Emergency? What Emergency?

Geneva is a nexus of international health and non-governmental organisations, covering a broad four disciplines: education, environmental conservation, healthcare and human rights. In keeping with this professional focus, its cultural tourism has profited by offering public tours around the United Nations and affiliated buildings and establishing an award-winning Musée International de la Croix-Rouge et du Croissant-Rouge (ICRC), also known as the Red Cross and Red Crescent Museum.

This museum, bookending Avenue Appia with the UNAIDS building, is a real game-changer. With a high-profile International Emergency Healthcare conference taking place this week in Melbourne, Australia, such institutions and dialogues demand an interrogation of the definable features of an ‘international health emergency’. To address this same point, in 2005 the World Health Organization established and currently oversees the International Health Regulations (IHR) Emergency Committee.

Andy Kirk, Flickr

ICRC Museum. Image Credit: Andy Kirk, Flickr

This committee is comprised of international experts who provide technical advice to Director-General Margaret Chan in the context of a public health emergency of international concern. They present views on:

  1. Whether the event constitutes a public health emergency of international concern.
  2. The short term, or temporary recommendations that should be taken by the country and impacted nations subject to this situation, to prevent or diminish the international spread of disease and to avoid unnecessary aggravation of international trade and travel.
  3. The termination of a public health emergency of international concern.

The ICRC museum’s permanent exhibition is divided into the three core principles that guide their global activity: defending human dignity, reducing natural risks and restoring family links. These constituents are similar to those identified by the WHO committee. They define the term public health emergency of international concern (PHEIC) as ‘an extraordinary event which is determined to constitute a public health risk to other States through the international spread of disease and to potentially require a coordinated international response’.

Image Credit: ICRC, Flickr

Image Credit: ICRC, Flickr

To both the global health participant and public reader, this articulation is vague (necessarily, perhaps), accommodating all existent and hypothetical scenarios. More explicitly, it bears significance as a situation that is serious, sudden, unusual or unplanned. One which carries implications for public health beyond the affected state or country’s national border. One which may require immediate international action.

This committee may sometimes include a representative from the ICRC whose work is informed by troubled periods of history, present conflict zones, and the motivation to address contemporary concerns which look set to colour the future for generations to come. As the largest humanitarian network in the world, established 150 years ago, such an association proves indispensable in countering the theorising that takes place in the boardrooms of committees.

Exploring the museum feels as though you are being physically dunked into circumstances and peoples who motivate the ICRC’s mission to alleviate human suffering, protect health and life, and to uphold human dignity especially during armed conflicts and other emergencies. Their Chamber of Witnesses brings témoignage from twelve representative holograms of people who have been involved (either as a civilian, medical or relief professional or policy-maker) in a humanitarian emergency. Via a combination of story-telling and evidence,  the so-called humanitarian adventure becomes almost palpable.

Chamber of Witnesses

Chamber of Witnesses, ICRC Museum

The chamber reminds us that human relations must remain front and centre of the entire emergency response process, from policy and management frameworks, identification of an emergency, through to operational procedures. The real people involved so often risk being left behind amidst advancing technology and run-away bureaucracy, that remembering that people are a key identifier of any global scenario is a big step towards working with, and through, such emergencies.

Water, water, everywhere

In an increasingly environmentally informed society, access to potable water and sustainable supply are fundamental priorities across both the developing and developed world. What often gets overlooked in this mission are the potential pitfalls associated with bodies of stagnant water, invariably a consequence of human reconfiguration of the environment.

World Water Week, an ongoing convention being held in Stockholm, is drawing attention to the dangerous underbelly of accumulating monsoon rainfall, poor irrigation systems and festering swamplands. The theme: Water for Development.

Directly water-borne diseases and the health risks of unclean water have long featured on the humanitarian research and advocacy agenda, but water as a risk factor for malaria? Less so. Standing water increases mosquito breeding and increases the rate of malaria transmission, as does intensive farming and associated overtasked irrigation systems. Crops such as irrigated rice and ‘ridge crops’ provide larval habitats and become prime vector breeding sites by allowing rainwater to accumulate,

Therefore, Roll Back Malaria’s Action and Investment to Defeat Malaria, 2016-2030 (AIM) publication makes drainage of such reservoirs a priority. As well as decreasing malaria transmission, this activity will improve the general water quality, generating further health benefits.

AIM also outlines some key strategies in the control of malaria: early diagnosis and treatment, indoor residual spraying and the use of long-lasting insecticide treated nets. However, these measures alone are not enough. With the rapid spread of developed resistance to commonly used drugs and insecticides, new alternatives need to be included in the offensive picture[2].

Vaccination against malaria is a topical option. By exploiting the genomic sequences of the malaria parasites and vectors, partners GlaxoSmithKline (GSK) and the PATH Malaria Vaccine Initiative recently announced that first stage trials show a statistically significant decrease in malaria diagnosis in neonates and babies who receive an initial administration and booster (at 18 months) of their product. But for all these promising signs, it may be years before an economically and effectively viable programme is rolled out where it is most needed.

So our attention and collective efforts must turn to the environments of endemic areas, and assess management solutions of mosquito populations. A systematic review authored by Jennifer Keiser et al. aimed to reduce the burden of malaria in different eco-epidemiological settings with environmental management. They concluded that ‘malaria control programmes that emphasis environmental management are highly effective in reducing morbidity and mortality[3].

How so? By manipulating the environment, focusing in particular on water-centred solutions, malaria transmission can, to a degree, be artificially managed. Implementations include the systematic elimination of standing bodies of water and the installation, maintenance and cleaning of drainage systems.

Of course, such strategies bring associated, and often conflicting, issues. It is hoped that this year’s World Water Week discussions will address toxicity concerns, assess cost-effectiveness, and ease of installation and maintenance. Global health leaders must account for these environmental management methods which create temporary, inhospitable conditions for the vector. So too, they must show an awareness of the further complexity of specific local environmental settings and make-up of said ecosystem[4].

Water bodies associated with rural malaria include: rivers, streams, coastlines, wetlands, swamps and non-agricultural manmade habitats. While the locales are different and require customised measures, the management options available remain largely the same: converting open to closed drains, creating effective irrigation drainage networks following harvest, filling of lagoons, pools and swamps within 3 km of human settlements, and introducing subsoil pipes.

