I first heard about Podoconiosis and APA (action on podoconiosis) during a church service back in 2013. Dr Paul Matts helped set up the charity about three years ago and has since been working along side a wonderful man called Zelalem establishing treatment sites in Ethiopia. A few people from church had just returned from a visit out there and with them they had brought back some incredible stories which made me cry for about 10 hours (almost non-stop). I remember throwing my arms around Pastor Peter after the service (sobbing uncontrollably) and saying " you're my kind of people". One of the things that really struck me was the response of the podo victims who believe that God had finally answered their prayers and sent his angels to help them. For as long as I can remember I had always wanted to take a trip like this but until last year I couldn't see why I would, or what I had to offer. I have no formal qualifications, am not a teacher or a nurse and so I couldn't see my place in it all. It all became very clear to me in 2014 when I started to believe in myself as a professional photographer.
Epiphany ……. “a moment of sudden and great revelation or realisation” . The main religion in Ethiopia is orthodox Christian. As part of this faith they celebrate Epiphany. As it happened the celebrations were taking place on the very day that we arrived. I thought little of it at the time… until I really thought about what it meant...
What is Podoconiosis?
Podoconiosis is a devastating, disfiguring disease of the lower legs and feet, a silent public health disaster ruining the lives of millions of people world-wide. Nowhere is incidence higher than in upland areas of Ethiopia where bare-foot farming and prolonged contact of feet with specific soil types means that Podoconiosis afflicts up to 10% of the local population, and APA estimate now that there may be up to three million suffers across the nation.
Who are APA?
The Action on Podoconiosis Association (APA) is a local Non-Governmental Organisation (NGO) passionate about preventing and treating this disease in Southern Ethiopia.
Meet the team: These are the wonderful people I had the privilege of travelling over 1,000 miles of dirt road with.
From left to right: Ephraim (driver) Dr Paul Matts, Lindsey Waine and Zelalem
I first spoke with Paul about Ethiopia towards the end of 2014 when he showed me some of his photos. It was a very short conversation which went a little bit like this: Paul "so will you come?" Me "yep". Little else was discussed until dates were confirmed and without hesitation I booked my flight.
January 18th 2015: arrived in Addis Ababa
Our first day in Ethiopia was spent mostly on the road. It was at least a six hour journey to Sodo where we were to spend our first night. Passing many a goat, herded by large numbers of locals the roads were also lined with over worked donkeys carrying water supplies and herds of cattle. The landscape was dry but stunning and as we journeyed further South the ground turned to hard red dust. The road you see below is typical of the ones we spent most of our time on and is what the locals walk daily and for many miles. Imagine walking it in flip flops, or simple canvas shoes (if you're really lucky to own a pair) or bare foot… for most this is the norm and a daily part of survival.
No road trip is complete of course without the odd car trouble (and bird spotting)..
It seemed as our journey to the first treatment site continued, the temperature increased and the reality of where I had found myself really started to hit home. I was definitely in Africa.
Meet Zelalem aka "Zelly" the main man on the ground in Ethiopia working for APA
During dinner on our first evening it struck me that I hadn’t really established Paul’s purpose for this particular visit and so I asked him. His response was simple, to spend some time with Zelalem and after dinner it became apparent just how important that was. Paul set up his laptop to show Zelly for the first time the video that was made in November 2014. Kleenex at the ready, we all sat silently and watched it together. Zelly was so overwhelmed by it he broke down. He cried as if he had been holding it in for a long time and we cried with him. The most overwhelming part of it for him was the stories told by the patients. Even though he is himself featured in the video and is faced daily with their suffering, he was choked by how powerful the video is and the realisation that now the voices of the people are being heard across the globe. I think he feels at times that he is never doing enough and the patients are always asking for more help. They are still in need of ongoing treatment supplies and shoes. It was obvious to me that Zelly cares more about the people he is dedicating to serving than anyone here in the developed world will ever understand. He has the heart of a warrior and it is full of purpose and love for his people.
