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October 3, 2008 Permalink

Nachtwey's Wish: Awareness of XDR-TB

Well-known and influential photojournalist James Nachtwey won the TED Prize last year, and as part of his award, he made a wish for help - help in bringing a story to light that he felt was important and underreported. The subject of this story is a new, dangerous type of tuberculosis called Extreme Drug-Resistant Tuberculosis, or XDR-TB. Tuberculosis is both preventable and curable, but inadequate treatment has been driving the emergence of XDR-TB, especially in developing nations. Tuberculosis is not a disease of the past - in 2007 alone, 1.7 million people died from TB - it is the leading killer of people infected with HIV. Nachtwey's wish was that he could break this story, and demonstrate proof of the power of news photography in the digital age. The 14 photos previously hosted here were on temporary loan - for all of the photos, and much more information about XDR-TB, please visit (14 1 photo total)

Group of Tuberculosis Hospitals, Mumbai, India. A patient with advanced pulmonary TB receives a daily injection as well as oxygen. (© James Nachtwey/VII)
more photos
This page lists only comments and the first photo for the entry.
To see the entire entry, with all photographs, click here.

84 comments so far...

Powerful images. Haunting... hard to believe they are just from this past year.

Posted by Gerald October 3, 08 12:57 PM

Powerful images! Nachtwey once again wakes the world.

Posted by Vaughn October 3, 08 01:02 PM

Heartbreaking photographs. That's all I can say.

Posted by hereiam October 3, 08 01:08 PM

It is hard to believe that some of these are real people. As Americans we are so used to seeing well nourished (probably over-nourished) men and women, seeing these dying patients, it is shocking. Thank you.

Posted by Devin October 3, 08 01:09 PM

there is nothing, but their eyes..

Posted by nanimo October 3, 08 01:11 PM

Black and White pictures are way better to get the "feeling" of the moment. Hope some day no one in the world has to suffer while others are just wasting resources. Thank you

Posted by Emerson Arguilen October 3, 08 01:18 PM

Breathtaking.... Almost too much.

Posted by Blake J. Nolan October 3, 08 01:18 PM

oh my gosh... this and the children's cancer photos are beyond words. they bring out so much emotion. truly great examples of how single pictures are worth more than words could ever explain. completely amazing! i love this site

Posted by chris October 3, 08 01:35 PM

A couple of days ago I said on another blog that I don't like James Nachtwey so much, but after watching this pictures I think I like him. :-)
I didn't like his movie so much.

Posted by October 3, 08 01:40 PM

e pensare che noi ci lamentiamo per molto meno. dovremmo vergogniarci!

Posted by girang October 3, 08 01:48 PM

I am such a fan of his work! One of the best photojournalists ever. Always inspiring. Always personal.

Posted by Corey Ralston October 3, 08 02:00 PM

Very powerful

Posted by The Baltimore Babe October 3, 08 02:04 PM

breathtakingly haunting!

Posted by Michele October 3, 08 02:23 PM

I can not believe we live in the same world. These photographs are incredible powerful.

Posted by Simon Christen October 3, 08 02:29 PM

I work in medicine at a busy trauma hospital and see tragedy everyday.
Even as desensitized as I am, these pictures really hit you at the core. It's unpleasant, but real life ...

... maybe we don't have it so bad here in the U.S. ?

Posted by aY October 3, 08 02:34 PM

Wow. #14 is scary...

Posted by Laust October 3, 08 02:40 PM

Makes you thankful for your health and healthcare system in the USA.

Posted by Jeff October 3, 08 03:21 PM

Truly haunting photographs.

Posted by John October 3, 08 03:36 PM

nachtwey chooses to use his camera as a tool to educate others on the suffering in this world. he should continue to be highly commended for the work that he does. for those of you who aren't familiar with him, you should watch the documentary "the war photographer".

truly gripping photos. thanks for sharing.

on a picky side note, tuberculosis is misspelled once in the description - it appears as "tubercolisis", i believe.

