jake lyell photography (blog)

As unemployment remains high and the region’s resources are rapidly being swallowed up by the booming population, family planning is something that every family should consider here in East Africa.  In Amuria, Uganda where I live, 57% of all people are under the age of 17.  When one compares that to my home town of Richmond, Virginia, in the US, that number falls to 22%. Uganda’s youthful population of 32 million has nearly doubled in the past twenty years.  It has one of the highest growth rates in the world.  If the current trends stay on track, the country will be home to more than more than 130 million people by 2050. 

I’ve recently been working with PSI, Population Services International, in Tanzania and Uganda. PSI works in a number of areas in Global Health, but I’ve been specifically documenting their family planning services here in East Africa. Working in both rural and urban areas of East Africa, PSI educates women and families about family planning and provides them with birth control solutions such as condoms, IUDs, and oral contraceptives. According to the organization, PSI prevented an estimated 3.5 million unintended pregnancies and over 17,000 maternal deaths in 2009 alone. Fewer pregnancies and spaced births provide families with a more sustainable way of life, and further boost the chances of survival for existing children. Above, women visit a family planning clinic in Dar es Salaam, Tanzania.

Most Ugandan women average seven children in their lifetimes. Here large families are needed to work the land, but the number of children a family has also determines that family’s, and larger clan’s, social hierarchy, especially in rural areas. However, when children reach adulthood they often find themselves in deeper poverty than their parents because their parent’s land must be divided among such a large number of children. Families who have large numbers of children in turn find it a struggle to come up with enough money to educate them all. Often families must choose which children to send to school and which ones to keep at home. When parents do choose education for their child, it is often in overcrowded classrooms, averaging about 70 students per teacher in Uganda. In my district this number reaches 120 students per teacher. Above, children learn in a crowded classroom in Tororo, Uganda.

Above, Sylvia Mkuteni (name changed) is twenty-five years old and lives in Masaka, in southwestern Uganda. Her husband lives and works in Kampala and only comes home once every few months. She has a hard enough time raising their five children on her own, and so, despite her husband’s wishes for a larger family, she’s decided not to have more children. Three months ago she received an IUD through PSI’s services. She hasn’t told her husband about it and doesn’t plan to.

While access to contraception in Africa is widely available in most cities, those in rural areas may be a day’s journey from any family planning services. In East Africa, PSI works to make their products and services available to all by establishing programs in small private clinics in both urban and remote, rural areas. Often women first hear about their option to plan families through PSI’s informational adverts on the radio.

While most women can pay for their contraception, PSI has designated one day a month in Masaka as a discount day, where women can receive services at a highly discounted rate. They’ve been extremely successful at stamping out common misconceptions about contraception that are whispered between women in the village: contraception makes you sterile, contraception causes abnormalities in future offspring, breast milk decreases during use, etc.

Above, Bashir Hassan (left) sells Salama brand condoms in his general store in Dar es Salaam. PSI is the manufacturer of these the most popular and widely available brand of condoms in the country.

Despite the large presence of the Roman Catholic Church (42% of Ugandans are Catholic), the nuns and clergy here are quietly supportive of family planning operations, directing parishioners to where they can receive such services or even handing out condoms. Above, Sylvia Mkuteni (right) examines an IUD at Kawoko Muslim Health Centre in Masaka District, Uganda.

PSI has programs in over 65 countries throughout the world. Reproductive Health is just one of the areas in which the organization works. Others include malaria and TB prevention, HIV/AIDS and water treatment. If you’ve ever wondered how many residents we have on our planet and at what point humans will outgrow the earth’s resources, this recent David Attenborough/BBC documentary suggest that things may get pretty tough within the next forty years. As the average American consumes as much of the world’s resources as 300 Tanzanians, it’s a topic in which we have a vested interest. Take a look. It’s thoroughly interesting. Take a look.

Amuria Health Centre has been packed beyond capacity in recent weeks, with more people occupying the floors than hospital beds. As the rains continue to fall, more and more people here contract malaria. During the rainy season, when streams rise and lowland areas become flooded, mosquitoes breed in greater numbers.

