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Dengue: Through the Looking Glass

On 7th December 2019, Pearl Gan and Dr Sophie Yacoub published an article on Lancet; Picturing Health: Dengue in Vietnam. The article highlighted the collaborative efforts by the Oxford University Clinical Research Unit (OUCRU) and the Hospital for Tropical Diseases in Ho Chi Minh City, Vietnam in combating dengue. Sharing with us her experience and motivations for this photodocumentary is Pearl Gan, photographer for OUCRU, Vietnam.

1. What was your motivation to document dengue in Vietnam?

My journey using photography to document infectious diseases in Asia Pacific began with a malaria project initiated by Professor Kevin J Baird, Head of Eijkman Oxford University Clinical Research Unit, Jakarta (EOCRU). In the last 4 years, I was involved in malaria engagement work and other infectious diseases such as leprosy and tuberculosis.

I am the honorary Photographer in Residence of OUCRU, Vietnam. In August 2019, I was invited to lead the photography project to highlight the dengue research work of Dr Sophie Yacoub, Head of Dengue Research in OUCRU, Vietnam. This photodocumentary project was indeed very successful and 8 of the dengue photographs were selected and published by The Lancet on 7 December 2019 in UK.


2. Through your photos what message do you hope to convey in relation to the dengue situation in Vietnam?

I hope that my photos communicate the message that dengue remains an important mosquito-borne disease which brings suffering and has a devastating impact on societies. My goal was to illustrate how the medical community works together in diagnosing dengue, treating dengue patients and reducing viral transmission.

In this context I would like to highlight the innovative system for mosquito surveillance being deployed by the local government officials in collaboration with OUCRU in HCMC. When the staff visit the patient’s homes, they would install a ‘pop-up’ mosquito trap. This portable trap will be left in the patients’ homes for a period of time to trap dengue-carrying mosquitoes. They then bring the mosquitoes back to the OUCRU labs for testing and analysis. Such active surveillance efforts are applauded as this targeted intervention has been shown to reduce mosquito breeding in the high-risk dengue zones in District 8 of Ho Chi Minh city.

I hope to convey the important message that the local community is already doing their part to battle dengue; I would like to see more global assistance by ensuring the availability of technology and resources for those living in both urban and rural communities.


3. What was your inspiration during the documentation process and how did you hope to portray this in your photos?

I am aware that severe dengue infections still occurred everyday around us. However, seeing first-hand, the devastation to the patients and their families; the courage of those suffering from dengue; and the dedicated efforts of the medical community to tackle these problems; had a tremendous impact on me.

I seek to increase awareness of dengue through my photographs. My photographic journeys would show the very human side of this ongoing struggle and lead to increased understanding, and support, for the many efforts underway. I hope the selected Lancet photographs published sparked this undying spirit for the audience. My goal is to be the bridge between my audience and my subject. I want them to feel “the connection” to dengue.


4. In your interactions with the locals in Vietnam, especially those afflicted with dengue, what lessons did you learn and how do you feel they can be applied?

My recent project in Vietnam was focused on dengue occurrence in Ho Chi Minh City, and in particular the hot spots in District 8. This project was only made possible with the active support of OUCRU and the Hospital for Tropical Diseases in HCMC.

Through these efforts I was able to meet many dengue patients and witnessed how dengue has shaped their world. I travelled on the back of a moped zooming in and out of busy Ho Chi Minh city to visit patients in high risk District 8 and local community health centres

Collecting consent is important in the photo documentation process. Local staff were always helpful in providing the careful translations for the important task.

Dengue is so common in high-risk zones that we found that most family members at some point in their lives had previously suffered from dengue. Such risk is often higher for those who live around the river in District 8 in Ho Chi Minh. This frequent occurrence leads to a silent acceptance of their fate; resigned to seeing it as part and parcel of their lives. Often their habitat is limited by their poverty. They appreciate the local government and medical staff’s continuous efforts in conducting regular testing and efforts in monitoring dengue in their communities.

In the face of this mammoth task the local health communities continue to apply their knowledge in the prevention of dengue in the high-risk dengue zones. The acute dengue cases are effectively managed. The areas for further engagement and improvement are: early recognition of symptoms, better engagement with educational dengue programmes in the local school level as well as better engagement efforts at community level.


5. How do you hope your photos impact others to help contribute to countries like Vietnam in fighting dengue?

In all of my projects I have tried to capture the dedicated efforts of the medical researchers and clinicians and what they face on a daily basis. On this recent trip I was especially honoured to profile Dr Sophie Yacoub’s research work on dengue, as well as the local community efforts to assist in the prevention and surveillance of dengue in Ho Chi Minh. Recognition of the commitment of the medical community to treat and eliminate infectious diseases is needed for these efforts to continue to be supported. By highlighting the toll of infectious disease in the disadvantaged communities, my goal is to bring the attention of a wider audience so that additional resources may be made available to help win this battle. Celebration of their successes encourages everyone to work even harder to move closer to realizing a possible dengue-free future.


6. Where else in Asia are you looking to document in the future, and what would be the disease area of focus?

I intend to continue my work towards increasing awareness of the wider burden of infectious disease across Asia and neighbouring countries. Infectious diseases can swiftly travel across international borders so the suffering of our neighbours can soon become the suffering of our own. The work for my recent publication illustrating the challenges of malaria and dengue has taken me to both urban and isolated rural areas across many countries, including Pakistan, Indonesia, Vietnam, Thailand and Cambodia.

I have initiated a leprosy and tuberculosis projects. These two projects have taken me to Bangladesh, Indonesia and Cambodia. I hope to be able to achieve a more complete picture of each of these diseases as they occur in the cities and peripheries of Asia. Due to different modes of transmission the endemic ‘hot spots’ for these infectious diseases can vary. In turn their impact to communities are also distinctive. Capturing the diversity of these experiences in different geographical regions can be a life-long journey. [APBN]

About the Interviewee

Pearl Gan, is a photographer, who helps to raise awareness of infectious diseases for Oxford University Clinical Research Unit, Vietnam. Her work is mainly documentary and candid shots of patients, families, caregivers and communities of infectious diseases in the edges of Asia Pacific such as border of Timor and Indonesia or locations off the beaten track.