Alison McCauley is a Geneva-based documentary photographer. The main themes that run through her work look at issues concerning identity and belonging, migration and living conditions. These interests were doubtlessly born from Alison's experiences of constantly moving from country to country and the resulting ambivalence towards the idea of her own national identity and her feeling of not belonging to any particular country or community. Among other projects, she is currently working on a long-term project documenting the lives of asylum seekers in Geneva. Alison has a fine arts background and holds degrees from the University of Southampton, the Haute Ecole d’Art et de Design in Geneva and the Open College of the Arts.
COPE (Cooperative Orthotic and Prosthetic Enterprise) is a non-profit organization that supports the Ministry of Health’s Center for Medical Rehabilitation (CMR) in Laos. COPE provides technical training for CMR prosthetists, orthotists, physiotherapists and occupational therapists. COPE and CMR work together to ensure comprehensive rehabilitation services for unexploded ordnance (UXO) survivors and other people with disabilities throughout Laos.
Laos is, per capita, the most heavily bombed country in the world and Xieng Khouang Province is the most heavily bombed province in Laos.
In the wake of the United States’ reaffirmation that it will provide further assistance for UXO clearance in Laos and before President Obama’s scheduled visit to Laos in September this year, I decided to take a closer look at the treatment of those injured by UXOs in Laos. In May and June 2016, I accompanied COPE during a mobile clinic that travelled to remote areas of Xieng Khouang Province, in Lao PDR.
Although COPE covers all the patients’ expenses to access physical rehabilitation services, difficult road conditions, family responsibilities, and fear about traveling far from the familiarity of home prevent many people with physical disabilities in Laos from seeking treatment. Acknowledging the existence of these barriers, COPE and the CMR are piloting mobile clinics. These clinics are sponsored by USAID and also supported by the government of Canada.
Cope’s mobile clinics enable people with disabilities to get the services they need. Lack of access can make a manageable health problem turn into serious disability. Difficulty accessing quality healthcare remains a recurring problem for most Lao people living in rural areas. Frequently, a simple treatment can have a big impact on a patient’s life, especially in underserved rural areas.
In May and June 2016, the mobile clinic treated more than 100 patients.
The term “hijra” is used in India to refer to individuals who consider themselves as transgender or transsexual male to female. India has an estimated one million hijras. The hijra communities in India have a recorded history that goes back more than 4,000 years. They have historically had a sanctioned place in Indian society and culture. Ancient myths bestow them with special powers to bring luck and fertility.
However since the Raj first classified the hijra as a “tribe” at the time the Raj outlawed all tribes, hijras have faced severe harassment and discrimination. Most hijras are uneducated and their lack of education and the discrimination they face makes it almost impossible for them to gain mainstream employment. Hijras earn their living singing and dancing at celebrations of births and weddings, and through begging and prostitution. Most hijras work in the sex trade.
The orthopedic compensation shoes that will help this woman to walk without limping and which will ease her back pain
Physiotherapist Am Heng comforts a boy while the doctor prepares a cast for his foot
Three siblings with fused fingers. They will have surgery to have their fingers separated. The high incidence of congenital anomalies in Laos is probably due to the more than half a million gallons of Agent Orange that were sprayed on Laos during the Vietnam War.
The team advises a man who has severe burn injuries to his hand
The mobile clinic van parked after the 12-hour journey from Vientiane to Xieng Khouang Province, Laos
Wiak, 13, having his bandages changed a few days after suffering terrible injuries to his left hand and losing part of his right index finger and thumb to a UXO explosion on his familyâs farm
On the move again after waiting four hours for a mud slide to be cleared after heavy rain
The casts that will be used to make leg braces for a little boy with clubfeet
The doctor fills in a chart for a little boy with clubfeet.
The team advises a young couple about treatment for their babyâs scoliosis. They also referred the family to a plastic surgeon so that the babyâs cleft lip and palate can be corrected.
