As a photojournalist for more than 20 years, Alan Hawes saw life up close. NFL playoff games from the sidelines. Bruce Springsteen from the front row. Standing on the deck of a barge as the Civil War submarine the H.L. Hunley was lifted from the bottom of the Atlantic Ocean.
But through all these exhilarating experiences, what stuck with him the most – what left a tack-sharp image in his mind, long after the photo was snapped and published – were the smaller, more intimate moments.
“One of my life goals was to make an impact on the world through my career. And for a long time, I felt like I was doing that with photojournalism,” Hawes says. But one day, after a particularly emotional assignment at a hospital, he began to doubt his convictions.
“I saw these life-changing things happening in front of me,” the Chicago native explains, before briefly pausing to take a small step back in thought. “As a photographer, you’re an observer – and it’s an important job, being that messenger – but seeing those people work, the way they cared for the patients, the difference they could make, I felt like it was time to be a participant.”
And just like that, Hawes enrolled in a human physiology night course. It was really hard – and humbling for a father of two who was experiencing a bit of professional uncertainty – but he managed to get an A.
“I know this sounds weird, but I felt like I had a gift for understanding how the human body works,” he says. That led to another class. And another. “Then I was in it,” he says, with a wry smile. For almost two years, he continued to work as a newspaper photographer during the day and take nursing classes at night.
Eventually, his side passion became his central one.
Developing a talent
When Hawes was 12 years old, his father gave him a camera – a real one, one of those really nice SLRs with a big fancy lens – as a middle school graduation present. It wasn’t completely out of the blue. This was the same kid who used to always save up his money to buy film for the family’s Polaroid.
“One of my life goals was to make an impact on the world through my career.”
Once he had his hands on a legitimate camera, he was in business. And so he began to learn all the little nuances of exposure, shutter speed, aperture. That curiosity led him to serve as a photographer for his high school yearbook. Over the next several years, he developed a deep passion for the craft. During one assignment, he met a firefighter who introduced him to the art of listening to a police scanner. It was the window into the community, he told Hawes. That’s where the good stuff was, he said.
“I immediately bought one of my own, thinking if I had a scanner and a camera, I could take pictures of what was going on and then sell them to the local paper,” Hawes says. And, as simple as that, it worked.
After a while, the Chicago Sun-Times and the Associated Press would buy just about anything he shot. His reputation landed him a full-time job with a newspaper in Greenville and ultimately with the Post and Courier in Charleston.
His camera became a part of him – like an appendage.
Over the next two decades, Hawes would carry that appendage with him to document emotionally charged and poignant moments. The confederate flag coming down from the S.C. Statehouse. A man whose motorcycle careened over the side of the James Island connector left covered in so much plough mud, you could only see the whites of his eyes. Two Citadel football players sitting inside an ice freezer, the kind you see in front of gas stations, doing whatever it took to escape the blazing summer heat.
“I will always have that news bug in me. To experience up close what the rest of the world doesn’t normally get to.”
He snapped tens of thousands of images over the years; a surprisingly high number of them were so good that they won regional and national press awards, some gaining international accolades. Those images would appear in newspapers across the country and giant magazines like Sports Illustrated, and they would earn him the reputation as one of the best photographers in the business. But ultimately, all of that wasn’t enough for Hawes. And as difficult as it was to leave behind a career he loved, he was convinced his calling was elsewhere.
Finding a higher resolution
In 2011, Hawes accepted his first job as a registered nurse at Summerville Medical Center. Two years later, he came to MUSC Health (Medical University of South Carolina) and has been here since. During his eight-plus years at the teaching hospital, he has worked in critical care, on the rapid response team (they are first on the scene in the hospital when there is concern for a deteriorating patient) and most recently, with some of the most serious COVID-positive patients in the hospital’s medical intensive care unit (MICU).
“Once I made it to the ICU, I knew I was in the right place,” he says. And when the world changed forever in March of 2020, not so surprisingly, Hawes was one of the first to jump into action in the COVID unit.
“I knew I was going into the belly of the beast in that unit, but that’s what I like to do,” he says. Just like all those years ago when he’d carefully keep an ear to the police scanner, looking for the action and then heading toward the trouble when most people would be headed in the opposite direction, he leaned into the heat and didn’t back off.
