Misha Friedman began training his lens on tuberculosis patients in the former Soviet Union in 2007, when he worked in logistics for the nonprofit Doctors Without Borders.
At first he took photos in his spare time, whiling away his off days by documenting the patients and hospital workers he met on the job. But this hobby quickly turned into more than that when he won a photo competition judged by renowned photojournalist Gary Knight, founder of the VII photo agency.
"He awarded me a grant and a prize," Friedman recalls. "I was on the sidelines at that point, contemplating whether I should convert this hobby into a career. It was one of the few moments when I thought that I should pursue this after all."
Friedman got down to work. He's been crafting intimate, behind-the-scenes photos of the ravages of this slow-moving disease ever since. For his series from the former Soviet Union, Friedman's photo essays are deliberately focused on themes. He identified specific emotions and ideas for each of the countries where he traveled — Uzbekistan, Russia and Ukraine.
Stigma became his focus in Uzbekistan. In one photo, a man with his head cropped out of frame wears a dress shirt that looks to be two sizes too big on his withered frame. Another photo simply shows the contours of a patient's emaciated body. His ribs and spine look like they are carved into his back, casting dark shadows.
In Russia, Friedman documented how patients received treatment according to social class. Those who received the worst treatment were the poor, homeless and handicapped. One photo shows an empty wheelchair and three patients forced to stay in a hallway because of overcrowding. Urine is spilled at the foot of one of the patients. "The closer to death, the worse you were treated," explained Friedman.
Misha Friedman/for NPR
TB patient, Russia 2011 Misha Friedman/for NPR
An overarching theme of Friedman's coverage is how the lack of funding since the fall of the Soviet Union has affected treatment. Photos show peeling paint in the office of a Russian hospital, rooms with filthy mattresses, and solitary patients crouched in their rooms. Friedman revisited this same hospital summer and found that, sadly, nothing has changed.
But amid the obvious suffering, Friedman has also tried to look for signs of optimism. His favorite photograph from his series is of one such moment. In the photo, a nurse peers at a scale to check the weight of a patient, a key indicator of how a patient is faring against the disease. "It was a rare moment of true empathy," he says.
See more of Misha Friedman's work at his website.