Photo story: A cruel disease

According to the World Health Organization, India accounts for one-fifth of global tuberculosis cases and 330,000 Indians die each year from the disease. Many of the TB cases are centered in urban areas, like the slums of Mumbai and Delhi.

TB can be a cruel disease, stripping people of their ability to live happy, productive lives, and whose chain of consequences extends from patients to their families and communities.

Photographer David Rochkind spent several weeks in Mumbai, meeting patients and health care workers, and learning about the risk factors associated with living in urban poverty.

Here is what he found:

Rhemat Shek lies on the floor of her mother's home in Rafik Nagar, a neighborhood next to a garbage dump in Mumbai. Her son, Sana Jameer, and mother, Husna Bano, sit behind her. Rhemat is currently so weak that she is often unable to sit up for more than 10 minutes at a time. (David Rochkind/GlobalPost)

Traffic on the streets of Mumbai. Poor hygiene and nutrition are risk factors that can make people more susceptible to developing active TB. (David Rochkind/GlobalPost)

Men crowd onto a commuter train leading from the poor suburbs to downtown Mumbai. Crowded environments make it much easier for TB to be passed from one person to another. It is estimated that nearly one in three people in India are infected with the bacteria that can cause active TB. (David Rochkind/GlobalPost)

A doctor visits a patient at the Group of TB Hospitals in Mumbai during the daily rounds. (David Rochkind/GlobalPost)

Workers at a local garbage dump, who scavenge for trash that they can sell, try to put out a fire so they can continue working. NGOs say poor nutrition and hygiene make TB a huge problem among workers. (David Rochkind/GlobalPost)

Rajeshree Bamsode, a lab worker with a local NGO, stands in a small makeshift lab where she examines patient sputum samples to determine if they have active TB. (David Rochkind/GlobalPost)

Vanita Chaudhary (center) takes her daily medication with other TB patients at the Mahama Nagar DOTS Center run by Maharashtra Janavikas, a local NGO. (David Rochkind/GlobalPost)

People walk in front of a small pharmacy in Jari Mari, a poor slum in Mumbai. The health services in the slums are incredibly inadequate. Many doctors are not properly trained and patients often resort to shopping for prescriptions or purchasing inappropriate medicines over the counter. (David Rochkind/GlobalPost)

A young girl walks through the Rafik Nagar slum, one of the areas in which Lok Seva Sangam, a local NGO, has set up free TB health clinics. People in the slums are often too poor to pay for proper health care, let alone the transportation to get to the hospitals or clinics. (David Rochkind/GlobalPost)

Nurses prepare an injection for a patient at the Group of TB Hospitals in Mumbai, India. (David Rochkind/GlobalPost)

The inhabitants of these buildings were asked to leave their homes in the slums, where they were squatting, and move to an apartment building were they now have a title to their apartment. But overcrowding is still a problem as are the socioeconomic factors that can lead to other risks, like poor nutrition and hygiene. (David Rochkind/GlobalPost)

Reshma Khavle, 16, has had TB for four months but is not getting any better. She sleeps on the floor in a small apartment that she shares with her grandmother and other family members. She rarely gets up and spends most of her time on the floor. (David Rochkind/GlobalPost)

A girl waits in the doorway as patients receive their medicine at the Lomboni DOTS Center, run by a local NGO. The patients are required to come to the center three times a week and take the medicine in front of a community health worker. The treatment typically lasts six to eight months. (David Rochkind/GlobalPost)

A patient sleeps at the Group of TB Hospitals in Mumbai. Nurses at the hospital place the most serious cases against the outer walls of the ward, where this patient is. (David Rochkind/GlobalPost)

Boys stand in front of an apartment building of resettled people from the nearby slums. The elevators in these buildings usually are not maintained and do not work, making it difficult for very sick or elderly patients to get up and down the stairs to go to the health clinics and get their medicines. (David Rochkind/Globalpost)

A young man stands in Ashok Nagar, a slum neighborhood that is far from the city center. Transportation to a clinic may only cost 20 cents a day, but that can represent nearly 10 percent of a patient's salary. (David Rochkind/GlobalPost)

These men are migrants, coming from all over India, and do not have the money to rent rooms. They work about 16 hours a day together sewing clothing and then they sleep together in the tailor shop. (David Rochkind/GlobalPost)

People look into a DOTS Center as they walk by in the late afternoon. There is still social stigma attached to having TB in India, and many patients are afraid their neighbors will find out they have the disease. Single women fear that if people know they have TB it will be impossible to marry. (David Rochkind/GlobalPost)

A patient at the Group of TB Hospitals in Mumbai draws a portrait of a nurse's daughter. (David Rochkind/GlobalPost)

Mohammed Haroon Khan takes his daily medicine while Hanifa Hussain Sayed, a community health worker with a local NGO, watches. If a patient intermittently takes the medicine, or stops treatment, it is possible to develop Multi Drug Resistant TB, a much more costly and difficult strain of the disease to treat. (David Rochkind/GlobalPost)

Reshma Shaik is a community DOTS provider with Lok Seva Sangam, a local NGO that offers a variety of TB services to the patients in the slums. (David Rochkind/GlobalPost)

The mother of a patient cries next to the body of her son at the Group of TB Hospitals. She found out her son had died when she arrived for her daily visit that morning. (David Rochkind/GlobalPost)

A man receives a chest X-ray during the admission process at the Group of TB Hospitals in Mumbai. (David Rochkind/GlobalPost)

A TB patient receives a daily injection at the Group of TB Hospitals in Mumbai. (David Rochkind/GlobalPost)

A patient at the Group of TB Hospitals in Mumbai lies on his bed as a crow sits perched next to him. Later that day the patient was moved to a different bed where he could receive oxygen. He died early the next morning. (David Rochkind/GlobalPost)

Orderlies at the Group of TB Hospitals in Mumbai remove a recently deceased patient as another patient sits on his bed. (David Rochkind/GlobalPost)

About the photographer:

David Rochkind graduated from the University of Michigan in 2002 with a degree in sociology. He spent six years covering Latin America while based in Caracas, Venezuela, and currently lives in Mexico City. His photographs have been honored by Photo District News, the National Press Photographer’s Association, the Magenta Foundation, the Anthropographia Human Rights and Photography Award and others. David has also received grants from the International Reporting Project at Johns Hopkins University, the Pulitzer Center in Crisis Reporting and others. He is currently working on a long-term project about the costs and consequences of Mexico’s violent drug war.