To perceive the world we live in is the first step towards changing it.

André François

Introduction

How do those working in healthcare remain empathetic and compassionate? The hours are long, the need unquenchable, suffering inevitable. How can this be sustained day after day, week after week, year after year? And how do those who are healthy understand or even recognise the situation of those who are sick and those who care for them?

These are questions that the Brazilian photographer André François has been addressing through his work for the past quarter century. He does so in a country so vast that many areas are severely under resourced, exacerbating the problems further. Yet, miraculously, in his photographs we do not find misery but acts of kindness, dedication and empathy. His purpose is not to blame or to shock with images of degradation, but to find, even in the darkest of situations, the light of human compassion. To capture the mutual connectedness not only of patient and healthcare worker but – through his photographs – subject and viewer. To engender a warm and humane awareness that does not stop at feeling but leads to action: to a desire to make things better. He is the best type of educator. He does not seek to force ideas into the viewer’s mind, but, like a skilled gardener, to cultivate compassion; to encourage it to grow from the inside and to flourish.

Alasdair Foster

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Interview

As a photographer, do you seek to encourage a compassionate response in the viewer?

It is important to raise awareness, but if you are too forceful, if you show very hard images, the viewer may simply look away. I try to find a balance. While there is some suffering, some pain, some loss, I approach it in an ethical and beautiful way, so that the viewer is encouraged to feel empathy and compassion.

But you have to be careful. Empathy and compassion must be more than theoretical ideas; they must be put into action. We each do this differently, so it is important to allow each individual’s personality to express compassion in its own way.

What about the person being photographed?

Yes, I not only aim to encourage feelings of compassion in the person who is looking at my photographs, but also in the person being photographed. They need to understand the purpose of that image. In the kind of health projects I have done, people are at a very delicate moment in their lives. Making such a photograph is an intimate process; it is important to create a bond, to have empathy. It is important that they understand what I’m doing: the purpose of my work. Once they understand that, it becomes easier to photograph and, as a result, they willingly participate.

A good place to start when considering compassion is your series ‘Caring’. How did this series begin?

‘Caring’ was my first book about health. Before I began the project, I had been thinking of it as a kind of protest about the poor quality of Brazilian healthcare. But then, photographing in the very first hospital, I realised that this was not the best way. It would be too easy to simply make accusations. Instead, I wanted to show how some health teams really managed to make a difference. These doctors demonstrate that it is possible to make a difference, even in an environment as harsh as that found in some Brazilian hospitals. So, while this project was born in an immature way, over time I learned the importance of compassion and the way in which I could use it strategically to sensitise people to a situation.

Brazil has many isolated rural communities. You explore this in ‘The Curve and the Path’.

Brazil is really vast, and rural people must often travel very far to reach a hospital. There are stories of mothers, like Dona Antonia, for example, who took almost nine months to travel from her house to get to a hospital where they could treat her son. She was lucky; others die while making the journey.

I spent two years in remote parts of Brazil making this work. I wanted to sensitise people to the plight of rural communities. Despite living in the same country, there are very different realities there. In a city like São Paulo, if one needs an ambulance, it costs USD $150; in Acre [in the rainforest of north-western Brazil] there is no ambulance. To transport a patient, requires a small aeroplane costing USD $3000–4000. In a country as big as Brazil, health provision is complicated – the path is curved.

The next two series explore living with chronic illness, each in different ways. The first, ‘Choosing and Living’, is a book about people with chronic kidney disease.

In Brazil, kidney patients are usually treated with haemodialysis: the patient has to go to the hospital on average four times a week to spend six hours plugged into a machine that filters the blood. That is very difficult for people who live in the countryside and do not have these clinics close to their home.

However, there is an alternative therapy: peritoneal dialysis. This treatment can be done at home. I wanted to explore why doctors were prejudiced against this treatment (which is partly because it is not in the economic interest of clinics and hospitals) and to demystify the medical technique. An example is the book cover itself, which shows a man who uses peritoneal dialysis swimming in the sea. Many doctors say that you cannot swim in a pool, much less the sea, if you are on this treatment. The book cover shows that is not the case, revealing just one of the prevailing prejudices.

The other series, ‘Back Home’ explores the benefits of dehospitalisation.

The hospitals are full. In many cases, it is cheaper, just as effective, and much more humane to be treated at home. In this book I focused on people who could have been at home, but were hospitalised, and other stories of patients who were already being treated at home.

‘Choosing and Living’ and ‘Back Home’ are books each with a very clear focus on their respective theme. Their purpose is to bring a new perspective to public health policy.

We spoke earlier about the vast scale of Brazil. Tell me about your project on the work of the health expeditions taking medical services out into the field.

‘Brazilian Health Expeditions’ follows a group of doctors and nurses who volunteer to perform surgical operations in isolated locations, such as the indigenous villages of the Amazon rainforest. Here there is no money, simply barter. It is incredible to see this cultural contrast. Highly qualified doctors who charge large fees for their consultations in big cities, who donate thirty days a year to work in remote areas without pay.

Why do you think they do this?

When a health professional donates their time and expertise in this way, the greatest return is ultimately not for the community, but for the doctor, who comes back from the expedition a different person: more empathic, more sensitive. In turn, that keeps them more humanised in their city clinics and hospitals. This is what I want to show in my book.

Tell me about ‘Beyond the Skin’.

This book talks about leprosy and two issues in particular. The first is stigmatisation. It is based on prejudice and an unfounded fear, because one does not catch the disease by touching someone who has leprosy. The second is about low visibility. This disease affects very poor people in rural areas and one simply does not hear about it in the big cities. The disease is easily diagnosed and simple to treat, but decisions about health policy are made in the city and, as a result, the necessary medicine is still not available in many areas.

When I visited families with leprosy, I used to make a point of shaking their hands and hugging to show that this was not a problem for me. I wanted to challenge the stigma and create an empathic bond.

You not only work as a photographer but also as an educator through ImageMagica. How did ImageMagica begin and what does it do?

I founded ImageMagica in 1995. It had a funny sort of beginning. I was in a small town in the state of Minas Gerais to photograph workers in a quarry. There was a group of children who gathered around me, wanting to know what I was doing. So, I decided to teach them photography and give them some cheap plastic cameras and rolls of film. That way, they could have fun and I could continue with my work in peace.

Later, I took their films back to São Paulo to develop and print. The images were incredible, very sensitive. When I took the photos back to the children, they began asking each other about various social, educational, and environmental problems that they had photographed in their city. In a very spontaneous, natural and creative way they were discussing important community issues. That started me thinking about using photography for social transformation and empowerment.

A quarter century later we continue to do the same thing. But over the years we have developed and improved our methodology. Thanks to the hard work of our team, today more than 380,000 people have taken part in our projects – in Brazil and in other parts of the world – in more than six hundred educational and health institutions.

What have you learned in the process of making these photographs?

When one cultivates empathy and compassion it is not only good for the person one helps, it is good for oneself. In a moment of compassion, I feel part of something much bigger than myself. I feel I am part of the whole, within this great community that is the planet … and I no longer feel alone.

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photo: © Camila Pastorelli

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This article was initially published in Chinese, in the June 2020 issue of PhotoWorld magazine, Beijing. The theme for the year was compassion.

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