Urbanization proceeds in stages, beginning with instant "cities", like Kikwit, Congo, where 400,000 people live on the edge of a rain forest in a town with no running water or electricity.
-- Photo by Laurie Garrett
“In the newly globalized economy of the twenty-first century no part of the planet is too remote, too exotic, or too forbidding for travelers or business development.” (pg.12)
The local Kikwit Red Cross volunteers bravely buried the contagious bodies of Ebola victims, 1995.
-- Photo by Laurie Garrett
“Trucks and a bulldozer were found, applied to the horrible job of creating enormous mass graves on the edge of town, in which the plastic-wrapped bodies of the dead were stacked.” (pg. 81)
Control of Ebola in Kikwit also involved removing ailing patients from their families and friends to avoid contact-spread.
-- Photo by Laurie Garrett
“Muyembe ordered all non-Ebola patients sent away from Kikwit General Hospital, and he decreed that all suspected Ebola cases in any other clinic, or in people’s homes, be collected by the local Red Cross and brought immediately to Pavilion No. 3, the hastily designated isolation ward.” (pg. 79)
The 1995 Ebola epidemic in Kikwit was stopped, in part, by creating a cordons sanitaire, isolating the Ebola patients in the back hospital pavilion.
-- Photo by Laurie Garrett
“The patients were in a sorrier state. The staff had no protection and they hadn’t been paid for risking their lives. So we decide to focus on Hospital sanitation and establishment of an isolation ward.”(pg. 79)
The medical microbiology laboratory for Kikwit General Hospital, Democratic Republic of the Congo, where Ebola broke out in 1995.
-- Photo by Laurie Garrett
“Two things are clear: Ebola spread in Kikwit because the most basic, essential elements of public health were nonexistent. And…Ebola haunted Zaire because of corruption and political repression.” (pg.59)
Tuberculosis care facilities in much of the world are as bad as this hospital, located near Tblisi, Georgia.
-- Photo by Viorel Florescu
“For decades Georgia’s health care system was based on enormous facilities like Republican State Hospital, located in downtown Tblisi. The twelve-story, two-thousand-bed concrete facility was so full during the 1980’s, doctors said, that patients often lay upon gurneys lining the hallways.” (pg.247)
There is a global, growing black market in antibiotic sales, which is fueling worldwide drug resistance. (Tblisi, Georgia)
-- Photo by Viorel Florescu
“It could be seen in Georgia, at the Deserter’s Bazaar in Tblisi, where Goga, an economics student with no medical training, sold antibiotics from an open-air booth, advising customers how to use the drugs, and which to take.” (pg.124)
In the Moscow TB sanitarium no drugs helped the Dagestani, so the physicians surgically removed one lung, half of the other and gave him a tracheotomy through which he can breathe.
-- Photo by Laurie Garrett
“But she didn’t know Khoubanov was infected with drug-resistant TB. Nobody did because none of the Dagestan hospitals had equipment to conduct drug sensitivity tests…worse yet, [he] developed a toxic liver reaction to the only one of the drugs that was effective against his TB.” (pg.195)
This young Dagestani man had been an Olympic weightlifter, but he caught multidrug resistant TB and spent years languishing in a Moscow sanitarium.
-- Photo by Laurie Garrett
“In the spring of 1997 Khoubanov lay lethargically in an isolated room in the intensive care unit, breathing through a one-inch diameter hole cut in his trachea. Painted daily with emerald disinfectant the hole gapes at horrified visitors.” (pg.195)
Dr. Galina Dugarova heads up TB control for the Buryatia people of Siberia. They have one of the world’s highest tuberculosis rates.
-- Photo by Viorel Florescu
“’It’s like a genocide,’ Declares Dugarova. ‘A holocaust. We’re dying.’
“Probably for genetic reasons, though no one was sure, ethnic Buryatis and other indigenous peoples of Siberia are especially vulnerable to the tuberculosis mycobacteria. In 1996 some 211 of every 100,000 Buryatis suffered active, symptomatic tuberculosis. That’s twice the TB rate seen in their ethnic Russian neighbors.” (pg.191)
Despite industrialization, many Russians lack indoor plumbing, and the government says that half of all drinking water is unsafe. This pump serves a neighborhood of downtown Novosibirsk, Siberia.
