NOVARTIS ANNUAL REPORT

Continuing down the path set by photographers Mary Ellen Mark, Giorgia Fiorio, Steve McCurry and James Nachtwey, I was chosen to photograph the 2018 Novartis Annual Report across the world. This is no typical big-pharma advertising project. It’s a creative long-term photojournalistic assignment open to the interpretation of the photographer. My images have been used throughout 2019, but now I have had time to edit and release my personal selection of photographs for you here. 

I traveled to six countries across four continents to photograph the life-altering stories of doctors, scientists and activists alike.

Despite the drastically varying conditions of each shoot, whether it was the Gobi Desert or the medical laboratories of Switzerland, therein lied a common thread. Each person I photographed shared a commonality amongst dedicating their lives to improving the well-being of their people. I intend on releasing this series in three parts. Each part contains subjects from all corners of the world.

Part 1: Mongolia & Ethiopia
Part 2: Switzerland & Slovenia
​​​​​​​Part 3: USA & Rwanda

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GOBI DESERT, MONGOLIA: We stood in the middle of the vast expanse of the Mongolian Gobi Desert, looking at the ruins of an old outpost town. The former concrete dwellings were likely built by the Soviets in an attempt to exert control over the Mongolian nomadic lifestyle, and redistribute the livestock of feudal masters. Now, the old outpost town lays abandoned, slowly being absorbed back into the Steppe.


​​​​​​​We were led around the decaying walls by nomadic herdswoman Tuya, her husband Bata, and their daughter Amra. The family’s livelihood depended on their livestock, particularly their camels. The camels provided them with milk, meat, and hair that was made into fine tethered fabric. 

Tuya's husband, Bata.

It would be rude to ask Tuya about how many camels her family possessed— this was much like asking someone how much money they have saved in their bank account.

“Where are your camels?” I asked, scanning the seemingly empty horizon with my dopey near-sighted vision. Which by the way has been crushed by endless hours staring at computer screens trying to mix the right tones on images in Photoshop.

Tuya's sharp nomadic eyes could see the tiniest details on the horizon. “The camels are scattered here and there, I only see a few now, but my neighbors will know exactly where they are. The herd will probably be back at the lake tomorrow to drink.” A network of neighbors living in caravans and gers, (traditional seasonal dwellings used by nomads), created a kind of invisible border fence in which Tuya’s livestock roamed freely. If the camels reached the outside perimeter of the known grazing land, her neighbors would reassure Tuya and call the phone inside her caravan that was powered by a car battery. Then, Tuya and her husband would go fetch the camels on horseback before they wandered too far off. Out here, it’s incredibly rare for animals to be stolen, and a system of trust is enforced by neighbors who can spot something unfamiliar from kilometers away.

The “lake” Tuya spoke of was an approximate 45 minute walk from where we currently stood— it was essentially a pool of collected rain water that resided on the flat Gobi desert. The infrastructure was minimal, and a recent downpour had hindered our access to the roads even further. This delayed our arrival to Tuya's caravan by a day, but the downpour was a blessing for Tuya’s slim herd of camels. With the rain, the potential for growth arrived, wild onion grass and other greens on the land meant that Tuya’s camels could soon regain strength.

Suddenly, Tuya paused her steps, then lept to the ground, and began rolling around in the dirt with her hands together held above her head. Through my translator Baigal, Tuya explained that she had been born in a concrete dwelling that used to be on this very patch of dirt. By rolling in it, she was absorbing the energy still radiating from the soil. Then, Tuya got up and continued as if nothing happened, and continued explaining where the health clinic used to be. This was going to be a special trip, and I knew I had a lot to learn from Tuya.

“The only thing this empty shell is used for now is a rest stop for the herdsmen.” It was used for more than just resting. It looked like a place the locals used to get drunk away from home. A pile of alcohol bottles were left stacked in the corner. Some were imported Vodka from Russia, and others were the local brand named after Chinggis [“Genghis”] Khan. It is said that the father of the Mongolian Empire had warned his followers to stay away from the hard stuff, and to only drink airag—  the traditional fermented mare's milk of the nomads. But out in the Gobi, the national hero’s advice was not being heeded. In a way, this pile of alcohol bottles was the very reason I had been sent to Mongolia, to the Gobi desert, and how I came to be speaking with and photographing Tuya and her family.

Three generations of Tuya's family: Her mother Chimed mother and her daughter Amra

Portrait of Orgon, Tuya's neighbor

The key photography subject I had been sent to shoot in Mongolia was Tuya’s liver doctor— Dr. Naranjargal Dashdorj— Dr. Nara for short. She grew up as a nomad with dreams of becoming a surgeon, and studied her way to prestigious universities and training programs in China, the UK and the US. After fulfilling her childhood goal, she was inspired to return to her homeland to make a difference in the lives of disadvantaged Mongolians. Today she heads the Onom Foundation, an organization she co-founded to address education and healthcare challenges in Mongolia, specifically liver disease. Mongolia has the world’s highest rate of liver cancer mortality – in both liver cancer and late-stage liver scarring account for 15% of all deaths in the country each year. Alcoholism cripples rural families like Tuya’s and is considered an national epidemic in Mongolia.