Naturally I started to wonder about my purpose for this visit. If I thought it was to just take a few photos and then hand them over to APA I was wrong. Very wrong.
First site visit: Kucha.
We were welcomed here by all these beautiful people with open arms and endless praise. Most of the patients that greeted us during this visit had stories of healing and the atmosphere was positive. Not quite what I was expecting if i'm honest. The man with his feet in the blue bowl below had come for the first time. It is here that he will learn how to treat his feet with simple soap, water and glycerine. It is here that hope for his future will be restored thanks to the nurse who will not only teach him how to clean his feet properly but will also get down on her hands and knees to show him herself.
After an introduction from Paul about who we were and why we were there, Paul met everyone individually, shook their hands, listened to their stories and checked the progress of their treatment by simply looking at their feet. Many were grateful that they were not only able to work again but were once again being treated as human beings.
During this time I decided to take the patients to one side and spend time with them in my own way (with my camera). My intention before I left the UK was to bring home some beautiful portraits and to be able to show the world that despite this awful disease, these people are beautiful. Often in life where there is deep sadness and despair we are presented with beauty as we are also faced with real emotions.
I wanted them to feel if only for a minute or two that they were important and to try and learn what I could in the limited time that I had. This was just the beginning of a wonderful experience for me and honour to meet the most stunning race of people I have ever seen.
As much as Podo is a physical disease it is as much a social one. For it smells and it can be debilitating. As a result not only can people not work or earn money to feed their families but they are also ostracised from their homes and communities. This happy chappy here had podo, received treatment and is now contributing to his community again and is working as a local hair dresser. As is the story of the lovely lady below. Cool eh?
THE SHOE FACTORY
As well as basic hygiene treatment, patients also face the problem of not being able to wear normal shoes as a result of the increase in size of their feet due to swelling. APA has therefore set up this wonderful shoe factory. Custom made leather boots are produced here and already thousands of patients have received the benefit. These boots cost around £8.00 per pair.
After an encouraging first site visit it's back on the road… and we're still having a little car trouble.
So we stop in a local village which of course draws a healthy, inquisitive crowd.
SITE VISIT 2
Here we are met with a different atmosphere and a 9 year old girl who is showing early signs of podo. When Paul took a look at her feet he said they didn't look like they had ever been cleaned. Due to a lack of education it simply doesn't seem to be a priority in a place where water is in very short supply and there is barely enough to drink let alone waste on cleaning feet.
Where there is faith, there is hope.
Here more lucky patients are measured for APA boots. This may look bad now but with treatment and new boots this man will get better.
Anyone of any age can be affected by podo, including young children. Many patients have families to feed and if they are unable to work, they are unable to do so. This is not a disease that only affects the inflicted.
Meet a very special lady indeed. This is about the only time during two meetings with her that I caught her smiling. Frankly she has little to smile about. She has had podo for about 9 years and one of the worst cases we've seen. She has never been able to marry and so lives with her Mother. She is unable to stand for long periods and as result is not able to continue her job as a teacher and is in terrible pain. You can see in her eyes she is suffering more than just physically. Her emotional being is deeply affected too. The smell in her home was distinct and not of anything you or I could have smelt anywhere else. The smell of podo is unique, like a sickly sweet decaying of flesh. Paul knows this lady well. She is regularly prayed for.
The sort of treatment that Brukteid needs involves wearing special compression bandages which cost around £6 each. She also has lymphedema which means her whole leg is swollen and she struggles to walk very far. She looks exhausted in every way.
We took her to the shoe factory to get fitted for a pair of APA boots. I struggled with holding myself together here. Bruk's suffering could not be masked or ignored, not even through a lens and this really got to me……
How many of us moan about having a blister I wonder. This was definitely a moment where I found myself putting my own life in to perspective.
She seems a bit brighter once she is fitted with her new boots and gets a warm hug from Dr Matts (which always helps).
