Kevin Carter’s most famous photograph is almost impossible to witness without taking a moment to collect yourself afterwards. An emaciated toddler, crouched low to the ground, buries her head between her legs as she nears collapse en route to a feeding center. Looming in the background, a vulture patiently waits for the toddler’s journey to end. Carter, a photojournalist from South Africa, took this photograph while covering the famine in Sudan in 1993.

For this image, Carter was awarded the industry’s most prestigious award, The Pulitzer Prize, in 1994. He also received some of the harshest letters of his career from people who had trouble understanding his reaction to the scene he captured.

Carter described having heard the “soft, high-pitched whimpering” of the girl and turned to witness the visceral scene.

He watched and waited. For twenty minutes he sat nearby, camera in hand, hoping the vulture would spread its wings.

For some, this response was unimaginable. And yet many others expressed their respect and appreciation for what he did: offer an image that allowed thousands of people on the other end of the world to bear witness to an undeniable truth and respond with compassion.

Carter’s story is an extreme example of the ethical dilemmas we face in using images to promote the work of non-governmental organizations (NGOs) focused on global health. It is a reminder that our choice of imagery and how it is procured matters greatly. Photography is an inimitable tool with the ability to instill an emotional connection in an instant. In many instances, photography is selected not for what it represents but for the impression it leaves.

In today’s knockdown, drag-out race for people’s time and money, the global health community is competing against an average of 3,500 commercial messages a person may see in a single day. With these kinds of numbers, an NGO can’t tap somebody on the shoulder with their plea for attention . . . they need to stop you dead in your tracks with a message that haunts or provokes you.

How then do we balance the need to fairly represent the positive growth of a country and its citizens with the need to communicate the dire need for funding, resources, and other humanitarian efforts? How can countries like Sudan and other parts of the developing world shed, or at least move beyond, the labels of poverty and pervasive disease when so many western media outlets reapply them daily with images of despair and famine aimed at garnering funding or attention?

Photography cannot objectively package a message without context. An image alone relies on the photographer’s perspective and assumes that a viewer can adequately interpret its value and meaning, which isn’t always the case. Often, the imagery we produce will be the only access somebody has to the stories we tell about far-flung people and places. The individuals depicted on so many NGO websites never get the chance to contribute to the context or interpretation of how their likenesses are used. It’s our responsibility to consider the voices of the people we photograph, to respect their sacrifice and consider that the subjects may never see a dime of the money a photo generates. I’d like our audience to know that so many individuals we capture in our work do need medicine, food, health care, or money, but they still smile. We’d just like to ensure that they do it a whole lot more.