Posted by hiddenexposures October 3, 08 04:09 PM

Thank you for sharing these images!
Also, I would like to point out a typo in the 4th picture. It is 'Tambaram', not 'Tambaran'.

Posted by meki October 3, 08 04:13 PM

Powerful images, but will anyone pay attention? I'm a big fan of Nachtwey and particularly of his attempts to get news media to pay attention to important stories. But the truth is, more than at any other time in recent history, mainstream media have no interest in stories like this and most of the people watching, listening or reading, don't seem to mind.

Posted by Miles October 3, 08 04:15 PM

Typos fixed, thanks all.

Posted by alan taylor October 3, 08 04:25 PM

XDR-TB cases have already been reported in the USA. The fragility and exclusionary nature of our healthcare system here will be put to the test if a disease like this or others gets a firm foothold in the population.

Posted by Randall October 3, 08 04:48 PM

The choice of black and white is interesting. Perhaps done for artistic purposes... however I think that colour photos may have brought more attention to the fact that that this isn't an issue of the past, but a pressing issue of today.

Posted by mort October 3, 08 05:44 PM

Full of so much sorrow and heartbreak - black and white is the perfect medium for this - it starkly highlights the despair and pain that comes across so many of these frames.

Posted by Anox October 3, 08 06:17 PM

Absolutely moving....reminds me of how as humans we are all so fragile.

Posted by Mark Breneman October 3, 08 06:56 PM

Unbelievable. Beautiful. Heartbreaking. Awful.

Posted by Renaud October 3, 08 07:20 PM

Oh my god, when I stumbled onto this, I was shocked with awe.

This is such a powerful photshoot, it really shows what's going on over there.

Posted by Colin October 3, 08 08:31 PM

Shock and powerful image.
Thanks for your work, and your work definitely reminds us who may ignore this reality in dailylife.

Posted by Richard October 3, 08 09:53 PM

Jim Nacthwey and Sebastiao Salgado define what is good photojournalism. I can't think of anyone who can match those two for sheer beauty of their work as they expose all sides of life.

I met Jim once, and he's one of the most humble people I've ever met in this business. Such an amazing eye, such true concern for his subjects. The definition of "The Concerned Photographer."

Posted by Eric October 3, 08 10:09 PM

$700 Million to bail out the filthy rich in the U.S.... while images like this seem to go unoticed. The world is one messed up place my friends...

Posted by Nick, Australia. October 4, 08 12:14 AM

Wow.... my jaw was dropped literally the whoooole time i saw these pictures. The conditions of these people is just terrible and heartwrenching

Posted by Karry M. October 4, 08 01:34 AM

Of course, it wouldn't take 700 Millions of US$ to cure all this (these) which make it so difficult to achieve! :(

Posted by Jean-Marc October 4, 08 05:58 AM

Sad pictures... Its something wrong with the world nowadays...


Posted by Alex October 4, 08 06:31 AM

700 b $ bailout bill? With only 1 b $ we could save all this people and thousands more. And no one f**king cares.

Posted by Ingo Vogelmann October 4, 08 10:59 AM

Sadly real

Posted by Ulises October 4, 08 11:19 AM

et pendant ce temps-là, M. ou Mme Dupont reçoivent deux ans de salaires en guise d'indemnité de départ alors que la banque qu'ils ont géré coule. Si on remettait ce monde à l'endroit ?

Posted by santiago October 4, 08 12:20 PM

I cryed. It's a crisis of consciousness. Humanity has to be better than they have ever been before, not in terms of religious doctrine but in terms of ethics. There are enough resources to struggle and win the war against ignorance, poverty and all the unnecessary pain and suffering depicted in these pictures. Mankind mostly chooses for self rather than a choice for community. Those, who for whatever reason, have been given an opportunity to prosper in this world have betrayed that gift. They most often by promote their own agenda's-their own self interest rather than promote the potential for a better world. Mankind use their little position of power, provided by their abundance, to assure for themselves more abundance until they become sick with there own greed. Until enough people can raise consciousness to a new level, which may have a lot to do with being couragious enough to hold each other accountable, I don't see how we can achieve, what must be achieved, to survive.