Case Study Malaria and Water

Larger scale engineering modifications include reconstruction of river boundaries and extensive overhauls of the infrastructure of canals and manmade waterways. When such measures are considered at the time of construction, there are nominal costs to the healthcare system, which is further proof that such action must be immediate and cross-disciplinary.

Comparably, personnel and advocates must be aware that water management cannot work in isolation. Such measures must complement the established practice of household barriers, and empowering education schemes promoting healthy behaviour. Collectively, these actions will promote better sanitation, hygiene and organisation of public services.

A limiting factor in this area of research is the absence of reliable data. Without this, it is incredibly difficult to offer a compelling proposition to donors and governments of the benefits such service provision would have to local consumers and to the fight to eliminate malaria. However, the h2.0 Monitoring Services to Inform and Empower Initiative, pioneered by UN-Habitat, is promising change.

The initiative tests innovations and enables installation of effective and powerful monitoring systems across the globe. We can all get behind this, by reviewing the outcomes of this World Water Week’s meetings, and supporting h2.0 – for safe water, everywhere.

 

References:

[1] Title: Samuel Taylor Coleridge, The Rime of the Ancient Mariner

[2] Reducing the Burden of Malaria in Different Eco-Epidemiological settings with Environmental Management: A Systematic Review. Keiser, Jennifer et al., The Lancet Infectious Diseases, Vol. 5, 11, 695-708.

[3] Reducing the Burden of Malaria in Different Eco-Epidemiological settings with Environmental Management: A Systematic Review. Keiser, Jennifer et al., The Lancet Infectious Diseases, Vol. 5, 11, 695-708.

[4] Prüss A, Kay D, Fewtrell L, Bartram J. Estimating the burden of disease from water, sanitation, and hygiene at a global level. Environmental Health Perspectives. 2002, Vol. 110, 5, 537-542.

Image Credit: Soil Science, Flickr

Humanitarian Photojournalists: exposing stories

The extraordinary Steve McCurry is something of a household name, a man whose art has become synonymous with compelling representations of human suffering and joy. Since the green stare of the Afghan girl, commanding attention from the front cover of National Geographic in 1985, McCurry’s currency is built on his ability to move, by evoking danger, through his artistic escapades and in the subjects he captures.

Increasingly, photojournalists who choose international development settings as their inspiration and focus are appraised for the aesthetic value of their work. Inevitably, this largely determines their public recognition, but often subsumes the phenomenal responsibility these photographers bear in relaying situations from an often remote, growing crisis situation.

Their visual coverage – the angle and story they seek to put under the spotlight – demands ethical answerability. The developed world observer’s opinions are heavily based on visual cues, with associated impact such as donations, informed judgements and advocacy strongly correlative to the narratives told by global health journalists (through both word and image).

I have long been fascinated by the import of such a commission: to faithfully depict a comprehensive, emotive and evocative snapshot of life on the edge. Since interviewing the founder and cameraman of the philanthropic Humans of New York venture, Brandon Stanton (which you can read here), I have increasingly sought out the photojournalists who most closely and alarmingly fulfil this brief.

Here are current global health photojournalists I think you should know about. Prepare to be challenged.

 

William Daniels

To begin with an ending. At my leaving drinks hosted by
the team at Roll Back Malaria (RBM) I was given a Daniels2glorious book from a photographer that only recently came onto my radar. William Daniels’ ‘Mauvais Air’ is a collection of work commissioned by RBM focusing on life for those in malaria endemic regions. ‘Malaria’ (or ‘paludisme’ in most French-speaking countries), derives from Italian, literally meaning ‘bad air’. The pages of this book are filled with images of this major international pandemic, striking in particular in the most underprivileged populations, from Uganda to Sierra Leone, from Burkina Faso to Calcutta. This dual language edition sees commentary supporting images that capture the spectrum of malaria’s consequences, fundamentally highlighting the enormity of the battle that spans before us before we achieve a world free of the disease.

 

Alyssa Banta

With publications such as Time and the Smithsonian magazine on her commissioned portfolio, Alyssa Banta’s work across these platforms and alongside NGO partners including the International Red Cross and the International Medical Corp has garnered critical acclaim. A Pulitzer Prize-nominated documentary photographer, Banta’s series on internally displaced persons is among the most astounding work I have yet encountered in this sector.

The terms ‘refugee’ and ‘displaced person’ are often used interchangeably. In actuality, refugees are defined by the UN Refugee Agency as people who ‘owing to a well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion, is outside the country of his nationality, and is unable to, or owing to such fear, is unwilling to avail himself of the protection of that country’. The category of displaced person includes those who remain trapped, but dislocated within their home country. The common thread across these groups, and Banta’s work, particulary her Afghanistan series, is the fear and loss that permeates her subjects’ figures and atmosphere.

 

Olivier Asselin

Olivier Asselin grew up in Canada, and pursued a self-identified pedestrian career in Information Technology. Since the millennium, Asselin relocated to France and the camera, and boasts an employment history with media and development organizations in over 25 countries across Africa, Asia and Latin America. Alongside these assignments, Asselin promotes sustainable media initiatives for the developing world through Possible Media, a project coordinator he founded in early 2013.

Asselin2

Reproduced with permission from O. Asselin

Possible Media employs video and short documentary reels to transcribe his static imagery into a literally moving location profile. His still photographs are notable for their experimental engagement with perspective, inviting considerations of the broken human form within potentially threatening geographic environs.

Asselin1

Reproduced with permission from O. Asselin

 

Mary F Calvert

Moved to document the under-reported humanitarian struggle of children and women worldwide, Calvert seeks to secure basic human rights for her subjects by raising their profile through a collaborative exhibit and advocacy approach. It is this conviction and consistent determination to give a voice to those who are not heard that has twice earned her the Robert F. Kennedy journalism award.

Perhaps because of the political complexity that informs her work and projected aims, Calvert’s portraits canvas high-profile world leaders, which nestle alongside projects such as ‘Nigeria – Polio’s Line in the Sand’. Few can be exposed to this collection without sharing in a visceral, almost physical, crippling that mirrors those her work brings out of soft focus into striking monochrome filters.

