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  • CAPTION: This is the Adolescent Reproductive and Sexual Health (ARSH) clinic at Ghatshila Community Health Centre (CHC). Atosi Shit (right) is an adolescent client, and Sarita Kumari Panna (left) is an ARSH Counselor. Here, Kumari is giving information on hygienic practices during the menstrual cycle in order to guard against infection and possible infertility. The ARSH clinics have been designed to provide health-related services to young people aged between 10 and 19 at a time when they are going through a lot of changes, both physically and mentally. This can mean anything from getting a small wound dressed to getting an abortion. LOCATION: Adolescent Reproductive and Sexual Health (ARSH) clinic, Ghatshila Community Health Centre (CHC), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: Sarita Kumari Panna (left) and Atosi Shit (right).
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  • CAPTION: The lady on the right is a sahiya. She serves as a link between the health system and the community, working at the grassroots in villages. Every village has at least one sahiya. They help health service professionals understand what community needs are and what issues community members are facing. LOCATION: Adolescent Reproductive and Sexual Health (ARSH) clinic, Ghatshila Community Health Centre (CHC), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: Dr Ram Chandra Soren (left) and Rupali Shit (right).
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  • CAPTION: ARSH Counselor Sarita Kumari Panna explains the use of iron and folic acid tablets to Atosi Shit. Most of the adolescent girls (perhaps 80-90%) in villages like this are anemic. There is large-scale absence of awareness of how to ensure their diets contain iron and folic acid, especially with the rising popularity of fast food while young people are away at school or college. Girls are especially unaware, after their menstrual cycles start, about when they ought to have particular types of nutrition. This often results in menstrual problems and anemia. LOCATION: Adolescent Reproductive and Sexual Health (ARSH) clinic, Ghatshila Community Health Centre (CHC), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: Sarita Kumari Panna (left) and Atosi Shit (right).
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  • CAPTION: Adolescent client Tulika Shit has a lower respiratory tract infection. Many adolescents in this area have tuberculosis (TB) but don’t realize it. So Dr Ram Chandra Soren is checking whether her symptoms add up to this. ARSH clinics provide services that extend far beyond reproductive and sexual health. They are far more accessible to young people than the outpatient department (OPD) at the hospital is, ensuring they can get the services they need quickly. LOCATION: Adolescent Reproductive and Sexual Health (ARSH) clinic, Ghatshila Community Health Centre (CHC), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: Sarita Kumari Panna (left) and Sujata Shit (right).
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  • CAPTION: Community COPE is promoting institutional delivery, and is raising awareness that the Government has set aside money to facilitate this through the Janani Suraksha Yojana (JSY) scheme. This roughly translates as 'New Mother’, and provides ₹ 1,400 for the mother and newborn child. This lady has received this money directly to her bank account, yet it turns out she’s unaware of this. Here, Vandana Maitry is assuring her that the money is there and she can withdraw it. During the initial days after birth, it’s especially important that the baby should get adequate nutrition. The system was changed to ensure mothers would get the money and it wouldn’t fall into the wrong hands, but the problem is that husbands or heads of households can also appropriate it under the new system. LOCATION: Adolescent Reproductive and Sexual Health (ARSH) clinic, Ghatshila Community Health Centre (CHC), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: Sarita Kumari Panna (left) and Atosi Shit (right).
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  • CAPTION: Dr Ram Chandra Soren, the area’s Medical Officer-in-Charge, notes that adolescents tend to be reluctant to visit their CHCs, preferring private clinics and 'quacks', because they assume that they will not get what they need there, or that there will be insufficient privacy. He assures them that they can get what they need from the ARSH clinic with full privacy and confidentiality. Changing awareness about this has resulted in significant positive changes, such as a marked reduction in septic abortions. LOCATION: Adolescent Reproductive and Sexual Health (ARSH) clinic, Ghatshila Community Health Centre (CHC), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: Dr Ram Chandra Soren.
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  • CAPTION: Dr Ram Chandra Soren is the area’s Medical Officer-in-Charge. He oversees the ARSH clinic here. He says that they’ve seen a lot of changes since the clinic opened. At first there were around 20 clients; this has grown to approximately 250. Though he studied and started his career in Orissa, Dr Ram is originally from this community and this gives him a great level of acceptance among the community members, which makes it very easy for him to communicate with them. People also know that he’s approachable outside of the regular office hours. LOCATION: Adolescent Reproductive and Sexual Health (ARSH) clinic, Ghatshila Community Health Centre (CHC), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: Dr Ram Chandra Soren.
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  • CAPTION: Dr Ram and his colleagues are forming what they call a 'chain of information', so that even if families don’t allow their youth to seek out the services they need in person, friends can pass on the news about what the ARSH clinic can provide. He observes that another problem is that most families think only of educating their boys on what they need, and just think about marrying their girls off. So it’s important to ensure that girls don’t fall through the net. These four girls are part of the discussion group that’s been established in Ghatshila. They have asked Dr Ram to come to the community college where they are studying nearby and take sessions for all the adolescent girls there to ensure they will then access the services they need. They therefore serve as the link between the college and Dr Ram. LOCATION: Adolescent Reproductive and Sexual Health (ARSH) clinic, Ghatshila Community Health Centre (CHC), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: From left to right: Tulika Shit, Sujata Shit, Rakhi Shit and Atosi Shit.
