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The Producer's Story

Filming the Fistula Women

  • By Mary Olive Smith
  • Posted 03.13.08
  • NOVA

To tell the story of women hiding in shame in a remote corner of Africa posed inherent problems in the making of "A Walk to Beautiful." How could we show their loneliness and isolation while at the same time time entering their intimate space? How would we follow a woman smelling of urine on a long bus ride to Addis Ababa, Ethiopia's capital, and remain true to the experience she and so many like her have endured? At the end of a day of shooting, how should we respond to 10 people suffering from various illnesses lined up outside the family compound hoping to get help from us—foreigners with cars and money?

Getting at the truth is our goal as documentarians, of course. But by virtue of our presence—crew, camera, microphone—the truth becomes invariably distorted. For decades, nonfiction filmmakers have confronted this conundrum, and our film shoot in Ethiopia was no exception. Could we capture the harsh reality these voiceless women experience?

Wubete, one of the fistula patients who appears in the film, reached her own personal "beautiful" when she began a new life working at a center for orphaned children following her treatment. Enlarge Photo credit: Courtesy Engel Entertainment

A hidden agony

I first visited the Addis Ababa Fistula Hospital in the spring of 2004. The idea for a film about the hospital and women with obstetric fistula came from a New York Times op-ed column by Nicholas Kristof entitled "Alone and Ashamed" (5/16/03). A friend of Steven Engel, head of Engel Entertainment, where I've worked for 12 years, brought the piece to Steve and said, "What are you going to do about this?"

Steve took the question to heart, and after discussing it with our development team, he decided to embark on the company's first feature-length documentary. We, his staff, were with him from the start. We are mostly women, and learning of the secret and excruciating suffering that millions of women experience, we felt compelled to begin this journey.

Full Circle

In many ways I personally had been preparing and hoping to make a film like this my whole career. Before joining Steve's company in 1996, I spent five years working in public radio on an interview program that focused largely on international issues. I then attended the School of International & Public Affairs at Columbia University, where, through a media concentration, I picked up a camera for the first time. I went on to make a documentary about a quadriplegic boy who learned to stand again while finishing a large painting in a children's art-therapy program at Harlem Hospital.

Mary Olive Smith with Yenenesh, one of the fistula patients who appears in the feature-length version of "A Walk to Beautiful" (see footnote) Enlarge Photo credit: Courtesy Engel Entertainment

I was hooked. After finishing my master's, I received a fellowship to spend five months in West Africa. My love for Africa began then. Camera in hand, I explored human rights abuses associated with a resistance movement in the tropical zone of Senegal. The years that followed at Engel Entertainment (at the time called Engel Brothers Media) took me to South Africa and Zimbabwe as well as many parts of Asia and Latin America to work on documentaries for television. The subjects I covered ranged from ancient mummies to cutting-edge cures for breast cancer.

But when Steve offered me the opportunity to direct a feature-length doc on women suffering from obstetric fistula, I jumped at it. I felt I would finally be able to bring my career and personal interests full circle.

Beauty and suffering

My weeklong scout in 2004 at the Fistula Hospital ended with an elegant dinner and tea at the home of Dr. Catherine Hamlin. Her small house, where she has lived for over 30 years, sat tucked into the hillside below the hospital she and her husband built. (Dr. Reginald Hamlin died in 1993.) The house is as naturally ensconced in the landscape as the flowers that adorn the hospital grounds. With hopes that a feature film with an international audience would help her build an endowment to keep the hospital running long after her own death, Dr. Hamlin graciously granted us approval to make the film.

After years of loneliness, they were desperate to be heard.

For the next nine months I researched obstetric fistula, imagined the stories, drafted a hypothetical narrative, and, most importantly, assembled a talented crew. Having been stunned over the years by Africa's beauty as much as by its suffering, I was determined not to show one without the other.

Jerry Risius, a talented cinematographer, accompanied my crew into Ethiopia's rural Amhara region (historically known as Gojam). The hilly landscape west of the Blue Nile Gorge was stunning. Working with a high-end HD camera and assisted by our coproducer Allison Shigo, Jerry's job for one week was to film the beauty and village life of the country. He rose every morning at 5 a.m. to shoot a time-lapse sunrise, and he found the perfect spot every evening to capture the sunset. He and Allison filmed women getting water from a well, washing clothes in the river, carrying inconceivably heavy jugs on their backs.

When Catherine Hamlin (center) and her husband moved to Ethiopia in 1959, they were told that the country's fistula patients "will break your hearts." Over 30,000 fistula surgeries later, she and her staff continue to repair over 1,500 of these grievous injuries each year. Enlarge Photo credit: Courtesy Engel Entertainment

A long search

Meanwhile, I went out with a team of two other people, a smart and gentle-voiced interpreter from Addis named Bethelhem Belaney and our staff associate producer Aysin Karaduman, who recorded sound. Aysin's vitality on our long hikes kept the crew energized and the local shepherd boys entertained.