 

Mark Tuschman

The portfolio of Mark Tuschman crystallises the reality that it has never been easier to take photos – or more difficult to capture the ones that matter. Citing global health development and medical stories as his raison d’être, Tuschman’s photography is, relative to the other artists on this list, perhaps the most immediately identifiable as global health imagery.

Tuschman2

Reproduced with permission from M. Tuschman

Acutely aware of his social responsibility, Tuschman’s photos commonly depict group shots, often in familial and quotidian settings. Less difficult to witness than their more explicit, graphic counterparts, his Guatemala collection captures the subtleties of human life, and the universal determinants of health. Vibrant colours, in jewelled hues punctuate his work, highlighting the richness in cultures other than our own.

Tuschman1

Reproduced with permission from M. Tuschman

 

Stefano de Luigi

An all time personal favourite, de Luigi relishes in development issues he seemingly stumbles across in his neighbourhood as well as those found in far flung pockets of the developing world. Currently based in Paris, de Luigi’s images are widely recognized, with his non-development related work including the iconic ‘Pornoland’ with accompanying by Martin Amis.

Drawing attention in particular to his T.I.A. project, one begins to comprehend the reason his work has gained such a following, for more than just its risqué flavour and provocative associations. Standing for ‘This is Africa’ the connotations of Total Information Awareness are certainly productive in this context. In T.I.A. we are invited to consider the narrative in what is not on display – in the gaps between the images, comparable to those existent in the lives of those who look into – and out of – his shots.

 

Carlos Cazalis

Documentary photographer Carlos Cazalis has lived in Mexico City his entire life. His work, however, has travelled further afield, taking him on trips to Dhaka, Bangladesh for live image feeds, as well as communications opportunities presented by the acclaim he has received across the world, most notably in France.

Cazalis1

Reproduced with permission from C. Cazalis

His Tumblr feed promises ‘some philosophy on the human condition’; one which resonates across his listed projects. To really understand Cazalis, ‘The Urban Meta’ portfolio is a critical starting-point. Started in downtown São Paulo, Brazil in 2006, this assignment gave the world an insight into the largest urban population Latin America had ever seen with 438 families squatting in the shadows. Many of these groups were Bolivian, brought together in the common hope to gain better opportunities within the megacity infrastructure. These images tell of a legacy, and recycling of previous generations who, like these peoples, had already fled rural poverty. Always alert to the imperative to humanise, his images depict people who can be lived and felt and imagined. A master of light work, this project has now fingered its way across eight other major global cities, facing similar challenges to greater or lesser degrees. To me, the original São Paulo collection remains the most forceful evocation of mechanical urbanity and its potential threat to the peaceful coexistence of fragile human populations.

Cazalis2

Reproduced with permission from C. Cazalis

 

Nick Ut

Much like McCurry, Nick Ut’s legacy has caught up with him. On June 8, 1972, he captured what would become a Pulitzer Prize winning photo depicting children, wide-mouthed and screwed-eyed fleeing from a Napalm bombing during the Vietnam War. The girl centre frama is a naked, nine-year old girl: Ohan Thu Kim Phúc. She became ‘Napalm Girl’ – one who made history by challenging the Associated Press of the time, and alerting Westerners to the extreme vulnerability of the population under threat.

Since those beginnings, Ut has continued to shock and revolutionise the photojournalist world and regular viewers alike, with images that push the bounds of his art, while simultaneously taking us beyond the safety of ignorance or incomprehension.

 

Ron Haviv

According to his bio, Ron Haviv is an Emmy nominated, award-winning photojournalist, dedicated to documenting conflict and raising awareness about human rights issues around the globe. Reluctant as I am to proponent book buying in lieu of seeing prints in real life, his ‘Questions without Answers’ folio is a treasured gift, which drains attention by vocally, and visually, demanding change.

Haviv2

Reproduced with permission from R. Haviv

Haviv is a truly phenomenol photojournalist, increasingly conscious of his ethical responsibility and immeasurable gift, played out in the frequent workshops and photography masterclasses he hosts across the world. However, there is scant trace of the conceited self-sustainable artist about Haviv. The nexus of his work stimulates a desire to shock viewers into action with his ‘Blood and Honey’ project a distressingly beautiful series based around conflict. In Susan Sontag’s 1977 collection of essays On Photography, she writes ‘the very insatiability of the photographing eye changes the terms of […] our world’. These international development photojournalists do just that, and demand recognition that viewers cannot be the same once we have cast a light on their work.

Haviv1

Reproduced with permission from R. Haviv

Vector-borne disease awareness

Today is the 118th World Mosquito Day, marked annually since doctor Sir Ronald Ross first identified female Anopheles mosquitoes as the vector that transmits malaria between humans.

In 2015, World Mosquito Day represents a time to highlight the enormous danger posed by the unassuming insect: 725 000 people die every year from mosquito-borne diseases; considerably more than those killed by lions, crocodiles or sharks.

An unimaginably large 198 million cases and 584 000 deaths from malaria were reported in 2013 with similarly outsize trends from such a small agent seen across its disease spectrum. Mosquitoes also transmit chikungunya (an incurable viral disease, causing fever and debilitating joint pain), dengue, yellow fever (from which half of all severely affected sufferers will die without treatment) and West Nile Virus.

In recent years, vector-borne disease management and prevention directives have prioritised use of insecticide-treated bed nets (ITNS) and indoor residual spraying (IRS). Their combined use can reduce the risk of such disease transmission by up to 50%.

As a result of this focus, progress has been made. In the past three years, 90 countries, nearly half of which are in the African region, have implemented policies for malaria control. IRS acts as an offensive shield as it coats the inside walls of dwellings to kill mosquitoes, working most effectively when applied to 80% of households in a community. A similar trend is witnessed through the use of ITNS: increased access to nets can help reduce malaria mortality significantly.

To defeat malaria and wage war on one of the biggest global health threats today, this generation must act to prevent transmission. In a world which has seen more casualties from mosquitoes than from wars, continued weighty and sustainable investments must be made. Innovative efforts to find new solutions to tackle mosquitoes is a buzz-worthy cause we must all be a part of.

 

Image Credit: Chris Clogg, Flickr

So you want to work for the World Health Organization?

Everyone has heard of the World Health Organization, and anyone who works or interns in one of their departments will no doubt have received a reaction from friends and family that suggests WHO is the Holy Grail of global health facilitators. At the very least, WHO enjoys an unparalleled profile recognition across public and sector-specific demographics globally.

