Glimpse of hope (Doc, HD, 52min. 16:9, 2010)

Background

Typically an obstetric fistula arises when a teenage girl, malnourished, circumcised and with an immature pelvis, tries to deliver her first baby. The foetus gets stuck and after several days of labour it is stillborn. But meantime some of the mother's internal tissues have been damaged and to her horror, she finds herself suddenly being incontinent, without knowing why. Since incontinence is a shame, these women are hidden and often the problem is misinterpreted as a sexually transmitted disease, for which the woman herself is to blame.

With surgery, fistulas can be repaired. There is a healing rate of 90%! But the problem is to reach women in remote villages and inform them about the possibility of an operation. However, most of them are too poor to pay for an operation, too poor even to pay the bus ride to the nearest hospital.

Apparently, 150 years ago, fistulas were a problem in the Western World too, and disappeared only when medical help became easily available. WHO reckons that 2 million women have untreated fistulas, and that the number increases by 50’000 – 100’000 women every year.

The story

The film starts with a colourful wedding in a remote village in Mali. The bride is beautifully dressed, with a special  hairstyle and make-up. For Sushuan it’s the first wedding after her own, 9 months ago. Now she is highly pregnant. Promised at the age of 10, the wedding took place soon after her first menstruation. She begged her parents to let her go to school and not to marry her yet, because after marriage she is not allowed to go to school anymore. Despite her condition she still does all the heavy work she used to, like chopping wood, walking miles to fetch water and cooking for the family of her husband. Now and then she feels a sudden pain in her belly. Nevertheless Sushuan, small and very delicate for her 14 years, welcomes her pregnancy then without children she is nothing.

Nobody is happy, that Mariam is expecting a baby. She is not married yet and her fiancé denies fatherhood. She never had a chance to visit a doctor or a health center, but she consulted the traditional midwife in her village. When labour starts, it’s in the middle of the rainy season and all the streets to the village are flooded. The last two days Mariam has been pacing the small hut of her family, pausing still when the labour pain struck her. By now she is completely exhausted. Finally her family put her on a donkey chart and take her to the nearest hospital. Arriving there one day later, the baby’s life couldn’t be saved. When Mariam wakes up the next day, her bed is wet with urine. She is ashamed and tries to hide, hoping that after some days it will better. But it won’t – she already developed a fistula.

After an obstructed labour 15 year old Kaneba has lost her baby and developed a fistula. In the local hospital they couldn’t help her. Back home people start to shun her, nobody eats the food she is preparing and she is too weak to work in the fields. When after several weeks she is still incontinent, her husband leaves her and marries another woman. Kaneba goes back to her parents. But in the little hut the smell is soon too dominant. They build a separate hut for her outside the village, but they nurse her and bring her food and water. In this hut Kaneba stays for two years – alone, ashamed, helpless. She barely eats, because the more she eats or drinks, the more wastes trickles down her legs. “I just curled up” she says.

But then, one day, she hears in the radio about a new treatment in Bamako. She wants to go there, at all costs. Her parents sell a cow to bring up to the money and she travels to the clinic. There, for the first time, she sees other girls with fistulas, all hoping to get healed. After a few weeks it’s Kaneba’s turn to go into surgery.

All these girls live in the area social worker Mme Dolo is in charge of. Since 10 years she is fighting with heart and soul against the stigmatization of women with fistulas. We see her travelling thousands of kilometres to remote villages, visiting women and inform them about the possibilities of treatment. She tours with an open-air-theatres from village to village to inform about the problem and does radio spots to sensiblise people. Mme Dolo has studied in Rumania, but decided to come back and stand up for underprivileged women in her country.

The filmic structure and visual style

We follow the three girls and Mme Dolo over a period of 6 months and see how they cope with their situation. Did Shunshuan, a girl highly at risk to develop a fistula, already give birth? Can they help Mariam in the regional hospital with her fistula? How is the situation for her when she returns to her village and how does her family cope with her incontinence? Will Kaneba, after her long history with fistulas, finally get cured? Will she return to her husband, who rejected her when she was ill?

By introducing three women with fistulas in different stages, I would like to show the bigger dimension of this problem and incorporate their social situation.

The story of the social worker Mme Dolo is the red thread throughout film. We follow her while visiting the villages, touring with the theater and holding lectures in crowed schoolrooms. We follow her to regional health centers and to the university hospital in Bamako and learn about the problems there, like notorious shortage of staff, crowed waiting areas virtually no surgical instruments. There we meet the head surgeon, Prof. Ouattara, who talks about the situation of women with fistulas in general and in comparison with other countries in Africa. Finally we hear about the personal motivation of Mme Dolo to engage in this matter.

For the visual style there are two approaches: on one hand I would like to show the living situation of these women in an observational way. We see them working at home, fetching water, preparing food and learn about their position in the family hierarchy. These sequences are shot in a bright, colourful style. On the other hand, when telling the women’s personal story, I would like to be very close with the camera, telling the story form their point of view and develop an intimate, sheltered space. These pictures are shot in low-key.

A leading visual motif will be the walking and riding scenes from the remote villages to the hospitals. It’s a journey of hope, after suffering for months or sometimes years without proper medical help.

We already went on a research trip to Mali with a Swiss film found and have secured access to the women and institutions involved. Since Mme Dolo is working for years in this field, women trust her and are ready to talk about as intimate things as fistulas.

The Red Cross and Médecins Sans Frontières are interested in the film and help financially and with logistics.

In 2003 UNFPA launched a global Campaign to End Fistula, with Natalie Imbruglia and Bertrand Piccard as Goodwill Ambassadors.

Motivation to make this film

In the villages nobody openly talks about fistulas, but everybody knows about this “hidden woman’s disease”, as they call it. The women themselves don’t know why they have developed a fistula, but feel ashamed and try to hide it. When they get excluded from society they don’t intervene, because they think it’s their own guilt or fate. Sometimes they seek the help of a fetish or traditional healer – but without result! When you see the situation on-site, 14-years old girls, who’s live in this misery and nobody helps, it really makes you cry!

It’s a shame when giving birth to a child, the most natural thing for a woman, becomes a highly life-threatening thing. For every woman who dies in childbirth, another 20 are injured, eventually developing a fistula. But because the victims are born with three strikes against them — they are poor, rural and female — they are invisible and voiceless, receiving almost no help neither from their government nor from the developed world. 
With this film I would like to give these women a voice and raise awareness for their problem in Western countries.