FREETOWN, Sierra Leone — In Kroo Bay, a slum located in the heart of Freetown, mounds of raw sewage seep into pools of stagnant water. Children play on doorsteps, and neighbors bathe in the nearby Crocodile River, which feeds into the Atlantic Ocean.
These devilish bodies of water all serve as a magnet for waterborne diseases like cholera, polio, malaria and diarrhea. They are all preventable diseases that take the lives of nearly one in five children in Sierra Leone before they reach their fifth birthday, according to UN estimates. And of all of these deadly diseases, diarrhea has proved to be the most vexing. Much of my work has been dedicated to documenting how lack of access to fresh water, and the diarrhea that often comes as a result, is the key issue in understanding the spread of disease and child mortality around the world.
I went to Sierra Leone in 2009 and 2010 to document the problem of maternal and infant mortality. At that time, a woman in Sierra Leone faced a one-in-eight chance of dying during pregnancy or childbirth.
Today Sierra Leone has the highest under-5 death rate in the world. According to 2011 data from the UN Inter-agency Group for Child Mortality, 185 of every 1,000 live births results in death.
But once I arrived in this tiny West African country, I quickly realized that maternal and infant mortality was only the first chapter of the story I was trying to tell.
The story of child and maternal mortality does not begin and end in a delivery room. What happens if mother and child make it past childbirth? What challenges do they face when home is an environment like Kroo Bay?
That is the question I have been seeking to answer through the craft of photography, documenting the ravages of AIDS in Africa, tuberculosis in Asia, and polio in Angola and Afghanistan. And I have learned that of all these deadly diseases, diarrhea is uniquely vexing.
Diarrheal diseases kill more children than AIDS, malaria, and measles combined, and as of 2010, about 780 million people in the world still lacked safe drinking water.
I saw women and children struggling for survival every day in Kroo Bay. In this neighborhood of 7,000, it all starts with the water.
Focus on Unclean Water from Ground Truth on Vimeo.
I will never forget the resistance I encountered from the community the first day I entered the slum. Angry men screamed at me, arguing that nothing could ever change in their neighborhood, their faith broken by the false promises from NGOs and local politicians.
Each day, families guided me to more and more places and people I would not have found on my own. I was told there are only seven sources of clean water in Kroo Bay. That equals one water source per 1,000 people. So children and parents bathe in the Crocodile River, sometimes bringing with them small bars of soap, as if soap could counteract the sewage they are bathing in. They drink the water that is available to them, without the ability to distill it.
Of the 2,000 children under the age of 5 who die every day worldwide from diarrheal diseases, some 90 percent suffer deaths linked to water, sanitation and hygiene.
While in Sierra Leone, I spent time with Dr. Samuel Kargbo, head of the Reproductive and Child Health Department in the Ministry of Health and Sanitation. Kargbo, who has committed his life to improving health conditions for women, told me that his motivation comes from one memory he will never forget.
One day, when he was practicing medicine in eastern Sierra Leone, a group of men entered the hospital carrying a woman. They told him they had carried her for three days to reach the hospital. She was in labor, and nurses rushed her to the operating table.
“Before we could lay hands on her, she died,” Kargbo said. “I will never forget her.”
I make photographs because I don’t want others to forget, either. I want those who look at my images to feel as if they cannot look away or stop thinking about them. Why? Because what is happening to the world’s poorest citizens is an outrage.
And the money and resources going to child and maternal health around the world will not matter if there is not clean water in places like Kroo Bay.
That’s why I won’t stop.
More from GlobalPost: Step by Step: The path to ending child mortality