Highlights Vol 386 December 19/26, 2015 2463Highlights 2015: pictures of healthWe are grateful to all our readers who entered this year’s Highlights competition. From the rich selection of photographs you sent us we have selected 12 winners.These images are full of contrasts. Confl ict continues to devastate Syria and Spencer L ewis James’ picture reminds us of its eff ect on health systems. Tobaccoadvertising is the focus of two pictures: Matthieu Zellweger and Johanna Dollerson show us strong action against illegal tobacco advertisements in Bangladesh,where a s Suchita Shah refl ects on commonplace tobacco advertising in Cambodia. But alongside these serious topics, there are also beautiful images full of hope: community health workers complete their training in India, a young girl leaves an Ebola treatment centre in Sierra L eone, connections are madebetween the generations in South Africa, and a young boy in Zimbabwe examines his face after surgery for his cleft lip. We hope you enjoy Highlights 2015.Joanna Palmer, Zoë MullanThe Lancet (JP) and The Lancet Global Health (ZM),London EC2Y 5AS, UKWhat remains?Spencer Lewis James; Geisel School of Medicine at Dartmouth, Hanover, NH 03755, USA In western Syria, a destroyed hospital lies in ruins after confl ict laid waste to its once-protective walls. Explosions have torn through its walls, and bullet holes litter everything from the fl oor to the ceiling. When I saw this place I imagined the health-care workers and patients with their families who once fi lled these rooms, their injuries and illnesses being treated just as they would be in any other health-care facility around the world. This hospital once served as a sanctuary for the sick and disenfranchised, but the indiscriminate brutality of war has rendered it a crumbling pile of cement. What remains when health services are destroyed? When innocent people are caught in the crossfi re of confl ict, hospitals are vital places where people can fi nd the treatment and support they need. When bullets and bombs destroy even this last respite, the warring forces have taken away people’s fundamental right to health in the land they are fi ghting over, and I wonder what is still left to be won.This online publication hasbeen corrected. The corrected version first appeared at on Dec 18, 2015Highlights2464Vol 386 December 19/26, 2015T h e fi r s t p a t i e n t S i b y l l e R a h l e n b e c k ; F a c u l t y o f M e d i c i n e , U n i v e r s i t y o f H a r g e i s a , H a r g e i s a , S o m a l i l a n d M o s t p h y s i c i a n s c a n r e m e m b e r t h e m o m e n t w h e n t h e y m e t t h e i r fi r s t p a t i e n t . R o u t i n e m e d i c a l t a s k s , s u c h a s m e a s u r i n g b l o o d p r e s s u r e a n d t a k i n g t h e p a t i e n t ’s h i s t o r y , h a v e t o b e d o n e r e p e a t e d l y b e f o r e a y o u n g p h y s i c i a n i s s u ffi c i e n t l y s k i l l e d . T o t h i s e n d , c l i n i c a l s t u d e n t s i n H a r g e i s a a n d i n B u r a o , S o m a l i l a n d , u n d e r t a k e r e g u l a r t r i p s t o r e m o t e c o m m u n i t i e s i n t h e d i s t r i c t . H e r e f u t u r e d o c t o r s h o n e t h e i r m e d i c a l s k i l l s t h r o u g h t r e a t i n g t h e s e m i -n o m a d i c i n