Voices behind the pictures: TB Photovoice Thailand

Photo by bobbyramakant“Those who have HIV or active TB [tuberculosis] are in enough trouble. No one wants to be infected. Please give them sympathy and understanding, not disgust,” said Daenchai Narai.

Daenchai, a TB Photovoice volunteer from Chiang Dao in Northern Thailand, went to the USA this month to portray his experiences with the disease through the use of photographs and to highlight TB prevention and treatment issues on World TB Day on 24 March.

“When I was first admitted to hospital for anti-TB medication, I saw some TB patients who hid their medicines or refused to take them because the drugs made them vomit. Soon they passed away and I was so scared about skipping my daily anti-TB dose,” Daenchai said.

“Sometimes when I vomited I took the pills out of my vomit, washed them and swallowed them again … I only received a set of 30 anti-TB pills for every 30 days so if I lost one it meant missing a day. I didn’t want to die. I wanted to complete the treatment and be cured.

“During the anti-TB treatment, I lost my appetite. I couldn’t eat and I lost weight. I weighed 65 kg before I was diagnosed and soon weighed 40 kg as the TB progressed. But my mother took care of me in the hardest times and now I am 73 kg.”

Soon after completing his TB treatment, Daenchai came into contact with TB Photovoice (TBPV). The rates of TB and HIV co-infection have reached alarming levels in Northern Thailand and the two diseases pose a serious threat to public health.

In an effort to promote a greater awareness of the issue and the impact it has on communities, TBPV empowers people affected by TB to tell their stories through the use of photographs.

Participants are trained to take photos and write about the effects of TB on their daily lives. The images and stories are then used to stimulate discussion on TB and HIV-related issues within communities in an effort to raise awareness and promote dialogue.

“When I first became a volunteer for TBPV I was given a camera. I didn’t know how to use it, but I got help with taking pictures, photo composition, how to write and how to talk to people using these photographs,” Daenchai said.

The stories told by TBPV participants are valuable national, regional and international advocacy tools. TBPV has held exhibitions at the Thailand National AIDS Seminar 2007, the Eighth International Congress on AIDS in Asia and the Pacific (ICAAP) 2007 and the 38th Union World Conference on Lung Health 2007.

Daenchai is now in the USA, sharing his perspectives on the fight against TB with other TBPV participants from around the world.

“I would like to thank TB Photovoice in Thailand because the programme offered me an opportunity to talk to other TB patients, share my experiences with others and help other people to get tested for TB,” Daenchai said.

“Some people told me that after discussions with me during TBPV sessions, they felt more comfortable with revealing their TB status and talking about experiences they have never discussed before.”

Daenchai said he felt tremendously empowered, having realized his own potential to help others. “I can make a valuable contribution too … Before this people discriminated against me and I felt low. I was losing my self-worth.”

Daenchai said working with TBPV had made him feel more positive about the fight against the disease but he also said that food security for TB patients remained a major challenge.

“In Thailand we have free TB medicines too but people with TB are sick, weak and if they are poor and have no savings, how can they manage the costs of food, transport to the hospital and other support they might need for themselves and their family?” he said.

Daenchai has used the photography skills he learnt from TBPV to help earn some extra money. “I can earn about 300 to 400 Thai baht (about US$ 10) per day by taking photos for people in the community, especially during festivals or special events,” he said.

“My favourite photo that I have taken is of innocent kids. Everyone would love to hold them and play with them but if they were born into the homes of people living with HIV or active TB, then people might not want to touch them. It pains me,” Daenchai said.

TBPV is coordinated by Health & Development Networks (HDN) in partnership with Chiang Dao Hospital, Chiang Dao Public Health Department, Chiang Dao PWHA Network and the Anti-Tuberculosis Association of Chiang Mai, in Thailand, with initial support from the Amaya-Lacson TB Photovoice Project.

Jitima Jantanamalaka-CNS

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