If you ever think you've got it rough at your job, have a look at the daily agendas handled by the team featured in the new documentary Living in Emergency: Stories of Doctors Without Borders. From Liberia to Congo, from war zone to hot zone, the surgeons and pathologists here battle a succession of obstacles in their pursuit to bring medical care to people who need it most. These really are their stories -- and they're riveting.
Director Mark Hopkins -- who knows a thing or two about workplace stress from having gotten his start assisting Scott Rudin -- introduces viewers to a quintet of doctors on missions from Medicines Sans Frontières, the Nobel Peace Prize-winning, Paris-based aid organization that's been treating the sick and wounded in some of the world's most treacherous settings since 1971. Among them: A pair of MSF rookies grappling with the strain and conditions of their surroundings; a pair of veterans well beyond the point of culture (and/or shell-) shock; and the unflappable MSF overseer who puts their efforts in sharp, resonant perspective.
The film was shortlisted for a Best Documentary Feature Oscar this past year, thanks in part to Hopkins's camera eye keeping it as real (if not more so) as any related film to emerge from these regions. Nevertheless, its Living in Emergency's humanity -- and the singular cause it represents -- that sets it apart. Movieline talked to Hopkins and MSF stalwarts Chiara Lepora and Arnaud Jeannin* about bringing MSF to the screen, watching oneself on film, and where a camera belongs in matters of life and death.
This film doesn't pull any punches as to how tough these missions are, but we don't get to see your own first missions. What were those like?
CL: My first mission was in Angola, and it was just at the end of the war. So they were just opening up zones that hadn't been reached by any humanitarian [aid] for more than 20 years. It was definitely overwhelming; there were something like 850 malnourished children in the nutritional camps we were running. I'd never seen malnourished children before that, so it was pretty depressing.
AJ: I was in Kenya, close to the border of Tanzania in a zone where at least a quarter of the adults had HIV or AIDS -- in a small hospital with about 40 adult beds and 80 patients without [medications] that are highly effective against the virus. So it was pretty overwhelming, with a lot of casualties and a lot of death, unfortunately.
Mark, how did you come to MSF as a filmmaker, and how did you settle on the subjects -- these individual doctors -- themselves?
MH: I did ask permission to cast, and I was denied. They said, "Pick the situations you want to go film in, and film our work. But we can't pre-screen people." So we went to different areas of work that they do. We chose a conflict and a post-conflict setting for contrast. Then when we were there we met everyone, filmed the different people and sort of focused in on the people we thought would be a better embodiment of the character we were looking for. As for how we chose to film MSF, I was always interested in doing something that took people into the intensity of life in the field. They do work in some of the more intense areas of the world. And also in a way, because it's emergency medicine, it's a very clear-cut general purpose. You don't have to spend a lot of time explaining to the audience the big picture, because they're there to treat patients. Which allows you to really get into the psychological journey of what it's like to be in that first mission to being a veteran.
When you say the "embodiment of the character you were looking for," what made Chiara and Arnaud those types of characters?
MH: Well it's more that we wanted to parallel the movement from first mission to 10-year veteran. So we tried to find the people who best voiced where they were in their MSF careers. Both Chiara and Arnaud are in their prime. They were no longer, by any means, in their sort-of green first mission. They were in their stride in their work for MSF. So being able to see how the special forces -- the guys who really knew what they were doing and how it worked -- was a useful contrast to seeing how some of the missions were trying to rationalize this completely overwhelming situation. Chiara and Arnaud were very good choices, I think, to try to convey the more veteran role.
Arnaud, you're featured here working in dire emergency situations with a film crew right over your shoulder. Looking back at those moments, what was going through your mind?
AJ: The situation was too complicated -- and I'll try to explain it in a minute -- for me to pay attention to the film crew. The film crew was no bother at all, probably due to their professionalism, but also because I just wasn't aware. Some situations were very complicated; I was resuscitating a very poorly [faring] child with a number of pathologies. And in thus doing, I was utilizing a number of resources that could have been used for other patients with better prognoses. That's why you see my friend and colleague, Dr. [Chris] Brasher, under his mask, saying, "We're giving him one hour, and that's it." And actually that hour did not elapse; the child died before the end of it, and that's it. The situation was complicated: Resuscitate or don't resuscitate? Give it a chance? I gave it a chance; the patient was there I took the chance of trying it.
For the doctors, what's it like watching yourselves in the film -- looking back on this part of your lives as not only doctors, but also characters in a movie?
CL: it's a humbling experience. To see your mistakes, to see how many stupid things you can say during the day. On the other side, it's pretty interesting to see yourself from a third-party perspective -- someone who hasn't been living through the same thing, but is somehow trying to capture the intensity and the richness of what we go through.
AJ: It was very, very difficult the first time I was watching it. It was very hard, for two reasons: One, like Chiara explained, was the humbling process of how you make mistakes and all, but also because of the re-trauma -- to have to relive this kind of experience. Going back again took you to that period of time. You're reliving experiences that are on the film, but there are so many experiences that aren't on the film -- that happened after the crew left or before they arrived. So yeah, it's not easy. Probably enlightening, but not easy -- probably as it will be for any member of the audience.
And the flipside, Mark, has you not wanting to interfere with doctors doing such serious work -- even while you have a pretty specific responsibility to depict this authentically. How did you find the balance?
MH: It's extremely uncomfortable, obviously. Especially when you're trying to talk to people at times that you know are extremely difficult for them. You weigh out situations all the time, but you're there to try and make the best film possible. It's not an easy position to be in. And also, they're great people; you don't want to have to push them on certain things that are sensitive or whatever. But you feel sometimes that you need to because it serves the story.
Was there a trust-building process for the doctors and hospitals? Did you let Mark get started straightaway, or kind of have to work one stage at a time?
CL: I think the slowness of it was before the crew came to the field. I think for us it was just trusting the choice that MSF made in general. Once they were there, there was no choice any more to trust them or not.
It's also pretty graphic in parts. What was your decision-making process in terms of what you wanted to show -- or even what you could show?
MH: It's remarkably not graphic in relation to what we actually saw. We put enough of it in the film to show people what it's like -- what the doctors are experiencing. It's a small number of minutes once you add it up over the body of the film, but I think because it's actually real -- it's happening to real people -- it's quite impactful. But we thought it was necessary to show for people to understand the environment.
We've all seen M*A*S*H, obviously, and this has some of that flavor and texture. But as docs go, what were some of the more influential for what you were doing here?
MH: Not really. M*A*S*H was a film we all watched and thought it captured the right frequency form the dramatic sense. These doctors who work and play in these environments was something where we thought, "There's got to be a real version of that" -- which is what you're looking at from the field.
Chiara, you totally rock in this film. You've got a great attitude, you look great, and you've just got such tremendous confidence. Considering the direness of these first missions, how did you get to the point where we find you in Living in Emergency?
CL: That's just how I look when I'm desperate. [Laughs] I didn't get whatever I wanted, for sure. I was far from there. There is a [point] where you realize that somehow the level of responsibility you have is toward the people you're working with. And therefore, the least I could do was to stay calm when they were losing it.
*This interview is an edited version of an AppleTalk conversation held May 24 in New York.