-- Photo by Laurie Garrett
“WHO water engineers discovered that all over the region Soviet urban planners had bundled drinking water and sewage pipes, burying them one atop the other under the region’s densely populated cities…by the 1990s sewer pipes commonly leaked directly into drinking water carriers.” (pg.181-182)
Outside Ulan Ude, Siberia children scrounge through garbage dumps in search of food.
-- Photo by Viorel Florescu
“Outside the Siberian city of Ulan Ude, a village has been created downwind of the municipal garbage dump. Fifty-two adults and eight children live in a pine grove that is covered in an artificial forest floor made of trash that blows off the ten-story-high, redolent garbage heaps.” (pg.133)
Well after the 1994 pneumonic plague outbreak had sparked a mass exodus of some 400,000 people from Surat, Indian military officials enforced quarantine on the town’s Civil Hospital.
-- Photo by Laurie Garrett
“In September 1994 all of India resonated with plague panic, coupled with a near universal condemnation of a filthy Surat.” (pg.17)
With evidence mounting that at least three countries are working on smallpox bioweapons it is worth noting that almost no people alive today are immune to the virus, despite once having been vaccinated.
-- (no photo credit)
“The single biggest killer of the twentieth century was the smallpox virus which, before its 1977 eradication, claimed more lives than all of the century’s wars, combined. The smallpox virus only infected Homo sapiens, and was spread through casual contact and in the air.” (pg.111)
During Soviet times people had money, but there was no food to buy. Today, even tropical foods are plentiful, but the people are malnourished for lack of purchasing power. (Irkutsk, Siberia)
-- Photo by Laurie Garrett
“But after the collapse of the Soviet Union the situation flipped 180 degrees. Suddenly fruit, vegetable, and meat markets sprung up in even the remotest parts of Siberia. But that was all most people could afford to do: look.” (pg.169)
When antibiotics proved in 1949 to be curative for gonorrhea and syphilis public health had a new weapon in its battle against disease, allowing a carrot-and-stick approach to control of sexually transmitted diseases.
-- (no photo credit)
“Gonorrhea, in contrast, could be treated with a single penicillin injection. So privacy-conscious people sought discreet care for their gonorrhea, leaving the disease woefully underreported.” (pg.227)
Long before modern medicines were invented, public health pioneers of 1890s New York City applied germ theory to contagion control --- with great success.
-- (no photo credit)
“For two hundred years New Yorkers fought off epidemics and pestilence, learning by erring how to create an enormous metropolis that was, from at least a disease perspective, safe.” (pg.2)
With male life expectancies declining in much of the former Soviet Union, what does the future hold for these Russian babies?
-- Photo by Viorel Florescu
“Then that frightening word demography appears, and it is clear that Russia today is on the eve of a demographic catastrophe: the death rate is exceeding the birth rate, life expectancy is declining sharply, the number of suicides is rising, and there are 240 abortions per 100 live births.” –Andrei Sinyavsky, 1997 (pg.122)
May Day celebrations in Ulan Ude, Siberia, which has one of the highest tuberculosis rates in the world.
-- Photo by Viorel Florescu
“It’s Patriote Day in Ulan Ude—May Day in the West—and the city’s population is pouring into Ploshehad Sovietov.” (p.191)
Under a bridge in Calcutta a mother and her three children live, having moved from Bangladesh. Every day some 1 million people cross a border, all too often ending up like this.
-- Photo by Laurie Garrett
“But unless this collective lurch toward progress is accompanied by a vision of a cleaner and more hygienic life, India will never quite qualify in the eyes of the international community as a modernizing nation.” (pg.18)
Downtown Kikwit, the Democratic Republic of Congo, where Ebola erupted in 1995.
-- Photo by Laurie Garrett
“By the time it [Ebola] surfaced in Kikwit after a nineteen-year hiatus the nation’s public health and medical infrastructure existed in name only. There were twenty-four thousand Zairois for every hospital bed in the nation.” (pg.58)
Newsday's page asks if New York is ready for bioterrorism.
“As writer Robert Wright put it, ‘If someone asks you to guess which technology will be the first to kill 100,000 Americans in a terrorist incident, you shouldn’t hesitate; bet on biotechnology’.” (pg.522)
A laboratory bench inside VECTOR, the biological warfare lab in Siberia.
-- Photo by Viorel Florescu
“Six years after the fall of the Soviet Union VECTOR, the USSR’s premier virus weapons facility, had a seedy, has-been look to it..Some of the laboratories and offices seemed in danger of collapsing.” (p.505) 
So great is the industrial pollution of Nori'lsk, Siberia, that snow falls black and the sun never shines clearly.
