to the hospital or because the blood never arrives, whether from lack of fuel in the ambulance or lack of cold bags to carry it.
PHOTOGRAPH BY NORIKO HAYASHI. ALL RIGHTS RESERVED.
A woman takes care of her mother, who is waiting to enter a nursing home.
She is not alone. Approximately 520,000 seniors are on waiting lists for nursing homes in Japan. As the country's elderly population continues to grow (people aged 65+ currently represent 25% of population) and as the government continues to scale back funding for nursing homes and staff, working-age children are increasingly feeling the pressure.
Many women and men must give up their careers to take care of their parents, and with people living longer, "young" senior citizens must even act as caregivers for their parents.
By 2025, Japan will need 2.5 million caregivers. By 2060, senior citizens will represent 40% of the population.
PHOTOGRAPH BY SIM CHI YIN/VII. ALL RIGHTS RESERVED.
After collapsing twice in one day, Chinese gold miner He Quangui is struggling to breathe, gripping the bed and his son He Jinbo's thigh while his wife Mi Shixiu holds him, crying. He eventually recovers his breath. But in the early hours of the next morning, he attempted suicide to end the suffering.
For 10 years, Mr. He battled silicosis: a irreversible but preventable disease he contracted from years of working in small, unregulated gold mines in the Henan province of central China. This illness is a type of pneumoconiosis (or "black lung" disease), which is China's most prevalent occupational disease, afflicting millions. Silica dust sucked into the lungs during years of blasting rock causes the miner's lungs to harden and eventually fail.
Workers who have access to good health care and are able to remove themselves from the harmful environment—particularly those who worked for state mines—can live a normal lifespan. But most of the growing number of victims in China today are migrant workers like Mr. He, with no insurance, no good health care and no legal recourse. They often live in the most remote parts of inland China where medical facilities are far away.
To get to the nearest reasonably-equipped hospital, Mr. He had to travel approximately four hours by van. Otherwise, all he could do was wait in his farmhouse for the minimally-trained staff member from the small local clinic who had access to only basic medicines.
Mr. He died 1 August 2015.
PHOTOGRAPH BY YOPPY PIETER. ALL RIGHTS RESERVED.
Gilang holds an x-ray of his right lung, damaged as a result of Bronchiectasis—a condition when airways are so damaged they no longer clear out bacteria, often leading to repeated and serious lung infections.
In Indonesia, Bronchiectasis is often not diagnosed or treated in a timely manner. Gilang waited through four medical examinations before his Bronchiectasis was identified, along with its likely source: an extended and untreated Tuberculosis infection.
Antibiotic therapy and physiotherapy brought no help for young Gilang. Six months after this photo was taken, his right lung collapsed. To prevent infection from spreading to his left lung, his right lung was surgically removed.
Sadly, his battle came to an end three days later.
Indonesia reports the fifth-largest number of Tuberculosis cases in the world after India, China, South Africa and Nigeria. Unfortunately, this means there is a good chance that Gilang’s story will repeat itself.
PHOTOGRAPH BY ANNE-STINE JOHNSBRÅTEN. ALL RIGHTS RESERVED.
More than 30, 000 refugees have so far crossed the Norwegian border in 2015. Asylum centers across the country are now overcrowded.
Wahid Mohammad Mustafa Alkarami (45) and his children Mohammed (17), Haitham (15), Oday (13) and Taghred (9) fled from their home in Benghazi and the civil war in Libya last year. Wahid lost his job as an engineer when his workplace was bombed in 2011. In April 2013, his wife, Nejla Elsatsai, was diagnosed with aggressive liver cancer. Due to shortage of medical institutions in Libya, Wahid took his wife to treatment in Tunisia every other week for nine months. Sadly, Nejla passed away at the end of 2013.
Hoping for a better and more stable life for his children, Wahid started the long process of seeking asylum in Europe. The family came to Norway on 28 October 2014, and after more than a year, recently got a permit to stay. On 14 December 2015, they will move into their new home.
But the wait for health continues. The proportion of refugee children and adolescents in Norway with mental health needs is alarming. While everyone in Norway is entitled to health care, the wait for services—especially mental health care—can be long. Although the children have experienced several traumatic events during the war, they say they have not been offered any psychological help.
PHOTOGRAPH BY SIDDHARTH JAIN FOR ACTION AID BIHAR. ALL RIGHTS RESERVED.
Early in the morning outside a primary health care center in Bihar, patients queue up to receive a token from the attendant. The center, which serves around 200,000 patients in the region, only has one doctor and two junior doctors. Everything depends on whether the doctors actually show up—and for the patients, arriving early rarely makes any difference.
Once inside, the conditions of the primary health care center are poor. Used syringes are disposed of in the sink.
PHOTOGRAPH BY RICARDO FUNARI. ALL RIGHTS RESERVED.
A mother and her one-year old baby with skin ulcers wait for medical care in a public hospital in the rural area of Palmares city in Pernambuco State, northeastern Brazil.
In the 1970s, Brazil had a segregated health system: the rich and salaried workers had access to private hospitals in urban settings, whereas limited public services existed for the poor and unemployed.
Now, health is a constitutional right in Brazil. The country established a unified health system for all citizens in 1988, with the principles of universalism, equity, integration, and democracy.
But promising health for all is not the same as achieving it. While health outcomes have improved across the population since the unified health system was adopted, persistent corruption and inequity mean that the the poorest communities still face tremendous barriers to accessing the same quality health services as the rich.
PHOTOGRAPH BY RADHIKA CHALASANI. ALL RIGHTS RESERVED.
American seniors seeking more affordable healthcare in Mexico.
The high cost of medical care in the U.S. is a growing concern to millions of Americans, especially seniors. U.S. Customs estimates that 10 million Americans bring home medications from across the border each year either from Mexico or Canada.
During the peak winter season when seniors and retirees flock to Arizona by the thousands, many also make the short trek across the border to Mexico for cheaper pharmaceuticals and significantly less expensive medical care.
Los Algodones is a small Mexican town on the USA/Mexico border. It caters to the market-driven north-south migration of American seniors seeking relief from the high cost of medical services and rising prescription drug prices. Los Algodones was once a tiny single industry town, relying solely on its cotton yields. Today, it is a boomtown with more than 200 doctors, dentists and pharmacies all catering to their neighbors from the north.
PHOTOGRAPH BY THOMAS DE CIAN. ALL RIGHTS RESERVED.
In the rural province of Siem Reap, a woman waits with two children for a routine prenatal visit under a joint scheme between the local government health centers and an NGO-funded hospital.
The fact that visits to the doctor can be "routine" is a sign of Cambodia's progress toward universal health coverage—reaching everyone with essential health services without causing financial hardship.
However, many people in Cambodia are not so lucky. For example, there is only one hospital in the country that offers any form of mental health services.
