Three hours later Phineas’ mother trusted her instincts and took him to another hospital to get a second opinion. He was admitted immediately.

Phineas in the intensive care unit at ECH, May 2010. Photo: © Michael Cockerham 2010

What followed was a battle to save his life and diagnose the problem. By the Sunday afternoon his condition had deteriorated so much that he was retrieved to the Paediatric Intensive Care Unit (PICU) of the Evelina Children’s Hospital in Central London.

Phineas’ Friends is a photographic study of the doctors and nurses and clinicians that were involved in treating him during his six days at the Evelina. It is a study that forces the reader to challenge naturally held preconceptions about the size of modern medical teams, and indirectly asks the question: if all these people are necessary to a treat one baby with an infection, who in this new age of austerity can we afford to do without?

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Phineas is my third son. His mother, Laura, is my wife. Any parent who has ever asked a doctor if their child is going to die, and been met with a long pause and a non-committal answer, will have some idea of the emotions that were raging for us at that time. We were lucky. Although his condition was life threatening, he was in the best hands. Laura travelled to ECH in the retrieval ambulance with Phineas. By the time I got there the PICU team were hard at work stabilising him, and Laura, though still beside herself with worry, was comforted with the feeling that he was in the best place to get better.

Fatima Meho. Paediatric Staff Nurse, Beach Ward. Provided nursing care for Phineas on the ward. Photo: © Michael Cockerham 2010

The doctors in PICU were able to stabilise him sufficiently that he was moved out of intensive care onto Beach Ward on the Monday afternoon. From then on it was about supporting him as he got better, and trying to establish exactly what was wrong with him.

From the outset the doctors were fairly certain that he had a viral infection. The problem was that without knowing which virus, it was difficult to know exactly how he should be treated. At his worst Phineas had been cannulated to all four peripheries, his blood sugar was perilously low, his temperature was dangerously and stubbornly high, and he was on a CPAP (continuous positive airway pressure) machine to help him breathe. He was having bloods taken every hour or so, he had chest x-rays, and at one point they attempted to put a long line into him because his blood sugar was still dropping and he was on the limit of what could be given to him as a peripheral infusion without burning his veins.

Laura never left the hospital, only leaving his bedside to wash and eat. Over time it became clear that he was improving, but still the tests continued. Lumbar punctures, electro-encaphalographs, ultrasound brain scans. More infusions, more drugs.

Dr Emma Aarons. Consultant Virologist. Ensures any patient with possible viral illness has the right investigations, and where tests show viral diagnosis that the appropriate care is given. Photo: © Michael Cockerham 2010

On the Wednesday afternoon I was sitting with Phineas while Laura got some lunch. Staff nurse Fatima Meho was attending to him while I flicked through that week’s Sunday Times Magazine. The cover story was about a patient in the renal ward at Great Ormond Street Hospital. I held the magazine open for Fatima to see and remarked how ironic it was that the story should be published just I was sitting in Beach Ward (the Evelina’s renal ward) with my son. “No one ever writes about us,” Fatima replied. I asked her what the difference was between Great Ormond Street and the Evelina. “Nothing,” she said. Both hospitals have the same specialisations, only the former is world famous and leverages that fame effectively to raise funds. I have to admit that I had never heard of the Evelina until I needed it.

It was Fatima’s response which set me thinking that I should document Phineas’ story and get some publicity for the hospital. But what was the angle? I did not want to rehash a story that has been done many times before. The fact was that although it was important to me, it was not significant to anyone else. If I was going to publish his story, it needed an angle.

The following afternoon Laura and I got a visit from three doctors from the Infectious Diseases Directorate. At first I was struck by how different these three characters were. Nuria Martinez-Alier, Ian Plumb and Emma Aarons seemed at first an unlikely trio, but it quickly made me reflect on all the different characters we had come across during Phineas’ time in hospital. Not simply the diversity of characters, but the sheer numbers of people involved. I had my angle.

Dr Marilyn MacDougall. Paediatric Intensive Care Consultant. On-call when Phineas was admitted to PICU, she made the decision to retrieve him. Authorised the retrieval team and responsible for his initial treatment. Photo: © Michael Cockerham 2010

Over those six days Phineas was treated by about one hundred clinical specialists, about four fifths of them at the Evelina. There were doctors, consultants, registrars, nurses, matrons, ward sisters, students, phlebotomists, radiographers, metabolic specialists, virologists, and these were just the ones that actually saw him. There were as many, if not more, clinical scientists and technicians analysing and interpreting the various tests he was subjected to and samples taken from him. There was the ambulance technician and the retrieval team who collected and treated him on the journey to the Evelina. There was the counsellor who was there for us as parents.

