I met with documentary director Ramona Diaz on Friday, May 5, 2017, at the Maryland Film Festival, to discuss her most recent film, Motherland (reviewed here), which premiered at Sundance. It tells the story of the “world’s busiest maternity ward“: Dr. Jose Fabella Memorial Hospital, in Manila, capital of the Philippines. Using purely observational techniques, without interviews, narration or explanatory title cards, Diaz fashions an extraordinarily compelling narrative about birth, life and death. Here is a condensed digest of our conversation.
Hammer to Nail: Filmmaking aside, one of the more remarkable aspects of your film is that of access, because you are right here and you’re seeing all these things, like childbirth, a D.o.D. [death on delivery]. It’s incredible that you were granted that kind of access. Could you talk about how you obtained permission to film?
Ramona Diaz: Well, there are many kinds of access. I started from the top. I got permission from the Minister of Health, because I wanted access to the entire hospital. And I was given that access, except the ICU – the Neonatal Intensive Care Unit – they would not let me in there. I tried, my hardest, till the very end, but they wouldn’t. I understand that. But they gave me access to everything else.
Now there’s access from the top – this sort of bureaucratic access – but the real access is from staff. So even if they signed off – if the Ministry of Health signed off – I knew I needed to get access from the people on the ground, who had to deal with me, every day. And they have enough to deal with, as you saw. So I spent a month there, before my DP [Director of Photographer] came in. That was also a condition of access: only the two of us could be in the ward at any given time.
HtN: So you were doing sound?
RD: I was doing sound, yeah. And I hadn’t done sound for years! But I did sound, and I had a field producer and a media manager, who were outside. We had a staging area, outside the ward. And so before Nadia [Hallgren], my DP, came in, I spent a month explaining to them what it was I wanted, to get them on my side. You want to get to a point where they are sort of your embedded producers. They understand what you are trying to do and they give you a heads-up whenever they see something that they think you’re interested in.
So at some point during that month, I think they understood. Because, you know, that hospital has been covered by the BBC, The New York Times, and other media outlets. And I said, I’m going to be here for a long time. They asked, “How long?” I said, “6 weeks.” “6 weeks!” I said, “Yeah!” And they go, “But it’s routine!” And I said, “But not to me.” Right? To them, who have been there for … the average tenure of the staff is 25 years, it was like, “Really?” And I said, “To me, it’s amazing, fascinating.” So, in that sort of month before Nadia arrived, I got to know the staff really well. And that was my entrée.
And then, of course, I made my life more difficult, because I was really following patients, and I couldn’t really cast that before Nadia came in. I wanted to catch them over time, over 4 weeks that they were in the hospital. But I think that since the staff was so welcoming, and the patients saw that, then they were more likely to talk to me. But I understood, as well, that there was a big power dynamic there, a very uneven power dynamic. So I had to make clear to the patients – the mothers – that their care was not dependent on them saying yes to me. Right? That they would still get care, that they could still give birth and still receive all the services even if they said no to me. I was separate from the hospital. Because by then, I seemed so much a part of the staff. So I made it very clear that I was not. And a lot of women said no. They didn’t want to. But some said yes, and of course we shot much more than that.
HtN: In the film, I never saw any blurred-out faces, but I assume you inadvertently shot some people that you weren’t supposed to, so did you just cut them out, then?
RD: Yeah. And, you know, there was a sign. We put a sign in the ward that read, “If you are entering here, you will be filmed. Let us know if you don’t want to be.” But for the most part, they were all cool. I mean, they didn’t want us in their face, or want to be the primary character or participant in the film, but they were fine being in the background. But the main ones, of course, signed off. Anyone who had a speaking part – even one speaking part – signed off.
HtN: Other than the Neonatal Unit, were there any other things that you were not allowed to film?
RD: No! Aside from the ICU, nothing else. We were in the labor room, we were in the operating room – which didn’t end up in the film – where we shot one C-section, but it wasn’t really relevant, so we didn’t end up using it. I mean, it’s … a C-section …
HtN: It’s far more effective, towards the end of the film, when you see an actual vaginal birth, then a C-section would be.
