At the heart of Sister, Brenda Davis’s documentary debut, are three inspiring stories of an Ethiopian health officer, a midwife in rural Cambodia, and a traditional birth attendant in Haiti. When Davis met Goitom Berhane in Ethiopia in 2008, she was taken with his vivacious personality and dedication to solving the maternal health crisis in his country. Berhane’s example encouraged Davis to explore women’s health as an international human rights issue. Eventually, he became a central figure in her film.
We meet Madame Bwa in the poverty-stricken Shada neighborhood of Cap-Haitien, Haiti. An aged woman who struggles with basic survival, Madame Bwa has delivered more than 12,000 children with no formal medical training.
In an area of Cambodia that is littered with land mines, Pum Mach puts her own life at risk so that geographically isolated mothers and their children may live through the common event of childbirth. In one of the more ghastly moments of Sister, a nineteen-year-old girl delivers her baby by caesarean section thanks to Mach identifying the child as breech and securing transportation to the nearest hospital, which is several hours away.
These moments make Sister as beautiful as it is brutal. The film showcases the passion of health workers who overcome incredibly difficult circumstances to combat the alarming rate of maternal and newborn deaths occurring around the globe — deaths that, with adequate care, are almost entirely preventable.
In The Fray spoke with Davis about her family’s experience with child mortality and the challenges of filming a tragic topic.
When did you develop an interest in maternal and child mortality?
My grandmother gave birth to sixteen children in rural Nova Scotia. Four died during childbirth and one died at the age of two. She lost her first child when she was nineteen and her last at thirty-nine. I remember my cousins coming together to buy a gravestone for all the children my grandma lost. They spoke about it casually because this happened a lot where my grandmother lived, but it had a lasting impact on me.
Why did you choose to explore this topic for your film?
As an artist, I’m interested in storytelling. If a subject is compelling to me, I want to pursue it, but I don’t want to speak for people. I want them to tell their own stories.
I was very fortunate to find people willing to tell their stories in Ethiopia, Cambodia, and Haiti. We were able to show similarities in women’s experiences, despite entirely different cultures, while also focusing on local strategies. The unifying theme to every story is a lack of access — access to basic health care, access to emergency obstetric care, and access to family planning.
How are health workers attempting to close these gaps in access?
It’s difficult to articulate just how important health workers are, and in many instances, it goes beyond the service they’re providing. In Ethiopia, Hirity Belay is a young woman who walks to places where there are no roads to provide women with the care they need to have healthy babies. While that service is invaluable, you must also consider what an amazing example she’s setting in these small villages. One of the things that inspired the name of the documentary was Hirity’s relationships. The women would often call each other “sister.” I thought this was so beautiful and warm.
Madam Bwa, a traditional birth attendant in Shada, Haiti.
In the case of Madame Bwa, being a traditional birth attendant has been passed down through her family. The work she does is important to her community, and for the most part Madame Bwa lives off donations from the families she helps. Traditional birth attendants fill a gap where there is nothing. I’m not a medical professional, but I don’t understand why so many people want to eliminate traditional birth attendants. They’re making a difference, and with a bit more support, they could be making a much bigger impact.
I found many of the scenes hard to watch, not because they’re graphic, but because they are heartbreaking. How do you approach filming people’s intimate tragedies respectfully?
In Ethiopia, we spent time in the hospital without cameras and became a familiar presence. The women often didn’t understand why we were filming or why anyone would be interested. I’d explain that we wanted to show what was going on in their communities.
Sister was definitely difficult to film, and the director of photography and I constantly struggled with the fear that we may be invading a woman’s privacy. When you’re meeting people in such intense and difficult circumstances, you constantly grapple with whether or not you’re being sensitive and respectful.
In some respects, I feel like Sister is a war movie. Women everywhere — but especially in developing countries — are fighting for their lives. What you see was exactly what was happening. The women, health workers, midwives, and birth attendants all speak for themselves and tell their own stories. It was a conscious decision not to narrate or pretend to know the answers.