As a photographer I found myself thinking about all the hidden talents within this huge team of people – the unsung men and women whose work as technicians and scientists underpin the decisions that the doctors make and the nurses carry through. The doctors get the plaudits, but the reality is that all these different facets of modern medicine need to work together to produce the outcomes that we as patients and parents yearn and pray for.

The more I thought about all these people, the more I kept thinking about Richard Avedon’s seminal work The Family, and more recently of Nadav Kander’s Obama’s People. Both these projects used portraits shot against plain backgrounds to highlight the differences in character – the repetition of style and of people was the motif, and yet it is this approach that highlights the enormous differences from subject to subject.

Tom Walton. Biomedical Scientist. Analysis of urine by gas chromatography and mass spectroscopy. Photo: © Michael Cockerham 2010

It is a form of typological study that was perhaps made famous by Bernd and Hilla Becher and their studies of blast furnaces, and taken up by other photographers including Donovan Wylie and his study of the Maze Prison. The difference is that with people the subject has the capacity to introduce its own character and agenda to the way that they are recorded; it is necessarily a two-way process. Certainly these are “my” portraits and they reflect something of my intention, but as each individual sits for me, they have control over the face that they present. For a good portrait there must inevitably be a balance in that “dialogue” between the subject and the photographer.

Avedon chose to shoot in large format black and white, with a simple white background. His subjects were the men and women who ran and shaped America. From Gerald Ford as President to Roger Baldwin, the founder of the American Civil Liberties Union.

Kander chose to use a similar approach to document the nascent administration of Barack Obama as he was about to take office, but in this case he shot in colour, with a creamy background. The images have been digitally worked to some extent, putting a shadow close in behind each person, and emphasising the texture of each person. There is a kind of hyper reality about them which makes each face fascinating to look at. Although the work was regarded by some as something of a departure from Kander’s norm at the time, it was nevertheless imbued with his artistic sensibilities. It had his “signature”.

Sean Hayes. Retrieval Technician. Part of the retrieval team that brought Phineas back to the Evelina PICU from Darent Valley Hospital. Photo: © Michael Cockerham 2010

Both of these bodies of work were successful for the combination of simple, arresting portraiture and the fact that the subjects were either household names, or held positions of power that made their faces worthy of closer inspection.

For Phineas’ Friends I felt certain that a similar approach would be ideal. To the best of my knowledge no one had taken this approach with a medical documentary before, and the strength of the story would reside in the fact that as the reader moved through all of these portraits it would dawn on them that the common link for all of them was a single patient – a baby. None of these people are famous, nor was the patient. But the pull of such a small child as a narrative element is undeniable. Perhaps more importantly, we are all able to see ourselves in that baby. And when we do Phineas’ friends become our’s. These are our doctors and nurses and technicians and scientists. These are the people that keep each of us alive if we need them. As Phineas is a metaphor for all patients, so too his friends are a metaphor for all the clinicians working in all the hospitals around the world. Once we realise that, the old narrative beloved of dramas and documentaries seems a pale approximation of the truth – modern medicine is not a doctor and a nurse, it is a vast team of specialists.

Habiba Kawu. Neonatal Staff Nurse. Agency nurse providing constant care and monitoring of Phineas' condition while in intensive care. Photo: © Michael Cockerham 2010

Nevertheless I was conscious that for the project to work, the standard of the portraits needed to be high. Each image had to work individually while they all worked together as a set. The choice of background, the style of lighting, the choice of lens, and the subtlety of any direction I gave would have to complement the image and the intent. I wanted very much to give viewers something of the experience of the parent or the concerned relative. Hopefully I have succeeded.

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I decided on a whim to enter the book of Phineas’ Friends in this year’s Photography Book Now Awards. Although it did not win, it was shortlisted in the Documentary Category, and as a result was eligible for the People’s Choice Award. To have been shortlisted by the jury in the first place is a tremendous honour. But more importantly it gave me a glorious reason to push the work in front of people as I tried to garner all the votes I could. I was able to enlist the help of a great many influential people around the world, and that in itself has helped in my quest to raise the profile of the hospital. All of you who voted, thank you. Your support means a great deal. But it does not end there.