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  • CAPTION: Adolescent client Sujata Shit is getting her blood pressure checked. She came to the ARSH clinic complaining of weakness and a spinning head. Most of the girls with anemia have low blood pressure. LOCATION: Adolescent Reproductive and Sexual Health (ARSH) clinic, Ghatshila Community Health Centre (CHC), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: Sarita Kumari Panna (left) and Sujata Shit (right).
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  • CAPTION: Adolescent Rakhi Shit is being taught about family planning methods. The counselor Sarita Kumari Panna is telling her about the different options available to her. This information is not considered something that should be given only after marriage; it is recognized that sexual activity could happen before as well, even though this is culturally unacceptable. Most of the girls here (and also the boys) are unaware that the condom is something that can be used to prevent STIs - including AIDS - and unwanted pregnancy. Owing to this ignorance, under-age pregnancies are quite common, and abortions - including unsafe illegal ones - are being sought. LOCATION: Adolescent Reproductive and Sexual Health (ARSH) clinic, Ghatshila Community Health Centre (CHC), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: Sarita Kumari Panna (left) and Rakhi Shit (right).
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  • CAPTION: Dr Ram and his colleagues are forming what they call a 'chain of information', so that even if families don’t allow their youth to seek out the services they need in person, friends can pass on the news about what the ARSH clinic can provide. He observes that another problem is that most families think only of educating their boys on what they need, and just think about marrying their girls off. So it’s important to ensure that girls don’t fall through the net. These four girls are part of the discussion group that’s been established in Ghatshila. They have asked Dr Ram to come to the community college where they are studying nearby and take sessions for all the adolescent girls there to ensure they will then access the services they need. They therefore serve as the link between the college and Dr Ram. LOCATION: Adolescent Reproductive and Sexual Health (ARSH) clinic, Ghatshila Community Health Centre (CHC), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: From left to right: Atosi Shit, Rakhi Shit, Sujata Shit and Tulika Shit.
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  • CAPTION: The Chamkol programme supports the government's response to the health and wellbeing of individuals with or at disk of disability. For Primary Health Centre (PHC) workers such as Dr Prasad, this means informal support during disability screenings, vaccination and immunisation outreaches. LOCATION: Panyadhundi (village), Kasaba (hobli), Chamrajnagar (district), Karnataka (state), India. INDIVIDUAL(S) PHOTOGRAPHED: Dr Prasad P.M. (left) and Navida Begum (right).
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  • CAPTION: Shanti Toppo is married. She would like there to be a gap before she has her second child. Health worker Dr Kusum Kumari Bara suggests two options for her, firstly the Copper T, which allows the user to delay pregnancy for a longer period, and secondly the condom, which must be used by her husband. It is stressed that the condom is the only thing that also prevents spread of reproductive tract infections (RTIs) and sexually transmitted infections (STIs). The service provider then suggests that it is a good idea to come back along with her husband, so that he can also understand these things. LOCATION: Adolescent Reproductive and Sexual Health (ARSH) clinic, Ratu Community Health Centre (CHC), Ranchi (city), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: Dr Kusum Kumari Bara (left) and Shanti Toppo (right).
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  • CAPTION: Shanti Toppo is married. She would like there to be a gap before she has her second child. Health worker Dr Kusum Kumari Bara suggests two options for her, firstly the Copper T, which allows the user to delay pregnancy for a longer period, and secondly the condom, which must be used by her husband. It is stressed that the condom is the only thing that also prevents spread of reproductive tract infections (RTIs) and sexually transmitted infections (STIs). The service provider then suggests that it is a good idea to come back along with her husband, so that he can also understand these things. LOCATION: Adolescent Reproductive and Sexual Health (ARSH) clinic, Ratu Community Health Centre (CHC), Ranchi (city), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: Dr Kusum Kumari Bara (left) and Shanti Toppo (right).
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  • CAPTION: This is a training of frontline workers (FLWs): auxiliary nurse midwives (ANMs) and lady health visitors (LHVs). The latter supervise ANMs. Across the state, there are more than 2,000 FLWs. The Government-approved plan states that these individuals must have five days of training on adolescent reproductive and sexual health matters. It is being conducted by Dr Jagannath Hembrom, a ‘Master Trainer’. His role is more as a facilitator than a teacher. There is a pool of 67 such master trainers in Jharkhand, and Dr Jagannath is recognized as one of the best of these.  LOCATION: Ghatshila Community Health Centre (CHC), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: Left: Dr Jagannath Hembrom; right: multiple people.
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  • CAPTION: The final group is listing out the various mental and social changes experienced by adolescents. One of these is the development of attraction to the opposite sex. It is impressed upon participants that this is something natural that happens to everyone, and that it should not be condemned as something 'bad'. Another is that girls start wanting to make themselves appear as beautiful as possible to others. Boys, meanwhile, might like to drive very fast in front of others, or smoke and take drugs. The group is considering the consequences of these things and how they may be addressed. After discussing these things, the groups join together and discuss what they have each found. This then leads to the enactment of role-plays. LOCATION: Ghatshila Community Health Centre (CHC), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: From left to right: Kalpana Mahato, Savita Horo, Dr Jagannath Hembrom, Krishna Chakrabarty and Shobha Kumari Nirali.