What do you hope viewers take from the film?
I hope Sister encourages people to think critically about what the United States does that affects other countries — from a its inability to grow food to being littered with land mines. People should think about how they’re connected to what’s happening in other places, or how they’re complicit in it. Donating funds is awesome, but it’s not enough.
Raised fatherless and poor in a Haitian coastal town, Dr. Jean-Gardy Marius studied medicine abroad thanks to the financial assistance of an American missionary. Now he is leading an innovative, grassroots effort to root out cholera and bring communities in Haiti’s rural north to health and self-sufficiency.
It’s easy to hear about what’s going wrong in Haiti. Search the news about the beleaguered Caribbean nation, and the negativity overwhelms. Cynical volunteers decry the country’s hopelessness. Aid organizations put forward flimsy justifications for their failures. Frustrated Haitians wait for foreign governments to make good on the “build back better” promises they made, with much fanfare, three years earlier, after an earthquake devastated the country. Today, over 350,000 people continue to live in shelters that were intended to be temporary. The ongoing cholera epidemic has claimed more than 8,000 lives, and malnutrition and famine plague the country.
It is not just that Haiti lacks homes to house its homeless, medicines to treat its sick, and food to feed its hungry. Over the decades, the country has been drained of its human talent, too. There are only four doctors, nurses, and midwives in the country for every 10,000 people, and most of them are located in Port-au-Prince, Haiti’s densely populated capital. The dearth of trained professionals contributes to some heartbreaking health statistics: seventy out of every 1,000 children in Haiti die before their fifth birthday, and 350 out of 100,000 mothers die in childbirth.
It is against this national backdrop of despair that local stories of Haitian resourcefulness and resolution stand out. Even in some of the country’s most impoverished areas, there are people like Jean-Gardy Marius, a Haitian doctor leading an innovative, grassroots effort to root out cholera and bring communities in Haiti’s rural north to health and self-sufficiency.
Photo courtesy of OSAPO
Marius and his humanitarian group OSAPO have worked over the past six years to bring health services to the people of Rousseau, a poor rural community about sixty miles north of Port-au-Prince. When the earthquake struck and cholera spread quickly through tainted water supplies, OSAPO responded by putting up tents to house infected patients, distributing water purification tablets and chlorine, and creating hydration stations for ill people making their way to the hospital — ultimately saving the lives of thousands. OSAPO is now partnering with international aid organizations Oxfam and UNICEF in the country’s north to stem the spread of cholera during Haiti’s hurricane season.
But OSAPO’s efforts go beyond emergency care — and even medical treatment. Marius, who grew up in extreme poverty in a western coastal town, believes that groups like his can provide Haiti’s rural areas with the basic knowledge and resources they need to grow successfully on their own. “Our vision at OSAPO is to improve living conditions,” says Marius, forty-three, whom I interviewed over the phone while he was in Lincoln, Nebraska, in June. “To do that, we have to come up with a good primary health care system. For me, this means education for adults and kids, access to latrines, and healthy drinking water — all the things human beings need to survive.”
After all, the roots of Haiti’s current health crisis go far beyond the 2010 earthquake. The country’s deep and pernicious inequalities have existed since its days as a slave colony, the first one where the slaves revolted and threw off the yoke of colonialism two centuries ago — only to be beset by forced reparations to France, American occupation, and international trade embargoes that stunted its growth from early on. Since then, through brutal dictatorships and corrupt democracies alike, Haiti has struggled to grow its economy in any sustainable fashion, leading to a vicious circle of privation and poor health.
With Haiti’s entrenched poverty in mind, OSAPO has adopted a holistic approach to health care. The group does more than run a health clinic in Rousseau. OSAPO’s staff have trained and deployed health educators into the community to teach people about sanitation, immunization, and family planning. They have dug latrines for 360 families and constructed wells to provide clean drinking water for 2,500 more. They have trained midwives to recognize signs that a particular childbirth might require medical intervention, so that women who live hours away from OSAPO’s clinic will arrive in time to save the mother and child if complications arise.