So it was only natural that when the offer of a competency-based interview talk arose while working  on Roll Back Malaria Partnership’s communications strategy at WHO that I went along to glean insider tips on how to secure some of the most sought-after employment positions across NGOs.

Preliminary considerations to take into account include the usual fine-tooth comb level of attention to the vacancy details and entry requirements. The initial screening process of WHO and similar international NGOs invariably out-selects candidates who identify from nationalities which are already fully or over-represented within the employee field. The quotas at WHO are determined by the relative contribution of that nation to the organization. So British nationals have little chance of being employed at WHO for the foreseeable future.

That aside, let us assume that you have been invited for interview. Congratulations. At WHO, these are performed on one of three platforms – in person, via video, or over the telephone. Where possible, avoid the latter as the rhythm and tone of your voice is a lesser alternative to the visual presence afforded by the first two options. Interviewers are encouraged to treat video and face-to-face interviews with comparable weight and without bias, so it is perfectly OK to interview from home if the plane fare or dates are prohibitive factors.

The interview process here is competency based. Whereas traditional interviews encourage an abstract bi-directional discussion in which we sell our attributes, in a behavioural, or competency based situation, the model aims to gauge a persons’ competencies related to the role applied for. These interviews often focus on past situations, rather than hypothetical ones, and demand careful structuring of answers, which invariably reveal more about a person than a traditional monologue.

This model is used to project how you as a candidate would perform in the role through a fair and standardised process. So you might be wondering what a competency is. It is not interchangeable with technical aptitude (which would be tested through written or practical tests as part of the application process), but rather as part of the collective personal behavioural picture the application process seeks to construct.

Invariably there is a situational pattern that is recycled in competency based questions, inspired by the following framework:

Tell us about a time when/can you give us an example of?

clipboard interview

The interview panel will subsequently follow up this structure with probe questions if they require clarification on any point.

This all seems fairly straightforward, but what are the people across the table from you actually looking for? They are watching out for positive and negative indicators based on the hypothetical model candidate for the role, which can be registered by verbal clues in your answers directly referencing required skills.

Competency based interviews need not be a source of mystery or anxiety. With preparation, they serve as a platform for you and the selection panel to identify whether the career individual as you are at the time of application has the relevant skills to succeed in the role and to develop within it.

The STAR approach is a fail-safe mnemonic to remember when answering situational based questions:

Situation:  a specific situation that addresses the question, your role or position, when it happened, the problem or assignment.

Task: the task demanded by the situation detailed (what were you asked to do).

Action: what actions did YOU take to address the situation (outline the development and execution of your plan).

Result: what were the results of your actions (measurable responses preferable).

This progression lets the panel know that you could replicate the hopefully positive effects for them. At WHO, positions will be mapped across three competency groupings: core, management and leadership, all of which align with the universal WHO aims and ethics.

For those of you who already see the roles reversed in the future, following are the score sheets detailing how your application is assessed at WHO:

Image reproduced courtesy of WHO

Image reproduced courtesy of WHO

Fundamentally, other tips to give you the best chances of success and prepare yourself to greatest effect, include the usual considerations of posture, body language, attentive listening, enthusiasm and courtesy. Notwithstanding the instructive nature of this post, the key is to not be someone you are not. If you are not prepared, you should be prepared to fail, so a healthy mental refresher and structuring of the skills and passions that shape you as a candidate will only enhance the underestimated personal, gut reaction, that often influences the final decision. Good luck.

Exhausted already?

Today marks the switch from black to red as humans have already exhausted the Earth’s resources for 2015. Termed Earth Overshoot day, this early expiration date is becoming an alarming year-on-year trend.

The Global Footprint Network records that this day fell on August 19 last year and is symptomatic of the general trend that sees human demand constantly outstripping the available products of our planet.

Between now and 2016, we will pillage local resource reserves, and continue to sequester carbon dioxide, adding to the atmospheric overload. Over the past eight months, humans have collectively lived beyond their means, asking the impossible of their biosphere. It is sobering to think that, today, we need 1.6 Earths to supply the demands made on nature.

1.6planets2.4

Image Credit: overshootday.org

The irony that I am writing this in Geneva airport waiting for a delayed EasyJet flight back for a weekend in Blighty is not lost on me. What it alerts one to is the absence of national average measures relating to this environmental budget: my usage is not necessarily the same as that of a 24-year old female living in Pan-America or Sub-Saharan Africa.

Notwithstanding the broad spectrum nature of these statistics, the global impact cannot be ignored. Without even considering other species, habits of the minority are damaging the state of the environmental economy for future generations, while indirectly crippling the lives of many currently sharing the same planet.

While interning at the WHO sponsored Roll Back Malaria Partnership this summer, my research focused on the commonsensical, but research- poor, association between malaria mortality and varying weather conditions. The exploration poses many questions, all of which will need answers that enact change.

The UN General Assembly’s Climate Change Convention, held this June in New York, marks the halfway point in what is a critical year for climate change negotiations, culminating in the United Nation’s Climate Change Conference.

This meeting provided impetus and political momentum for an ambitious climate action plan, the framework for which is being drawn from work hubs in Addis Ababa, New York, and Paris. Roll Back Malaria’s Action and Investment to Defeat Malaria, 2016-2030 publication identifies the following climate related goal: ‘given that climate change is predicted to increase the range and intensity of malaria transmission, plans to mitigate the effects of climate change are likely to include an increased commitment to controlling and eliminating malaria, and vice versa’.

Weather and climate are major determinants of malaria. The Intergovernmental Panel on Climate Change has concluded that changes in temperature and rainfall will affect the natural habitats of mosquitoes, changing the prevalence of the vector or prolonging transmission seasons (or both) in some areas [1].

Climate change increases the global burden of diseases and reverses developmental gains. Malaria has been identified as one of the most climate sensitive diseases in a review of the Bulletin of the World Health Organization in 2000, with studies suggesting significant associations between temperature and malaria incidence, a connection also made in other vector-borne diseases.