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  • CAPTION: Packs of enough sanitary pads for five days are available from the ARSH clinic at the cost of just ₹ 6 (US$ 0.10). Out of this, ₹ 1 goes towards sahiyas’ incentives. Here, the medical officer is explaining the use of sanitary napkins, the cost and where more can be bought (for around ₹ 20) within the community. LOCATION: Adolescent Reproductive and Sexual Health (ARSH) clinic, Ratu Community Health Centre (CHC), Ranchi (city), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: Dr Kusum Kumari Bara (left) and Pritee Kashep (right).
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  • CAPTION: This is Ratu CHC’s ARSH clinic. The sahiyas, sitting to the left, have accompanied some of the girls from their respective areas to the facility so that they can discuss issues that sahiyas can’t handle themselves. This has not yet been incorporated into the sahiya incentive system, yet some have already willingly started doing it. At the clinic, the girls meet with Multi-Purpose Health Worker (Female) staff, formerly (and often still, unofficially) known as 'ANMs' (auxiliary nurse midwives). LOCATION: Adolescent Reproductive and Sexual Health (ARSH) clinic, Ratu Community Health Centre (CHC), Ranchi (city), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: Adults, from left to right: Kanti Devi, Yasmin Kahtun, Rina Devi and Raj Kumari Sinha; children: Ayesha Khatun (entering the room) and multiple other people.
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  • CAPTION: While Shanti Toppo discusses contraceptive options with the health worker, another ANM checks her blood pressure. This is because she has been complaining of a spinning head and pains in her abdomen. The cause of this might be anemia, though there are other possibilities as well.<br />
LOCATION: Adolescent Reproductive and Sexual Health (ARSH) clinic, Ratu Community Health Centre (CHC), Ranchi (city), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: From left to right: Dr Kusum Kumari Bara, Raj Kumari Sinha and Shanti Toppo.
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  • CAPTION: This group is considering sexual changes, such as the start of the menstrual cycle. Girls tend not to be aware that this is coming up, as parents and even the health system tend not to orient them on it. Then, when bleeding happens for the first time and it shows through a girl’s clothes, she may feel very embarrassed. So adolescents, schools, parents, and other family members all need to be sensitized. A similar example in the case of boys is night emissions after 'wet dreams'. The first time this happens, the boy may be very startled. In the rural Indian cultural context, boys are unlikely to want to talk about it with parents or healthcare professionals, nor are these people likely to want to talk about what's happening for them. Often, boys will consult 'quacks' or low-cost books available in local markets, and may get information that's far from the truth. Again, ways to tackle this must be considered. LOCATION: Ghatshila Community Health Centre (CHC), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: From left to right: Sunita Patra, Jayashree Sawayan, Dr Jagannath Hembrom, Suhagini Kisku and Sefali Dandapat.
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  • CAPTION: The final group is listing out the various mental and social changes experienced by adolescents. One of these is the development of attraction to the opposite sex. It is impressed upon participants that this is something natural that happens to everyone, and that it should not be condemned as something 'bad'. Another is that girls start wanting to make themselves appear as beautiful as possible to others. Boys, meanwhile, might like to drive very fast in front of others, or smoke and take drugs. The group is considering the consequences of these things and how they may be addressed. After discussing these things, the groups join together and discuss what they have each found. This then leads to the enactment of role-plays. LOCATION: Ghatshila Community Health Centre (CHC), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: From left to right: Ratna Das Banerjee, Kalpana Mahato, Savita Horo and Krishna Chakrabarty.
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  • CAPTION: Shanti Toppo is married. She would like there to be a gap before she has her second child. Health worker Dr Kusum Kumari Bara suggests two options for her, firstly the Copper T, which allows the user to delay pregnancy for a longer period, and secondly the condom, which must be used by her husband. It is stressed that the condom is the only thing that also prevents spread of reproductive tract infections (RTIs) and sexually transmitted infections (STIs). The service provider then suggests that it is a good idea to come back along with her husband, so that he can also understand these things. LOCATION: Adolescent Reproductive and Sexual Health (ARSH) clinic, Ratu Community Health Centre (CHC), Ranchi (city), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: Dr Kusum Kumari Bara (left) and Shanti Toppo (right).
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  • CAPTION: Health worker Dr Kusum Kumari Bara demonstrates the use of a mala chakra, a necklace made of red and white beads, to her client. It will help her know when it’s safer to have sex if she does not want to conceive. It is provided by the ARSH clinic free of cost. LOCATION: Adolescent Reproductive and Sexual Health (ARSH) clinic, Ratu Community Health Centre (CHC), Ranchi (city), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: From left to right: Dr Kusum Kumari Bara, Sabita Devi and Najmain Parveen.
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  • CAPTION: Training of frontline workers (FLWs) is being rolled out in phases. Topics include developmental changes among adolescents and their consequences; nutritional requirements and how to meet them, plus what happens if they are not met; family planning; reproductive tract infections (RTIs) and sexually transmitted infections (STIs); menstrual hygiene; non-communicable diseases; and how to counsel on all of these things. Of these, counseling takes the major focus. LOCATION: Ghatshila Community Health Centre (CHC), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: Left: Dr Jagannath Hembrom; right: multiple people.