This health centre’s resources (Amuria has no official hospital) are stretched thin even outside the rainy season. The entire district of over 300,000 shares just one doctor for all its public health centres. He travels around from village to village and is rarely in one place for more than a day. When medicine and supplies are available, the cost is picked up by the government. When they run out, which is all too often, the only option for patients is to pay cash for drips, drugs, and needles from the local pharmacy and bring them to the hospital. “Most of the time the drugs are out of stock because the patients are many and the drugs are few,” says nurse Damali Akello.

Amuria town’s health centre is the largest in the district of the same name. Patients from all over the district are sent to this, the largest town in the district, in order to treat ailments of any kind requiring more advanced treatment. “Severe malaria they refer here,” says nurse Akello.

“Usually six months out of the year I have it pretty consistently. I am always attacked when the rains come,” says Grace Auma, while connected to a drip of sodium chloride mixed with quinine. Pictured above, she’s spent the last two nights on the concrete floor of the centre, her pillow a plastic bag stuffed with a change of clothes brought from home.

Children and pregnant mothers, those whose immune systems are weak, are most susceptible to malaria. According to the World Health Organization, 2,800 children die every day in Africa as a result of the disease. Here in Amuria, nurse Agnes Alungat sees the most deaths when malaria is present alongside other health problems. “We only lost one child the day before because of malaria complicated with anemia.”

Earlier this year, Bill Gates announced that his foundation was in the last trial phase of a malaria vaccine that could change the future of Africa and other continents affected by the disease. It is hoped that within five to ten years a fully effective vaccine will be on the market and available to all. In the mean time, seeking treatment and doing so early is the key. I know this from personal experience, and it seems that all here in the centre tonight know this as well. Thankfully for now it it looks as though everyone here is going to pull through.

It’s not really what you think of as Africa, but neither is it the Middle East. The island of Zanzibar, otherwise known as Unguja, is in part its own entity, and the center of Swahili culture in East Africa. In an area of the world where political unrest is not uncommon, it’s a wonder Zanzibar has been in union with the Tanzanian mainland for as long as it has.

The Sultanate of Zanzibar, an archipelago nation off the Indian Ocean Coast of East Africa, merged with the East African nation of Tanganyika in 1964 to form the United Republic of Tanzania, a hybrid name reflecting both countries. Earlier that year Zanzibar, a newly independent state itself, experienced a revolution in which over 12,000 ethnic Arabs and Indians on the island were massacred overnight. In the wake of the revolution most of Zanzibar’s wealthy and educated fled the country never to return. Its president, facing a potential coup by extremists and a devastated economy, had little choice but to join forces with the mainland country of Tanganyika.

Culturally, Zanzibar is almost quite literally oceans apart from its mainland counterpart. The population today is overwhelmingly unhappy with what they see as the destruction of their conservative Islamic culture brought on by relaxed travel rules between the island and the mainland and their limited autonomy as part of the union government. However, each cycle of elections, the results of which are usually disputed by international observers, sees victory for CCM, the party favoring closer ties to the mainland. The union government has survived to this day, but the marriage has never been happy.

These photos were taken over a four-day period while practicing my Swahili in Stonetown, known as Mji Mkongwe to speakers of the language. I intended to get out of Stonetown and photograph a bit more of the island, but the myriad of winding alleyways, hidden rooms and endless cups of fresh coffee brewed over open coals on the street were enough to keep me wandering around in town for more than a week.

More like an ocean, Lake Malawi runs almost the entire length of this Southern African country. I went to one of the least developed parts, the northern town of Karonga, on my way down to a recent assignment shooting Gucci funded UNICEF projects for Marie Claire Magazine.

I was recently in Western Kenya. What was intended to be a quick stopover en route to Uganda turned into four days of rummaging through a rainforest with my camera wrapped in plastic shopping bags. As my “hotel” was without it, I had to hitch a ride on the back of a motorcycle to the nearest place with electricity so I could download images and charge batteries every night.

Not too long ago Africa’s midsection was a band of almost solid rainforest, stretching over six million square kilometers from West Africa along the Atlantic, through to the Central African Republic and the DRC, into East Africa. Today, the Guineo-Congolian rainforest, as it is known, is now just a remnant of what it once was, its canopies having suffered the impact of logging, oil and mineral exploration. In the case of the Kakamega Forest, large areas were cleared during colonial times to make way for large tea plantations. Below, children stand in front of tea fields along the the forest’s periphery.