Temperature rises (associated with current rates of carbon emission) of just 2-3 degrees Celsius will increase the number of people at risk of malaria by up to 5 per cent, representing several hundred million people [2]. By comparison, a World Bank report indicates that by 2050, climate change might threaten some previously unexposed regions of South America, sub-Saharan Africa and China causing a 50 per cent higher probability of malaria transmission [3].

Such preliminary research invites policy engagement. Findings published in the Open Journal of Ecology call for a better understanding of the relationship between rainfall patterns and malaria cases in order to adopt effective climate change strategies involving planning and implementation of appropriate disease interventions. Their results suggest that maximum temperature is a better predictor of malaria trends than minimum temperature or precipitation, particularly in the transition zone.

Climate change effects on malaria caseloads are increasingly seen to be multi-factoral. For effective malaria control, interventions should be coordinated with the most important climatic predictors of the disease for greater impact. This research registers the necessity to implement cross-sectoral change both in tackling neglected tropical diseases, and in diminishing our demands on the planet.

Collectively, small changes from unsustainable practices to resource-secure models, education around climate change, and national and third-tier government accountability for such an agenda, will not only hold the promise of a living planet in the future, but one from which people can see malaria eliminated.

 

References:

[1] http://www.rollbackmalaria.org/about/multisectoral-action-framework/library [Environment and Climate]

[2] Appendix B, Action and Investment to defeat Malaria 2016-2030, June 2015.

[3] The Postdam Institute for Climate Impact Research and Climate Analytics, ‘Turn-down the Heat – Why a 4 degree Warmer World Must be Avoided,’ International Bank for Reconstruction and Development and World Bank, Washington, DC, 2012.

Image Credit: woodleywonderworks, Flickr

The rise of exhibitionist campaigners

In the past week alone, digital and print media outlets in London and Geneva, my regular and current homes respectively, have featured profiles of individuals making a scene for goals of equity, awareness of gender perspectives and – less compellingly – a token 24 hours of virtual fame.

Last Thursday, Kiran Gandhi spoke publicly for the first time about her decision to bleed freely when she ran the London Marathon in April. Her feature in this month’s Cosmopolitan magazine details how her period started on the eve of her first long distance race. Correspondingly, Gandhi’s personal blog relates the choice she faced: to run (and bleed) with the flow, or to complete the distance ‘with a wad of cotton material wedged between my legs’. She goes on to reveal that, for a 26.2-mile race, ‘chafing is a real thing’.

Kiran Gandhi

Kiran Ghandi on race day

Across these publications, Gandhi repeatedly voices her self-identified position: “I ran with blood dripping down my legs.[…] I felt very empowered by that”. The proposed motivations of exposing the often unseen reality of menstruation and to manage that biological process in a manner that is culturally liberated are indubitably admirable.

They are also, however, inherently problematic. Not only was Gandhi’s decision to forgo protection made on impulse, but so too her hoped-for impact wildly deviates from the reality. Her act assumes a collective activity of pre-menopausal women to hide their monthly ovulation in a habit of Western cultural and societal oppression. In fact, many women use tampons, sanitary towels and menstrual caps as pragmatic solutions based upon the desire for the very factors Gandhi considers to be flouted by these same tools: comfort, hygiene and management of our own bodies.

Her act has made headlines as much for its divisiveness as for being a one-hit wonder. The lexicon surrounding her decision and retrospective expression of intent is polarising. ‘Unnatural’, ‘blocking’, and ‘protective’ oppose ‘free’, ‘flow’, ‘liberated’ and ‘empowered’. That such charged language arises when reading and considering Gandhi’s act reveals the imperative need for such awareness campaigns to be grounded in mediated preparation. Although she recently claimed that her aim was to showcase the global imbalance in management of, and community-based belief systems around, menstruation, no one along the London course, at the time of her activity, was aware. Her running bib advertised her status as a fundraiser for Breast Cancer Research – but not the projected intentions of her choice to free-bleed.

Even the tone of expression in her blog presents oxymoronic opinions. Gandhi simultaneously highlights the disparate nature of menstruation management worldwide, suggesting her action was to remind spectators that females globally do not have equal access to sanitary supplies, while also claiming that free flow is a necessary choice for empowerment. Fundamentally, Gandhi is attempting to present a poorly-developed awareness drive within the context of developed nation feminism. While the two can be, and have been, effectively coordinated in global health and development advocacy initiatives, they make tricky bedfellows.

Gandhi deployed sarcasm to shut down, rather than engage with, a fellow runner who informed her that she was bleeding. The opportunity for a dialogue about menstruation in developing nations: lost. Of course, an endurance race is not the time for a fully formed conversation, but a visible sign pinned to her sportswear detailing her aims may have prompted that well-meaning peer to challenge their reasons for vocally intervening. It is challenging to support the development agenda Gandhi’s aligns with her high profile bleeding because she speaks as a female who enjoys identity privilege in terms of wealth, educational and geographical statuses. Instead, spectators watch a female who has not reconciled a desire to be an empowered woman in the 21st-century (surely the ultimate societal demand amongst any educated female youth, not to mention readers of Cosmo) and a desire to address the practical realities of a far more pressing demographic – those women who are not heard, and who will not hear.

This instance of confused motivations and ultimately a devaluation of activities that prioritise transparent and inclusive approaches to global health awareness is more alarmingly seen in the case of David Hyde. A 22-year old from Christchurch, New Zealand, Hyde was employed as an intern on the United Nations in Geneva. Since he arrived a fortnight ago, he has slept in a tent, pitched on the lakeside near the UN Headquarters – the nexus of the Declaration of Universal Human Rights outlining equal claims to shelter, food and recompense for labour.

Unlike Gandhi, Hyde had an agenda – and, superficially, a cogent and morally valuable one: to be the change by opening eyes. He pinned the colours of his action to the campaign work of the Pay Your Interns Initiative, demanding fair pay for part time and relief work employees in UN and associated NGOs, including the World Health Organization and UNAIDs. The manifesto of this movement can be read in greater detail here, but this act of apparent desperation, defiance and social responsibility for future interns has been completely overwritten in the revelation it is all a stunt. Hungry (not figuratively) for media attention, Hyde’s original discovery by a ‘journalist’, his two weeks working at the UN and subsequent resignation, are all part of a scheduled hoax in aid of little more than a scam documentary.