It is hard to believe that this foot belongs to this face isn't it? Often when we think of the poor and we see photos we say "oh but they look so happy". I have to admit, when I first met this beautiful man I thought he had been cured. Then I saw his foot. Apparently it was a lot better the last time Paul had seen him and he was deeply saddened that it had developed to this stage. We all were. However, he smiled just like this when we arrived and when we left. Totally infectious.
Happiness to us is what? A new car? A new outfit? A night out with friends? How many of us are truly happy with the fact that we simply have good health? How many people reading this I wonder have multiple pairs of shoes upstairs (myself of course included) that we hardly wear or take completely for granted. Most of these people are lucky if they get to replace their only pair of shoes once a year.
I took several shots of this man below and in all of them he had the same expression. Slightly solemn and empty. Probably once a very proud man, a well respected one in his community even and here he is awaiting a free coffee and a roll with so much sadness in his eyes.
I don't know much about this young man but his name is Makuria Malago. We know he is an orphan and he has podo. He emanates sadness, loneliness and rejection and his eyes tell me that perhaps he is broken.
This stunning lady was with her sister and her brother here at this site. They all had podo.
During our visits Lindsey followed Paul around the sites as he visited each person and spoke with them. She took notes, and very importantly wrote down people's names. She also hugged some people or simply made eye contact with others or greeted them with a smile. Not a regular occurrence for podo patients who are rejected by others and treated as non humans.
These feet belong to this lady. I struggled to get a shot of her eyes as she, like many others struggled to fix her eyes in one place for more than a second or two. She lacks confidence and probably human interaction. She too emanates sadness and despair. She was once cured but her job is to fetch water for a building site and therefore spends a lot of her time bare foot in water and so her feet are not given a chance to heal. I gave her my socks and we picked her up a pair of wellies to work in.
Up in the stunning hills this is a common site. At the end of the day people return from their work farming the land, many with simple plastic flip flops for work shoes. These regions are incredibly poor, the children wear filthy rags for clothes and if they are torn, they are simply mended as there is no spare money to replace them. I saw two children squabbling over a couple of beer bottle tops and one held on carefully to his empty light bulb box - their toys I guess.
Beauty in abundance
As we were returning one day from a day visit I jumped out of the land rover to shoot two ladies climbing a steep hill with straw bales on their heads. It wasn't until they reached the top that I realised how old they were. We gave them each a bottle of water and in return they praised God. I doubt they can ever afford the luxury of bottled water.
So, Ethiopia. A beautiful country populated by undeniably beautiful people. But they are poor and many need our help. The reason I have decided to get on board the APA team stems from a genuine desire to help people. I am passionate about supporting local charities too and for some to support a cause outside of their local community perhaps makes no sense. I am a photographer who is passionate simply about people and the people of Ethiopia just stole my heart. My intention is to produce a book with images from this trip and as I write this a load of greeting cards have just been delivered to my door which will be ready for sale in February.
All I would ask of anyone reading this is to consider the following:
The price of one cup of coffee or two greeting cards would treat one patient for one month. An £8.00 donation would provide a custom made pair of APA boots. It is not the intention of APA to ask for donations from the west to help these people forever but we do hope to continue to establish new sites across much needed areas of the country where there are people with podo who are yet to learn about APA and are currently living without hope. Another problem APA face is accessibility. Most of the people that are yet to be reached can not be reached by road. Zelly has been known to travel via donkey when he has needed to. He will go to just about any lengths to help and we have assured him that he is not alone and that others want to support him. The best thing about the organisation is that sustainability IS possible (an issue raised by many during our visits). People are concerned and fearful that the programme will not continue and quickly they will lose hope. We know the project is working, already over 5,000 people have been treated in the last three years.
Thank you all for taking the time to read this. This is the beginning of something more important than anyone will ever truly understand. I had to go there to find out for myself.
For more information or to make a donation please follow the links and if you haven't already, check out the amazing video.