A stethoscope, a blood pressure cuff
and a few other tools are all pediatrician John Moses needs to obtain basic
information about the health of his patients. But when he wants to go beyond
the clinical setting and find out more about their health issues -- the whys
and wherefores of teen pregnancy, for example - he puts the medical instruments
down and picks up a camera.
That's what he did as a young doctor
embarking on his career in Henderson. He wanted to know more about the pregnant
teens who came into his office. So camera in hand, he stepped out of his world
and into theirs.
What he learned is that young women get
pregnant for myriad reasons, and few of those reasons have anything to do with
what he could dispense - birth
control pills, condoms and other contraceptives.
Janie, for example, was 16 or 17, and
she had two children. "She was unapologetic about why she became
pregnant," he said. She had an alcoholic mother and an abusive
step-father, so "she got pregnant and had her kids at a very young age in
order to have a family that she could feel good about."
That's not, he said, "what a
teenager would necessarily walk into a pediatrician's office and announce at a
check-up. So now when I see teens in the clinic, my agenda hasn't really
changed. I still want them to be healthy and make good decisions for themselves
and not get pregnant, or at least delay childbearing until they get older, but
I'm just more open to the range of possibilities from their point of
view."
Moses, who published photographs of
teen mothers in a book called "The Youngest Parents," said he learned
through taking their pictures to look not only for vital signs, but also for
signs of depression, poor academic performance, and a family history of teen
pregnancy. And he now asks them if they've had sex, if they need birth control,
and if they want to get pregnant. "It's not a question I used to
ask," he said.
Moses left Henderson in the late 80s to
work at Duke Children's Hospital and Health Center, where he works as a general
pediatrician. He also teaches two courses at Duke's Center for Documentary
Studies, one called Medicine and the Vision of Documentary Photography and
another called Children and the Experience of Illness.
The children's class looks at
illness through the eyes of pediatric patients. Undergraduate students show
young patients how to use a camera, and the results, Moses noted, are often
revealing.
"Many of the pictures...are not
photographs that I would take or a photographer looking at childhood illness
would make," he said. "Maybe a photographer would photograph the IV
poll e, but they probably wouldn't call it ‘My Buddy.' "
One teenage patient who spent months of
her life attached to an IV drip did just that; another took a picture of his
father sitting on a sofa and called it "My Dad and Jerry," with Jerry
being the child's imaginary friend; and a third focused the camera on his shoes
and their Nike logo, not because of his affinity for the brand name, but
because of his affinity for the Greek goddess of victory, Nike.
Two of the children -- the one who
dubbed her IV pole her buddy and the one who put his faith in Nike -- had
cancer and have passed away. The young boy who photographed his imaginary
friend had an eye disease and is alive and well.
Moses has also used his camera to
capture the work of primary care practitioners - generalists who year in and
year out keep tabs on the overall wellbeing of their patients, the ones for
whom the relationship between doctor and patient is, or should be, a top
priority.
Moses travelled from Maine to
California taking pictures of general practitioners in a range of settings;
all, he said, were inspirational in how they approached their craft. One stood
out, and that was Dr. Donald Moore, who at the time had been practicing family
medicine for 49 years in Coats, N.C.
"I was reminded of the basic
importance of the doctor-patient relationship when I went out to photograph Dr.
Moore," Moses said. "(He) had it in his bones how to build trust and
develop a good relationship with his patients."
Moore "had good communication
skills, which don't have to be all that complicated. Listening is important.
Sitting down can make all the difference."
Many of the primary care photos
appeared in a book called Big Doctoring
in America: Profiles in Primary Care, which came out in 2001. Since then
Moses has taken on a new project, this one focused on gunshot victims.
"I got the idea as a result of one
of my patients coming in with a gunshot wound, an 8-year old boy," he
said. "He was shot right between the eyes and the bullet miraculously
lodged in the skull. It did not penetrate the brain." The bullet was
ultimately removed and the boy was fine.
Moses knew the boy from one of Duke's
pediatric clinics, and his shooting inspired Moses to learn more about why it
happened, so he now uses his camera to explore the lives of young gunshot
victims. Like his other projects, he's motivated by one fundamental truth:
"There is a lot to look at beyond the clinic," he said, "and
that's certainly true with gun violence."