-- Photo by Viorel Florescu
“And there was equally strong anecdotal evidence that the rape of the land in places like Noril’sk and Murmansk, key mining and industrial centers, contributed to rising incidences of cancer, cardiovascular disease, and the like.” (pg.143)
At the leading medical institute in Irkutsk, Siberia all manner of bizarre medical devices are commonly used, such as this UV light ray that allegedly cures all respiratory ailments.
-- Photo by Viorel Florescu
“The line between vaudeville-style magicians and Soviet Academy of Sciences members was fine in this area, perhaps undetectable.” (pg. 258)
Prisoners in the tuberculosis ward of the Tblisi, Georgia jail eagerly grab cigarettes.
-- Photo by Viorel Florescu
“According to TB expert, staying just three years in the Russian jail system—home to an amazing 1 in 148 Russian residents in 1997—was tantamount to a death sentence from tuberculosis.” (pg.185)
In the tuberculosis hospital in Tsvingali, Georgia, TB patients have to chop their own wood to survive the bitter winter cold.
-- Photo by Viorel Florescu
“Though the numbers of prisoners dying each year of TB in Georgia paled when compared to neighboring Russia, tuberculosis was the leading cause of death in prison.” (pg.186)
The leaders of the fight to stop the Ebola epidemic in Kikwit, Zaire,1995: Dr. Tamfum Muyembe (University of Kinshasa), Dr. Barbara Kiersteins (Medecins sans Frontieres) and Dr. David Heymann (WHO).
-- Photo by Laurie Garrett
“But this landa-landa was different, more terrifying than all the other diseases that had taken the lives of Kikwit’s children and young adults. The victims died fast. But first, they bled, had long fists of hiccups, cried out in agonizing pain, even went mad, and screamed incoherent phrases of appartent devilish origin.” (pg.51)
Inside the VECTOR biological warfare lab, outside Novosibirsk, Russia, scientists work with astoundingly dangerous viruses. If they get infected, quarantine in these tiny sheds would be their fate.
-- Photo by Viorel Florescu
“In Building Number 1, for example, row upon row of industrial freezers housed Ebola, Lassa, smallpox, monkeypox, tick-borne encephalitits, killer influenza strains, Marburg, HIV, hepatitits A, B, C, and E, Japansese encephalitits, and dozens of other human killer viruses.” (pg.505)
A Russian scientist works inside a maximum containment suit in the VECTOR biological warfare laboratory, located outside Novosibirsk, Russia.
-- Photo by Viorel Florescu
“At VECTOR in 1990—just one year before the collapse of the Soviet Union—Alibek led a team that figured out how to weaponize smallpox, dispersing the deadly microbes in aerosols…and they manufactured eighty to a hundred tons of the horrible stuff.” (pg.508)
The local Kikwit Red Cross brought the Ebola epidemic under control in 1995, by, among other things, burying the bodies well outside of town, with no funerals.
-- Photo by Laurie Garrett
“Similarly, MSF put the Red Cross burial crews on modest salaries and helped their leaders create manageable schedules for their grim tasks. Trucks and a bulldozer were found, applied to the horrible job of creating enormous mass graves on the edge of town, in which the plastic-wrapped bodies of the dead were stacked.” (pg.81)
In January 1995, Gaspard Menga died mysteriously, as did nearly every family member pictured here at his funeral. Only months later would it be determined that he was the first case in the Kikwit 1995 Ebola epidemic.
-- Photo by Laurie Garrett
“Gaspard Menga Kitambala was a forty-three-year-old charcoal maker, Jehovah’s Witness, husband, and father of five small children. By all accounts, Menga was a hardworking fellow, devout Jehovah’s Witness Christian, and a devoted father.” (pg.59)
Somewhere in this forest Gaspard Menga, the first Ebola case in the Kikwit 1995 outbreak, got infected. But nobody has discovered what creature carried the deadly virus, passing it on to poor Menga.
-- Photo by Laurie Garrett
“Nobody in Ndobo understood the terrible landa-landa that struck the Menga relatives. It would be months before explanations would come from distant Kikwit.” (pg.62)
Dr. Robert Swanepoel, of the Institute of Virology in Johannesburg, struggles to work inside a biohazard suit amid 100 degree, high humidity conditions, during the Ebola epidemic in Kikwit, Zaire, 1995.