Before departing for the Gobi desert, I spent a week in Ulaanbataar photographing Dr. Nara and her colleagues, as well as the revolving door of patients who received care at the ONOM Foundation. We visited the the “Ger District”, a low income neighborhood on the outskirts of Ulaanbaatar where many of Dr. Nara's patients come from. We also took a portrait inside the Winter Palace of the Bogd Khan, a temple where Nara's great grandfather, Llama Navaan, stored his sudar [religious textbook] to protect it from communists in the 1930s.First, Llama Navaan stored the books in secret in a mountain, but later on the research center collected the texts and brought it to the temple-museum. Nara’s grandfather is also a Llama named Onom, which is where her foundation gets it’s name.

Although organizations in Mongolia like the Onom Foundation are equipped with modern medicine, many rural people in the country believe in the traditional healing rituals of shamans. We watch two young shamans conduct a ritual in a sacred space protected by the Mongolian government just outside Ulaanbaatar.

While approximately half of Mongolia’s population lives in the capital city, the other half resides in the countryside. Patients from all over Mongolia travel great distances to visit Dr. Nara at the ONOM Foundation, and it was important for me to include this element as part of the project.

​​​​​​​Before visiting the Gobi, I was set to photograph a Mongolian soldier based on the border of China. The soldier cancelled last minute. I followed my gut instinct based on Dr. Nara’s second recommendation— the phone number of Tuya. I was told when Tuya visits Dr. Nara, she is driven by her daughter on motorcycle across the Gobi to the nearest town, where she then hitches a ride or takes a bus to the capital of Ulaanbaatar.

We set out from Ulaanbaatar with minimal information, and after the weather delays, we met Tuya’s young relative, who led us off the main road into the vast open blue sky. We found the family’s summer dwelling of a caravan, where we slept under the stars, learning Tuya and her family’s way of life, and what an important figure Dr. Nara was in her life.

I met Dr. Nara's blood relatives living on the Mongolian Steppe in Terelj, Tuv Province, to get a better impression of what her former life was like as a nomad. We meet Batmunkh (father, 43), Oyunbileg (mother, 42) and their adopted son Nyamzul (8).

ADDIS ABABA, ETHIOPIA: We arrived in Ethiopia at a very auspicious time. Not only for me, but for the nation as well. I still have remnants of the feeling in the air that I have not felt in over a decade photographing on and off in Ethiopia. Setting a new chapter for peace, Ethiopian Prime Minister Abiy Ahmed had shaken hands with Eritrean President Isaias Afwerki. This pushed forth in motion the end of a 20 year old conflict that was normalized for an entire generation of Ethiopians- many of whom questioned the purpose of the conflict itself.

The Ethiopian Prime Minister gave a promising speech that was broadcasted on television sets across the nation. For the first time, Ethiopians could legally call or text their kindred across the border and the national airline would land in Asmara. Other conflicts bubbling under the surface of the nation could take a back seat, at least for now the mood was pure elation and a welcome step towards peace.

Following the Eritrean leader’s unprecedented visit to the capital of Addis Ababa, thousands of citizens paraded into the streets, waving the green-yellow-red flag of Ethiopia. Taking a little more risk than others, one group of men chanted “27 years of tyranny is over!” By openly criticizing the current regime, they had invoked the passion for reform and progress.

Mixed among the crowd were the faces of Amhara, Oromo, and the other diverse ethnic groups of a nation that holds over 80 unique spoken languages. “Ethiopia and Eritrea… forget about that. There is only one habesha!” Declared one cosmopolitan-looking youth to a video camera filming for a new pan-African television station. 

A woman from this aspirational generation of Ethiopians sat across from me in a small local restaurant. The restaurant served only doro wat, or, chicken stew, an Ethiopian classic usually served during the holiday season or for celebrations. My dinner guest was Dr. Helen Yifter- one of only seven endocrinologists serving the entire population of Ethiopia, specializing in treating diabetes and other hormonal disorders. Similar to Dr. Nara from Mongolia, Dr. Yifter refused to take her talents to Europe where she would’ve encountered a better wage and benefits. She chose to remain with her nation, to be part of the positive change slowly unraveling itself in the country.

At Dr. Yifter's practice in Black Lion Hospital in Addis Ababa, she helped establish the first diabetic foot clinic in sub- Saharan Africa. Diabetes is on the rise in Ethiopia as more people move from rural to urban areas and adjust their diets and lifestyles. While nearly 3 million Ethiopians have diabetes, the overwhelming majority are undiagnosed – and without treatment, they risk developing further complications, such as heart disease, kidney damage, in addition to foot and vision problems.

