jake lyell photography (blog)

It’s been ten years since world leaders came together to form what became the eight Millennium Development Goals (MDGs) to tackle world poverty. Heads of state recently met again for a summit at UN headquarters in New York to discuss progress made in the last decade.

My most recent assignment with Water Aid UK was not to document progress that the NGO has made in communities where it works. Instead I was commissioned to visit areas where there is still much work left to be done. Unfortunately, it’s not too hard to find schools, hospitals and communities that lack clean water sources or proper toilets and sanitation facilities here in NE Uganda, which is the poorest and least developed area of the country. Water Aid has used these stories for awareness campaigns that led up to the summit. They’ve also shared them with the decision makers themselves. They hope to highlight how clean water and proper sanitation facilities can help achieve the MGD’s goal of, among other things, cutting poverty in half by 2015.

Recently the UN declared access to clean water and sanitation a fundamental human right and pressed donors to “scale up efforts to provide safe, clean, accessible and affordable water and sanitation for all.” Half the world’s population lacks access to proper sanitation facilities such as a simple toilet, whereas one in eight is in need of access to clean water. As a result diarrhea kills over 4,000 children alone every day. Poor water and sanitation facilities also lead to drop-outs in school attendance and unhygienic standards at clinics and hospitals.

In the wake of the global economic downturn it is unlikely that all the goals will be met. However, some significant progress has been made.










all photos Jake Lyell and Jake Lyell/Water Aid

I honestly thought she would make it. I’m not even sure I would have started this story if I knew she wouldn’t have. Wednesday after midnight I got a call from Sarah. “Mtoto yangu amekufa,” she repeated over and over again on the phone hysterically, “My child has died.”

I went immediately to the hospital where I was the only one there to mourn with Sarah. Several times I almost pulled my camera out of my bag to start shooting but it just wasn’t the time. As the sun came up, I rode in a taxi with Sarah to the village of Abia, where she returned with Grace’s body to bury her along side her late husband. Here, friends of her late husband mourn with her. Grace was the last surviving member of her father’s family, all of whom fell victim either to the AIDS virus or to LRA invasion four years ago.

Two weeks ago, Grace seemed like any other nine year old girl in northeastern Uganda’s Amuria District. She was attending school and helping her mother around the house. Suddenly she was unable to hold down food. The medicine her mother bought at the local clinic was of no help. Now Grace hasn’t eaten in over two weeks and weighs just 13 kilos (28 pounds). Sores on her lips and mouth make any ingestion of food far too painful to bear.

Grace’s mother, Sarah Kembi (27), found out that her daughter was HIV positive only two years ago. Since that time Grace has been taking Septrin, a stabilizer drug that, while not an ARV, still reduces the chances of opportunistic infections. Sarah’s husband, Grace’s father, succumbed to AIDS around the same time Mrs. Kembi figured she had better get her daughter tested. Though Grace was likely healthy enough to forgo ARV treatment two years ago, her system is now too weak to begin them.

Sarah has brought her daughter to Amuria Health Center IV, the largest in the district. At first she identifies Grace as her niece, too ashamed to confess her as her own in her present state, and too afraid of fellow patients thinking that she herself shares the same disease. But the health center here is not capable of handling such cases as dire as Grace’s. They connect her to a hydrating drip and wait for her mother to scrounge up enough money to fuel the ambulance and pay its driver or hire a taxi to the Regional Hospital in Soroti, 50km away. “What we’re doing here is just minimal life support. The longer we delay to get her on ARVs, the greater her chances of developing some very serious opportunistic infections. She’s at risk of dying,” says Dr. Raymond Malinga.

Today Sarah’s results come back from the lab. She took the test just yesterday. They confirm what I’m sure she’s known all along. Sarah, too, is HIV positive, but until this time has put off knowing for certain. “We have a problem with denial here,” says Dr. Malinga, and that denial is likely why Grace is in the state she is now. “At the time (of testing) there was no reason to go on ARVs. The child was healthy.” However, from the test two years ago until now, there was likely never any periodic testing or even follow up by her mother.

Besides her newly confirmed HIV positive status, Sarah Kimbe (above) is an outsider here in Amuria, land of the Iteso tribe. She comes from neighboring Democratic Republic of Congo, where she met her husband, a Ugandan soldier from Amuria , whose job was to chase after Joseph Kony and his Lord’s Resistance Army. Sarah doesn’t speak the local language but communicates instead with Swahili, which in Amuria is usually only used in trade or transportation.