As I intimated earlier, my motivation from the outset has been to help publicise the work of the Evelina and perhaps raise its profile just a bit. As a part of that process, Blue Filter has published Phineas’ Friends in three formats: as an iBook for the iPad and iPhone, as a small format paperback, and as a limited edition signed hardback. All of these can be ordered from this site, and the profits from the sale of these books will be donated to the Evelina Children’s Hospital.

Please, buy the iBook or the paperback. If you are feeling flush and want some exclusivity, buy the hardback. But whatever you do, encourage all your friends, family and acquaintances to read this post and buy the iBook too. If you just want to donate with nothing in return, you can do that as well.

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Buy the iBook for iPhone & iPad

Buy the paperback

Buy the limited edition hardback

If you would like to support the Evelina Children’s Hospital, some of the Evelina Team recently undertook a sponsored climb up Mount Kilimanjaro, and you can still donate now. Their target was £400,000, with the current total raised standing at £396,616.63. It is to this fund that monies raised from the sales of Phineas’ Friends will be donated, but if you would rather donate directly, please click here.

]]> http://www.bluefilter.co.uk/phineasfriends/feed/ 5 http://www.bluefilter.co.uk/a-reasoned-approach-simon-norfolk/ http://www.bluefilter.co.uk/a-reasoned-approach-simon-norfolk/#comments Sat, 07 May 2011 11:13:32 +0000 admin http://www.bluefilter.co.uk/?p=872 There are a great many photographers that I admire as photographers, but for the most part it is simply the quality of their output that attracts me. Simon Norfolk is a rare exception, someone who admire not only for the quality of his images, but as much (if not more so) for the thought, reasoning, personal politics and agenda that they are embued with.

I came across this short film today about a new body of work that he has been creating in Afghanistan, that references the work of Eighteenth Century commercial photographer John Burke.

Simon has a very clear idea of what he feels about the events going on in various parts of the world, and whereas many photographers drop in to a place “report” and leave, his approach is to make a statement about his views. It is less the supposedly objective reporting that others may (often incorrectly) believe they are undertaking, and more the subjective response as reporting. As a younger photographer Norfolk was often considered quite militant in his pronouncements. With age and experience his methods have become more nuanced and precise, but he has lost none of his anger and desire to hold a mirror up to the follies of the west. Long may he continue in this vein.

Note: The soundtrack does not start until about 45 seconds into the film.

Well there is a new one about to be released, with the subtle difference that it is based on a true story. The Bang Bang Club is due to have its cinematic release in the United States on April 22 (as yet there is no date for release in Europe). The trailer (see below) promises everything that we have come to expect from these films.

I have no idea, it may actually be very good, but I would hope that it places plenty of empahsis on the fact that of the four members, one was killed on assignment, one committed suicide after finding it increasingly difficult to reconcile the fame that came with his Pulitzer Prize with the public opprobrium he faced for the photo that won the award, and a third has recently lost both his legs in Afghanistan.

I know that the surviving photographers have been involved in the making of this film, and it is based on the book of the same name written by both Greg Marinovoch and Joao Silva (the other two members of “the club” were Kevin Carter and Ken Oosterbroek), so one hopes there will be rather more accuracy than is often the case when Hollywood is let loose on the truth. Having said that, it would be folly to suggest that there wasn’t something inherently glamourous about the life the club led. The problem, therefore, is how to convey the story without spurring ever more young and naive wannabes to pick up a camera and head for a war zone in the hopes that some of that glamour might rub off on them. Most of the time it won’t.

I confess I am looking forward to seeing the film, but I would urge anyone not familiar with the story to read the book first, and if possible see the Oscar nominated documentary The Death of Kevin Carter too. At the very least that will give some scope to strip the truth from the good yarn that the film must almost certainly be.

I have to confess that I am a nosey sod, so I find most things interesting, but I was thrilled to be invited by Ben and Cathrine to document the birth of their second child following some pregnancy studies I had made of Cathrine in December.

While I was present at (and to some extent, photographed) the births of my own three children,  I always felt too close to the event emotionally to do it any justice. In the case of Ben and Cathrine I was able to be an impartial observer, but it was still a magnificent experience. Here’s a taste of what I caught. Oh, and if you know of anyone else who’s expecting and would like to have it documented let them know that I am looking for more subjects as part of a larger project.