-- Photo by Laurie Garrett
“Based on what they did know at the time, however, the team felt American provisions for universal precautions, modified to include goggles and rubber boots, were probably adequate for the Red Cross and health care workers. For Swanpoel and his tiny group of on-site lab workers full-body space suits were, despite the stifling heat and humidity, deemed wise.” (pg. 91)
On a paltry budget public health workers in Ulan Ude, Russia struggle to cope with record numbers of tuberculosis cases.
-- Photo by Viorel Florescu
“Every individual found to have tuberculosis in Ulan Ude is brought to the log cabins that currently constitute [the] TB sanatorium.” (pg.191)
With unemployment at record levels and little optimism about the future, alienated youths across the former USSR are turning to drugs and alcohol. Picture taken in "Club 888", Novosibirsk, Russia.
-- Photo by Viorel Florescu
“On the staff of the Moscow-based drug group NAN, which stands for ‘No to Alcoholism and Drug Addiction,’ she said she saw a steady daily stream of young men and women similar to those at Club 888.” (pg.142)
Remarkably, a nurse working on an AIDS ward in Kyiv, Ukraine, draws blood from an HIV+ patient without wearing protective gloves.
-- Photo by Viorel Florescu
“The new face of health care in the former USSR could be seen at an AIDS clinic in Kyiv, where a nurse took blood from an HIV-positive man without wearing protective latex gloves, using her bare forefinger to apply pressure to the site of injection.” (pg.123-124)
Overcrowding in the jails and prisons of the former Soviet nations is extreme, as depicted in this jam-packed jail in Tblisi, Georgia. As a result, tuberculosis is spreading rampantly.
-- Photo by Viorel Florescu
“Mirian caught TB in jail in 1993…Arrested for robbery, Mirian served three years in a thirty-square-meter jail cell inhabited by more than a hundred prisoners.” (pg.185)
A nurse rinses instruments in tepid water before reusing them on a hernial resection operation in Tsvingali, Georgia.
-- Photo by Viorel Florescu
“The patient’s respiratory ventilator was hand-pumped by a nurse, his anesthesia was dripped onto a cloth over his face. The surgeon was working quickly because the generator only provided fifteen minutes of electricity for the lights.” (pg.124)
In a neighborhood dubbed "Palermo" in Odessa, Ukraine, teenagers by the hundreds inject narcotics.
-- Photo by Viorel Florescu
“About halfway into the Palermo neighborhood, where there are some ten thousand Gypsies and their ‘slaves’—drug-addicted Ukrainian adolescents who work for nothing more than daily hits of narcotics—the road becomes impassable.” (p.207)
Sex slaves, sold to brothels like this one in Pune, India, are at high risk for HIV.
-- Photo by Laurie Garrett
“In 1998 the World Bank sadly estimated that India’s failure to respond swiftly to spread of HIV among prostitutes and IV drug users in the early 1990s would, by 2000, cost her $11 billion, or 5 percent of her GDP, in direct medical care and lost worker productivity due to death and illness.” (pg. 46)
A Ukrainian man displays "chorny", a narcotic concoction cooked in kitchens, emulsified with often contaminated human blood, and injected with 20 cc syringes.
-- Photo by Viorel Florescu
“From 250 grams of poppy straw, three cups of water, about a liter of solvent, and a few drops of acetic anhydride, this is it—enough opiate extract, called chorny, to get two addicts high. The cost: about $10 and three hours of dangerous labor.” (p.210)
Soaring HIV/AIDS numbers in the countries of the former Soviet Union.
-- Source: UN AIDS Programme.
“As the HIV toll mounted at a frightening pace in the former Soviet Union, Eastern Bloc governments found themselves in the unique position of having a small window of time to take public health actions that might forestall medical disaster.” (p.222)
The "Chimney Effect": demographic disruption AIDS is bringing to Botswana.
-- Source: Lampty, PR; BMJ 2002; 324: 207-211.
“It was one thing for Botswanna, for example, with a population of 1.4 million people, to have a 32 percent infection rate among its young adults, or about 200,000 HIV cases.” (p.574)
Kikwit, in the Democratic Republic of Congo, where Ebola emerged in 1995.
-- Photo by Laurie Garrett
“The padding of feet on Kikwit’s mud paths paused as people turned their ears to catch the name of the latest landa-landa victim. In a city without newspapers, radio, television, telephones, or electricity, such cries in the night constitutes local broadcast news.” (p. 51)
The new mass urbanization finds millions living in slums like this one, in Surat, India, where pneumonic plague emerged in 1994.
