• 224 pages
  • 7.5 x 10
  • 60 halftones

Dust to Dust

A Doctor's View of Famine in Africa

David Heiden

In Dust to Dust, an American physician takes us on an intensely narrated visual journey through the refugee camps of Eastern Sudan, where the reality of medical work dissolved into the haunting experience of being part of the catastrophic Ethiopian famine of 1985. Through personal journal entries and alarming but compelling photographs, David Heiden reveals the horror of the camps, the inhumane morass of bureaucracy and political partisanship, and the fierce and noble fight for survival among people whose situation the rest of the world viewed as hopeless.

In spare prose the author recounts a series of disasters—political, climatic, and medical—that culminated in near total social and personal breakdown. Western doctors, nurses, Ethiopian health workers, and Sudanese camp administrators attempt to weave their own meanings, often at odds with each other, often recognizing that each is struggling to control what, in fact, cannot be controlled. The demoralizing frustrations, the small victories, and the shared perils of the environment are portrayed in parallel through words and photographs.

As the reader relives the relief workers' battles against usually curable or preventable cases of measles, tuberculosis, malaria, meningitis, and malnutrition, the images of African people suffering, dying, yet sometimes surviving are juxtaposed to reveal the common humanity but extreme cultural distance. Photographs of the skeletal bodies of starving children playing in streams that are infested with cholera and the serene face of a new mother who has miraculously delivered a health infant in the squalor and chaos of a refugee camp eloquently portray the dogged hope of these victims.

Unlike the relentless newswire photos of Ethiopian refugees that shocked Western viewers into dazed immunity, Heiden's images are those of a sensitive participant observer. He presents the relief agency volunteers as altruistic individuals working against impossible odds to do some simple good, while grappling with their own Western notions of justice, responsibility, privilege, and comfort. Despite language barriers and cultural differences, genuine connections arise between volunteers and refugees, yielding riches for both. David Heiden reveals the human face of disaster, the personal effect of wanting to make a difference, and the extraordinary resilience of the human spirit.


"Writers write, photo journalists document, doctors attempt to heal. David Heiden fused all his talents, knowledge, and passion to relate a great human tragedy that he witnessed and played a part in. Dust to Dust is a memorial to 40,000 powerless human beings, caught in a disaster which ran its course and would be forgotten, but not if Dr. Heiden has his way. A profoundly moving chronicle of our times; a contemporary version of Dante's Inferno."
Cornel Capa, International Center of Photography

"David Heiden is a truly humanistic and dedicated doctor with a strong and always compassionate visual sensibility."
Mary Ellen Mark

"A gripping, personal account of the horrors of famine. Through words and photos, Heiden takes us in a world almost impossible to imagine. Starving children, pompous bureaucrats, and bewildered relief workers—all play a role in this tragic drama."
Roger P. Winter, Director, U.S. Committee for Refugees

About the Author(s)

David Heiden is a physician in San Francisco and a photographer. He has served as a medical relief worker for Kampuchean refugees in Thailand, at the Boo'co refugee camp in Somalia, and at the Wad Kowli and Fau 3 refugee camps in Eastern Sudan. His photographs have been shown in solo and group exhibitions throughout the United States. He was awarded the Media Alliance Meritorious Achievement Award for Photography in 1985 and was a nominee in 1990 for the first annual award from the Mother Jones International Fund for Documentary Photography.

In the Series

Visual Studies

No longer active. Visual Studies, edited by Douglas Harper, will consist of a broad range of books that regard photography, film, and other visual media as vehicles for exploring social and cultural themes. We are developing a series of illustrated books that draw on photographs as primary documents and that include a substantial analytic text; however, we will also consider unillustrated manuscripts on visual subjects. Douglas Harper is a photographer and sociologist who teaches at Potsdam College of the State University of New York.