d i g e n o u s p o p u l a t i o n , f o r w h o m t h i s i s o f t e n t h e o n l y o p p o r t u n i t y t o r e c e i v e m e d i c a l a t t e n t i o n . M e d i c a l s t a ff f r o m t h e u n i v e r s i t y g u i d e a n d s u p e r v i s e t h e m i n t h e i r a c t i v i t i e s . O n t h i s d a y , t h e l o c a l s c h o o l s e r v e d a s a m e d i c a l f a c i l i t y a n d p a t i e n t s c a m e f r o m f a r a w a y , o f t e n a f t e r w a l k i n g l o n g d i s t a n c e s . T h i s c o m m u n i t y o u t r e a c h p r o j e c t i s s u p p o r t e d b y t h e G e r m a n f o u n d a t i o n E l s e K r ön e r -F r e s e n i u s -S t i f t u n g .Highlights Vol 386 December 19/26, 20152465A c o n v e r s a t i o n b e t w e e n t w o g e n e r a t i o n s C h a n d r a k a n t L a h a r i y a ; N e w D e l h i , I n d i a I t o o k t h i s p h o t o g r a p h i n a c a r e h o m e f o r o l d e r p e o p l e i n t h e W o o d s t o c k a r e a o f C a p e T o w n , S o u t h A f r i c a . T h e o l d e r w o m a n i n t h e p i c t u r e w a s l i v i n g o n t h e s t r e e t b e f o r e s h e b e c a m e a r e s i d e n t a t t h e c a r e h o m e . O t h e r r e s i d e n t s a n d c a r e g i v e r s t o l d m e t h a t t h i s w o m a n , w h o w a s i n h e r e a r l y 70s , w a s a b i t o f a r e c l u s e a n d r a r e l y t a l k e d t o a n y o n e i n t h e h o m e .B u t w h e n s h e m e t t h e y o u n g w o m a n i n t h i s p h o t o g r a p h , a c o l l e a g u e o f m i n e , s h e o p e n e d u p a n d h a d a v e r y l i v e l y c o n v e r s a t i o n a b o u t h e r l i f e , f a m i l y , a n d e x p e r i e n c e s . T h e t w o w o m e n m a d e a c o n n e c t i o n a c r o s s t h e g e n e r a t i o n s . O l d e r p e o p l e a r e o f t e n o v e r l o o k e d i n o u r s o c i e t y . T h i s p i c t u r e u n d e r l i n e s h o w i m p o r t a n t i t i s f o r u s t o r e a c h o u t t o o l d e r p e o p l e a n d g i v e t h e m o u r a t t e n t i o n , t i m e , a n d c o n c e r n .Highlights2466Vol 386 December 19/26, 2015P r o u d t o w o r k w i t h m y c o m m u n i t y A d r i a n a C u r a d o ; G A T I N -M o u r a r i a H a r m R e d u c t i o n C e n t r e , L i s b o n 1100496, P o r t u g a l J o ão S a n t a M a r i a i n j e c t e d d r u g s f o r 13 y e a r s a n d w a s d i a g n o s e d w i t h h e p a t i t i s C a n d , l a t e r , w i t h H I V . H i s h e p a t i t i s C t r e a t m e n t w a s d e l a y e d b e c a u s e o f h i s d r u g u s e b u t fi n a l l y , i n 2000, h i s h e p a t i t i s C w a s s u c c e s s f u l l y t r e a t e d w i t h 6 m o n t h s o f a n i n t e r f e r o n -b a s e d r e g i m e n . J o ão i s n o w a n a d v o c a t e f o r u n i v e r s a l a n d e a r l y t r e a t m e n t f o r b o t h i n f e c t i o n s , p a r t i c u l a r l y f o r i n j e c t i n g d r u g u s e r s . A s a p e e r c o u n s e l l o r f o r I N -M o u r a r i a , a h a r m r e d u c t i o n c e n t r e i n L i s b o n , P o r t u g a l , J o ão ’s d a i l y w o r k i n v o l v e s p r o v i d i n g H I V a n d h e p a t i t i s C v i r u s r a p i d t e s t i n g , a d v i c e o n s a f e r d r u g u s e , b l o o d -b o r n e d i s e a s e p r e v e n t i o