“It was super exciting but terrifying. But that was where the news was. I will always have that news bug in me. To experience up close what the rest of the world doesn’t normally get to. I had a front-row seat.”
Only this time, it was with a terrifying and largely unknown virus, not Tom Petty or the Green Bay Packers.
Depth of field
Somewhere along the line, Hawes had the idea to marry his two passions. After talking with hospital leadership, he got the green light to bring his camera into the units, something that is particularly tricky in the new world of patient privacy laws. But with the right permissions and everybody on board, it was something that could be carefully navigated.
“This virus robs us of so many things. It’s heartbreaking. Hardest thing I’ve ever had to do in my career. I wouldn’t wish it on anybody.”
Hawes wanted people to see what he and his colleagues saw on a daily basis. He wanted them to see the compassion. The struggle. The reality.
“Honestly, as I was walking toward the building on the first day in the COVID unit, I knew how good a story this would be to cover as a photographer,” he says. Pride in his team coupled with frustration surrounding all the vaccine-related misinformation were the main reasons he wanted to do it. What “it” was, he wasn’t sure at the time, but he knew that through photographs – something not even the best writers can compete with when the pictures are really good – there was an opportunity to tell a powerful visual story. One that lets the general public peek inside a place that rarely pulls back the sliding blue drapes – and for good reason. After all, there is no more private, intimate or vulnerable environment than inside a hospital.
For the next several weeks, whether he was on the schedule or not, Hawes would grab his camera and head into the hospital. At first, he explains, his colleagues were a bit leery of him. But he wasn’t just a guy with a camera. He was one of them. Slowly, they began to let down their guards, and eventually, they forgot he was even there.
What he witnessed was humanity at its absolute best … and worst.
A man dying slowly from COVID. Another with seemingly the same fate who miraculously made a turn for the better. A woman with the illness giving a pep talk to three other COVID-positive patients, passionately declaring how they were going to beat this. And along the way, there were a few smiles. And a lot of tears.
“I am really proud of my team, and I wanted people to see how hard they work, how much they care,” Hawes says. “But truly, I just wanted people to know that the people in here, these ones that are really sick, a lot of them are just regular people who weren’t vaccinated. And they’re dying because of it.”
During his time on the COVID unit, Hawes has seen miracles, families estranged over vaccine disagreements, laughter, tears. But the hardest thing he and his colleagues have had to do is facilitate a goodbye with no loved ones in the room – something no one should ever have to experience.
“You’re standing there, holding an iPad so a dying patient’s family can say goodbye. And the patient isn’t even conscious,” he says. “As a nurse, it’s such a helpless feeling. You need to be there, but on some level, you feel like you shouldn’t – their family should be the ones there. But this virus robs us of so many things. It’s heartbreaking. Hardest thing I’ve ever had to do in my career. I wouldn’t wish it on anybody.”
Which is why he wanted to show the world his photos. Because it matters. What will become of them – an installation in a local art gallery possibly – he’s not sure. But what he does know is that this was an opportunity to use all the skills available to him.
“I will never stop seeing the world as a photographer,” Hawes says. “That guy is still in there, but these days, my heart is on the other side of the camera.”
And though he might not admit it, it proves that through both of his careers, he is able to impact the world.
The 6 years that have passed since a gunman mowed down her Bible study class at Emanuel AME have been busy for the former prison nurse who was among the five survivors.
When the brutal shooting took place, Polly Sheppard had just retired from nursing after 14 years at the Al Cannon Detention Center in South Carolina. The former nurse has channeled her grief since then by speaking around the country to spread the word about gun violence. Now, with the nest egg she has accumulated from her speaking gigs, our Nurse of the Week is working to address the staffing crisis in her own way – by setting up a scholarship fund for nursing students – particularly those who are interested in a career as prison health care workers.
Prison nursing, she says, is all about caritas: “I learned how to be compassionate. [How to be] more compassionate, and caring. And not assume everybody that goes to jail is guilty. Because everyone is not. You are innocent until proven guilty.” After a year of counseling, Sheppard even found forgiveness in her heart for the man who killed nine of her classmates, and she affirms that “Everybody deserves a second chance.”