Photo courtesy of OSAPO
The organization’s focus is on helping people to help themselves. At OSAPO’s clinic, patients are charged nominal fees for each service. The fees, Marius says, are about teaching the community about self-reliance and accountability, while also avoiding the corruption that plagues other clinics. Likewise, instead of handing out food, OSAPO’s nutrition program provides seeds and chickens along with agricultural assistance and educational workshops. “You have to put people back to work,” Marius says. “Agriculture is one of the best solutions to help them economically.”
Marius knows something of self-reliance. The oldest son in a poor family, he never met his father and grew up watching his stepfather abuse his mother. After he stood up to protect her, his stepfather threatened him, and Marius moved in with an uncle.
“I took a bus to his house with hope that he could help me get back into school,” Marius says. “But my uncle used me for household labor.”
At the age of thirteen, Marius ran away from his uncle’s home. For a year, he slept and begged on the streets of Port-au-Prince. Then, a friend brought Marius with him to stay with his family in Pierre Payen, a small village in the northwest. When he was fourteen, he got a job assisting Dr. Victor Binkley, an American surgeon working in Pierre Payen. Through him, Marius met an American missionary who supported him financially when he decided to pursue a medical degree.
After studying medicine in the Dominican Republic and Germany, Marius decided — unlike many of his Haitian peers — to return to his country to work as a doctor.
Photo courtesy of OSAPO
In 2007, he founded OSAPO, or the Oganizasyon Sante Popilè (Popular Health Organization). After a year of working out of a mobile clinic, OSAPO built a permanent health-care center in Rousseau. Today, OSAPO has a staff of five doctors, nine nurses, and one agronomist; last year, it served roughly 52,000 clients.
OSAPO’s model of charging small fees for its services makes sense even in impoverished communities, says Dr. Kim Coleman, a radiologist from Lincoln, Nebraska, who has been to Haiti five times as a visiting doctor at OSAPO’s clinic. She points out that international aid organizations that step in to provide free services can unwittingly create “beggar economies” that undercut local organizations. “The buy-in from patients is so important,” Coleman says, “You can see the damage done by giving handouts. [Marius’s approach] is better for the people, and makes for better compliance.”
Whether foreign aid creates perverse incentives is a major point of controversy in the development world. In recent years, prominent economists such as Jeffrey Sachs and William Easterly have taken opposing views of its effectiveness, while social entrepreneurs ranging from Paul Polak to Muhammad Yunus have argued — to varying degrees — for more market-driven solutions to the problems of poor nations. Perhaps nowhere else is that debate more relevant than in Haiti, which is believed to have more aid groups per capita than any other country except India — as many as 10,000, according to a 2006 report from the World Bank. (During the rule of Haitian dictator Jean-Claude “Baby Doc” Duvalier, foreign governments sought to sidestep the corrupt regime — notorious for funneling aid into Duvalier’s personal coffers — by sending their funds to NGOs instead.)
Since the 2010 earthquake, ninety percent of the six billion dollars disbursed to Haiti has been given to international NGOs and private contractors, while less than half a percent has gone to Haitian businesses and locally run organizations like OSAPO. As the group’s partnership with Oxfam and UNICEF makes clear, the two approaches are not necessarily mutually exclusive. And yet OSAPO’s supporters argue that its cost-effective, comprehensive, and grassroots approach to development should be scaled up. At the moment, Marius points out, there are not even enough qualified candidates to fill his clinic’s need for trained doctors and nurses. If Haiti’s most educated health-care workers continue to flock to Europe and North America, Haiti will need to keep relying on foreign assistance.
Marius hopes that his example will inspire other Haitian professionals to stay at home and tend to a country that desperately needs their talents. When the aid dries up or the foreign doctors fly off, who will be there to care for the sick?