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  • CAPTION: This group is considering sexual changes that adolescents go through. The idea that these things should even be discussed is often resisted by the trainees, and this often comes up in a big way during the first day of training. However, as the days unfold, they are encouraged to open up and relax, and generally a much more positive attitude to such discussion evolves by the end of the program. LOCATION: Ghatshila Community Health Centre (CHC), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: From left to right: Suhagini Kisku, Sefali Dandapat and Sarojini Mahato.
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  • CAPTION: The final group is listing out the various mental and social changes experienced by adolescents. One of these is the development of attraction to the opposite sex. It is impressed upon participants that this is something natural that happens to everyone, and that it should not be condemned as something 'bad'. Another is that girls start wanting to make themselves appear as beautiful as possible to others. Boys, meanwhile, might like to drive very fast in front of others, or smoke and take drugs. The group is considering the consequences of these things and how they may be addressed. After discussing these things, the groups join together and discuss what they have each found. This then leads to the enactment of role-plays. LOCATION: Ghatshila Community Health Centre (CHC), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: Standing: Dr Jagannath Hembrom; sitting: multiple people.
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  • CAPTION: During the first day of the training, the participants are divided into three for group work. In this exercise, the groups have been asked to consider the various developmental changes that occur socially, physically, and mentally among adolescents, and what the consequences of these are. This group is listing out the consequences of the various physical changes that occur in the body. For example, breast development among girls leads them to bend forward slightly, which can cause them pain in the lower back and waist region. LOCATION: Ghatshila Community Health Centre (CHC), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: From left to right: Ruby Kumari, Bela Sarkar, A Sharada and Dr Jagannath Hembrom.
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  • CAPTION: Sahiya Anupa Devi brings two girls from her area to the ARSH clinic. Whenever adolescents come to their sahiyas with concerns that they themselves cannot solve, they are encouraged to bring them to this facility. LOCATION: Adolescent Reproductive and Sexual Health (ARSH) clinic, Ratu Community Health Centre (CHC), Ranchi (city), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: From left to right: Anupa Devi, Shakuntala Kumari and Dipika Kumari.
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  • CAPTION: Dr Jagannath Hembrom is the Medical Officer-in-Charge in Chaibasa in the Jharkhand district of West Singhbhum. The facility here is recognized as the best clinic in the state. In addition to FLWs, he also trains medical officers and outreach workers. He is particularly passionate about working with adolescents. He also serves as a referral point, where sahiyas are unable to answer adolescents' particular questions or meet their particular needs. Dr Jagannath has even been recognized for his training talents at the national level. LOCATION: Ghatshila Community Health Centre (CHC), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: Dr Jagannath Hembrom.
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  • CAPTION: The training of frontline workers (FLWs) is very participatory, and it is not held exclusively in classrooms. There is a lot of group work, which the master trainer facilitates, as well as role-plays wherein case studies are acted out. Service providers are taught not only on how to counsel children, but also their parents. EngenderHealth is measuring the effectiveness of what it’s doing in different ways. One involves looking at how those they train perform using a performance to standard tool. Knowledge is tested, counseling is observed, and a check on what services are being given is carried out. If there are gaps, an effort is made to consider how these might be addressed. Another considers how many adolescents (male and female, across different ages) are accessing these services, and which services specifically. So far, it has been noted that male take-up has been slightly lower than female. LOCATION: Ghatshila Community Health Centre (CHC), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: Left: Dr Jagannath Hembrom; right: multiple people.
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  • CAPTION: The final group is listing out the various mental and social changes experienced by adolescents. One of these is the development of attraction to the opposite sex. It is impressed upon participants that this is something natural that happens to everyone, and that it should not be condemned as something 'bad'. Another is that girls start wanting to make themselves appear as beautiful as possible to others. Boys, meanwhile, might like to drive very fast in front of others, or smoke and take drugs. The group is considering the consequences of these things and how they may be addressed. After discussing these things, the groups join together and discuss what they have each found. This then leads to the enactment of role-plays. LOCATION: Ghatshila Community Health Centre (CHC), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: Standing: Dr Jagannath Hembrom; sitting (far side, from left to right): Kalpana Mahato, Savita Horo, Krishna Chakrabarty and Shobha Kumari Nirali.
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  • CAPTION: During the first day of the training, the participants are divided into three for group work. In this exercise, the groups have been asked to consider the various developmental changes that occur socially, physically, and mentally among adolescents, and what the consequences of these are. This group is listing out the consequences of the various physical changes that occur in the body. For example, breast development among girls leads them to bend forward slightly, which can cause them pain in the lower back and waist region. LOCATION: Ghatshila Community Health Centre (CHC), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: From left to right: Ruby Kumari, Bela Sarkar, A Sharada and Dr Jagannath Hembrom.