-- Photo by Laurie Garrett
“But despicable as Surat’s verminous filth was, the stench, garbage, and rodents of the city played little, in any, role in the start or spread of the nation’s plague epidemic…the plague in Surat had much more to do with horrid housing, human panic, and bereft health care than Ratus ratus.” (p.18)
The plague ward of Surat.
-- Photo by Laurie Garrett
“Behind thick isolation doors in two sealed chambers were the most dangerous patients – those who were actively coughing up Yersinia-contaminated blood and sputum.” (pg. 30)
Surat train station during the plague.
-- Photo by Laurie Garrett
“The Exodus Began.
Within twelve hours of the BBC broadcast an estimated 100,000 Suratis boarded trains headed to every imaginable direction across the Indian subcontinent.” (pg. 27)
TIME magazine’s international edition calls for “coping” with the plague.
“News reports across India ran the gaumt from the Times of India’s calming headline that day…to the Daily’s claim that more than 250 Suratis were dead, and 10,000 had the plague.” (pg 28)
India’s reputable FRONTLINE declares the return of plague.
“No one in India had seen a case of plague in more that thirty years.” (pg. 19)
Cover of India’s TODAY magazine declares PLAGUE
“So from the first moments of Surat’s epidemic the Indian public was deluged with at least as much misinformation as actual facts…The information schism – between truth and fantasy, accuracy and exaggeration – would prove disastrous for India in coming days.” (pg. 29)
The poor took care of themselves in Surat.
-- Photo by Laurie Garrett
“Meanwhile, in Surat, poor women, one hand clutching their saris in place, spread white DDT powder with bare hands along Ved Road.”
Newsweek headline declared KILLER VIRUS.
“By the time Ebola struck Kikwit the dictator and his friends had stolen at least $11 billion from the Zairois people. The national bank had been shut down since 1991, when soldiers looted Kinshasa heaving learned that the currency in which they were paid carried no value. There was no cash in the bank, and no legal exchange of currency.” (pg. 57)
Scientists gathered local monkeys and drew blood samples in search of the virus.
-- Photo by Laurie Garrett
“He swiftly ruled out Ebola infection in the primates, and set about searching for other possible Ebola-carrying animals. The amiable South African managed to recruit local volunteers who helped snare bats from Kikwit’s trees and church belfries.” (pg. 97)
Children grieve, having just learned their parents died of Ebola.
-- Photo by Laurie Garrett
“’Someone has died! He was my pap!’ screamed a teenage girl. Surrounded by her six younger, grieving siblings the girl’s face and blouse were drenched in tears. ‘He was my pap,’ she cried again, pushing a photograph of the deceased into the hands of a passing stranger.” (pg. 91)
A teenager’s hepatitis jaundice is so bad that the film seems too yellow to believe.
-- Photo by Laurie Garrett
“At Narcology Hospital No. 17 in Moscow deputy director Tatiana Lysenko sees addicted boys every day. They come in droves, their bodies sickened by the drugs – and by hepatitis.” (pg. 215)
Teenager injects chorny narcotic in his apartment.
-- Photo by Viorel Florescu
“Until 1991 healthcare workers simply called in the police and locked up the users. And the patients cold-turkeyed, repented, underwent political re-education, and either learned the error of their ways or were sent to prison. It was simple.
“But after 1991 and the collapse of Communist rule narcologists had no idea what to do.” (pg. 215)
“’I like Edgar Allan Poe. His poems are about death. Live fast, die young,’ says 27-year-old Aruslan Kurcenko. (pg. 200)
Drug user holds his syringe in his mouth.
-- Photo by Viorel Florescu
“Following universal rules of marketing, drug traffickers were creating clienteles in the region by selling everything from raw opium to heroin at rock-bottom prices, more than tenfold lower than equivalent drug sales in New York City.” (pg. 213)
The grounds were littered with drug injecting equipment.
-- Photo by Viorel Florescu
“Minov and the staff of a small drug addiction clinic called Trusting Spot collected thousands of syringes found in the Odessa shooting field in January 1997: fully a third of them tested positive for HIV.” (pg. 212)
The tracks of a hardened drug injector.
-- Photo by Viorel Florescu
“’It doesn’t matter anyway,’ he adds. ‘I’m HIV positive. Whether it’s from drugs or AIDS, I will soon die.’” (pg. 210)
By mixing the contents of these packets she can get high for hours.