n , t r e a t m e n t , a n d c a r e t o d r u g u s e r s . I n t h e p i c t u r e , J o ão a n d v o l u n t e e r C l a r a A b d u l l a h a r e fi l m i n g a v i d e o a b o u t c r a c k p i p e s t h a t d r a w s o n t h e e x p e r i e n c e s o f c l i e n t s a t t h e p r o j e c t . T h e fi l m s h o w s h o w t o u s e a c r a c k k i t a n d e x p l a i n s t h e r e l e v a n c e o f t h i s i n i t i a t i v e f o r d r u g -r e l a t e d h a r m r e d u c t i o n a n d s e e k s t o e n g a g e p e o p l e w h o h a v e o f t e n b e e n o u t o f r e a c h .Highlights Vol 386 December 19/26, 20152467P r e v e n t i o n i s t h e m o t h e r o f c u r e H i m m a t r a o S a l u b a B a w a s k a r , P a r a g H i m m a t r a o B a w a s k a r , P r a m o d i n i H i m m a t r a o B a w a s k a r ; B a w a s k a r H o s p i t a l a n d C l i n i c a l R e s e a r c h C e n t e r , M a h a d R a i g a d , M a h a r a s h t r a 402301, I n d i a (H S B , P r H B ); a n d T o p i w a l a N a t i o n a l M e d i c a l C o l l e g e a n d B Y L N A I R H o s p i t a l , M u m b a i , I n d i a (P a H B ) M a n y p e o p l e i n I n d i a l i v e i n v i l l a g e s w h e r e m o s q u i t o e s , s c o r p i o n s , a n d s n a k e s fl o u r i s h . T o h e l p p r e v e n t m a l a r i a , d e n g u e f e v e r , c h i k u n g u n y a , J a p a n e s e e n c e p h a l i t i s , a n d l y m p h a t i c fi l a r i a s i s c a u s e d b y m o s q u i t o e s , a s w e l l a s l i f e -t h r e a t e n i n g e n v e n o m i n g f r o m k r a i t b i t e p o i s o n i n g a n d s c o r p i o n s t i n g s , w e p r e p a r e d a p o s t e r t o p r o m o t e t h e h e a l t h a d v a n t a g e o f s l e e p i n g i n a b e d o r c o t a n d u s i n g m o s q u i t o n e t s . O u r p o s t e r u s e s l o c a l v e r n a c u l a r l a n g u a g e t o c o m m u n i c a t e t h i s m e s s a g e a n d w a s d i s t r i b u t e d a n d d i s p l a y e d a t p r i m a r y h e a l t h c e n t r e s , r u r a l h o s p i t a l s , p a n c h a y a t o ffi c e s , a n d t e m p l e s i n t h e v i l l a g e s i n o u r a r e a .Highlights2468Vol 386 December 19/26, 2015A S H A w o r k e r s i n j u b i l a t i o n a f t e r t r a i n i n g N P J a y a n , M a l l i k a T h a r a k a n , H L M o h a n ; N P J a y a n S c h o o l o f P h o t o J o u n a l i s m ,B a n g a l o r e 560074, I n d i a (N P J ), a n d K a r n a t a k a H e a l t h P r o m o t i o n T r u s t , K a r n a t a k a , I n d i a (M T , H L M )T h i s p i c t u r e s h o w s a g r o u p o f c o m m u n i t y h e a l t h w o r k e r s , k n o w n a s A c c r e d i t e d S o c i a l H e a l t h A c t i v i s t s (A S H A ), h o l d i n g u p t h e i r A S H A d i a r i e s i n j u b i l a t i o n a f t e r t r a i n i n g . T h e d i a r i e s a r e u s e d t o p l a n a n d d o c u m e n t t h e i r s e r v i c e s t o r u r a l c o m m u n i t i e s . A S H A c o m m u n i t y w o r k e r s , i n s t i t u t e d b y t h e G o v e r n m e n t o f I n d i a , f o r m a c r i t i c a l l i n k b e t w e e n t h e h e a l t h -c a r e s y s t e m a n d v i l l a g e r s . T h e y u n d e r t a k e h o m e v i s i t s a n d h e l p w o m e n a n d t h e i r f a m i l i e s d u r i n g a n d