A two image narrative of the birth of Espen

Cathrine manages the pain of labour with the support of husband Ben and some gas and air

Espen weighed a considerable 10lb 1oz at birth

I have to confess to a personal interest. Fifteen years ago today, a matter of weeks after giving up the day job to pursue photography full time, I was in Japan working on the research for a picture story I was going to do on the A Bomb survivors. It was coming up to the 50th anniversary and I wanted a counter in the western press to the stories that were inevitably going to run. I had interviews set up, access to the archives and museums, and a great many people eager to help. What I lacked was an innate understanding of what it was like to be in a city that is destroyed in a matter of seconds. I was based in the Kansai city of Kobe.

The former (and now deceased) PA picture editor (and one of the founder members of the Picture Editor's Guild) Eric Pothecary told me that this was the best photo of "shell shock" he had seen since McCullin's famous image from Vietnam.

Fires consumed whole city blocks.

At 5:46am local time an apparently dormant fault under the northern tip of the island of Awaji, about 20km from Kobe, ruptured at a depth of 14km. The resulting earthquake was measured at 7.3 on the Richter scale, and was the first recorded earthquake in Japan to reach 7 on the Japanese Closed Scale which measures the intensity of the tremor as experienced by people and objects on the earth’s surface, as opposed to the Richter Scale which is concerned with the seismic energy released at the epicentre of an earthquake. In terms of how it felt for people in Kobe, it recorded an 11-12 on the Modified Mercalli Scale; that is “Very Disastrous” to “Catastrophic”. It was, and remains, the first major earthquake to strike at close quarters and a shallow depth relative to a major metropolitan conurbation. Japan is used to having earthquakes, and for years buildings have been built to “withstand” them.

The remains of a hopeless battle three days later.

Nevertheless, the violence of the earth’s motion was too great. Nearly 6500 lost their lives, with thirty thousand requiring hospital treatment and almost a third of a million rendered homeless. The final cost of the quake has been estimated at as much as US$200 billion.

I got what I was missing and discovered what it was like to be in a city flattened in seconds: it has coloured my view of everything ever since.

On the face of it, the quake in Haiti is similar, a shallow hit. But Haiti isn’t built to withstand it, and it does not have the resources to pick itself up. Japan, despite its considerable wealth  struggled, and to some extent through misplaced pride, it paid the price. Haiti asked for help right from the start, and it needs all the help it can get.

In the end, the size and place of this kind of disaster is incidental. Only those who have experienced it first hand can ever truly understand how terrifying it is when the ground – that one thing that we all take as a constant – turns against you.

Today, of all days, my thoughts are with all those who have been scarred by earthquakes, and in particular it is with those in Haiti.

These are some of my photographs from Kobe, and form part of a very long term project called Shikata ga nai 仕方がない, a very common Japanese expression that translates as “It Can’t Be Helped”.

If you want to help the people of Haiti click here and donate to the Disasters Emergency Committee Haiti Appeal.

Because the water mains were ruptured, appliances had to be daisy-chained together from the nearest culvert to provide water to tackle the blazes. Many of the appliances were destroyed in their stations.

The high frequency earthquake was particularly devastating for low rise buildings.

Burnt out area in Nishinomiya, January 24, 1995.

Frequently only one hose could be spared for a fire that in normal circumstances would have required 10-15 appliances, let alone hoses.

This was as close as I could get with a 200mm lens without losing my hair.

The building to the right was a multistory carpark. The only noise you could hear was that of car horns and alarms, a noise which continued until the car batteries died.

The upmarket Kobe suburb of Ashiya.

Burnt out area, Amagasaki, January 24, 1995.

Fumi and her daughter Hana were pulled from the ruins of their home in the background. January 17, 1995.

Locally based soldiers tried to offer some assitance for search and rescue, but were hampered by the destruction and the peculiarities of the terrain: a thin strip of habitable land bordered by mountains and the sea.

Where people were pulled alive from the ruins friends and family used anything as a makeshift stretcher to get them to the hastily erected field medical centres, all the time dodging live sparking power cables.

People were stunned by the destruction and ensuing fires, not really knowing what to do next.

Every now and again someone has an idea so blindingly obvious it is difficult to see why it has not already been done.

Take the Magnum photographers for example.  They spend their lives chasing stories; stories are their raison d’ètre.  Sure they publish books on particular stories:  Larry Towell has The Mennonites, and Paul Fusco has RFK Funeral Train.  They even have collective books on given stories, like New York September 11, and Arms Against Fury, but generally they are retrospectives.

