We Are in Hiding From Each Other, Not Together in Public Anymore
A conversation about health with journalist and filmmaker Ed Kashi by Kimberly J. Soenen | January 31, 2023
(Street scenes at dusk in the Mission District of San Francisco. Photo by Ed Kashi / VII)
Ed Kashi is a friend, colleague and collaborator.
I began working with Ed in 2011 as the Director of Global Business Development and Special Projects for VII Photo Agency in New York. We have worked together on mass incarceration stories, labor rights stories, and multiverse health projects, including “SOME PEOPLE” (Every)Body.
Recently, Ed worked on a health feature for TIME Magazine that gave us good reason to discuss the state of Global Health in 2023. I caught up with Ed on the road. He is currently traveling across the United States working on a project with his creative and life partner Julie Winokur.
What follows is an engaging exchange on reportage, parenting, health and hope.
(For the first time in history, as people grow older, they're gambling more. With free time to fill and heightened social needs, the elderly have become easy prey for the gaming industry. Slot machines are a favorite pastime for many seniors on gaming tours in Reno, Nevada. Photo by Ed Kashi / VII)
Soenen: In your decades of covering Public Health and Global Health issues worldwide, what notable shifts related to health and healthcare have you seen since 1980?
Kashi: In the United States I’ve seen the bureaucracy of health care explode, as well as the costs. The quality of care is very uneven and truly based on how much money you have and your race, gender and geographic location. In many ways, your zip code determines the quality of care you’ll receive.
Even with the Affordable Care Act (ACA) national healthcare legislation being accepted more and more, it hasn’t solved our healthcare crisis. While more people are “insured,” the costs are way too high and the stress of dealing with the bureaucracy can be overwhelming at times, especially if you’re already in a vulnerable or debilitated state due to your health.
Finally, regardless of who you are and how much money you have, it’s imperative to have an advocate with you if you get absorbed into the healthcare machine. That can be a family member, friend or ideally someone who is familiar with healthcare, but to go into the void alone can be stressful, lead to bad outcomes and a complete loss of agency with your health.
In other countries, particularly in the developing world, it’s hit or miss. In many places in Africa, if you get very sick or have an accident or heart attack, you’re out of luck unless you are in a major city.
The good news is there are more and more well-trained and highly skilled healthcare practitioners. Countries that have Universal Healthcare tend to overall have better outcomes and getting sick doesn’t make you sicker by having to deal with the system. Then there are countries like India and Mexico, among others, where medical tourism has taken hold, attracting people from the United States and other developed countries to take advantage of the high level of care and the low cost.
Soenen: You recently covered the indentured servant / modern day slavery worker conditions at the World Cup in Qatar. After all of these years covering health, conflict and human-interest stories, does anything shock you anymore?
Kashi: Even with all I’ve had the opportunity and privilege to witness around the world, I continue to be angered by the inequities I see. The situation in Qatar and other Gulf states makes it clear modern day slave labor still exists. It might not look like slavery in the past, but the bottom line is people from poor countries are taken advantage of, paid poorly, treated without dignity or respect and in some cases, taken complete advantage of, including not being paid their earned wages and not having the freedom of movement.
In general, we continue to live in a world that is unequal and people continue to take advantage of those who have less power or wealth. The indignities and moreover, the health risks, inspire me to continue to look for stories that will uncover these endemic problems in the global workforce.
(Marvin Wilson, 94, owns the only house left standing on the south side of town. Even before a tornado nearly wiped the small town of Spencer, South Dakota, off the map in 1998, the community was a metaphor for decimation. Over half the residents are senior citizens, witnessing their town and their traditional way of life die out. Photo by Ed Kashi / VII)
Soenen: What are the three health and healthcare stories that have impacted you personally the most in the last 20 years and why?
Kashi: I would say the first is witnessing my father-in-law treated as less than human when he went to the hospital after a fall. They mis-prescribed medication that caused him to have hallucinations and deteriorate to the point we thought he’d need a feeding tube.
If it weren’t for my wife’s cousin, who is a world class gastroenterologist living in New York, who came to the hospital in New Jersey where my father-in-law was being kept, and pushed to find the medications and treatments he was getting, things could have turned out horribly. This event dramatized two things for me: that you need an advocate once you’re in the clutches of the American healthcare system, and, that our elders can often be treated as less worthy to treat and save.
Another story that continues to absorb and inspire me as a visual storyteller is the issue of CKDnT (Chronic Kidney Disease of Non-Traditional Causes.) I’ve been working for a decade on this issue and have reported from seven countries. It’s devastating to see a preventable disease take the lives of tens of thousands of mostly rural manual laborers, as well as cause tremendous disruption to the lives of families, communities and even nations. This is a disease that is connected to Climate Change and our warming planet and lays bear the inequities of manual labor, the lack of respect for so many of our workers globally, and ultimately, a Human Rights violation for so many of the workers who make our lives more affordable and aplenty with foods and other stuffs.