A medical technician takes measurements, so that he can begin making prosthesis for a patient
A typically busy morning during the Xieng Khouang mobile clinic
A physiotherapist and a doctor help a boy with nerve and muscle damage in his arms.
The casts that were made in one day of the mobile clinic
Physiotherapist, Am Heng, checks a young patient
Wiak, 13, in hospital with his brother four days after suffering terrible injuries to his left hand and losing part of his right index finger and thumb to a UXO explosion
A mother waits for a lift back to her village after getting support from the clinic for her babyâs hip dysplasia
A prosthesis and crutches put to the side while a patient is measured for his new prosthesis
COPE Rehabilitation Manager, Suresh Selvaraj, helps a patient with cerebral palsy
A young man with a congenital malformation of his hands has a cast made. The cast will be used to make a support that will increase the flexibility of his atrophied muscles.
Before the arrival of the mobile clinic, 30 year old Hone has crawled all his life on his hands and feet
30-year-old Hone, who lives in an isolated mountain village, could not reach a hospital because of his heavy disabilities. A truck was sent to Honeâs village with some mobility assistive devices and a physiotherapist.
A young boy, wearing his new orthopedic shoes, catches up with his father after having his legs cast so that he can get braces made to support his legs
A twenty-year-old woman who canât walk sits proudly in her first ever wheel chair that the mobile clinic team has given her
COPE Rehabilitation Manager, Suresh Selvaraj, helps a patient to exercise his atrophied muscles
A boy, happy that his orthopedic shoes give him more stability
A young man, who lost an arm and who was badly burnt in an explosion at work, waits patiently for the doctors to make a cast of his arm.
A doctor examines the worn out prosthetic leg of a 14-year old girl
14-year old Ler, who was born without a tibia bone in one leg, has used a lower-leg prosthesis since she was 4. She came to the mobile-clinic to adjust her prosthesis. Children and teenagers need to do have adjustments every 6 months.
A woman who has had surgery on her foot after suffering serious burn damage, comes to the clinic in need of further treatment
Two burn victims help the doctors fill in their medical forms, while other patients wait in the background
Onh, on the left, lost most of his left hand in a fire when he was a baby. Dr Boavanh, one of the few female surgeons in the Lao PDR, explains how he could get back a thumb and have better use of his hand.
COPE Rehabilitation Manager, Suresh Selvaraj, waits for patients to make their way across a river to the mobile clinic
On the road
COPEâs vehicles make their way through the mountains of Xieng Khouang Province, Laos
A young man, who recently lost his leg in a traffic accident, makes his way to the mobile clinic in Xieng Khouang Province, Loas
A young man, who recently lost his leg in a traffic accident, tries on prosthesis for the first time, Xieng Khouang Province, Laos
The mobile clinic makes a stop at the medical rehabilitation clinic of a district hospital
Hijra communities in Mumbai after the Indian Supreme Court reinstated Section 377.
The term “hijra” is used in India to refer to individuals who consider themselves as transgender or transsexual male to female. India has an estimated one million hijras. The hijra communities in India have a recorded history that goes back more than 4,000 years. They have historically had a sanctioned place in Indian society and culture. Ancient myths bestow them with special powers to bring luck and fertility. However since the Raj first classified the hijra as a “tribe” at the time the Raj outlawed all tribes, hijras have faced severe harassment and discrimination. Most hijras are uneducated and their lack of education and the discrimination they face makes it almost impossible for them to gain mainstream employment. Hijras earn their living singing and dancing at celebrations of births and weddings, and through begging and prostitution. Most hijras work in the sex trade.