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  • CAPTION: The Chamkol programme supports the government's response to the health and wellbeing of individuals with or at disk of disability. For Primary Health Centre (PHC) workers such as Shilpa - seen here addressing a meeting of anganwadi workers - this means informal support during disability screenings, vaccination and immunisation outreaches. LOCATION: Benderwadi (village), Kasaba (hobli), Chamrajnagar (district), Karnataka (state), India. INDIVIDUAL(S) PHOTOGRAPHED: Shilpa K.N.
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  • CAPTION: Community COPE members come to ask a householder about what her expectations of the health system are and what she feels ought to be done to get more people into the Government-run Community Health Centre (CHC). She says she’s happy with what she’s been accessing, but reveals a lack of awareness of what she is actually entitled to. Shyam Bahadur Sonar is therefore suggesting that she should discuss her needs with knowledgeable community members. Kalicharan Namata (second from left) is one of the two adolescent representatives in Community COPE, and has an important role in bringing adolescent voices into the community dialogue. LOCATION: Pawra (village), Ghatshila (block), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: Shyam Bahadur Sonar (left) and Rupa Namata (right).
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  • CAPTION: Community COPE members come to ask a householder about what her expectations of the health system are and what she feels ought to be done to get more people into the Government-run Community Health Centre (CHC). The men and women have teamed up here; mostly the men talk with the male heads of households. This lady has been living in this community for around 40 years since marriage. She has observed many changes in health service provision. She says that the panchayati raj system has brought significant health service changes for her, which she’s very happy about. She says that people hear from the newspapers and TV what they can access. The newly-elected female panchayati raj members, reserved 50% of the positions as part of women’s empowerment efforts, have been very active in changing how the government system works and serves people. LOCATION: Pawra (village), Ghatshila (block), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: From left to right: Vandana Maitry, Kalicharan Namata, Shyam Bahadur Sonar and Rupa Namata.
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  • CAPTION: Community COPE members come to ask a householder about what her expectations of the health system are and what she feels ought to be done to get more people into the Government-run Community Health Centre (CHC). The men and women have teamed up here; mostly the men talk with the male heads of households. This lady has been living in this community for around 40 years since marriage. She has observed many changes in health service provision. She says that the panchayati raj system has brought significant health service changes for her, which she’s very happy about. She says that people hear from the newspapers and TV what they can access. The newly-elected female panchayati raj members, reserved 50% of the positions as part of women’s empowerment efforts, have been very active in changing how the government system works and serves people. LOCATION: Pawra (village), Ghatshila (block), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: From left to right: Daya Nidhi Shit, Damodar Shit, Shruti Deogam, Punta Hansda and Parwati Murmu.
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  • CAPTION: Community COPE members come to ask a householder about what her expectations of the health system are and what she feels ought to be done to get more people into the Government-run Community Health Centre (CHC). She says she’s happy with what she’s been accessing, but reveals a lack of awareness of what she is actually entitled to. Shyam Bahadur Sonar is therefore suggesting that she should discuss her needs with knowledgeable community members. LOCATION: Pawra (village), Ghatshila (block), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: Vandana Maitry (left) and Rupa Namata (right).
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  • CAPTION: These are sahiyas attached to Ghatshila CHC who've been trained on adolescent reproductive and sexual health, and in how to communicate with adolescent girls on these issues. At the beginning of the sessions they conduct at the anganwadi center (literally: 'courtyard shelter' in Hindi), they start with a song about the importance of young women taking care of their health as they grow up and how important adolescents are in bringing change in their society in the long run. The song includes mention of how everyone has the power to take decisions on their own health, and to change both themselves and society as a whole (which includes the importance of completing Higher Secondary education). LOCATION: Pawra Anganwadi Centre (AWC), Ghatshila (block), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: From left to right: Dipali Baskey, Rupali Shit, Bhasa Sharma, Anupma Soren and Sombari Tudu.
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  • CAPTION: Sahiya Anupma Soren takes a monthly session with the 15-19-year olds. The discussion covers delaying the age of marriage, antenatal care, where the ARSH clinic is and what it does, the methods of family planning that the facility can help with, and what their respective pros and cons are. The Government requires these sessions to be conducted monthly. Sahiyas are given an incentive of ₹ 75 per session they lead. The girls are asked to come on a regular basis, as the knowledge imparted builds over time. LOCATION: Pawra Anganwadi Centre (AWC), Ghatshila (block), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: From left to right: Anupma Soren, Pritilata Giope, Sarshati Hansda, Maya Namata, Kajal Namata and Sunita Murmu .
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  • CAPTION: Sahiya Anupma Soren quizzes the girls on such subjects as the legal age of marriage, their daily nutritional needs and the foods that can provide these, the sort of medical advice that’s available for them, etc. There are two groups in the room. One is made up of married adolescents, aged 15-19, which discusses delaying the age of marriage, the different methods of family planning that are available, and antenatal care; the other consists of 10 to 14-year olds, with some school-going girls and some school dropouts, and this group focuses in a big way on nutrition, menstrual hygiene, and developmental changes. LOCATION: Pawra Anganwadi Centre (AWC), Ghatshila (block), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: Anupma Soren (standing, left) and multiple others.