For a week we interviewed women off the main road of a town called Finote Selam, shacking up at night in a flea-ridden truck stop called the Extreme Hotel. We spoke to and interviewed many sick women, but none with the most common symptom of obstetric fistula—incessant leaking of urine.

Each evening I called my counterpart, director Amy Bucher, at the Fistula Hospital. She had begun interviewing women there and, among the 120 patients, she had found two stunning young women—Wubete and Almaz—who would bring the humor and hard-earned joy that gave the film its ending.

Amy's crew consisted of another staff associate producer named Jess Beck and cinematographer Tony Hardmon. Jess and Amy bonded like sisters with the girls and women they spent time with at the hospital, and Tony's calm presence and patient eye made him welcome on the ward. To act as their interpreter, we hired a dazzling Ethiopian woman named Makda Teklemichael. (A year later, we had the good fortune of hiring Makda at Engel Entetainment when she moved to the United States to be with her husband.)

Within just a few days, Amy was able to lock in her characters, but so far I had come up short. Would we have a film?

Mary Olive Smith (left), her cameraman Jerry Risius, and associate producer and sound recordist Aysin Karaduman film Zewde in the starkly pastoral countryside of western Ethiopia. Enlarge Photo credit: Courtesy Engel Entertainment

Success at last

After extending our trip, our luck finally changed. In the local marketplace a boy told us of "a woman who is leaking" that he knew of in his village. At first he resisted taking us to her, afraid he would get in trouble for exposing her shame. But after much persuasion he led us on our first long walk to a village, where we met Zewde*. Bearing an infectious smile, Zewde was a 38-year-old woman who had suffered through obstructed labor in the birth of her sixth child.

Our luck held over the coming days. Our encounter with Ayehu occurred exactly as it appears in the film. We were led to her by Fikre, the young woman in a white turban whom we film walking briskly toward Ayehu's village. After spending 10 years with fistula, Fikre had been cured in Addis and wanted the same for her friend. Lastly, just two days before we left the country, a concerned family brought Yenenesh to us at our hotel.

Dr. Hamlin's hospital is truly an oasis, a flower-filled haven where social stigma melts away.

We tried to be as true to the women's experiences as possible, using a vérité or "fly-on-the-wall" approach to filming, combined with conversations with the women. The interviews with Dr. Hamlin and her fellow doctors provided the context and took the place of a narrator. Later, our editor Andrew Ford worked the material elegantly—holding the shots, never using dissolves. Without Andrew's talent and David Schommer's haunting soundtrack, the stories would not have held together as effectively. The music combined David's original composition and his collaborative work with our featured cellist, Dave Eggar, with the music of traditional musicians that we recorded in Ethiopia and the a cappella voices of the nurses at the hospital.

Her face says it all as Almaz reunites with her father following her successful surgery at the Addis Ababa Fistula Hospital. Enlarge Photo credit: Courtesy Engel Entertainment

Becoming whole

Though I had traveled to more than 30 countries, I was not prepared for the mix of emotions I felt during the filming in Gojam. I ached from the grief of the women we met even as I felt enormously privileged to be allowed a glimpse into their private hell. I was struck by the rural beauty even as I stood in awe of the dignity of the people who survived there on a subsistence level.

Each of these women was grateful for a chance to tell her story. After years of loneliness, they were desperate to be heard. Ashamed, in some cases near-suicidal, they needed compassion as much as a chance to be cured. The women had placed a great amount of trust in us, and I felt a huge responsibility for their safety. You cannot know my relief when they finally walked through the gates of the Fistula Hospital, into the caring and skilled hands of Dr. Hamlin and her staff.

Dr. Hamlin's hospital is truly an oasis, a flower-filled haven where social stigma melts away, where smiles appear on drawn faces for the first time in years, and where women eagerly learn to read or knit. We watched as some women sat pensively on the steps above the garden and others giggled on the cool grass, each one becoming whole again in her own way and her own time.

I realized that the "walk to beautiful" that these women hoped to make was not just to the hospital for a cure but for social acceptance and the ability to be part of a community again back home. If as filmmakers we succeeded in revealing this simple truth in a dignified way, then we fulfilled our purpose.

*Note: NOVA's "A Walk to Beautiful" is a 50-minute version of an original feature-length film of the same name, two of whose "characters"—Zewde and Yenenesh—do not appear in the NOVA version.

Mary Olive Smith coproduced and codirected "A Walk to Beautiful."

Related Links

  • A Walk to Beautiful

    A powerful story of healing and hope for women in Ethiopia devastated by childbirth injuries

  • The Fistula Healer

    Dr. Catherine Hamlin explains why she has dedicated her life in Ethiopia to treating a devastating childbirth injury.

  • Two Worlds of Maternal Health

    See how women in rich and poor countries face very different risks when it comes to childbirth and maternal health.

  • Joining the Medical Tribe

    Filmmaker Michael Barnes once thought he wanted to go to medical school. After making "Doctors' Diaries," does he still?