Portrait of Dr. Helen Yifter in the Sheromada neighborhood of Addis Ababa, Ethiopia

When I asked Dr. Yifter about her hobbies outside of the clinic, she explained that in addition to work and raising her children she rarely had free time besides her morning coffee and reading. I was able to capture this morning ritual.

Dr. Yifter was selected by Novartis as a “healthcare hero” as she was a prominent leader within her community, and I had the honor of photographing portraits of her, as well as capturing her naturally in her work environment. Dr. Yifter was incredibly humble. Her work clearly wasn’t ego driven, she spoke very softly, often times I had to lean in over the food to properly hear her words. She spoke about some of the challenges she faced while working, “People think disease comes from an evil spirit or people think disease comes from a curse.”

Despite her reserved nature, Dr. Yifter’s presence demanded respect amongst the other health professionals. This was evident through the way she was greeted by her colleagues as she entered each medical wing. One morning while I was photographing the crowded halls of Black Lion Hospital, a patient angrily tapped me on the shoulder and demanded to know why I was taking photos, to which I explained that I was a colleague of Dr. Yifter. His reaction changed as he said, “you’re right. It is crowded in here. You should show the real situation here.” He then offered to help and stood by my side while explaining to the other curious patients what I was doing.

As one of seven endocrinologists working in Ethiopia, it’s critical that Dr. Yifter helps train the next generation of medical professionals. Black Lion Hospital functions dually as a university teaching hospital. Medical students have a bedside teaching session with Dr. Helen and a patient once a week. It was the students first day with Dr. Yifter when I photographed the bedside teaching sessions. The students were extremely timid, nervous, and spoke in voices even softer than Dr. Yifter’s. I asked if their behavior was a result of the shoot I had set up, but Dr. Yifter explained that it was normal, and they’d relax over time.

In another ward, there are patients that stay as permanent residents as a result of the severity of their case. Which brings me to Shenkora. I first noticed her as she was smiling at me as I photographed Dr. Yifter’s bedside teaching. She has been diabetic for 4 years, and also happens to be a rheumatic heart disease patient. She is currently waiting her turn to get a heart procedure done. So later that week, we asked Shenkora and her family for their permission to photograph her. She immediately agreed and continued to smile despite her devastating condition. 

Every Monday morning Dr. Yifter and her colleagues have a patient intake session. Guests from all corners of the country visit to be screened, to update their medical prescriptions, or to receive medical advising. This is where I first met Amina Shafi.

Amina is a 62 year old charcoal seller in Africa’s largest open air market: Merkato. Amina has two daughters that live with her and her husband, but she is the sole source of income for the family. She has been a patient of Dr. Yifter’s for the last 2 years. As a diabetic, she is unfortunately developing complications with her eyes and kidneys. With very little means to sustain herself, Amina still remains grateful for the free and subsidized health services that Black Lion Hospital provides her. This is despite the travels costs she must cover in order to access the clinic.

I exchanged numbers with Amina, and over the next few days I was able to photograph her at work, at home, and through her journey to the clinic. She travels by a mini bus from the Mesalemia area of Merkato, to visit Dr. Helen once every 3 months.

One day, I entered Dr. Yifter’s office with Amina for her check-up. While I was photographing her sitting across from Dr. Yifter, she began to cry as she received the news that she would have to switch from oral medication to insulin injections. At first, I didn’t know what to do. I felt uncomfortable getting in close with my 50mm lens to capture such a personal moment. But Amina encouraged me with a wave of her hand to continue taking photos, and I felt like a ghost in the room as the doctor and patient discussed their options in Amharic. Amira didn’t feel confident that she could administer the injections herself. She was waiting for her daughter to come back from Dubai to help her, where she worked as a domestic worker. For the time, her 16 year old granddaughter Hayat would have to learn how to assist her medically. As Amira’s situation evolved, Dr. Yifter agreed to continue provide for her in terms of medication, and advising.

​​​​​​​Amina told me, “Diabetes is like a flooding because one doesn’t know when it comes.” This seemed to be an issue that rapidly grew amongst Ethiopians, but thankfully they had people like Dr. Yifter. 

Dr. Yifter and her colleagues on the roof of Black Lion Hospital, Addis Ababa

JL

I would like to thank the following people for helping this project come together:

Sudest 57: Giuseppe Ceroni, Biba Giacchetti, Eliana Izzo

Novartis: David Woodruff, Andrea Principalli, Esther Keller, Taulant Komani, PJ Kaszas

Mongolia Team: Baigal Tsedenbal, Brian McGuffog

Ethiopia Team: Meseret Argaw and Nebiyu Bekele at BiraBiro Films​​​​​​​, Will Martinez