a f t e r p r e g n a n c y b y g i v i n g a d v i c e a b o u t h e a l t h y m a t e r n a l , n e w b o r n , a n d c h i l d h e a l t h (M NC H ) p r a c t i c e s . T h e K a r n a t a k a H e a l t h P r o m o t i o n T r u s t i m p l e m e n t e d a p r o j e c t t o i m p r o v e c a p a c i t i e s a n d m e t h o d s u s e d b y A S H A s t o e n h a n c e o u t r e a c h o f M N C H s e r v i c e s t o a l l a c r o s s t h e c a r e c o n t i n u u m f o r p r e g n a n c y , d e l i v e r y , a n d p o s t -p a r t u m p e r i o d s . A s a r e s u l t , A S H A s h a v e f e l t e m p o w e r e d a n d e q u i p p e d t o a d d r e s s g a p s i n o u t r e a c h , e s p e c i a l l y t o m a r g i n a l i s e d g r o u p s , a n d t h e p r o j e c t ’s p r o g r e s s r e p o r t i n d i c a t e s t h a t m o r e t h a n 90% o f A S H A s i n p r o j e c t d i s t r i c t s h a v e u s e d t h e s e n e w m e t h o d s .Highlights Vol 386 December 19/26, 20152469T h e p a t h t o t h e h o t z o n e N a h i d B h a d e l i a ; S e c t i o n o f I n f e c t i o u s D i s e a s e s , B o s t o n U n i v e r s i t y S c h o o l o f M e d i c i n e , B o s t o n , M A 02115, U S A T h i s p h o t o i s f r o m a n E b o l a c o m m u n i t y c a r e c e n t r e i n S i e r r a L e o n e , a p e r i p h e r a l h e a l t h -c a r e s i t e w h e r e p a t i e n t s i n r e m o t e c o m m u n i t i e s c o u l d r e c e i v e i m m e d i a t e m e d i c a l c a r e w h i l e w a i t i n g f o r c o n fi r m a t i o n o f t h e i r E b o l a d i a g n o s t i c r e s u l t s a n d p o t e n t i a l t r a n s p o r t a t i o n t o a n E b o l a t r e a t m e n t u n i t . T h e c o m m u n i t y c a r e c e n t r e s w e r e o f t e n r u n b y c o m m u n i t y h e a l t h o ffi c e r s a n d n u r s e s w o r k i n g i n t h e a ff e c t e d v i l l a g e s . T h e y t o o k c a r e o f t h e i r n e i g h b o u r s a n d s o m e t i m e s t h e i r o w n f a m i l y m e m b e r s . H e r e d u r a b l e p e r s o n a l p r o t e c t i v e e q u i p m e n t i s h a n g i n g o u t t o d r y a f t e r b e i n g d i s i n f e c t e d f o r u s e d u r i n g t h e n e x t t r i p i n t o t h e h o t z o n e . F o r m e , t h i s i m a g e s y m b o l i s e s t h e h a r d w o r k t h a t h e a l t h -c a r e w o r k e r s , p a r t i c u l a r l y n a t i o n a l s t a ff , p e r f o r m e d i n b a t t l i n g t h e E b o l a e p i d e m i c d a y i n a n d d a y o u t , f o r m o n t h s o n e n d , a n d t h e m e a g r e r e s o u r c e s w i t h w h i c h t h e y d i d i t .Highlights2470Vol 386 December 19/26, 2015L i g h t i n g t h e w a y t o a s m o k e f r e e w o r l d M a t t h i e u Z e l l w e g e r , J o h a n n a D o l l e r s o n ; t h e I n t e r n a t i o n a l U n i o n A g a i n s t T u b e r c u l o s i s a n d L u n g D i s e a s e , E d i n b u r g h E H 3 7T H , U K I n D h a k a , B a n g l a d e s h , a m o b i l e c o u r t h e a d e d b y E x e c u t i v e M a g i s t r a t e S i f a t -e -J a h a n g a t h e r s a c r o w d a s i t s u p e r v i s e s t h e d e s t r u c t i o n o f i l l e g a l t o b a c c o a d v e r t i s e m e n t s . T o b a c c o a d v e r t i s i n g i s b a n n e d i n B a n g l a d e s h a s p