Filmmaker Brenda Davis' new documentary, Sister gives a breathtaking and often heartbreaking look into the complications of pregnancy and child birth — powerfully revealing the brutal reality that exists behind the statistics and safely diluted medical terminology. Sister also calls attention to the incredible work being done by health workers in the area who work tirelessly to save lives, deliver babies, and provide health education in their communities.
The film is made uniquely powerful in that it is the story of the health workers, their experiences, and their patients, rather than the story of a narrator. There is no “white knight” lamenting the conditions of poverty or universal conditions for women, rather it is a beautiful, painful and honest film, allowing the viewer to draw her or his own conclusions.
I asked filmmaker Brenda Davis about her artistic choices in making Sister.
CM (Caitlyn Mattil): Why did this subject resonate with you so deeply? What started your interest in making this movie?
BD (Brenda Davis): It wasn’t so long ago in North America that maternal and newborn mortality was a commonplace situation. There is an article called Under the Shadow of Maternity, which documents women’s commonplace fear of death and disability in the 19th century. If you go to a graveyard in upstate New York, or any turn of the century graveyard you will see many graves of women who died in childbirth.
When I was a little girl I would always hear stories about my grandmother Martha. I grew up in Toronto, but my parents grew up in Nova Scotia in poverty with large families. It was disturbing to hear that Martha lost four babies in stillbirth, and had eleven more children and one of them was my mother. It wasn’t until the 1980s that there was a gravestone, it is very moving to see the gravestone and see that Martha lost her first child in stillbirth at 19 and the last at 39.
CM: What drew you to film in Cambodia, Haiti, and Ethiopia?
BD: Each country is so beautiful, each country has different light. It was important to show this. The film was made with a strong solidarity for the health workers who are really on the frontline of the crisis of maternal and newborn mortality, and with women everywhere. I wanted to make a film about the story behind the statistics.
In Ethiopia I had met Goitom Berhane when he was taking a course in Emergency Obstetric Care, it is a pretty radical three week workshop given each year by the amazing Dr. Staffan Bergström, it’s called the Gotland Course and it is all by scholarship to the health workers. He brings about 30 health workers from Africa and Asia together for three weeks for lectures, discussions, presentations by the health workers, etc. It’s very interactive and in solidarity with the hard work the health workers do on a daily basis. It was when I got home from documenting the course and was transcribing an interview with Goitom and was sitting at my computer weeping that I knew I was making a film.
In Cambodia I made a short video with the midwives working doing outreach to remote villages in Battambang Province in 2007. That’s when I met Pum Mach, the midwife who is in Sister. It’s such a beautiful country and the midwives had such an amazing sense of camaraderie, there were hours of walking and a lot of laughing.
In Haiti I knew that I wanted to feature a traditional birth attendant in Sister and that I wanted to film in an urban area, so I thought it would be a good place to try to find that situation. I did a lot of research.
CM: In developing nations the maternal mortality rate is astronomically higher than in western nations (as you note in Sister, Cambodia has a rate 100 times that of the U.S.). What do you see as contributing to such high rates?
BD: Let’s start with access, or actually the lack of access. Women need access to trained health workers, access to health facilities, access to a clean and safe deliveries, access to family planning, access to safe abortion, access to clean water, access to transportation, access to education, etc.
CM: What makes this a human rights issue?
BD: Maternal mortality is not a disease. It is preventable, and it occurs where there is a failure to give effect to the rights of women to health, equality and non-discrimination. Preventable maternal mortality also often represents a violation of a woman’s right to life. This fundamental human right is recognized in the International Covenant on Economic, Social and Cultural Rights, as well as other international human rights treaties. It requires action to break down political, economic, social and cultural barriers that women face in accessing the interventions that can prevent maternal mortality.
CM: What’s being done to combat this?
BD: Each country has a local strategy. In Ethiopia, they are training health officers as Surgical Health Officers to provide comprehensive emergency obstetric care. This strategy was to fill the gap to expand care for the remote population where there are no obstetrician-gynecologists. Ethiopia has a population of 82 million and has only 300 OB/GYNS, and about 70% of the population is living in rural areas.
In 2009, with the support of the UNFPA, the Ethiopian Ministry of Health and the Ethiopian Ministry of Education initiated a Masters of Science program to train health workers to provide Comprehensive Emergency Obstetric Care, including such life-saving skills as managing severe hemorrhage, obstructed labor and in extreme cases, Cesarean sections.
In Cambodia, the area where we filmed in Battambang Province is one of the most landmined areas in the world, they use a strategy they call the chain of survival, it’s based on a strategy to move landmine victims from remote villages, to health centers and then to hospitals if necessary. They train people in the villages to know when they should transport a pregnant woman who is showing danger signs during her pregnancy or labor (bleeding, fever, dizziness, headache, blurry vision, etc.). They will transport them from the village to the health center and then to the hospital if necessary.
In Haiti, the issue of lack of infrastructure is huge, but the strong community is a huge strength. I wanted to show this in the film.
There is a lot of great support work being done supporting and training health workers and midwives to grow and maintain the health worker work force in Haiti. Midwives for Haiti and Partners in Health are really nurturing local sustainable programs for women’s health.
CM: What do you hope viewers take from this film?
BD: I would like viewer to ask why? It’s not a film to watch to get the answers. It’s not an academic film, but I would like the viewers to ask why do the women in this neighborhood in Cap Haitien not have access to running water, why do the women in Battambang Province have to worry about landmines when making their way to the health centers? It goes back to ‘think globally and act locally,’ and looking at what foreign policy is in place that affects women in other regions.
Something that I will always remember is when Dr. Staffan Bergstrom said, “I think we should think of taking our politicians, male politicians, to a maternity ward in Ethiopia or Sierra Leone to go into the smell of poverty to see with the senses.”
For more information on Sister or Brenda Davis, check out sisterdocumentary.com