-- Photo by Viorel Florescu
“Those more recently inducted into the opiate world haven’t yet sold winter coats and boots for hryvnya; enough, perhaps, for another hit of chorny.” (pg. 210)
The face of alienation.
-- Photo by Viorel Florescu
“By the end of 1998 the Russian Ministry of Health had to acknowledge two things: nearly all new HIV cases were among youthful IV drug users, and the ranks of said narcotics and amphetamine injectors had swelled dramatically.” (pg. 223)
Glue-sniffing children in Novosibirsk.
-- Photo by Viorel Florescu
“’Our main task is to save the younger generation,’ Mogilevsky sternly says. ‘If we can manage to pull them out of the reach of the Mafia structures, we will win this battle.” (pg. 213)
Cooking up chorny in an Odessa kitchen.
-- Photo by Viorel Florescu
“Artur puts the tin bowl into the jury-rigged double boiler and cooks it another twenty minutes until nothing remains but a thin dark green film reminiscent of pond algal scum. He grabs the syringe full of acetic anhydride and carefully injects it into the pot, producing yet another vile, vinegarish odor. He stirs slowly, his tattooed wrist rotating round and round, bearing the Russian phrase, GOD BE WITH US.” (pg. 210)
Man dying of highly drug-resistant TB in Moscow.
-- Photo by Viorel Florescu
“Konstantin, an emaciated, bedridden thirty nine-year-old former Soviet soldier, lies dying at the Moscow Tuberculosis Research Center. Drug-resistant TB has invaded his lungs, liver, kidneys, and heart.
“Still, he says with a smirk that he appreciates the irony of the situation. ‘It’s like a joke,’ he notes, his soft, ruined voice interrupted frequently by fits of coughing, ‘a particularly Russian joke.’
“’I did it all,’ Konstantin begins. ‘Komsomol, Communist Party, fighting in Afghanistan….’” (pg. 184)
Alcoholism is so tolerated that booze is used to raise campaign money.
-- Photo by Laurie Garrett
“Vladimir Zhirinnovsky, an ultra-nationalist presidential hopeful, raised campaign funds selling his own brand of vodka, picturing himself on the label as Vladimir Lenin.” (pg.136) 
The Marlboro Man in Tallinn, Estonia.
-- Photo by Laure Garrett
“Neurostimulation is a greedy mistress. The brain wants more and more of it: the longer a smoker uses cigarettes, the more the brain actually changes physically, adapting to nicotine stimulation so thoroughly that it cannot readily function without it.” (pg. 354)
May Day celebrants in Ulan Ude, Siberia.
-- Photo by Laurie Garrett
“In comparison to ten to fifteen years ago we see that the quality of children’s health is decreasing.” (pg. 189)
Left to the streets by the drunken parents, in St. Petersburg.
-- Photo by Laurie Garrett
“Russian children bore the brunt of it all, turning into a massive, orphaned subpopulation that lived by its wits on the street of the snowy nation. The Russian Association of Child Psychologists and Psychiatrists estimated in November 1998 that the number of abandoned and orphaned children suddenly doubled, to two million – up from essentially zero in 1990.” (pg. 187)
Passed out drunk on a Ulan Ude street.
-- Photo by Viorel Florescu
“Later, when the discussion turns to alcohol’s effects on their future, Sergei blurts out a bit of his past. ‘I tried to commit suicide,’ he says, pulling up his black leather sleeve to reveal the scares of slit wrists.
“’Me too!’ Alex says, displaying a similar set of scars, and quickly, all five of the young men in the group roll up their sleeves to the astonishment of a reporter, excitedly comparing suicide methods and scarred reminders.” (pg 141) 
Katia is one of an estimated one million children abandoned by Russian parents
-- Photo by Viorel Florescu
“Eight-year-old Katia, for example, boldly approaches a stranger and responds to a smile with heartbreaking warmth, crawling into the adult’s arms. But she cannot answer when asked about her parents’ names or whereabouts.” (pg. 139)
Vanya was found living inside a Moscow phone booth in the snow.
-- Photo by Viorel Florescu
“When Vanya was just nine years old, he explains with utter lack of emotion, his parents’ drinking escalated. His father – whom Vanya says he detests – beat the boy and his mother repeatedly. And his mother drowned her sorrows in moonshine purchased at local kiosks. …
“…She dragged little Vanya to the massive Belarus train station, located on the western end of Moscow…And then it happened. As a train was about to leave the station Vanya’s mother let go of his hand and jumped into the departing train, never looking back.” (pg. 140)
Man living in a city dump.