The Fat Baby is the new book from Eugene Richards, one of the brightest stars in the Magnum firmament.  It bucks the trend with something really unique: a retrospective of stories.  Rather than put together a large coffee table tome of great images taken out of context which would undoubtedly sell, Richards has chosen to publish the original stories as he took them, with his own notes or text alongside.  This may not be ground breaking stuff, but on a book of this size (432 pages with some 300 duotone images) it feels as though it is.

Richards’ work is powerful, poignant and eloquent.  The images stand on their own merits in isolation, but put into the context originally envisaged the effect is magnified.  They really do become greater than the sum of their parts.

Now sixty years old, Richards is well established as one of the leading exponents of the photoessay, and could easily have chosen to use work from throughout his distinguished career.  Any such retrospective would have been well received, but one suspects that he might look upon the retrospective as the preserve of retired photographers.  Make no mistake; Eugene Richards is very active, and The Fat Baby draws only on his considerable pool of recent stories. 

Arguably Richard’s greatest achievement, and indeed the reason he is able to gain access to groups of people who might otherwise be hostile to his advances, is the manner in which he gives voice to other people’s stories without being judgemental.

While there are many photographers who view “concerned photojournalism” as an invitation and means to voice their own views, the real genius of Richard’s narrative is the manner in which he presents deeply moving stories and leaves the reader to form their own opinion.  This is no small achievement, and one suspects it is a large part of his reason for producing the book.  While his Magnum credentials give him considerable clout when it comes to the use of his images and captions, he nevertheless often finds his photographs being used as mere illustrations to accompany text, which can put a completely different slant on a story to that which he may have intended.

The Fat Baby is a collection of 15 essays, with subjects ranging from gay parenting issues in Tuscon (Here’s to Love), to the famine suffered by the villagers of Safo in Niger (The Fat Baby – from which the book takes its name).

By reproducing the notes and keeping the original narrative of the stories together, it invites the reader to consider the issues: it provokes a response.  No one who professes to support what documentary photography is about should ignore The Fat Baby.  It is a monumentally important book.  Not simply because it is well produced, but because it actually gets back to the root of why pictures such as these are made in the first place.

The Fat Baby by Eugene Richards, £59.95/€90.00, Phaidon Press, March 2004.

We are all inexorably drawn to war.  Tales of courage under adversity, heroism under fire, acts of selflessness and love, men in uniform and the pomp and technology of the military in action.  It is at once fascinating, horrifying, shocking and guaranteed to provoke a response.

It is no wonder then, that war has always exerted a pull on photographers.  Some go to make a name for themselves; others hoping their work might make a difference.  Some go for the rush.  Whatever the motivation, they are usually divided into two camps: those who look for the dramatic images of combat in the front line, and those who turn to the plight of the civilians caught in the crossfire.

New York based photographer Lori Grinker has uniquely found a different way to portray war.  When the truces are signed and the guns fall silent, the press turns its attention elsewhere, but the sights, sounds, smells, relationships and losses are necessarily etched into the psyches of the combatants.  While other photographers have concerned themselves with showing the man within the war, Grinker has strived to portray the war within the man.

Afterwar manages the substantial achievement of personalising the conflicts of a century.  Men and women caught in the dehumanising chaos of war are left to reconcile their experiences with their own fundamental humanity.  Some meet it head on, others try to file it away, and get on with their lives.

Readers looking for groundbreaking photography or iconic images will be disappointed with Afterwar, but they will also be missing the point.  Allied with the testimony of her subjects in their own words, Grinker’s colour photographs achieve something that has eluded every other photographer: they deglamourise war.  While each of the subjects is portrayed with incredible dignity the overall effect is unremittingly dark and depressing.  War is hell.

Afterwar is elegantly designed, using a reverse chronology to take us back from a taste of the recent war in Iraq through all the major conflicts of the past century to the First World War.  It crosses continents, cultures and languages setting each conflict in context.  Ostensibly each person in the book represents a survivor of war, but their experiences have necessarily robbed them of something precious, and mankind as a whole is diminished by what they went through.  If there is any justice Afterwar will find its way to the desks of all those charged with calling men to arms.

Afterwar, Veterans from a World in Conflict is published by de.MO, and priced at £29.00.  Hardback ISBN 0-9705768-7-0.  248 pages.