Dave Hyde

Dave Hyde speaking, in front of the UN, on his resignation

Whereas Gandhi’s activity and resultant articulation of intent is cobbled together from a place of impulsiveness, Hyde’s disclosure of his stunt status in light of a carefully curated plan exposes a far more damaging position: confusion over the fall-out. Furthermore, there is reason to think that Hyde’s revelation, which has become the focus of media attention, will devalue the considered, collective, and quietly progressive aims and activities of the Pay your Interns Initiative. Gandhi and Hyde reveal that change on a global scale, whether advocacy, administrative, policy, internally or externally-based, cannot be realised by an individual showman, but requires continuous – and collective – engagement.

The faceless portraits of Gideon Rubin

In The Birth of Tragedy, Friedrich Nietzsche repeatedly insists on the ‘primacy of aesthetic over moral criteria’ grounded in the ‘art for art’s sake movement’ in which external pressures collate to create material art, through often tragic processes[1]. Much as Nietzsche’s work sought, as dictated by his very title, to consider the origins and roots of tragedy, so too was he concerned with making it relevant to his contemporary world. In a similar manner, Gideon Rubin asks what it means to be a contemporary painter: he tests his chosen medium, its possibilities and limitations’[2]. Much like Nietzsche, or any tragic playwright, Rubin positions himself as an artist, and as a channel for tragic release that must find expression through his struggles to create work that is relevant to his age. This lexicon of ‘possibilities and limitations’ brings into focus the omnipresent concerns of art that is tragic: how to be categorised as such, and to what extent a felt experience can be transcribed into the chosen medium, be that paper, the stage, or in Rubin’s case, linen and stretched canvas. As with any mode of tragic expression, critics and audience alike seek to pinpoint the cause of the trouble, seeing diverse tragic experience as a chronological trajectory that fits into a linear cause and effect movement. Notwithstanding that tragedy never moves in such unidirectional narratives, there is benefit in contextualising an artist’s motivations and triggers, as they, in turn, offer some enlightenment as to the results and hopes they aim to provoke through their art. As Karle Heinz Bohrer identifies: ‘any such concentration on the tragic as an art form always requires us to respond eventually to a specific objection: that we are dealing only with impact and effect, not with the thing itself’[3]. Rubin was born in Tel Aviv, and while he is currently based in London, his work of the past three years (in which he discovers and depicts the faceless subject) has attracted attention from sponsors in his homeland who have tempted him back to create work inspired by the tragic space and performance that is political and military warfare. Prior to his faceless series, Rubin self-identified as a ‘realist’: someone who sought to capture the flare of a nostril, or the shard of light through an iris. It was his first-hand experience of the 9/11 terrorist attacks in New York, witnessed from a friend’s rooftop on 10th Street and Broadway, that triggered his move into broken and blank characterisations of his portrait subjects. Of this experience he recalls: ‘watching the events unfold […] was probably the most surreal and terrible thing I’ve ever experienced. After seeing that tragedy unfold before my eyes, I knew I couldn’t paint what I was painting before […] I had to communicate in a more direct style’[4]. Few can argue that the terrorist attacks on the Twin Towers was a tragedy. ‘Tragedy’ has, however, become the lexical equivalent of a dead metaphor, used to scope out teenage registers to signify homework overload, as well as seeming misappropriations in every other Daily Mail headline. Notwithstanding this troubled semantic field, what seems most identifiably tragic in Rubin’s account is his recognition that the importantly visual experience of events represented human against human, and, potentially of a jihadist punishment from higher powers, resulting in death, destruction, and erasure of history through eruptive damage. This acknowledgement that his eyes were witness, and in some way accomplice to this ‘tragedy’ is intriguing in prompting the query of why Rubin’s tragic subjects do not see, either through choice or through disability. Regarding his own work, Rubin identifies his hopes in a manner rarely so ‘directly’ articulated among his literary predecessors: ‘I’d like to think the figures in my paintings remind the viewer of certain people or evoke memories rather then portray specific identities’[5].

Yet as much as Rubin claims that his paintings are not designed to characterise specific beings, they and their tragic mode are fundamentally about roots: empirical, genetic and historical. In the immediate aftermath of 9/11, Rubin began a series of rapid-fire paintings using thick and energetic oil daubs of imploded dolls and distorted toys: broken time capsules of a city and time that had become bygone – literally overnight. From here he began to look at old anonymous family photographs and draw from them in a manner that ‘reads’ to a viewer like the tracing of a lost past or unearthing of forgotten histories. Rubin stumbled across these anonymous photographs with no prior intention of seeking them out, so in this manner, his self-conscious distancing from identifying himself with the figures is credible, but it is unarguably an innate human impulse to relate to another and consider their own stories and histories. At this point we turn to consider Rubin’s ‘Family Portrait’ in which the interlocking hands offer a visual association and lineage articulated in spaces of dance and theatre through touch, costuming, and in music through harmonization or the carol form. His source photographs were frequently from the turn of the century and Rubin selects characters and scenes from them to convey onto his chosen material, in a manner that overlaps the triggers of Victorian and Edwardian histories, as well as the trauma of New Yorkers of the new millennia. Beverley Knowles comments: ‘Gideon Rubin’s paintings are largely figures and group scenes, underpinned by an atmosphere of elusive narrative’[6]. ‘Elusive narrative’ both identifies the generic difficulties in finding a verbal story within the meshwork of painting, while ‘narrative’ pinpoints a determinant of the tragic experience for both the original subject and all who encounter the received reproduction. The blank faces of Rubin’s portraits demand a looking, an active searching, into and through history to ask why these faces are blank and, indeed, to identify the tragic circumstances that inspire Rubin’s work. ‘Class of 1947’ a series of female faces found in a high school yearbook depicts busts of women wearing identical clothes, only distinguishable by a slight tilt of the face or curling hairstyle. One must question the artistic attraction Rubin feels for his subject matter. Surely it is the tragic potential in these stranger’s stories that attracts him, and, indeed, the potential to create a narrative for them. He says ‘[I love] the anonymity of the subjects. On the one hand, these people had nothing to do with me—unlike my earlier paintings, which were of myself, my family, and my friends; on the other hand, it was as if each of these people was holding a key to a story, a history that I was trying to tap into. This thread of history—of style, people, fashion, et cetera—and storytelling is, in many ways, what I’m still trying to paint today’[7]. The metaphor of history as a ‘thread’ is fascinating, as this allusion situates us within the legend of Theseus and the Minotaur, in which the backward movement, feeling one’s way along a length of silken thread, promises both escape from the linearity of time and experience, as well as a return to a place before tragedy. Pertinent here is Beth Greenacre’s assertion that the painting process, like these Classical allusions is akin to ‘the memory of something that’s at the point of fading completely, or remembering a history that you were told about but never actually experienced first hand’[8]. This observation captures the fluid nature of Classical tragedy that occupies a hinterland between reality and fantasy, mortal and immortal, much as Rubin’s portraits both re-write (through painting) as well as seem to capture the stories of his subjects. Interestingly, the figures in ‘Class of 1947’ have some suggestion of ears, so these beings act as vessels that absorb and hear experience but have no means of expressing themselves, comparable to the most repressed and frustrated of tragic characters, from the literal and metaphorical gagging and silencing in Shakespeare through Aeschylus. Meanwhile, in ‘Family Portrait’ the blank face persists across the siblings, suggesting that this anonymity is a trait, once again filtering into the tragic role of family and relations. However, it is important not merely to consider Rubin’s art at face value: it is not ‘art for art’s sake’. The tragic significance of his work importantly, lies, as Jennifer Wallace remarks, ‘less in the physical depiction itself than in the knowledge of the context, either of its original composition or of its subsequent interpretation’[9].