-- Photo by Viorel FLorescu
“’What is self,’ she asks. ‘Where are the broders of me versus us? This is all new. The Soviet state used to decide such things. The value of one’s self was not supported. Individualism and personal reflection were discouraged, even penalized.’” (pg. 142)
Confused patriotism and dreams in Irkutsk.
-- Photo by Viorel Florescu
“The Siberian teens of Irkutsk flirt, frolic, and strut, as do adolescents the world over. One draws admiring throngs of girls as he strolls nonchalantly into the bandshell, dressed in a genuine Nike jacket and pants made from an American flag, one leg the stars, the other red and white stripes.” (pg. 143)
Child hawks a brothel guide in Moscow.
-- Photo by Viorel Florescu
“Little Natasha apparently could not read. Had she been able to she would have known that the book, authored by Edvard Maksimovsky, was subtitled An Anti-Brothel Guidebook. In page after depressing page Maksimovsky detailed horrors of the lives of Moscow’s sex workers…” (pg. 230)
Female pimps hustle drivers in front of the Duma in Moscow.
-- Photo by Laurie Garrett
“’That’s the Duma across the street. If they can’t do anything how can we,’ asks the tall guard, who says his name is Sash. ‘It’s been like this since 1980 when the Olympics happened. Now it’s more open. People used to be afraid, but now we have democracy.’” (pg. 229)
Prostitution is open and abundant in Moscow.
-- Photo by Viorel Florescu
“A few blocks away Marina pimps her six girls in front of Russia’s legislative building, the Duma. Duma security guards dressed in combat fatigues watch but do nothing.” (pg. 229)
TB Control Headquarters in Buryatia.
-- Photo by Viorel Florescu
“The region’s hospitals and medical clinics outside the hallowed Kremlin walls ranged from appalling to astonishingly horrible. Most were staffed by personnel who rarely – if ever – were paid. Supplies of all kinds were scarce. Physical maintenance had long since been abandoned, and many health structures were poorly built in the first place.” (pg. 245)
Staffer scrubs hospital walls, yet infections continue to spread.
-- Photo by Viorel Florescu
“…the medical community of the former USSR suffered in the 1990s for having been isolated from the rest of the scientific world for seven previous decades. After all, it was well known everywhere else that burn units, neonatal ICUs, and mechanical ventilators were key sources of nosocomial infections. But it was not because something was ‘growing’ there; it was because the patients and equipment in all three sites were subject to a lot of contact with the ungloved hands of doctors, nurses, orderlies, and family.” (pg. 239)
A Georgian “blood bank.”
-- Photo by Viorel Florescu
“The central blood bank system of Georgia fell apart from 1992 to 1995 during its civil war. In its place emerged a chaotic hodgepodge of hospital banks and blood donation clinics, all of which paid donors, thus attracting alcoholics and drug users in need of quick cash.” (pg. 218)
A glass wall supposedly provides an infection barrier in Georgia.
-- Photo by Viorel Florescu
“Two such donors, Yuri Nevandovski and Viktor Yakolev, reeked of alcohol as they stuck their arms through a portal in a glass wall. On the other side of the barrier a nurse drained their blood.” (pg. 219)
There is no heat on the neonatal ward.
-- Photo by Viorel Florescu
“The situation only worsened after 1991, as elevators broke down, compelling ailing individuals to scale stairs in order to get from test sites to their hospital beds. Food fell into short supply, with most hospitals stating frankly that families needed to provide rations for their ailing relatives, much as they would in India or Zaire.” (pg. 245)
A child is dying of leukemia in Kiev.
-- Photo by Viorel Florescu
“Cancer is genuinely a problem. Though national cancer rates are generally below those seen in the West, cancer hot spots exist all over the former Eastern Bloc and Soviet Union….’There is a real trend upward especially among children.’” (pg. 148)
Smelters belch stench over Noril’sk, Siberia.
-- Photo by Laurie Garrett
“The pollution was undeniable. It assaulted the senses, both physically and aesthetically.” (pg. 148)
Siberian forests are dying due to massive pollution.
-- Photo by Viorel Florescu
“The Taiga forests around Angarsk were denuded by acid rain. No floor of scrub or greenery formed a protective bed for dying trees, their trunks encrusted with black filth. Weighed down by their pollution burden trees leaned at sad angles, eventually collapsing.” (pg. 153)
Frozen pollution.