a r t o f t h e g o v e r n m e n t ’s s t r a t e g y t o r e d u c e t o b a c c o u s e a n d p r e v e n t t h e s u ff e r i n g i t c a u s e s . M o b i l e c o u r t s a r e o n e c o m p o n e n t o f B a n g l a d e s h ’s u n i q u e t o b a c c o c o n t r o l t a s k f o r c e s , w h i c h i n c l u d e r e p r e s e n t a t i v e s f r o m h e a l t h , j u s t i c e a n d p o l i c e d e p a r t m e n t s , a n d c i v i l s o c i e t y . T h e y h a v e t h e p o w e r t o u n d e r t a k e r a n d o m i n s p e c t i o n s , i s s u e fi n e s , a n d d e s t r o y i l l e g a l m a t e r i a l t o u p h o l d t o b a c c o c o n t r o l l a w s . S u c h o n -t h e -s p o t j u s t i c e p r o v i d e s a p o w e r f u l v i s u a l c o m m u n i c a t i o n o n t h e d a n g e r s o f t o b a c c o u s e . B a n g l a d e s h h a s h i g h r a t e s o f t o b a c c o u s e a n d l o w l i t e r a c y r a t e s . W o r d a b o u t t h e s p e c t a c l e c a p t u r e d h e r e w i l l b e s p r e a d b o t h b y i m m e d i a t e b y s t a n d e r s , a n d b y t h o s e t r a v e l l i n g o n t h e b u s i n t h e b a c k g r o u n d .Highlights Vol 386 December 19/26, 20152471T he b i g g e s t k i l l e r ?S u c h i t a S h a h ; O xf o r d , U K S t o r i e s h a v e a l w a y s f a s c i n a t e d m e , b u t w o r k i ng a s a g l o b a lh e a l t h f e l l o wi n C a m b o d i a o p e n e d m y e y e s t o a n e w , v i s u a l w o r l d o f n a r r a t i v e s , w h i c h c o u l d b e c a p t u r e d o n c a m e r a . T h i s i m a g e h i g h l i g h t s a n u n e x p e c t e dj u x t a p o s i t i o n . R o a d t r a ffi c i n j u r i e s a r e a m a j o r p u b l i c h e a l t h p r o b l e m i n C a m b o d i a . V e h i c l e s l ik e t h e o n e o n t h e r i g h t , p il e d w i t h p e o p l e , a n im a l s , an d go o d s , a r e c o m m o np l a c e . I w a s g l a d m y t u k -t u k d r i v e r w o r e a p r o t e c t i v e h e l m e t . Y e t , m y g a z e d r a w n t o t h e l o g o o n h i s h e l m e t , I c o u l d n ’t h e l p b u t w o n d e r w h i c h o f t h e h a z a r d s i n t h e p h o t o g r a p h w o u l d t u r n o u t t o b e t h e b i g g e s t k i l l e r i n t h i s c o u n t r y .Highlights2472Vol 386 December 19/26, 2015C e l e b r a t i o n S a v e r i o B e l l i z z i ; S a s s a r i , I t a l y T h e l o n g e s t a n d m o s t c o m p l e x E b o l a e p i d e m i c e v e r s t i l l p e r s i s t s i n w e s t A f r i c a . T h e p i l l a r s o f t h e s t r a t e g y a g a i n s t E b o l a a r e i s o l a t i o n , t r e a t m e n t o f c a s e s , s a f e b u r i a l s , c o n t a c t t r a c i n g , h e a l t h p r o m o t i o n , a n d p s y c h o s o c i a l s u p p o r t .D u r i n g t h eE b o l a o u t b r e a k I w o r k e d a s a n e p i d e m i o l o g i s t f o r M éd e c i n s S a n sF r o n t i èr e s (M S F ) m o n i t o r i n g a c t i v i t i e s i n t h e E b o l a t r e a t m e n t c e n t r e a n d t r a c i n g o r i g i n s o f p a t i e n t s t o h e l p t e a m s i n t h e i r e ff o r t s t o p r e v e n t f u r t h e r s p r e a d o f t h e e p i d e m i c . I n t h i s p i c t u r e , s t a ff a t M S F ’s P r i n c e o f W a l e s E b o l a t r e a t m e n t c e