“I wanted to make something that is strong,” Marius says of his group. And in building that vision, he has made the people of Rousseau stronger.
In her deeply personal account of life in post-earthquake Haiti, journalist Amy Wilentz looks at how outsiders' distorted views of the country have misrepresented its culture and history and encumbered its progress.
Farewell, Fred Voodoo: A Letter from Haiti By Amy Wilentz
Simon & Schuster. 352 pages.
Amy Wilentz first visited Haiti in 1986, when she was a writer for Time magazine and the ousting of dictator Jean-Claude “Baby Doc” Duvalier was underway. Admittedly, Wilentz was not the type of foreign correspondent who traveled from war zone to war zone, or from one uprising to the next in pursuit of a grand and dramatic news event. Rather, Wilentz’s journalistic demeanor ran more along the lines of observational witness; she was a spectator of all that surrounded her, and sparked her imagination and curiosity.
Yet, when it came to Haiti, there was something “eternal” about the country that called to Wilentz. She had read The Comedians, Graham Greene’s 1966 novel about the reign of Jean-Claude’s father, François “Papa Doc” Duvalier, and scenes from the book remained etched in her mind.
Elected president in 1957, Papa Doc Duvalier is one of history’s most unforgettable political figures. His fourteen-year reign was the longest and most brutal in Haiti’s history. To quash political dissent, and protect himself from being overthrown, Duvalier created the Tonton Macoute, a personal police force that terrorized citizens and assassinated anyone Duvalier thought was a threat. In 1971, when Jean-Claude succeeded his father as president, Duvalier-style despotism continued.
From her office in Manhattan, Wilentz perused the daily news written by Haitian exiles in the 1980s, which heralded Baby Doc’s impending departure from power. Wilentz felt an impulse to witness the end of the Duvalier era. Plus, she wanted a firsthand look at the Tonton Macoute, which was still in use by Baby Doc. With guns tucked into their waistlines and hats lowered over their sunglasses, the Tonton Macoute haughtily prowled Haiti’s streets to search for so-called troublemakers.
Thus began Wilentz’s love affair with Haiti. Her decades-long relationship with “La Perle des Antilles” (“The Pearl of the Caribbean”) has been anything but straightforward, simple, effortless, or predictable. In her first book about Haiti, The Rainy Season, Wilentz chronicled a nation and a people that were oppressed by the Duvalier regimes’ terror and totalitarianism. In her latest book, Farewell, Fred Voodoo, a deeply personal narrative about post-earthquake Haiti and Wilentz’s connection to the place, she revisits the country to listen to Haitians and recount her astute, unvarnished impressions.
Hello, Fred Voodoo
Wilentz’s experiences on her initial trip to Haiti commenced her “Haitian education,” and introduced her to stereotypes of Haitians invented by the outside world. One stereotype that persisted was the idea of “Fred Voodoo” — a dismissive term used by many reporters to refer to the ordinary Haitian man (or woman) on the street. “Fred Voodoo” could be a presidential candidate, a market lady, a renowned academic, a taxi driver, an unwed mother, or an Army general.
In 1986, Wilentz routinely interviewed Haitians, who told her what it was like to not have enough food for themselves and their families, and who wondered what it was like to live in a real house, not a shantytown shack. They discussed what it would be like to live freely and vote openly for a president who cares about ordinary Haitians and their suffering. They talked about democracy.
That was in 1986.
In 2010, after the 7.0-magnitude earthquake struck, many Haitians Wilentz interviewed still said a lot of the same things. Although this time they added more details of death and dying, blood, pandemonium, loss, amputation, starvation, and fear.