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  • CAPTION: Sahiya Anupma Soren takes a monthly session with the 15-19-year olds. The discussion covers delaying the age of marriage, antenatal care, where the ARSH clinic is and what it does, the methods of family planning that the facility can help with, and what their respective pros and cons are. The Government requires these sessions to be conducted monthly. Sahiyas are given an incentive of ₹ 75 per session they lead. The girls are asked to come on a regular basis, as the knowledge imparted builds over time. LOCATION: Pawra Anganwadi Centre (AWC), Ghatshila (block), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: From left to right: Anupma Soren, Pritilata Giope, Sarshati Hansda, Maya Namata and Kajal Namata.
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  • CAPTION: Sahiya Anupma Soren takes a monthly session with the 15-19-year olds. The discussion covers delaying the age of marriage, antenatal care, where the ARSH clinic is and what it does, the methods of family planning that the facility can help with, and what their respective pros and cons are. The Government requires these sessions to be conducted monthly. Sahiyas are given an incentive of ₹ 75 per session they lead. The girls are asked to come on a regular basis, as the knowledge imparted builds over time. LOCATION: Pawra Anganwadi Centre (AWC), Ghatshila (block), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: From left to right: Anupma Soren, Pritilata Giope, Sarshati Hansda, Maya Namata, Kajal Namata, Anjana Hembrom and Sunita Murmu.
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  • CAPTION: Sahiya Anupma Soren takes a monthly session with the 15-19-year olds. The discussion covers delaying the age of marriage, antenatal care, where the ARSH clinic is and what it does, the methods of family planning that the facility can help with, and what their respective pros and cons are. The Government requires these sessions to be conducted monthly. Sahiyas are given an incentive of ₹ 75 per session they lead. The girls are asked to come on a regular basis, as the knowledge imparted builds over time. LOCATION: Pawra Anganwadi Centre (AWC), Ghatshila (block), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: From left to right: Anupma Soren, Pritilata Giope, Sarshati Hansda, Maya Namata and Kajal Namata.
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  • CAPTION: Sahiya Anupma Soren quizzes the girls on such subjects as the legal age of marriage, their daily nutritional needs and the foods that can provide these, the sort of medical advice that’s available for them, etc. There are two groups in the room. One is made up of married adolescents, aged 15-19, which discusses delaying the age of marriage, the different methods of family planning that are available, and antenatal care; the other consists of 10 to 14-year olds, with some school-going girls and some school dropouts, and this group focuses in a big way on nutrition, menstrual hygiene, and developmental changes. LOCATION: Pawra Anganwadi Centre (AWC), Ghatshila (block), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: Anupma Soren (standing, left) and multiple others.
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  • CAPTION: Sahiya Anupma Soren quizzes the girls on such subjects as the legal age of marriage, their daily nutritional needs and the foods that can provide these, the sort of medical advice that’s available for them, etc. There are two groups in the room. One is made up of married adolescents, aged 15-19, which discusses delaying the age of marriage, the different methods of family planning that are available, and antenatal care; the other consists of 10 to 14-year olds, with some school-going girls and some school dropouts, and this group focuses in a big way on nutrition, menstrual hygiene, and developmental changes. LOCATION: Pawra Anganwadi Centre (AWC), Ghatshila (block), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: Anupma Soren (standing, left) and multiple others.
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  • CAPTION: Sahiya Anupma Soren takes a monthly session with the 15-19-year olds. The discussion covers delaying the age of marriage, antenatal care, where the ARSH clinic is and what it does, the methods of family planning that the facility can help with, and what their respective pros and cons are. The Government requires these sessions to be conducted monthly. Sahiyas are given an incentive of ₹ 75 per session they lead. The girls are asked to come on a regular basis, as the knowledge imparted builds over time. LOCATION: Pawra Anganwadi Centre (AWC), Ghatshila (block), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: From left to right: Anupma Soren, Pritilata Giope, Sarshati Hansda, Maya Namata and Kajal Namata.
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  • CAPTION: This is the group aged 10-14. The song the sahiya is leading is about the nutritional requirements of the adolescent age group, and how nutrition affects their mental, physical, and social development, as well as how important it is for future generations. They are singing in Santhal, the local tribal language. LOCATION: Pawra Anganwadi Centre (AWC), Ghatshila (block), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: Multiple people.
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  • CAPTION: This is the group aged 10-14. The song the sahiya is leading is about the nutritional requirements of the adolescent age group, and how nutrition affects their mental, physical, and social development, as well as how important it is for future generations. They are singing in Santhal, the local tribal language. LOCATION: Pawra Anganwadi Centre (AWC), Ghatshila (block), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: Multiple people.
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  • CAPTION: Sahiya Anupma Soren takes a monthly session with the 15-19-year olds. The discussion covers delaying the age of marriage, antenatal care, where the ARSH clinic is and what it does, the methods of family planning that the facility can help with, and what their respective pros and cons are. The Government requires these sessions to be conducted monthly. Sahiyas are given an incentive of ₹ 75 per session they lead. The girls are asked to come on a regular basis, as the knowledge imparted builds over time. LOCATION: Pawra Anganwadi Centre (AWC), Ghatshila (block), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: From left to right: Anupma Soren, Pritilata Giope, Sarshati Hansda, Maya Namata and Kajal Namata.