Another story that reflects the dysfunction and greed that too often infects America’s healthcare system was in Dallas, Texas. We worked on a story about a woman who had breast cancer and it cost her husband his six-figure tech job. Once the medical bills came in, he was let go from his job. It put tremendous pressure on the family and led her to go out onto the streets of Dallas to panhandle for money to support her husband and two children.
It was devastating to witness this and ultimately, she passed away after a double mastectomy. This left her husband a widower with two kids and no job. This story reflected the absurdity and cruelty of the United States Commercial Health Insurance industry and corporate healthcare system.
Soenen: Can we discuss that absurdity and cruelty more deeply? How do you protect yourself from getting cynical? What do you witness in the field that keeps you hopeful and motivated?
Kashi: I don’t believe in cynicism. That is a defeatist attitude that accomplishes nothing. Within all the misery and unfairness, there are so many great folks who work as nurses, doctors, technicians, and other jobs in our healthcare system. They care, they innovate, they treat people with dignity and true concern. I take solace in those folks.
The Commercial Health Insurance industry companies, many of our hospitals, and the cynicism based into our political system is what bewilders and angers me so. It’s important to take stock of the positives and good people, and continue to all do our part to move the needle towards a more equitable and affordable system.
I just went on Medicare —the United States taxpayer-financed Single Payer National Healthcare Program for senior citizens —and can already see, once all the paperwork was done, how much simpler my healthcare reality will be. As I’ve heard over and over, our government system, for all its faults, works very well, and is much more affordable than private insurance.
(Inmates at the Hamilton Aging and Infirmed facility in Alabama gather to smoke in the designated outdoor smoking area. Photo by Ed Kashi / VII)
Soenen: One of my favorite photo books—Photographs Not Taken: A Collection of Photographer’s Essays (Daylight Books) contains no photos at all. You were a contributor to this stand out concept. Can you describe one or two memorable “Camera Down" moments over the course of your lifetime?
Kashi: There have been many times where I decided to not make an image of a scene I was confronted with. Two that stick out are from Pakistan, which is the moment I contributed to Will’s book.
We were returning from a long day in the field in the Punjab province of Pakistan, when we came upon a horrific scene of a young couple with a small baby that had collided with a truck on the highway. The father was already dead, his entrails spilled out beside him, the wife was wailing, holding their dying son. I decided at that moment there was no value to documenting this scene, it was not part of our story, there was enough tumult and uncontrolled energy around the scene and if I picked up my camera it would cause more harm than do any good.
Another situation was when I was working on my personal project about the messianic Jewish settlers in the West Bank, and specifically in the Palestinian city of Hebron. I knew that many Saturdays, during the Jewish sabbath, some settlers would run rough shod on Palestinian areas, smashing car windows and spraying graffiti. I also knew that if I came to photograph this, I’d lose my access to their story, which I had spent years developing. In the end, I made the decision to not photograph these scenes to maintain their confidence and thereby my access.
Soenen: Has there ever been an instance when a person asked you not to photograph them? Your body of work called “Eye Contact” walks this high wire.
Kashi: There are too many instances where people have asked me to not photograph them and generally, I respect these wishes. It’s only in public events or circumstances where the need to photograph outweighs the concerns of the subjects that I have forged ahead against someone’s wishes. But I’ve never pushed it to the point of confrontation or violence!
(With its resources strained, the U.S. Department of Veterans Affairs has taken an innovative, home-based approach to caring for elderly veterans. 81-year-old veteran James Bowlding's son helps to care for his father at home. Photo by Ed Kashi / VII)
Soenen: What is the common thread that pulls through all of your health-related work? From sugar cane laborers in Central America, to Americans who cannot afford access to medical care, to industry’s effect on health in Nigeria…what, in your view, is the common denominator in these stories?
Kashi: The common denominator is that every country must move towards Universal Healthcare. All the monies that go into maintaining a behemoth healthcare bureaucracy drain the quality of care and force healthcare professionals to make decisions based on economics instead of what’s best for their patients. Healthcare is indeed a right, not a privilege.
Soenen: One word: Guns. What do you and your adult children discuss around Public Health and Safety? How do those discussions take shape as a family?
Kashi: Don’t many Americans live in this amnesiac state of affairs when it comes to the deeply ingrained social and political ills that plague our house? It’s one of the illusory ways we live as Americans. Gun violence, racial injustice, lack of medical care and insurance for millions, homelessness, political gridlock and infighting…the list is long and troubling if you are paying attention. As Americans, we tend to try to forget. I’m proud of our kids in that they remain aware of these ills but have learned to live their lives without the constant strain of these realities.