4de6427707b9973d85747b05b0ac96b5

Class of 1947

Gideon Rubin’s paintings are pervaded by dichotomy. Their subject matter is unapologetically nostalgic, with a self-conscious over-lapping of Rubin’s own experiences with those of the figures he paints. As will be further explored, it is paramount that his subjects are without eyes or mouths, and are, therefore, fundamentally different from the physical status of Gideon Rubin who both saw and watched 9/11 open-mouthed. But of course, this is just speculation. Perhaps he wanted to shut his eyes, to stopper his mouth, or acknowledge a silent scream. Perhaps now, through his art, he puts on a mask, or blanks out these organs of experience, precisely so that tragedy cannot exist for his painted figures. However, this is troubled as we are aware that these figures are drawn from actual photographs, so this erasure of their physical features almost traps their tragic experience within them. In a rather anachronistic, but useful analogy, it is akin to the sadistic creation of a swimming pool in the popular computer game ‘The Sims’ only to bulldoze the stepladder while your family are happily swimming away, trapping them until they ultimately drown because they cannot escape, and their screams go unanswered[10]. This erasure seems to be the reverse action of putting on a mask, which covers the face and, therefore, traps the true identity of the actor behind it, but it is temporary. Rubin may argue that he can always edit in facial features, much as a mask can be applied and removed, so it is this charged potentiality of masking that is of interest here. Turning our attention to Rubin’s ‘Boy Wearing Gas Mask’ and ‘Girl Wearing Gas Mask’ and one can see that the positioning of a facial gas mask serves to give them features, much as the multi-coloured grotesque masks of Classical comedy did. However, the Classical masks of tragedy were blank, designed to sweep everyone with the same, levelling, neutralising brushstroke. This is important, because, on closer observation, one realises that the faces behind the gas masks in ‘Boy’ and ‘Girl Wearing Gasmask’ are still featureless: there are no blinking eyes behind the sight-giving aperture. This sense of ‘sight-giving’ inspired by the function of the glass opening of the aperture not only highlights the impotence of this feature, but also suggests an active agency in these faceless figures. Simon Goldhill remarks: ‘“Classics” is not a single block of cultural knowledge […] With each of these pictures the position of the viewer […] is integral to the process of reception. […] With a recognition of the role of the viewer at the scene of reception, we pay due regard to the performativity of the artwork’[11]. Taking up Goldhill’s phrase the ‘performativity of the artwork’ it is important to note that Classical tragedy rarely puts the mutated, disabled victim centre-stage. Of course, death and disabilities are seen as in Oedipus’ blindness and Polyneices’ lameness, but relatively, wounds are slight or they are immediately fatal. The viewer is troubled by the faceless figures of ‘Class of 1947’ and ‘Family Portrait’ amongst others as one questions whether they are perpetually disabled, or whether this state is reversible, or, perhaps is not one of deficiency, but is a position of superiority in having evolved so as to escape the horrors of tragic experience. Turning once again to the ‘Boy’ and ‘Girl’, the sense of wounding is paraded on a sharper knife-edge, as, like Classical tragic masks with their gaping mouths and hollowed out eyes, there is a layering of able-bodiedness, which seems to be destroyed through these empty holes. This idea of flux and fragility is a tragic issue relevant to the many forms and genres of tragedy. As Wallace elucidates: ‘not only does it [art] successfully represent the internal, fragile life of the subject but it is also in a constant state of change, from liquefaction to solidification and vice versa. We witness the making and unmaking of art, which seems to replicate the human, mortal condition. Some artists recently have explored the possibility of art which depicts the processes of weariness and decay’[12].