While vast ares of the rainforest are still present in Central Africa, only a tiny section of it remains in Kenya, where it is now a protected area. The Kakamega Forest Reserve occupies 240 square kilometers in Western Kenya and contains huge varieties of birds, insects, snakes, plants and small mammals. Many of the plants in the forest are highly medicinal.

The most exhilarating of events for me came as I accompanied a group of forest rangers on their daily rounds through the reserve. Following behind these soldiers with loaded weapons in tow, through thick vegetation and winding streams, really got my adrenaline going. At one point we were in hot pursuit of some poachers who were cutting down a tree, but they managed to escape.

The area around the forest, though rural, is one of the most densely populated areas in Africa, with around 400 people per square kilometer on average at its western and southern perimeters. As the communities around the forest are impoverished, the pressure is great to exploit the forest for its vast stocks of wood to be used as firewood or made into charcoal. Arrests do occur here every day. Steep fines accompany arrests and increase with repeat infractions.

KEEP (Kakamega Environmental Education Program) is the government agency responsible for the care and protection of the forest. It also provides guides for tourists wishing to visit the reserve. These guides double as educators who teach environmental education awareness classes to children at the reserve headquarters on weekends, and also in public schools around the forest. Below, Mr. Abraham Imbai speaks to the Environmental Management and Conservation Club at Lunyu Secondary School.

“If we destroy the forest we lose rain.” says Maurine Cecilia, below, whose corn and herb gardens rely on the (usually) daily rainfall that results from the evaporation of the mist from the forest. Indeed, the land around the forest is extremely fertile, and farmers often reap several harvests a year because of the year-round rain. Soil erosion, a serious problem in most other parts of the county, is not an issue here.

Still many who live around the forest have little choice than to operate on the one day at a time mentality. “I know its illegal but its my responsibility to cook food for my family,” says one poacher (below, left) who along with her children have cut several fresh trees down and have to risk making three trips through the forest to take it all home.

Villagers are willing to risk fines in order to pilfer the abundant, free, firewood that comes out of the forest, especially if they can turn it into valuable, slow burning, charcoal. Though the production of charcoal is illegal, its lucrative rewards tempt some around the villages to produce and sell it. Below, men in the village of Virembe, on the forest’s western perimeter, smolder wood for charcoal.

“Right now there’s a total ban, but we’d like to allow it in order to bring prices down and discourage lucrative poaching,” says head Forester George Aimo. “If it was allowed under certain circumstances the forest would be better protected.” While there is an outright ban on charcoal production, it is permissible to collect dead wood in some areas of the reserve as long as the scavenger bears a receipt costing 100Ksh (USD $1.25) per month. The fine for a first time offense of collecting dry wood without a receipt, or felling trees or limbs is 2000 Ksh ($25 USD). Below, Mr. Patrick Asutzi, a KEEP employee, prepares seedlings for planting at the central ranger station.

Other problems in the forest include illegal logging, grazing and grass cutting. The A1 highway runs along the western edge of the forest making guerrilla logging easier. Villagers also graze their cattle in the periphery of the forest or even in the forest itself causing long term problems. “Overgrazing degrades the soil and inhibits regeneration of trees,” says Forester Aimo. Below, a man cuts grass in a high glen in the forest.


Above, a Black and White Colobus Monkey hides in the treetops. Its numbers have boomed back in the forest since the time when they were hunted for their fur, which was used in ceremonial garb. Today the monkey is still endangered, as the tree whose leaves are crucial to its digestion, the sandpaper tree, is also in danger due to logging and predation from pest trees in the forest. These predator species wrap themselves around other trees and over years suffocate them to death (see below).


We can never convince an entire generation that it must make sacrifices in order to provide quality of life for those to come, but for the most part KEEP is succeeding in this. Though serious problems exist, the forest not only remains but in some areas is growing. For the moment life is abundant here, though it is not without heavy cost and toil.

Gender roles are strictly divided in Sub-Saharan Africa – more so here than in any other place I’ve traveled. Women perform most of the tasks here from fetching water, to washing clothes, to taking a child to the hospital. However, few roles are solely set aside for men, except perhaps playing football or napping in the afternoon shade. A breach of code whereby men venture into women’s work is a sore embarrassment and one not to be done publicly. For the majority of those living on this continent life is hard. For women, the burden is harder still.