-- Photo by Viorel Florescu
“Welcome to the most polluted place on Earth, Noril’sk. Located 200 kilometers above the Arctic Circle. No sunlight four months out of the year. Population 280,000.” (pg. 155)
“Onward!” the statue commands the child.
-- Photo by Viorel Florescu
“Next to the requisite stern stature of Lenin was a sign: ‘Angarsk City – Born by Victory!’ From behind the sign American disco music blared. Rows of concrete apartment buildings, each exactly the same as the last, lined the streets of Angarsk, creating a visually numbing landscape.” (pg. 153)
An entire family dies together of AIDS in Kagera, Tanzania.
-- Photo by Rian Horn
-- Photo by Laurie Garrett
“’What you have is a kind of modern conflagration. It’s the modern equivalent of the great Plague,’ said Larry Gostin, professor of law at Georgetown and expert on AIDS and human rights. ‘And that’s what you’re going to get in all of the developing world. It’s going to be losses of whole generations.’” (pg. 573)
Kampala kids demand HIV prevention.
-- Photo by Laurie Garrett
“Perhaps African leaders who failed to place HIV prevention on their top priority lists would be drummed out of office by millions of grown-up AIDS orphans.” (pg. 583)
Iron Lungs
-- Archive photo
“The image of large open hospital wards filled with row-upon-row of the coffin-like devices would become a lasting legacy of American polio.” (pg. 648)
Child dying of polio
-- Archive photo
“By 1950, when about thirty-two thousand people contracted the disease, acute poliomyelitis was the most fear communicable disease in the United States.” (pg. 328)
1947 smallpox vaccination in NYC
-- Archive photo
“By April 20th, with more than 6 million New Yorkers having been vaccinated, the health department could justifiably boast of having executed the world’s largest rapid immunization campaign and limited a potentially devastating epidemic to just eleven cases with only two deaths. By any measure it was a genuine public health triumph.” (pg. 328)
Fight Syphilis!
-- Archive photo
“U.S. average rates of syphilis fell from an all-time high of 447 per 100,000 in 1943 to 154 per 100,000 in 1950. By 1970 the U.S. syphilis rate would be 43 per 100,000.” (pg. 323)
Girl with Polio Braces
-- Archive photo
“On April 12, 1955 – a date deliberately selected because it marked the tenth anniversary of the death of polio victim Franklin Delano Roosevelt – Jonas Salk announced that the polio vaccine was safe and effective. The reaction nationwide was jubilant…” (pg. 329)
Sign of the times on a Ugandan hospital wall
-- Photo by Rian Horn
“The new globalization pushed communities against one another, opening old wounds and historic hatreds, often with genocidal results. It would be up to public health to find ways to bridge the hatreds, bringing the world toward a sense of singular community in which the health of each one member rises or falls with the health of all others.” (pg. 585)
About photographers
Viorel Florescu in Moscow sculpture park, leaning on Stalin, 1997
Viorel Florescu was born in Sighisoara, Romania, and grew up under the dictatorship of Nicolae Ceausescu. As a young man he dreamed of making movies, and escaping the stifling confines of communist Romania. In 1979 Florescu managed to get into Italy, and ended up in the Bronx. He has worked as a photojournalist ever since, putting in 21 years at Newsday, and now at the New York Daily News. In 1997, Florescu traveled across Russia, Georgia and Ukraine with Laurie Garrett, documenting the collapse of the region's health systems and lives of its people. The resulting more than 32 stories published in Newsday were complimented with dozens of Florescu's photos, some of which are posted on this website. You can see more of Florescu's work at http://viorelflorescu.com/
Rian Horn was a young South African on his first photojournalism assignment outside of his home country when he traveled with Laurie Garrett in Uganda and Tanzania, documenting the impact of HIV. Horn continues to live in South Africa, working as a freelance photojournalist for such entities as Reuters, The Guardian and The Washington Post. See more at: http://www.facebook.com/people/Rian-Horn/100000010571266.
Laurie Garrett sitting in Brezhnev's lap, Moscow, 1997
Though Laurie Garrett is not a professional photographer, more than a hundred of her pictures have been professionally published over the years, particularly by Newsday. Many of her photographs appearing on this website – including all of those shot in September 2001 – are herein seen publicly for the first time.