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  • CAPTION: Sahiya Anupma Soren takes a monthly session with the 15-19-year olds. The discussion covers delaying the age of marriage, antenatal care, where the ARSH clinic is and what it does, the methods of family planning that the facility can help with, and what their respective pros and cons are. The Government requires these sessions to be conducted monthly. Sahiyas are given an incentive of ₹ 75 per session they lead. The girls are asked to come on a regular basis, as the knowledge imparted builds over time. LOCATION: Pawra Anganwadi Centre (AWC), Ghatshila (block), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: From left to right: Anupma Soren, Pritilata Giope, Sarshati Hansda, Maya Namata and Kajal Namata.
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  • CAPTION: The Chamkol programme supports the government's response to the health and wellbeing of individuals with or at disk of disability. For Village Rehabilitation Workers (VRWs) like Kumara Naika, pictured here helping Govinda reach his local anganwadi, informal support to service delivery means provision of tailored quarterly training. LOCATION: Badanaguppe (village), Kasaba (hobli), Chamrajnagar (district), Karnataka (state), India. INDIVIDUAL(S) PHOTOGRAPHED: Kumara Naika (man), Govinda K. (disabled boy) and Puttbassamma (woman).
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  • CAPTION: At the end of a classroom session, Hemavathi gets the children to do a group work exercise that reviews, in a fun way, what has been taught. This is a particularly inclusive technique, which she learned during training by The Teacher Foundation (TTF). In spite of his locomotor disability, Sidaraju (centre) feels very much a part of the action. LOCATION: Mangala (village), Kasaba (hobli), Chamrajnagar (district), Karnataka (state), India. INDIVIDUAL(S) PHOTOGRAPHED: From left to right (visible faces only): Mallikarjuna, Sidaraju, D. Mahendra, B.P. Hemavathi, S. Asha and Rachana.
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  • CAPTION: 13-year-old Chowdamma could only stand rooted to the spot when she first started attending her local After-School Club (ASC) five years ago. She has a learning disability, and was afraid to communicate with the other children in any way at all. Under her ASC tutor's careful strategic guidance, she has been able to build her confidence levels dramatically. LOCATION: Marialla (village), Kasaba (hobli), Chamrajnagar (district), Karnataka (state), India. INDIVIDUAL(S) PHOTOGRAPHED: Chowdamma.
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  • CAPTION: Madhushree has a profound learning disability. Chinnaswamy and his family are determined that in spite of this, she should be able to enjoy a gradually improving quality of life. To assist with making this a reality, Mobility India have helped to draw up an Individual Education Plan (IEP) that is tailored to Madhushree’s specific needs. Together with her local After-School Club (ASC) coordinators, her family have resolved to work with her to meet each goal that’s been set in this plan in turn. Activities in Madhushree’s plan include brushing her teeth, eating and bathing without support and identifying colours. LOCATION: Heggotara (village), Kasaba (hobli), Chamrajnagar (district), Karnataka (state), India. INDIVIDUAL(S) PHOTOGRAPHED: From left to right: Chinnaswamy, Madhushree and Asha.
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  • CAPTION: Mobility India's Sudhamani R. trains Drakshayani in the skills she'll need as an After-School Club (ASC) Coordinator. LOCATION: Handrakalli Mole (village), Kasaba (hobli), Chamrajnagar (district), Karnataka (state), India. INDIVIDUAL(S) PHOTOGRAPHED: From left to right: Sudhamani R., Chinnu and Drakshayani.
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  • CAPTION: After-School Club (ASC) Coordinator Asha, who herself has scoliosis, leads children in a card game. The game is very visual, designed to be inclusive for those children who struggle to recognise words. LOCATION: Heggotara (village), Kasaba (hobli), Chamrajnagar (district), Karnataka (state), India. INDIVIDUAL(S) PHOTOGRAPHED: From left to right: Megha M., Chennanjamma and Asha.
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  • CAPTION: Mantesh, who has a learning disability, hardly communicates with other children or even with his parents. His family is keen for him to get involved in the local Chamkol programme-supported After School Club (ASC), but feels the challenge lies in getting him to attend and participate. His case worker will therefore be working with him according to his Individual Education Plan (IEP) to help him develop his self-belief, and also with his mother, who needs encouragement to believe in him. LOCATION: Mallianpura (village), Kasaba (hobli), Chamrajnagar (district), Karnataka (state), India. INDIVIDUAL(S) PHOTOGRAPHED: Mantesh (left) and Vathsalakumari (right).
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  • CAPTION: After-School Club (ASC) Coordinator Kalappa demonstrates a paper helicopter to his group, after Chowdamma - who has a learning disability - asked him how helicopters work. Kalappa says that one of the ways he makes the club more inclusive for Chowdamma is that he finds ways to explain principles as visually as possible. LOCATION: Marialla (village), Kasaba (hobli), Chamrajnagar (district), Karnataka (state), India. INDIVIDUAL(S) PHOTOGRAPHED: From left to right: Kalappa, Chowdamma and Kavya M.