large1

Boy wearing a gas mask

If the face is blank, then Rubin’s subjects are not looking outward. This troubles our certainty in how we are to visually and emotionally engage and empathise with beings who are unreceptive to our voyeuristic gaze. As has been recognised, Rubin’s characters (subjects) are anonymous which seems paradoxical to the characters of Renaissance tragic drama. However, surely Rubin acts as representative for the uncharacterised figures of some fifth-century tragedies, such as Aeschylus’ named but colourless characters. But if Rubin’s figures are nameless, as well as faceless, (as is the case with the majority of his titles, in which the oeuvre is labelled only by gender or source material) it is hard for historical or social focus to be pinned onto them (unlike the figure of a spectator) and for them to be anatomically and culturally culpable for the rise and fall of an identifiable tragic hero. Rubin’s figures are, then, at once tragic in the conventional sense, and at the same time not tragic. His figures are watertight; they have no visible, sensual apertures – they are two-dimensional beings. The multifarious ways of viewing tragic performance (be that within the space of art, music or theatre) are called into play, as one questions whether the viewer projects their own stories metaphorically and pictorially onto the inaccessible and in so doing realise the hidden self. Rubin’s paintings are distinguishable for their disturbing narratives, or the seemingly disturbing narratives that are suggested through forms that are reduced to a few sure brushstrokes that suggest rather than describe a figure or landscape’[13]. Rubin suggests that ‘it is impossible to directly identify with the characters in my paintings rather I want to offer alternative ways of viewing the figures, where the viewer is also involved in completing a narrative or scene’[14]. As with any tragic artist, there is evidence of contention and paradox at the very heart of the experience. What the tragedian intends, and what actually results from the work are often distinct things. Returning to the introduction, and Rubin described his desire to ‘communicate in a more direct style’. Yet here he claims that his work cannot be received directly, which suggests that he too, through the creative process, has been forced to acknowledge the multidirectional and chaotic potential of tragic experience and narrative. We, and Rubin, are alerted to the fact that tragedy can be experienced not only through a ‘meta’ form of looking at art but also of the sense of being observed, of being heard and listened to, of feeling and being felt. Wallace identifies ‘the emphasis in tragic drama has repeatedly been upon seeing things. Again and again, the playwright demands that we bear witness to the tragic climactic moment, whether it be the vision of Oedipus emerging from the palace blinded or Lear returning to the stage with Cordelia in his arms. These are iconic moments in theatre. And yet icons within visual culture are rarely considered for their tragic significance by academic critics’[15]. Of course, as has been identified, the visual is important in affecting tragic results, but this experience is holistic and illimitable, impacted by so much more than the material or the visual.

Man, woman, child, grandparent; all are capable of responding to Rubin, just as, by extension, he was originally able to relate to the collective suffering of those who caused and those who lost during the 9/11 attacks. The agency of ‘attack’ identifies the destructive potential of tragic circumstances and the effects that result, but Rubin’s art serves to destroy the hypothesis that tragedy can only be understood or represented through a clearly defined set of narrative orders. It is the questions – the unanswered and sceptical questions, posed in any tragic medium that elevate Rubin’s work to the status of tragic. Thomas Rosenmeyer points out that ‘the greatness of [a play / artwork / creative performance] can be measured in part by the questions, profound or superficial, which it provokes in the minds of those who love it’[16]. Rubin’s subjects do not have lips nor mouths to shape and frame these questions but they do not need them. Rubin acts as the vessel through which their voices are heard on canvas, albeit voices that are confusingly pictorially stifled and silenced. This aesthetic potential of art that transcends the accusation of ‘art for art’s sake’ derives as early as Aeschylus in his self-referential poetic form. ‘The terror of tragedy as an imaginative medium of artistic representation […] has lost none of its relevance’[17]. In Rubin’s faceless works, as in any tragic material, it is the tension between the appalling visual or interpretative content and the recorded history (through poetry, or, in this case, through Rubin’s interviews with the media and personal accounts) that characterises tragic expression and ‘defines the paradox of tragedy beyond modern interpretation’[18].

 

References:

[1] Friedrich Nietzsche, The Birth of Tragedy: A New Translation by Douglas Smith, Oxford World’s Classics (Oxford: Oxford University Press, 2000), p. viii

[2] Beth Greenacre, ‘Spotlight on Gideon Rubin’ in Rokeby Gallery <http://www.rokebygallery.com/artists&gt; [accessed Monday 24 November]

[3] Karle Heinz Bohrer, ‘The Tragic: A Question of Art, not Philosophy of History’ in New Literary History, Volume 41, 1 (2010), The John Hopkins University Press, p. 45

[4] Alex Greenberger, ‘Gideon Rubin on the Tragic Origin of His Faceless Portraits’ in Artspace: Insider Access to the World’s Best Art <http://www.artspace.com/magazine/interviews_features/gideon_rubin&gt; [accessed Saturday 22 November]

[5] Gideon Rubin, ‘Artist Gideon Rubin on how he paints’ in The Observer, Sunday 20 September 2009 <http://www.theguardian.com/artanddesign/2009/sep/20/guide-to-painting-gideon-rubin&gt; [accessed Monday 24 November]

[6] ‘Good Things about Damien Hirst’s Latest’ in Diary of a Thirty-Something Art Dealer <http://diaryofathirtysomethingartdealer.blogspot.co.uk/2009/10/good-thing-about-damien-hirsts-latest.html&gt; [accessed Friday 21 November]

[7] Alex Greenberger, ‘Gideon Rubin on the Tragic Origin of His Faceless Portraits’ in Artspace: Insider Access to the World’s Best Art <http://www.artspace.com/magazine/interviews_features/gideon_rubin&gt; [accessed Saturday 22 November]

[8] ‘Spotlight on Gideon Rubin’ in Rokeby Gallery <http://www.rokebygallery.com/artists&gt; [accessed Monday 24 November]

[9] Jennifer Wallace, The Cambridge Introduction to Tragedy (Cambridge: Cambridge University, 2007), p. 159

[10] please don’t judge me. It was common practice amongst morbid-minded 11 year olds!

[11] Simon Goldhill, Victorian Culture and Classical Antiquity: Art, Opera, Fiction and the Proclamation of Modernity (Princeton: Princeton University Press, 2011), pp. 63-4

[12] The Cambridge Introduction to Tragedy (Cambridge: Cambridge University, 2007), p. 162

[13] Gideon Rubin, ‘Biography’ in Hosfelt Gallery <http://www.hosfeltgallery.com/index.php?p=artists&a=Gideon%20Rubin&gt; [accessed Saturday 22 November]

[14] Gideon Rubin, ‘Artist Gideon Rubin on how he paints’ in The Observer, Sunday 20 September 2009 <http://www.theguardian.com/artanddesign/2009/sep/20/guide-to-painting-gideon-rubin&gt; [accessed Monday 24 November]

[15] The Cambridge Introduction to Tragedy (Cambridge: Cambridge University, 2007), p. 158

[16] Thomas G. Rosenmeyer, The Masks of Tragedy: Essays on Six Greek Dramas (Austin: Texas Press, 1963), p. x

[17] Karle Heinz Bohrer, ‘The Tragic: A Question of Art, not Philosophy of History’ in New Literary History, Volume 41, 1 (2010), The John Hopkins University Press, p. 49

[18] Karle Heinz Bohrer, ‘The Tragic: A Question of Art, not Philosophy of History’ in New Literary History, Volume 41, 1 (2010), The John Hopkins University Press, p. 49