But in describing her career, Sheppard does not mince words. She loved her work, but prison nursing is NOT easy. Prison health care facilities were understaffed long before Covid, so the hours could be as challenging as the job itself. “Sometimes,” she recalled, “I would work till 2 o’clock in the morning. Get there at 3pm, working till 2 am. Sometimes double shifts…” All while treating a population that rarely had access to regular preventive care and often were “suffering from mental illness, seizures or other chronic diseases.”
Hard as it could be, Sheppard found prison nursing to be deeply fulfilling and wants to see younger generations fill her place. Hence her decision to invest her post-Emanuel speaking engagement fees in a Polly Sheppard Scholarship Foundation for nursing students at Charleston college Trident Tech. The ongoing nurse shortage in prisons was a key factor in deciding to fund the scholarship: all recipients are expected to work for at least a year treating inmates.
At Trident, Sheppard is helping students who know what it’s like to dream of a career, only to find that the necessary education is utterly beyond their means. Shepperd herself has been in nursing for over 55 years. She graduated from high school in 1963 and became an LPN at her school’s vocational center in New York City, then pursued further studies at local community and technical colleges while working in city hospitals. Eventually, she moved to South Carolina and found her niche as a prison nurse.
In 2021, the first Sheppard Scholarship award went to Niki Walker, a 34-year-old mom of two and a former corrections officer. Far from being jaded by her earlier corrections experience, Walker sounds like a future prison nurse after Polly Sheppard’s own heart when she says, “Just because you are in jail doesn’t mean you don’t deserve adequate care. No one is immune from making one bad choice.”
For more on Polly Sheppard—and her first scholar, Niki Walker—click here.
National Nurses United (NNU), the largest union of registered nurses in the United States, today applauded the Occupational Safety and Health Administration (OSHA) for taking a critical step in protecting health care workers in Arizona, South Carolina, and Utah who had been left behind when their states failed to adopt the OSHA Emergency Temporary Standard (ETS) on Covid-19 in Health Care issued in June. The OSHA ETS on Covid-19 mandates optimal PPE and other critical protections for health care workers.
Twenty-two states across the country that have state-based OSHA programs are legally required to have those state plans be at least as effective as federal OSHA. When Arizona, South Carolina, and Utah failed to implement the Covid-19 ETS in their state plans, however, they abrogated their legal requirements. Federal OSHA announced today that it is reconsidering and potentially revoking the final approval for these three noncompliant states.
“It’s unconscionable that some states think they can just ignore their responsibility to protect health care workers. Registered nurses had been demanding the OSHA ETS since day one of this pandemic, and we finally won our fight in June of 2021. At that point, Arizona, South Carolina, and Utah had the duty—legally and morally—to come into compliance and protect workers. They did not, and we could not be more proud that OSHA is standing up to hold them accountable today,” said NNU President Deborah Burger, RN. “We are beyond grateful to OSHA for the work they are already doing to enforce this standard, and to the Biden administration for standing up for nurses on the front lines of this pandemic.”
After leading the campaign to win the OSHA ETS, NNU has been campaigning to ensure health care employers across the country comply. When NNU nurses in Arizona filed complaints about their hospitals’ non-compliance, Arizona’s state OSHA plan stated they will not enforce the requirements of the federal OSHA ETS. So NNU nurses testified at the most recent meeting of the Industrial Commission of Arizona (ICA). The ICA voted against emergency rulemaking needed to protect nurses and other health care workers, and NNU filed a Complaint About State Plan Administration (CAPSA) with federal OSHA.
“Nurses and other health care workers in Arizona, Utah, and South Carolina must be assured the same protections as they would receive in other states that have already adopted and begun enforcing the ETS,” said Burger. “We urge federal OSHA to act expeditiously to put in place the necessary elements for federal OSHA to resume enforcement in Arizona, Utah, South Carolina, and any other states which fail to enforce the ETS to ensure protections for health care workers. We will never emerge from this pandemic if we don’t make sure nurses and health care workers are safe at work.”
National Nurses United is the largest and fastest-growing union of registered nurses in the United States with more than 175,000 members nationwide.
Facing a yearlong siege from the coronavirus, the defenses in another, older war are faltering.
For the last two decades, HIV/AIDS has been held at bay by potent antiviral drugs, aggressive testing and inventive public education campaigns. But the COVID-19 pandemic has caused profound disruptions in almost every aspect of that battle, grounding outreach teams, sharply curtailing testing and diverting critical staff away from laboratories and medical centers.
