Made by Canadian film-maker Brenda Davis, Sister provides an often heart-breaking insight into the world of childbirth in three impoverished nations: Cambodia, Ethiopia and Haiti.
The film has been shown at several film festivals around the world, and is available to download below.
We spoke to Brenda about the challenges of making such a film, and the even greater ones involved in reducing maternal and infant mortality in the developing world.
Tell us a little bit about your background before Sister…
I’ve worked in various aspects of film for over 20 years, primarily as a researcher and script supervisor. I wanted to make my own films, so started taking camera and editing workshops in 2006. I’ve made a few short films as a one-person crew, but wanted to make something more cinematic.
How did the film come about?
The subject of maternal health and maternal and newborn mortality is something that has circled me my whole life. My Grandmother Martha lost her first born at 19 and went on to give birth to 16 babies – of which 11 survived. I would hear this story, told in hushed tones, by older family members as a little girl, and about my grandfather taking the baby to the gravesite in a shoebox by himself. It was so lonely and quiet and matter of fact. I wanted these stories to be heard.
I was documenting a course on Emergency Obstetric Care in Sweden, a workshop that is completely by scholarship to about 30 health workers from African countries. The first time I went I was blown away by the dedication and passion of the health workers, particularly Goitom Berhane from Ethiopia. His single mindedness really stood out… he really only speaks about this issue and perhaps football!
I was transcribing the interviews after I returned home and found myself so moved when he said, “When an innocent mother, because of her pregnancy, is dying from lack of appropriate care in the right time in the right place with the right skill. That is what is actually happening in the developing world.” It was then that I realised that I was going to make a film.
Why did you choose the locations you filmed in?
I chose to film in Ethiopia because they were using the strategy of training health officers as Surgical Health Officers to provide Comprehensive Emergency Obstetric Care where there are no doctors. This strategy is to fill the gap to expand care for people living in rural areas, which is about 85%. When we started filming, Goitom was in his residency and by the time we completed filming he was about to graduate.
I wanted to film with a midwife at a rural health centre in Cambodia to show the day-to-day work of a midwife. I had met Pum Mach a few years before and was honoured that she allowed us to film with her. In Cambodia, they use a method called ‘Chain of Survival’ for moving women when there is an emergency, which is based on how landmine victims are moved from remote villages to regional hospitals when necessary. They train ‘village health volunteers’ and Traditional Birth Attendants about danger signs during pregnancy or labour, so they know when they need to move women to a health centre or hospital.
I knew I also wanted to film somewhere urban. After months of research trying to find the right place, I feel so lucky be connected with the amazing Madam Bwa. The strong community is a huge strength in Haiti, but the lack of access to things like running water and lack of infrastructure in general makes it very challenging.
On the cinematic side of things, each country was visually very different having a very different landscape, light and colour palette.
Tell us about the filming process. It must have been a memorable experience for you.
As a first time film-maker it was a challenging undertaking. I feel honoured to have made a film where the health workers speak for themselves and not include any great white saviour. Building trust was a huge part of making the film, we kept the crew to a minimum – two-three people. Having women behind the camera was very important to me.
As a mother yourself, witnessing women suffering and their babies dying must have had a profound effect on you. Was there ever an urge to intervene, even if just to hold someone’s hand?
I think the tone was definitely set by having women behind the camera in brutal situations. Our objective as filmmakers was to provide a gentle presence while filming. There were some very difficult days, but nothing compared to what the women themselves were experiencing. We often interacted with the women, families and health workers on a personal level, but that is not the story we were telling with the film, which was to show what the health workers and women experience on a day-to-day basis.
Transport is very clearly a major issue in the three countries you profiled – to the point where women and babies die because of a lack of it. Do you know of any efforts being made to counter this?
Transportation is a huge issue in all three countries, definitely. The first time we filmed in northern Ethiopia, the road from Mekelle to Adigrat was not entirely paved and took about five hours to travel, the last time we filmed there in 2010 the road was entirely paved and took about half that amount of time. Access to mobile phones is very important to helping people in remote villages get help when needed – the first time I went to Cambodia in 2007 there was no mobile service in the remote part of Battambang where we filmed. That can make a huge difference.
Millennium Development Goal No.5 – ‘Improve Maternal Health’ – states that maternal mortality dropped by 45% between 1990 and 2013. Is there a danger that such statistics will allow the world to become complacent, despite millions of preventable deaths still occurring globally?
There is a huge danger of complacency, for sure… and in many cases the deaths are happening in remote places and not being counted. Sometimes I feel hopeful and sometimes I get angry or sad and don’t think change is possible. Someone said something beautiful at a screening once, something like, ‘maybe one day the film would be like a cave drawing about something that doesn’t exist any more’. I thought that was really hopeful.
For any midwives and student midwives reading this who were touched by your film, is there anything they can do to help?
More midwifery training, midwives supporting and advocating midwife training around the globe where more midwives are needed. Also, there are such amazing large midwife organizations that can sponsor training midwives and providing resources were there are not enough resources. I would love to hear for midwives and/or student midwives after seeing the film.
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