Posted by Margie Hendricks October 4, 08 12:23 PM

Hi from Indonesian .

By chance I also the sufferer the TB that was undergoing medical treatment 6 months.

Pray for it is hoped I could recover !


sorry for my bad english,because i using software translator

Posted by reges October 4, 08 01:48 PM

What can we do to help?

Posted by MARA FRATTASIO October 4, 08 03:16 PM

Take a long look at the conditions that exist in #11. In that very city, mogul Mukesh Ambani is in the process of building his 27-story, 400,000 square foot "residence antilla". The construction costs are estimated to be nearly $2 billion US ( He and his brother Anil are respectively listed as 5th and 6th wealthiest people in the world at a combined net worth of over $80 billion. The fact that this man lies in squalor in the shadow of this monstrous construction project is shameful.

Posted by Mel October 4, 08 03:28 PM

Cases of this disease will be coming here thanks to our open borders immigration policies. The increase of TB cases in places like Milford, MA have been attributed to the influx of illegal immigrants who bypass whatever health screening is done through legal means of immigration. I am guessing that the strain of the disease here in the US is not the drug resistant variety but with time and continued tolerance of illegal immigration the resistant strain will no doubt make it.

Posted by Richard October 4, 08 03:28 PM

Margie, wake up (#38). It's not our job to take care of the entire world, just our country. If you want to save the world then go for it, girl: but the rest of us are not signing on to your crusade.

Posted by Bob B. October 4, 08 03:35 PM

Very touching images. Lets spread awareness about XDR-TB to help those people!

Posted by Maldo October 4, 08 03:40 PM

Very powerful photos. Eye-opening. The world has enough resources to help people with TB and with many other diseases. We should stop being so greedy that we eat up so much of the world's resources. Let's give up the latest gadget, the new fancy restaurant, the idea of a new car when the old one works fine and consumes less, the expensive and preservative-laden ready meals, the brand name jeans and put our money to better use. While we worry about Wall Street, ordinary people the world over are going through real crises.

Posted by euge October 4, 08 04:47 PM

My god, Unbelieveable!

Posted by fabio santos October 4, 08 06:19 PM

It's nonsensical that people in such a condition as documented in the photos receive medical care in hospitals. Part of the reason the worldwide TB infection rate has risen is because of life-extending treatments for such patients.

Numerous epidemiology studies have shown that the best strategy to reduce overall infection rates of TB and AIDS in undeveloped populations is quarantine without life-extending medical care. Resources can then be devoted to halting the progression of the disease in early-stage patients.

Posted by S. Murray October 4, 08 06:21 PM

It is so shameful that this country is spending billions to wage war in a wealthy country like Iraq and letting this disease rage on - what next? So graphic, so heartbreaking! This is why I support the "Doctors Without Borders" group. The USA isn't doing much - just preaching abstinence as a deterrent to HIV! I'm so disgusted!

Posted by Neysa October 4, 08 06:39 PM

James Nachtwey's work is just unbelievable, impossible. Those photographs are only be possible if he'd be invisible.

Posted by John K. Frink October 4, 08 08:07 PM

And we think we have it bad sometimes!

Posted by Clarence October 4, 08 09:37 PM

Bob B. and S. Murray, those are pretty cold statements. I assume that if someone in the street reached out their hand to you to help them up, you would, instead, recoil in disgust and walk the other way back to your warm house.

Posted by Saddened by all of this October 4, 08 10:19 PM

while the western worlds fight over billions of dollars, obesity and celebrity tabloids, the rest of the world is facing the horrors of preventable diseases.

sometimes my own culture disgusts me.


Posted by david smeaton October 4, 08 10:40 PM

James Nachtwey is one of my favorite photographers of all times. Sadly enough such heavy subjects that he photographed and brought awareness to took a toll on him and possibily costed him his life.