Returning to Haiti almost didn’t happen for Wilentz. She knew an abundance of international relief groups with “their money [and] their development résumés” would descend on a nation that already had more than ten thousand aid organizations in operation before the earthquake. She wasn’t sure she could tolerate a “salvation fantasy” from the international community, in which well-intentioned, post-disaster relief workers insist their presence would solve Haiti’s unmanageable, centuries-old troubles. Exasperated by the media’s reductionist portrayals of Haitians in despair — which she calls “the objectification of the Haitians’ victimization” — Wilentz wondered if she could “bear to watch the difficult lives of most Haitians rendered even more unbearable by this dreadful event.”
But she could not stay away. Within two weeks of the earthquake, Wilentz was back in Haiti for what may have been her thirtieth or fortieth visit. (She lost count after so many years.) The experience was consequential. She explains:
This book in your hands, then, is my attempt to put Haiti back together again for myself, to understand why all the simplest hopes and dreams of the men and women [that outsiders] call Fred Voodoo have been abandoned, and to stack the pieces flung apart by the earthquake back up into some semblance of the real country. I wanted to figure out, after so many attempts by so many to uphold democracy, why Fred and all his brothers and sisters have become, in our eyes at least, mere victims, to be counted up on one ledger or another as interesting statistics, casualties of dictatorship, of poverty, of disaster, of outside interference, of neglect, of history — of whatever you want to point a finger at — rather than as active commanders of their own destiny.
Amy Wilentz. Paula Goldman
“Nothing You See Is What It Seems to Be.”
The long-standing misapprehension about Haiti and Haitian identity has everything to do with the country’s history, religion, culture, isolation, and relationship to the United States. As Wilentz discusses in great detail, and with keen insight: “[Haiti] defies categorization.… It’s eccentric and unexpected. At every corner, in every conversation, with every new event, Haiti makes you think, it challenges you.”
One of the many indeterminable stereotypes about Haitians is that “ninety percent of Haitians are Catholics, and one hundred percent are voudouisant, or voodoo worshippers.” Wilentz attended several voodoo ceremonies, during which various African gods were worshiped and spirit possession occurred. At the end of these “stunningly theatrical and participatory” services, she wondered whether Haitians really believe in voodoo, or if its practice is more tradition than conviction.
Wilentz knows this question is formalistic, and the answer is as enigmatic as the country itself. “Tou sa ou we, se pa sa,” a Haitian proverb warns. It translates to: “Nothing you see is what it seems to be.” Still, Wilentz doesn’t sit back and leave a gap in her analysis. She delves deeply into voodoo’s cultural importance.
“For most Haitians at a ceremony,” Wilentz asserts, “this is community, escape, entertainment, and as much transcendence as is allowed to them. For others, the ceremony represents Haitian patrimony and inheritance, and they take pride in it even when they have little or no religious belief.… This is a culture that values theater and a certain degree of artifice, even a great degree. Artifice and duplicity were natural and necessary survival methods during slavery.… How much of what the white man sees in Haiti is specifically a show for the white man to see — and this not just in terms of voodoo ceremonies, and not just today?”
Although an answer is unattainable, a look at Haitian history is instructive. In 1804, after obtaining freedom from France in the only successful slave-led revolution in history, Haiti became the first independent black nation in the Western world, but its legitimacy was suspect because it was ruled by descendants of slaves. After wresting power and prosperity from a European colonial power, Haiti was regarded by many as a nation that “never really had the right to exist.” As Frederick Douglass said in a speech at the 1893 Chicago World’s Fair, “We have not yet forgiven Haiti for being black.”
Haiti is much like the U.S. and France, countries whose histories cite revolution as a defining force that established sovereignty and national identity. Haiti’s revolutionary forefathers — Henri Christophe, Toussaint Louverture, Jean-Jacques Dessalines — maintain a presence in many Haitians’ minds similar to that of George Washington and Thomas Jefferson for Americans. Folklore has it that Dessalines “ripped the white stripe from the French tricolore in order to create the new red and blue Haitian flag, [sending] the message [that] the white man will have nothing to do with [Haitians’] destiny.”
It wasn’t to be.