With no land of her own, she moves from plot to plot in the village as a hired farm hand, earning less than fifty cents for every field she tills. Though she longs to return to her family in neighboring DR Congo, Sarah thinks her situation may be better here in Uganda, due to its comparatively superior health care system. She hasn’t had to pay for the Septrin Grace has been taking for the past two years. Although the health center has been out of Grace’s needed drips and Sarah has had to purchase them from the local pharmacy, the nursing and bed Grace has received from the center have been free of charge. “In Congo you have to pay for everything,” she complains.

Thankfully, Sarah doesn’t have to pay to get to Soroti Regional Hospital either. After a week of Grace languishing in the Amuria’s health center, a compassionate passer-by takes note of her serious condition and springs for the $2 journey for her and her mother. They pile in to a taxi with four other passengers and head out of town.

Throughout my time with her, with the exception of a couple brief crying jags, Sarah has remained remarkably stoic. Yet it’s clear that she’s hopeful, and perhaps even certain of her daughter’s recovery: “When she’s stronger I want to return to my home in Congo. I want Grace to be able to go to school and to study.” Above, Sarah Kembi removes washing from the line outside Amuria Health Center.

It takes just an hour to reach the hospital. Grace weighs in at the aforementioned 13 kilos, more to the surprise of the other patients than to the doctors and nurses. Unfortunately her case seems only slightly less than routine.

Grace’s referral paper gets her through the queue at the hospital more quickly than the other patients. She’s first sent to pediatrics, after which she’s sent to a special feeding center, a critical care unit for malnourished children. Dr. Okwairwoth Justine, the in-charge on-duty, offers cautious optimism: “If it was just malnutrition, I’d say she’d definitely recover. Right now she’s dealing with malnutrition and severe infections. She’s running a fever. But even now she can sit up straight. She can improve. I have hope.”

Once Grace is settled into her new bed, she falls to sleep. Her mother runs out and returns 15 minutes later with a black plastic bag that she cradles with one arm so as to keep it from bursting. Out of it she draws a thermos of warm milk for her daughter. She places the bag with its remaining contents on the floor underneath the bed. The contents turn over and clang on the floor: two sealed bottles of beer. She glances at me in embarrassment. I pretend not to notice. “How could she at a time like this?” I think to myself. However, as I make my way out of the hospital I begin to sympathize. The woman must be a frantic mix of gloom and fear on the inside. Once Grace makes it, she knows she has herself yet to deal with. I may go and have a drink myself.

I’ve recently been impressed with the work of the agricultural NGO One Acre Fund. While on assignment in Kenya for business magazine “FIVE,” I documented the organization’s work with small farmers. These farmers usually cultivate no more than approximately one acre of land and therefore are usually the most in need. While OAF works in both Kenya and Rwanda, these photographs are from western Kenya’s Webuye district.

Why is One Acre Fund featured in a business magazine? Its model differs from that of most non-profit organizations. Instead of handing out improved fertilizers and seeds, farmers are given loans for these things and organize in groups under the supervision of a extension worker to learn how to use them. The groups then bring their harvests together at the end of the season when One Acre Fund acts as a bulk selling agent, thus commanding higher prices for the farmers. In 2009, farmers working with One Acre Fund increased crop yields at a rate of 100%, with a 98% repayment rate of loans. Currently, 45% of One Acre Fund’s field costs are covered by farmer repayments, a percentage that continues to grow. Sound more like a sustainable business than aid? Let’s hope so.

One of these days I am going to have to get a car, but I’ll hold out for as long as I can. I came to East Africa in part seeking a simpler lifestyle. I enjoy chatting with people around me and getting to know the culture in-depth. I watch in fascination as the preachers and hawkers board at one town, shout and sell to their captive audience and disembark at the next. Getting across the country is cheap and my clients appreciate the transit fees on the final invoice. But bumping around on buses is starting to wear on me. Above, a busy Kampala street as seen from the window of the Teso Coach to Soroti.