The exact impact of one pandemic on the other is still coming into focus, but preliminary evidence is disturbing experts who have celebrated the enormous strides in HIV treatment. While the shift in priorities is nationwide, delays in testing and treatment carry particularly grievous risks in Southern states, now the epicenter of the nation’s HIV crisis.
Clinics have limited in-person visits and halted routine HIV screening in doctors’ offices and emergency rooms, with physicians relying instead on video calls with patients, a futile alternative for those who are homeless or fear family members will discover their status. Rapid-testing vans that once parked outside nightclubs and bars and handed out condoms are mothballed. And, in state capitals and county seats, government expertise has been singly focused on the all-hands-on-deck COVID response.
Concrete signs of the impact on HIV surveillance abound: One large commercial lab reported nearly 700,000 fewer HIV screening tests across the country — a 45% drop — and 5,000 fewer diagnoses between March and September 2020, compared with the same period the year before. Prescriptions of PrEP, a preexposure prophylaxis that can prevent HIV infection, have also fallen sharply, according to new research presented at a conference last month. State public health departments have recorded similarly steep declines in testing.
That dearth in new data has led to a precarious, unknowable moment: For the first time in decades, the nation’s lauded HIV surveillance system is blind to the virus’s movement.
Nowhere will the lack of data be felt more profoundly than in the South: The region accounts for 51% of all new infections, eight of the 10 states with the highest rates of new diagnoses, and half of all HIV-related deaths, according to the most recent data available from the Centers for Disease Control and Prevention.
Even before the COVID pandemic, Georgia had the highest rate of new HIV diagnoses of any state, though lower than that of Washington, D.C. The Georgia Department of Public Health recorded a 70% drop in testing last spring compared with spring 2019.
The slowdown in HIV patient services “could be felt for years,” said Dr. Melanie Thompson, principal investigator of the AIDS Research Consortium of Atlanta.
She added, “Every new HIV infection perpetuates the epidemic and will likely be passed to one or more people in the months to come if people are not diagnosed and offered HIV treatment.”
Coronavirus testing has commandeered the machines previously used for HIV/AIDS testing, further straining surveillance efforts. The polymerase chain reaction — or PCR — machines used to detect and measure the genetic material in the human immunodeficiency virus are the same machines that run COVID tests around-the-clock.
Over the decades, as HIV migrated inland from coastal cities like San Francisco, Los Angeles and New York, it took root in the South, where poverty is endemic, lack of health coverage is commonplace, and HIV stigma is pervasive.
“There is the stigma that’s real. There is legacy racism,” said Dr. Thomas Giordano, medical director of Thomas Street Health Center in Houston, one of the largest HIV clinics in the U.S. The state’s political leaders, he said, view HIV as “a disease of the poor, of Blacks, Latinos and gay. It’s just not mainstream at the state level.”
HIV clinics that serve low-income patients also face limitations using video and phone appointments. Clinic directors say poor patients often lack data plans and many homeless patients simply don’t have phones. They also must contend with fear. “If a friend gave you a room to sleep and your friend finds out you have HIV, you might lose that place to sleep,” said del Rio of Emory University.
Texting can be tricky, too. “We have to be cautious about text messages,” said Dr. John Carlo, chief executive officer of PRISM Health Care North Texas in Dallas. “If someone sees their phone, it can be devastating.”
In Mississippi, HIV contact tracing — which was used as a model for some local efforts to track the coronavirus — has been limited by COVID-related travel restrictions meant “to protect both staff and client,” said Melverta Bender, director of the STD/HIV office at the Mississippi State Department of Health.
Of all regions in the U.S., the South has the weakest health safety nets. And Southern states have far fewer resources than states like California and New York. “Our public health infrastructures have been chronically underfunded and undermined over the decades,” said Thompson, the Atlanta researcher. “So we stand to do worse by many metrics.”
Georgia’s high HIV infection rate and the state’s slow pace of COVID vaccinations “are not unrelated,” Thompson said.
The porous safety net extends to health insurance, a vital need for those living with HIV. Nearly half of Americans without health coverage live in the South, where many states have not expanded Medicaid under the Affordable Care Act. That leaves many people with HIV to rely on the federal Ryan White HIV/AIDS Program and state-run AIDS drug assistance programs, known as ADAPs, which offer limited coverage.