For more than a century, France forced Haiti to pay reparations for the loss of the slave economy, while the slaveholding U.S. imposed a burdensome embargo that crippled the fledgling nation’s integration into the world economy. The U.S. occupied Haiti from 1915 to 1934, and it has meddled in the country’s affairs ever since.
Wilentz explains that, for almost all of the twentieth century, only U.S.-approved Haitians were allowed to become president in Haiti. She also cites a U.S.-led military intervention in 1994, Operation Uphold Democracy, that re-imposed President Jean-Bertrand Aristide. (Aristide had been overthrown by the Haitian Army just three years before the U.S. intervention.)
“I cannot recall another U.S. military deployment that performed regime change by reinstating an unseated leader,” Wilentz writes.”But Haiti is always singular, and so is America’s long, torrid relationship with it.”
Wilentz continues:
How Haiti works in general has historically had more to do with foreigners than is the case in most other countries, and this has never been so obvious as in the post-earthquake era. With so many coming down to assist in relief and reconstruction, so much of it concentrated in the capital, it has sometimes felt as though the country is being taken over by a new occupation, by a different kind of army.…
Rather than disrupting old ways of thinking about Haiti, the earthquake allowed many commentators, political analysts, and columnists to restate what they’d always imagined to be true about the world’s first black republic. The white Western world has a tendency, when confronted by Haiti’s intractable problems, to fall back on easy stereotypes and a deep-rooted, unconscious racism that suggests to them that this is all “depressing” and “hopeless,” and that somehow all the problems are the fault of this irresponsible, ungovernable people, with their weird old African customs and religion. It’s all Fred Voodoo’s fault.
But in fact, this depression and hopelessness come from “experts” who don’t understand Haiti, don’t acknowledge its strengths (and don’t know them), don’t get its culture or are philosophically opposed to what they assume its culture is, and don’t know its history in any meaningful way.
Despite billions of dollars in aid that flowed into Haiti, and thousands of relief workers who donated their time, it’s no secret that the country remains in disrepair. Wilentz is unsparing in her criticism of the failures of the international community and the Haitian government, and her writing on their dereliction is superb. She is unafraid to ask whether it is worth continuing to provide humanitarian assistance to a “kleptocratic” country that lacks a “functioning government that works for the people.”
Two Westerners who receive indisputable praise from Wilentz for “getting Haiti” are Megan Coffee, a doctor who cares for tuberculosis patients at her perpetually under-resourced Port-au-Prince clinic, and actor Sean Penn, who ran a refugee camp and moved refugees to real housing within days of the earthquake.
In the end, the most profound and perplexing question Wilentz asks, and tries to answer, is: “All the outsiders who come to Haiti, and come again, and never absolutely leave … what is it they get out of Haiti? This is the mystery I was trying to solve, after all. What do I get out of Haiti?”
At this point, Farewell, Fred Voodoo comes full circle. Wilentz’s love affair continues, yet it is changed. Indeed, Wilentz is changed. After “years of being schooled by Haiti,” she realizes the lessons have exacted an emotional toll.
“This book is … what I’m doing to relieve the pain,” she confides. “Putting down these marks across my computer screen: I can feel the release.… Yet what I’ve done in Haiti, what I’ve achieved with marks on paper, I cannot help but feel is useless, especially in the wake of this terrible disaster.”
Is Farewell, Fred Voodoo Wilentz’s goodbye letter to Haiti? For both her readers and a country that has been misunderstood for so long, I hope it is not so.
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At the heart of Sister, Brenda Davis’s documentary debut, are three inspiring stories of an Ethiopian health officer, a midwife in rural Cambodia, and a traditional birth attendant in Haiti. When Davis met Goitom Berhane in Ethiopia in 2008, she was taken with his vivacious personality and dedication to solving the maternal health crisis in his country. Berhane’s example encouraged Davis to explore women’s health as an international human rights issue. Eventually, he became a central figure in her film.