For those interested in his work, rent or buy the documentary War Photographer. He was a brave soul.

Posted by AN October 5, 08 10:21 AM

Hey, S. Murry (#47), does that solution include your relatives?

Posted by Jeanne Benjamin October 5, 08 12:13 PM

Hey, Jeanne Benjamin (#54), that solution would indeed include my relatives if they were members of undeveloped populations and infected with TB or AIDS.

By the way, I'm an epidemiologist at a major research institute in Boston, so I suspect I know more about population-based health management than you do.

Posted by S. Murray October 5, 08 05:27 PM

S. Murray (47): That is a truelly callous and short-sighted statement you have made. Your solution is to basically let the third world die? Or are you proposing death camps a-la WWII? First it'll be AIDS, then TB, then Cystic Fibrosis, then it'll be anyone who carries a gene that may cause these diseases in their offspring.
Maybe we should quarantine you?

Posted by Yaseen Joolay October 5, 08 06:10 PM

XDR-TB developed from the mismanagement of multidrug-resistant TB (MDR-TB), often when first line treatment was not reliably continued. There is substantial funding of ongoing research into the disease, including the Bill and Melinda Gates foundation.

XDR-TB demonstrates the impact of misapplication of continued strong scientific advances in antibiotics. Many in the United States even demand antibiotics for the common cold as a sort of socially acceptable placebo... and future generations will continue to pay a price for this sham which remains accepted and enabled by the medical profession. Even today, I would guess that innovations like Zyvoxx are probably prescribed as much for celebrity status or physician arrogance as medical need.

Roman Catholic priests would be spending less time in AIDS hospices were the church to cease the theological, inhuman insistence on abstinence-only education throughout the world. TB is one of the most common infections of individuals with HIV/AIDS. This abstinence teaching policy by the Catholic church and the United States government continues to result in the needless deaths of millions.

Posted by puzzling October 5, 08 06:20 PM

Wow! A prayer for them is all we can really do at this point. I am a firm believer that the over use of antibiotics for common colds and viruses are a huge part of not having a cure for such dieases!

Posted by shocked October 5, 08 08:46 PM

How fortunate we are to have the medical care that we do in the USA!!!!!!!!

Posted by Anonymous October 5, 08 09:49 PM

Yaseen (#56), my statement may be callous, but it is certainly not "short-sighted." Quarantine and elimination of life-extending care for dying TB and AIDS patients minimizes infection rates in undeveloped populations, and reduces the likelihood of the emergence of drug-resistant strains. Multiple studies and models have concluded that this approach to population-based health management reduces the rate of infection in the long run.

This has absolutely nothing to do with eugenics, cystic fibrosis, or death camps. And clearly the people who pay me $100,000 a year to research infection dynamics in undeveloped populations don't believe that I should be quarantined.

Posted by S. Murray October 5, 08 10:03 PM

#57: Stop perpetuating the lie. Neither the availability of condoms nor their widespread use DO NOT lead to fewer STD transmission rates. Stop with the subrosa racism, also, by suggesting that 'Third Worlders' cannot control their sexual impulses and be abstinent.

AIDS victims in 1987: Philippines 135 / Thailand 112

In 1991 the WHO predicted the Philippines would have 80,000 to 90,000 cases and Thailand 60,000 to 80,000 AIDS victims.

Thailand promoted the use of condoms in massive campaigns; the Philippines promoted 'Abstinence' and 'Be faithful'.

The prognosis of the WHO was wrong for both countries:

1999: Philippines 1,005 / Thailand 755,000 AIDS victims

(Source: British Medical Journal, Volume 328, April 10th 2004)

Now we are seeing some of those gains lost in the Philippines as condom use rises:

Here is another case:

The March 2004 article in the medical journal, 'Studies in Family Planning' published an article titled "Condom Promotion for AIDS Prevention in the Developing World: Is It Working?". The piece was a meta-review of the scientific literature on the question.