n t r e i n F r e e t o w n , S i e r r a L e o n e , c e l e b r a t e t h e s u c c e s s f u l t r e a t m e n t o f a 6-y e a r -o l d g i r l. T h e c u r e d p a t i e n t i s a b o u t t o l e a v e t h e o u t e r p a r t o f t h e c e n t r e w h e r e s h e w i l l fi n a l l y b e r e u n i t e d w i t h h e r f a m i l y a n d r e c e i v e h e l p f r o m t h e p s y c h o s o c i a l s u p p o r t w o r k e r s t o a l l o w h e r t o m o v e o n w i t h h e r l i f e .HighlightsM f a k a z i ’s n e w l y r e p a i r e d c l e f t l i p D a v i d A S h a y e , J e s s i c a L E l l i s , J e n n i f e r M o r a , T r a v i s T T o l l e f s o n ; M a s s a c h u s e t t s E y e & E a r a n d H a r v a r d U n i v e r s i t y , B o s t o n , M A 02114, U S A (D A S ), J E l l i s M e d i a , B o s t o n , M A , U S A (J L E ), O p e r a t i o n o f H o p e , L a k e F o r e s t , C A , U S A (J M ), a n d U n i v e r s i t y o f C a l i f o r n i a a t D a v i s M e d i c a l C e n t e r , S a c r a m e n t o , C A , U S A (T T T )M f a k a z i , a 5-y e a r -o l d Z i m b a b w e a n b o y , g a z e s i n t e n t l y a t h i s c l e f t l i p t h a t w a s r e p a i r e d j u s t h o u r s e a r l i e r . H e h a s l i v e d w i t h t h i s f a c i a l d e f o r m i t y s i n c e b i r t h , w h i c h h a s a ff e c t e d h i s s o c i a l s i t u a t i o n , f a m i l y , a n d i n t e g r a t i o n i n t o s o c i e t y . O p e r a t i o n o f H o p e , a n o t -f o r -p r o fi t , a l l -v o l u n t e e r s u r g i c a l t e a m , h a s t e a m e d u p w i t h l o c a l s u r g e o n s , o r t h o d o n t i s t s , a n d s p e e c h t h e r a p i s t s t o h e l p d e v e l o p Z i m b a b w e ’s fi r s t m u l t i d i s c i p l i n a r y c l e f t l i p a n d p a l a t e t e a m t o t r e a t c h i l d r e n a n d a d u l t s w i t h c o n g e n i t a l f a c i a l d e f o r m i t i e s . T h e i m p o r t a n c e o f a c c e s s t o s a f e s u r g e r y a n d a n a e s t h e s i a , a s e r v i c e l o n g f o r g o t t e n i n t h e d o m a i n o f p u b l i c h e a l t h , h a s b e c o m e m o r e r e c o g n i s e d i n r e c e n t y e a r s .HighlightsExistential recuperationJohn Heintz; Department of Anthropology and Harvard Medical School, Boston, MA 02115, USAThe March for Peace in Bogotá, Colombia, was held on the anniversary of the assassination of populist presidential candidate Jorge Eliécer Gaitán in 1948. At the march this year, there was a general call for a new constitutional assembly to address persistent inequalities. I took this photograph of a citizen reading posters on Calle 26, the main route for the march. The posters include such slogans as “a peace as an excuse to perpetuate inequality”, “in rebellion Latin America recuperates its existence”, and “rebellious memory does not allow the domestication of a hegemonic transition”. As health professionals we deal with the wellbeing of patients in the isolated spaces of clinic rooms. But the March for Peace and the posters pictured here stand as a powerful reminder that health is also negotiated in public spaces, at particular historical junctures, and that to engage in the wellbeing of patients is also to engage in some way with the broader politics of collective identity.。