On July 2, 2009 the Delhi High Court passed a landmark judgment where Section 377 of the Indian Penal Code was overturned. Under Section 377, which dates back to 1861, lesbian, gay, bisexual and transgender individuals are not accepted by Indian society. Only two genders are recognised and only heterosexual relationships are legal. After the 2009 judgment, sexual acts in private between consenting adults of the same sex were no longer criminalized. Although this had been the foremost long-standing demand of the LGBT movement in India, the Delhi High Court’s ruling that decriminalized homosexuality did little to end a long history of discrimination for the hijra communities. In December 2013, the Indian Supreme Court reinstated Section 377 of the Indian Penal Code. A date was set to review this verdict, but on January 28th, 2014 the Supreme Court declined to review its verdict reviving a Victorian, colonial era provision that declares consensual homosexual acts in private a criminal offence punishable with life imprisonment. The reinstatement of this law could affect the government support and funding that is given to organisations and charities that help the hijra communities and this in turn will have repercussions on the hijra communities’ safety, welfare and health.
Hijras, like other sexual minorities in India, are usually rejected by their families and communities once they reveal their sexual identity and they are almost always forced to leave the family home. Ostracised by family and friends and harassed constantly by the police, hijras form small groups for their protection. These groups are lead by a “guru” or mother figure. At their best, the groups can be supportive, nurturing and family-like. Out of a necessity to protect themselves, hijras developed their own language - a mixture of Hindi, Farsi, Urdu and a little Arabic. Some hijras are castrated, but there is no pressure to undergo castration and the decision is left to each individual. Many opt for breast enlargements as soon as they have put enough money aside. The Humsafar Trust, a non-profit organisation that works with the lesbian, gay, bisexual and transgender communities in Mumbai, subsidizes the cost of hormone treatments for hijras. HIV rates are very high among the hijra community. Statistics vary between 50 and 80 percent. The Humsafar Trust has community outreach programs that care for and support the hijra community. The trust’s employees and volunteers distribute thousands of free condoms each week even though they run the risk of being arrested for “encouraging sex”. Despite the excellent work that The Humsafar Trust is doing, protecting hijras from the frequent abuse and violence they face at the hands of customers and the police is almost impossible.
Puja is an energetic and talkative hijra guru, who lives near King's Circle Station, in Mumbai. She told me that she is raped on average ten days out of every month. She says, that the police won’t help and she thinks the reinstatement of Section 377 will make the police more likely to treat hijra abusively. Puja, like most of the hijra sex workers, charges 100 IRP ($1.60) for 15 minutes. She says she has between 6 and 10 clients a day. She was in a relationship with a man for two years, but he has since bowed to family pressure and married and started a family. Puja still loves him and he comes to spend time with her at least once a month. She says, “It’s better than nothing”. Kajal, a quiet, sad-eyed 20-year-old hijra, also lives near King’s Circle Station. She says, “I have felt like a woman since my early childhood. When I became a hijra three years ago, my family forced me out of the family home in southern India.” She is still in contact with an aunt and uncle and she sends them money when she can, as is the custom in India. Kajal says she hopes one day to be able to afford to be castrated in a hospital. A drunken client slashed her two years ago and she has a long, raised scar across her back. Husna is also a sex worker. She picks up clients at the train station and says, "I don’t think about the danger because I have to survive." Shalu, is gay, but he has been adopted into Puja’s hijra family. He is gentle and shy. He has a boyfriend who he loves. Shalu is also a sex worker. The graceful, Urmi, is a Transgender Representative with The Humsafar Trust. She works six days a week supporting the hijra in different communities spread throughout Mumbai. Maduri is a guru who works for SPARC (The Society for the Promotion of Area Resource Centres) in Laloobhai Compound in Mankurd, Mumbai. She resolves disputes within the community and she’s responsible for a community money lending scheme. Maduri was born with intersex anatomical sexual characteristics but she has always felt more female than male. Ankita was a guru who died of an infection 15 days after being castrated in a hospital. Her portrait hangs in one of the community offices used by The Humsafar Trust. These are just some of the many hijra I met in Mumbai. Their stories describe the positive work being done by organisations such as The Humsafar Trust, but also the emotionally and physically difficult and dangerous lives hijra are still forced to lead in contemporary India.
Kamal attracts customers at Thane station in Mumbai. She will find customers there and take them to a nearby hotel that charges by the hour.