“As a matter of equity, insurance is critical for people to live and thrive with HIV,” said Tim Horn, director of health care access at NASTAD, the National Alliance of State and Territorial AIDS Directors. Ryan White and ADAPs “are not equipped to provide that full sweep of comprehensive care,” he said.
Roshan McDaniel, South Carolina’s ADAP program manager, says 60% of South Carolinians enrolled in ADAP would qualify if her state expanded Medicaid. “The first few years, we thought about it,” said McDaniel. “We don’t even think about it nowadays.”
Enrollment in the Ryan White program jumped during the early months of the pandemic when state economies froze and Americans hunkered down amid a grinding pandemic. Data from state health departments reflect the increased need. In Texas, enrollment in the state’s AIDS drug program increased 34% from March to December 2020. In Georgia, enrollment jumped by 10%.
State health officials attribute the increased enrollment to pandemic-related job losses, especially in states that didn’t expand Medicaid. Antiretroviral treatment, the established regimen that suppresses the amount of virus in the body and prevents AIDS, costs up to $36,000 a year, and medication interruptions can lead to viral mutations and drug resistance. But qualifying for state assistance is difficult: Approval can take up to two months, and missing paperwork can lead to canceled coverage.
Federal health experts say Southern states have generally lagged behind getting patients into medical care and suppressing their viral loads, and people with HIV infections tend to go undiagnosed longer there than in other regions. In Georgia, for example, nearly 1 out of 4 people who learned they were infected developed AIDS within a year, indicating their infections had long gone undiagnosed.
As vaccinations become widely available and restrictions ease, HIV clinic directors are scouring their patient lists to determine who they need to see first. “We are looking at how many people haven’t seen us in over a year. We think it’s over several hundred. Did they move? Did they move providers?” said Carlo, the doctor and health care CEO in Dallas. “We don’t know what the long-term consequences are going to be.”
The ACHDNC advisory committee provides advice, recommendations, and technical information about aspects of heritable disorders and newborn screening to Health and Human Services. The committee also works to develop policies and priorities that will enhance the ability of states and local health agencies to provide screening, counseling, and healthcare services for newborns and children who have or are at risk for heritable disorders.
DeLuca tells newsstand.clemson.edu, “Being able to be part of this very important process is incredible. People take their cue from the ACHDNC for deciding which disorders to include in states’ screening panels. Each state screens for particular conditions, and I look forward to being able to help with those recommendations.”
DeLuca’s career started in genetics, working with infants identified with metabolic conditions as a result of newborn screening. Now a professor, she collaborates on research with the Greenwood Genetic Center and teaches genetics to undergraduate and graduate students. She also chairs the recruitment committee for the Clemson School of Nursing and is a member of the Women’s Commission at Clemson.
To learn more about Jane DeLuca, an associate professor in the Clemson University School of Nursing who was been appointed a member of the Advisory Committee on Heritable Disorders in Newborns & Children in the US Department of Health and Human Services, visit here.
According to the US Health Resources and Services Administration, South Carolina is projected to have a shortage of registered nurses by 2030. The shortage is expected to be more significant than in most other states, possibly topping 10,000 nurses.
Clemson University’s School of Nursing and the Greenville Health System (GHS) recently collaborated on a plan to address that shortage in the state of South Carolina through the opening of the Clemson University Nursing building. The building is an education and research facility that houses an expansion of Clemson’s baccalaureate nursing program at GHS, which opened in August.
Clemson’s new building allowed the School of Nursing to increase its first-year enrollment from 64 in fall 2015 to 173 in fall 2018. The university expects to increase total enrollment in the baccalaureate program to top 700 by 2021.
Kathleen Valentine, director of Clemson’s School of Nursing, tells Clemson.world, “The collaboration will not only expand our enrollment, but will also integrate teaching and clinical practice in innovative ways that will positively impact nursing education and patient outcomes.”
Nursing students at Clemson take their general education and nursing foundation courses on the main campus during their freshman and sophomore years. Then they are placed into one of two cohorts allowing students to complete their nursing courses in Greenville under the guidance of Clemson faculty and complete their clinical rotations at a GHS campus, or take their junior and senior nursing courses on Clemson’s main campus and complete their clinical rotations at health systems across the state, including GHS.
To learn more about Clemson Nursing’s partnership with Greenville Health System to open a new education and research facility, visit here.