The results shocked condom advocates. In the article, researchers Sanny Chen and Norman Hearst noted that, "In many sub-Saharan African countries, high HIV transmission rates have continued despite high rates of condom use." In fact, they continued, "No clear examples have emerged yet of a country that has turned back a generalized epidemic primarily by means of condom distribution."

No surprise, then, that Botswana, Zimbabwe, Kenya, and South Africa — the nations with the highest levels of condom availability — continue to have the highest rates of HIV prevalence.

(Source: "The White House Initiative to Combat AIDS: Learning from Uganda," Joseph Loconte, Executive Summary Backgrounder)

And yet another case:

Uganda at one time had the highest rate of HIV/AIDS in the world. Starting in the mid to late 1980s, their government instituted a program to teach abstinence before marriage and fidelity to one's partner afterwards. They only reluctantly advised condoms for high risk groups (like prostitutes) whom they knew would not accept the other two approaches.

Billboards, radio announcements, print ads, and school programs all promoted the virtues of abstinence and fidelity to prevent HIV/AIDS.

The results were astonishing.

In 1991, the prevalence rate of HIV was 15%. By 2001, it had dropped to 5%. It was the biggest HIV infection reduction in world history.

Among pregnant women, the drop was even more dramatic (as reported by CNS News, January 13, 2003). In 1991, 21.2% of expecting mothers tested positive for HIV. By 2001, the number had plummeted to 6.2%. Compare this with the 2001 numbers from Kenya (15%), Zimbabwe (32%), and Botswana (38%). All three countries focus on condom distribution, and all three countries continue to see their rates rise.

But wait, the condom advocates object. The Ugandan "miracle" is simply the result of more widespread condom use.

Not so, says Dr. Edward C. Green, an anthropologist at the Harvard University School of Public Health. Dr. Green was a strong proponent of condom distribution to stem HIV/AIDS... that is, until the U.S. Agency for International Development (USAID) hired him to study the reasons behind the success in Uganda.

The results of his research left him little doubt. "Reduction in the number of sexual partners was probably the single most important behavioral change that resulted in prevalence decline," he noted. "Abstinence was probably the second most important change" (testimony before the Subcommittee on African Affairs, as reported by Joseph Loconte).

"It is a very indicting statement about the effectiveness of condoms," he told Citizen Magazine. "You cannot show that more condoms have led to less AIDS in Africa.... I look at the data and I see that what might be called a more liberal response to AIDS — more and more millions or billions of condoms — has simply not worked, especially in parts of the world with the highest infection rate, Africa and the Caribbean."

(Source: )

Posted by JB October 6, 08 12:50 AM

The pictures can nearly bring one to tears. Some very sad and haunting images. Very powerful.

Posted by Dano October 6, 08 11:19 AM

Go to to take action against tuberculosis.
Then visit to learn more.

Posted by Abigail G October 6, 08 05:36 PM

Incredible, Powerful, Gripping images...

Posted by Gloria October 6, 08 09:08 PM

I am not surprised by the images, but nice practise of art!

Posted by Ahmed October 7, 08 02:49 AM

These photos surely remind us that we are mere mortals in spite of how technologically advanced we are. All the statements made, address a common theme of human behaviour. It may be a high risk sexual behaviour, it may be, not following social hygiene and so on. We need to be careful in phrasing strongly worded sentences. We all are capitalizing on problems and thinking that we are working towards a solution at the same time benefiting ourselves in solving those problems. By Capitalizing I don't mean just monetary benefits but also solace, deriving satisfaction in caring for fellow beings.But we need to realize that researchers would not be paid so much if there was nothing to research on, so Dr Murray should be grateful to undeveloped nations and infections...and yes if condoms are not as efficient as compared to limiting sexual partners why is so much spent on Condoms.