The last month has seen me traveling from the shores of Lake Victoria in Tanzania to the remote and mountainous Uganda-Sudan border and various places in between, much of the way spent with my camera hanging out the window. Above, pedestrians on the streets of Lira, Uganda. Below, after months of arduous journey, I reach the source of the Nile.


Toward the end of June I was in Bukoba, Tanzania, on the western (and least accessible) side of Lake Victoria. There I did photo and video work for Computers 4 Africa. C4A takes second-hand PCs and ships them to a school, hospital or institution in Africa that can make use of the machine you thought was out of date. It’s an excellent concept and needs to implemented en masse in order to both create jobs and improve productivity on the continent. Above and below, students from Rugambwa Girls’ Secondary School are recipients of computers from C4A.

Take a moment to experience the hub-bub of the bus park in Mbale, eastern Uganda:

Let’s hope no one’s waiting on this bus for their next paycheck.

Above, open-air passenger lorry in Karamoja. Below, motorcycle taxis, or boda bodas, in Lira.


In Uganda the landscape changes quickly from plains to mountains to bustling towns within a span of a few dozen kilometers. For the northern leg to Kidepo National Park I had to hire a 4 wheel drive, as roads tend to resemble craters more than anything else.

I know I’m not breaking any new ground in wildlife photography, but I am starting to pay more attention to the fauna around me. Stock photo sales, of course, contribute to my motivation. Above, Vervet monkeys in Entebbe, Uganda.

It’s important to travel with in convoy or with armed escort in the Karamoja region of NE Uganda. Though bands of armed cattle raiders are more under control than in the past, they’re still operating. Karamoja is the least developed area of Uganda, and one which I plan on exploring more thoroughly in the future.



Weighing up to 900kg (2000 pounds), the Cape Buffalo is reported to kill the most people in Africa each year, though the hippopotamus is a close rival for this accolade. They travel in massive herds and are able to defend themselves against predator attacks, sometimes even killing lions. On the other hand, giraffes eat leaves and really don’t have to worry about much.

Lastly, a rain storm looms on the horizon. I was caught in this same deluge five minutes later- lucky for that waterproof camera bag.

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.

I’ve made remote Amuria District my base this year. However, I may not be able to go back for some time as all the roadways into the main town have been rendered impassable by floods. A month ago we were wondering if the rain was ever going to start. Now it has come full-force, isolating villages, bringing down huts, and flooding farmers’ fields. For the moment, more work from PSI has kept me in Kampala. Below, a motion picture of the dreary view from my concrete house in Amuria town.

Nature is never kind in this part of Uganda. Far from the dependable, fertile, rolling hills and mountains of the west, the eastern land of the Teso tribe almost counts on nature’s capriciousness, alternating between flood and famine. “Every year it changes,” says Samuel Opio, a resident of Kapelebyong, a sub-county of Amuria District. “Some years there’s too much sunshine, some years too much rain. This year the rain started in March, and it has already resulted in floods.”

Last year only a few showers fell from the sky causing widespread hunger and skyrocketing food prices. Conversely, 2006-2007 saw some of the worst flooding in memory in northeast Uganda. The devastating waters affected 17 districts and resulted in a 60% crop loss in the northeast, a delayed second planting season, the uprooting and relocation of entire villages, and the outbreak of waterborne diseases like cholera.

There’s isn’t one stretch of tarmac in Amuria District. All the roads are as you see them below. The sandy red mud turns into an all out slip n’ slide at the slightest downpour. While being based out of such a remote area of East Africa has had it’s rewards, it’s also quite challenging.

The village of Asuksuk in Amuria District’s Kapelebyong sub-county has been particularly hard-hit by flooding this year. Mr. Philipo Odella (pictured below) has lost nearly his entire harvest of cassava, peanuts, corn, millet and sorghum. Walking through his cassava fields things look pretty green, but you can smell the roots starting to rot below. “Even if I pull them (the cassava root) up now, there’s not even any sunshine to dry them out.”

“Why not grow rice?,” I counter, but the irregularity of rainfall from week to week makes it too risky a prospect.

“We have appealed to the sub-county headquarters and we are hoping for word that we’ll receive tents and food” says John Robert Ogwang, a Kapelebyong LC (local council leader) and resident of Asuksuk village. While the loss of home and harvest now is nowhere near as widespread as it was three years ago, this is of little comfort to those in Kapelebyong, where most endure the heavy rains in delicate grass huts.