Thankfully, our kids don’t seem concerned in their daily lives about gun violence. It would only take one unthinkable act for that to change, of course. We actually don’t talk much about gun violence within our family, other than wringing our hands at the tragic loss of life and disruption that this kind of violence causes. We always tell our kids to be aware of their surroundings and not be too loud in public, especially when abroad, but when in the United States, it’s basically life as normal.
I am relieved my kids are out of school and working in places that seem “safe,” yet after the recent shootings in California, one of which was within 20 miles of where our son works, it’s hard not to hold a background sense of anxiety. The fact we must even think this way is a perverse reflection of how damaged our society has become. Like homelessness, gun violence has become an accepted norm instead of a problem to be stamped out. There is no logic, other than the greed of weapons manufacturers, and politicians who prey on the unfounded fears of gun owners.
(One byproduct of the recent focus on more and longer prison sentences has been the growth of geriatric prison wards, where overcrowding and chronic illness among the inmates are straining the system. Inmates at the Hamilton Aged and Infirmed facility in Alabama sleep in bunk beds due to overcrowding. Photo by Ed Kashi / VII)
Soenen: What is the one healthcare or Public Health story you would like to shoot in 2023 that has been under-reported?
Kashi: The lack of adequate caregiving in our society. There are not enough caregivers and the way we support them publicly is perverse. We can pay strangers to care for our loved ones but we cannot be compensated for doing it ourselves. We have crippled many of our community and family structures, yet refuse to acknowledge the need to support our caregivers.
Soenen: Your close friend and longtime colleague in photojournalism, George Steinmetz, has been shooting on food, environmental health and global food systems for a long time. When you two get together, what are your concerns about Global Health as men, photographers and fathers?
Kashi: His work is focused on the grandeur of food production and he seems to purposefully avoid politics or environmental issues. The concerns we do share are that the Food Industrial Complex is necessary to feed the planet, but the quality and humaneness of certain aspects of mass food production leave a lot to be desired.
Soenen: Does one photograph still have the power to move the dial legislatively? Are people saturated and desensitized, or, does the work of exceptional photojournalists still cut through?
Kashi: Still images continue to have power and currency to have impact and change the way people think. Perception is everything, and even with the diminished credibility of the media, images still hold value, truth and impact.
I believe the only way for lasting impact is repetition of the same stories and images, so people across many platforms see and share the images and stories. I also believe that folks who are fine with their health, Commercial Health Insurance coverage and healthcare needs tend to tune out of the conversation about Health Inequity, Health Disparities, Barriers to Healthcare Access, The Death Gap, The Wealth Gap, and ongoing Commercial Health Insurance Industry White Collar Crime.
Like many aspects of life in America today, we are a bifurcated society, of those who have and those who don’t, those who care and those who are tuned out, those who are directly affected by health issues and those who are not. The collective sense of a society in it together has been shattered by politicians who act as demagogues, media that trumpets the wrong elements of issues and a social media society that is too often deluged with too much information.
We are in hiding from each other, not together in public anymore.
( Three / Photo by Ed Kashi / VII)
Soenen: Best advice a journalist ever gave to you?
Focus on your strengths and don’t try to be a generalist.
River, lake or ocean?
Ocean.
Canon, Leica, Nikon, Hasselblad, Sony or…
Canon.
Amsterdam or the United States?
United States.
Do you ever relax and if so, how?
Yes, by watching TV and putting my phone down.
Insomnia or sleep like a baby?
Sleep like a baby.
Favorite band/music?
Impossible to say!
Favorite meal?
Thai food.
Soenen: Who is Julie Winokur, your creative and life partner?
Kashi: Julie is both a muse and editor of me and my work. She represents the highest quality of intelligence and storytelling, so I listen to her opinions whenever possible.
(Scenes from the 2001 Senior Olympics in Baton Rouge, Louisiana. In fifteen years, the Senior Olympics has grown from a modest experiment to a national phenomenon drawing more than 12,000 athletes in dozens of events. Part of the success of the Senior Olympics is competition among athletes of the same age group. A sprinter crosses the finish line during a track event. Photo by Ed Kashi / VII)
Soenen: Words of advice for talented up and coming young photojournalists?
Kashi: Find what you care about and delve deeply into it.
Soenen: Thoughts on the future?
Kashi: Hope is an unlimited renewable energy source for humanity!
Soenen: Thank you, Ed.
To view more films, writing and photo essays, visit Ed Kashi, VII and Talking Eyes Media.