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  • CAPTION: Until the age of five, Naveen - who has cerebral palsy - was confined to his bed. That was the point at which he got his first life-changing surgery, after which he started to receive training from Mobility India. Rehabilitation Therapy Assistant (RTA) Kavitha patiently worked with him on a one-to-one basis, teaching him how to stand, balance and walk. Since then, he has been an enthusiastic participant at his local After-School Club (ASC). In this image, we see him standing on his own two feet at the front of his class, leading his fellow attendees in a Kannada literacy session under the watchful eye of his ASC tutor. LOCATION: Mallianpura (village), Kasaba (hobli), Chamrajnagar (district), Karnataka (state), India. INDIVIDUAL(S) PHOTOGRAPHED: Naveen Kumar N. (boy) and Vathsalakumari (woman).
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  • CAPTION: Under the Chamkol programme, anganwadi (pre-school) workers like Shashikala will soon start receiving focussed training on ways to minimise the risk of disability during pregnancy, childbirth or infancy, on how to identify and respond to suspected impairments and how to care for, nurture and support children with different impairments. LOCATION: Uttuvalli (village), Kasaba (hobli), Chamrajnagar (district), Karnataka (state), India. INDIVIDUAL(S) PHOTOGRAPHED: From left to right: Pavitra, Komala and N. Shashikala.
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  • CAPTION: Jayamala keeps an eye on Madhushree while leading a game at her anganwadi (pre-school). Through the Chamkol programme's Early Years' Clubs, anganwadi workers like Jayamala will play more of a role in the lives of the youngest children with special needs, like Madhushree, who has autism. LOCATION: Masagapura (village), Kasaba (hobli), Chamrajnagar (district), Karnataka (state), India. INDIVIDUAL(S) PHOTOGRAPHED: From left to right (visible faces only): Madhushree, Jayamala, Chamdama M., Radhika B., Chamdama M. and Aishwarya S.
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  • CAPTION: Shilpa, who has cerebral palsy and moves around in a wheelchair, has developed her confidence level dramatically since joining her local After-School Club (ASC). Its sessions are designed to be highly inclusive, so she feels she is able to engage in activities without disadvantage compared with the other children there. LOCATION: Heggotara (village), Kasaba (hobli), Chamrajnagar (district), Karnataka (state), India. INDIVIDUAL(S) PHOTOGRAPHED: Manasa and Shilpa N. (right).
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  • CAPTION: For many years, Mantesh - who has a learning disability - would hardly communicate with other children or even with his parents. His mother Roopa supports him with his Individual Education Plan (IEP), which includes his attendance at his local After-School Club (ASC). This is very important in developing his self-belief. Just ensuring he attends regularly is a challenge, so it helps if his mother drops him there directly herself, and then meets him once the session is over. LOCATION: Mallianpura (village), Kasaba (hobli), Chamrajnagar (district), Karnataka (state), India. INDIVIDUAL(S) PHOTOGRAPHED: Roopa (left) and Mantesh (right).
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  • CAPTION: Basavanna has a severe locomotor disability. Loans from the Chamkol programme's Revolving Fund Scheme have helped to ensure that he can support himself through his business of bicycle repairing. LOCATION: Ummathuru (village), Santhemarahalli (hobli), Chamrajnagar (district), Karnataka (state), India. INDIVIDUAL(S) PHOTOGRAPHED: Basavanna.
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  • CAPTION: Healthcare practitioner Thuong Thi My Dung holds a leaflet which shows measures households can take to prevent dengue fever outbreaks. The leaflets, along with posters and other educational materials, are distributed in local communities to raise awareness of dengue fever prevention measures. LOCATION: Long Tuyen Health Centre, Can Tho, Vietnam. INDIVIDUAL(S) PHOTOGRAPHED: Thuong Thi My Dung.
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  • CAPTION: Healthcare practitioners Nguyen Thi Mai and Thuong Thi My Dung examine a leaflet which shows measures households can take to prevent dengue fever outbreaks. The leaflets, along with posters and other educational materials, are distributed in local communities to raise awareness of dengue fever prevention measures. LOCATION: Long Tuyen Health Centre, Can Tho, Vietnam. INDIVIDUAL(S) PHOTOGRAPHED: Nguyen Thi Mai, Thuong Thi My Dung.
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  • CAPTION: Volunteer mobile waste collectors separate waste at the mobile recovery centre. Flooding is a big problem in Makati City, made worse by inadequate waste disposal. Norma de Leon talks about the disruption caused by flooding, pointing out that children can't go to school. She also says that there’s a discernible increase in health problems at times of flooding, because the water is so unsanitary. LOCATION: Materials Recovery Facility and Urban Garden, East Rembo Barangay, Makati City, Metro Manila, Philippines. INDIVIDUAL(S) PHOTOGRAPHED: From left to right: Con, Norma de Leon, Lori and Gigi.
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  • CAPTION: Volunteer mobile waste collectors separate waste at the mobile recovery centre. Flooding is a big problem in Makati City, made worse by inadequate waste disposal. Norma de Leon talks about the disruption caused by flooding, pointing out that children can't go to school. She also says that there’s a discernible increase in health problems at times of flooding, because the water is so unsanitary. LOCATION: Materials Recovery Facility and Urban Garden, East Rembo Barangay, Makati City, Metro Manila, Philippines. INDIVIDUAL(S) PHOTOGRAPHED: From left to right: Gigi, Lori, Norma de Leon and Con.
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