Posted by Subhash October 7, 08 08:03 AM

RESULTS ( has been working on the issue of TB for the past 10 years. When we started the U.S. was putting $2 million into global TB. The Lantos-Hyde Act that was passed this summer authorizes $4 billion over the next 5 years to combat TB as part of U.S. efforts to combat AIDS, TB, Malaria. Drug resistant TB is moral issue and security issue. If we do not combat regular TB properly, it turns into MDR and XDR TB and will end up in our country. Join a local chapter of RESULTS and make sure your elected officials know what actions to take to avoid the human suffering represented in these photos and protect our own nation.

Posted by Ken Patterson October 7, 08 09:14 AM

These are really thick photos.I have strange feeling in my chest.

Posted by Palo October 7, 08 09:44 AM

"I have been a witness, and these pictures are

my testimony. The events I have recorded should

not be forgotten and must not be repeated."

-James Nachtwey

Posted by Moussa Hashemzadeh October 7, 08 11:42 AM

this make me so sad :[

Posted by Stella October 7, 08 09:36 PM

To S.Murray (#55) While working with numbers and population - you might be right, but from the point of view of the person which works with REAL people in need - your way of thinking is the cowardly way to hide and/or be ashamed of doing nothing to change their situation. But once you are involved you may see that a dollar, resources and prescise calcutations have little to do with what human being can do, helping to a brother/sister. Stay in the office, wash your hands regularly, enjoy your life.
Natchwey's sharp eye does not help to see some "blinds" unfortunately...
Excellentwork, James Natchwey! Thanks for visiting Siberia!

Posted by Rost October 9, 08 12:18 AM

I wish TV channels would be brave enough to show such images.

Posted by Rhys October 9, 08 04:37 PM

Lost for word's. How sad that the world has come to this.. Best in photographic work I've seen in a long time. I am a retired Photo person...

Posted by Larry Parr Michigan USA October 9, 08 06:09 PM

Skin on Skeletons... #5, #11
And to think TB is so trivial in the Western World.

Posted by open source md October 9, 08 09:13 PM

thanks for posting, i wish there would be a wider coverage in the media.

Guido Steenkamp

Posted by Guido Steenkamp October 21, 08 01:37 PM


Posted by bolare November 17, 08 09:43 AM

To: Yaseen (#56):

Don't worry.
The Third World will effectively exterminate itself if it continues its unchecked population growth.
And if a pandemic does occur and millions of us are piling up in the streets, I'm afraid the suffering seen in these photos will only be looked back upon as avoidable scenes in The Great Human Folly.

My grandfather died at age 50 of TB in 1934, by the way - in enforced isolation and without modern drugs. Amazing - that system actually worked.

Posted by Truthist November 17, 08 01:04 PM

parce qu'on nous cache ce qu'il faut voir
tous aveugles & sourds...

Posted by Jü February 5, 09 10:22 AM

if you guys are so touched by this..
not being mean, but seriously..
thank you for reading.

Posted by Spread the word! February 11, 09 08:06 PM

For those of you who love James Natchwey as much as I do, check out a video interview of him with CEO of NEED Magazine.

Posted by NEED Magazine May 12, 09 11:41 PM

The picture is very haunting and powerful. The look in his eyes says it all. I like is because it's so real it's almost frightening. I get many emotions from the photo. I feel angry because there is so much technology out there that people shouldn't have to go through this, sad because he looks hopeless. Natchwey captures the essence of the moment and I think he is the definition of a photojournalist.

Posted by b. May 26, 09 10:12 AM

oh my God, i think God gives James Natchwey opportunity to share his pictures and show to the world that we are human, and must help each other, make a better world for human being.

Posted by febrian karimunjawa August 4, 09 02:47 AM

Why don't people look at these pictures and then tell us how great god is? It's always the beauty of nature that they try to use as proof of god never the needless suffering of people.

Posted by Arkay October 1, 09 05:36 AM

* Possible mechanisms by which antiphospholipid antibodies may induce thrombotic events include the following:

Posted by Duke October 4, 10 02:10 AM
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