RD: Yeah! We shot a lot of vaginal births, but it’s the kind of film where you have to ask, “How much is too much?” Especially with D.o.D.’s, as well. Less so with vaginal births, but the D.o.D. … that was tough, even for us, to shoot. And we could never go close. We could have, if we had pushed them, but who wants to do that, right, to a mother? We didn’t want to do that.
HtN: Right. You’re not making a snuff film.
RD: Exactly. Yes. Thank you.
HtN: So, this is a purely observational doc, with no interviews or text to lead us. How did you decide on this approach, which is different from your previous films?
RD: I think I decided when I first saw the hospital. I was in the Philippines actually doing another film. I thought I was chasing another film having to do with reproductive health and reproductive justice, as well, but it was about a legislative bill and it was steeped in politics. I felt like the country was turning a corner, severing its ties to the Church, and I felt that sort of shift in the culture, and I wanted to cover that. While researching that film, I was told to visit Fabella. Someone said, “That’s an amazing place. There are people on the ground. That’s your issue.” And I saw it and said, “This is the film. It’s right here. The themes will be the same, but this is the film I want to make.”
And I knew then that it was going to be completely observational. Because I was just fascinated, first of all, with the conversations that the women had, on the beds, and the communities they formed. And when I first visited, I would just walk around the ward, and I just sat in on conversations and they never even minded me. (laughs) They wouldn’t stop their conversations! They would just continue and I would sit there and listen and be like, “Sheesh. I want the cameras to be like this, and to have the audience have this experience of just sitting in, listening to all this great conversation, and no one ever kicks you out.” So that was the film in my head, and from the very beginning, I knew I wanted to make an observational documentary.
HtN: So, going back to my question about things you couldn’t film – and it turns out there really wasn’t much – related to that, I get so uptight, at times, watching the babies left alone – or the one that gets lost – and they almost seem as if they are treated cavalierly. I know it’s not intentional, as the mothers have a lot going on. Did you ever have any moments, as a filmmaker, where you, yourself, were concerned about the kids?
RD: There were so many people around, constantly, and I felt that if the parents were OK getting up and asking someone to just watch their baby, then I’d be OK with it. I mean, there were constantly people around. So I was never really concerned. Maybe with the lost baby. It’s very tenuous. The only thing that connects the baby with the mother is this name tag that falls off … and you see it falling! And you’re like, “Oh, my God! How do you ever really know that it’s your baby?” Even in that scene, in the film, you never know if it’s her baby or not. I mean, the telling mark … the mole (laughs) … wasn’t there. The one telling mark … wasn’t there! But she took the baby anyway, right?
HtN: As long as the baby is loved.
RD: There you go, right? So it also calls into question what is motherhood. What is family? Because I’m not very sure that’s really her baby. Neither is she.
HtN: Frightening to think about, but again, as long as the baby is loved … So, have you followed up with any of the families within your film, beyond the end-credit photos? Do you know how any of them are doing now?
RD: I was in the Philippines in December, and with my field producer we found one of them. We found Lea, who has the twins.
HtN: Whose husband has the cleft palate?
RD: Yes. So we found her. She’s still living where we left her. But Lerma and Aira are no longer where they were. They’re squatters, you know, and the phone number they gave us didn’t work, and they don’t have email addresses. So we couldn’t find them. My field producer is still trying to look for them, because I want them to see the film. I just want to show it to them. We haven’t yet shown it to anyone in the Philippines. We haven’t shown it at Fabella. I think we’re going to do it this summer. Because I want to be there, you know? I think it’s important. I just don’t want to send the film and have them watch it, without me there.
HtN: So, the trailer for your film, which I assume you had a part in making, has an almost jaunty feel to it, with that music, which is not necessarily in opposition to the movie, but does offer an interesting take on it. I saw it at the Maryland Film Festival Sneak Preview event, and was struck by its almost comedic aspect. How did you come up with that approach?
RD: By the time the trailer is cut, there are so many cooks in the kitchen. (laughs) Dogwoof was involved – they’re the international sales reps – and I think POV was involved and, you know, it becomes this other thing. I had a say. I fought the music for a long time. I said, “There is no music in the film! I don’t want to put music in it!” They said, “It’s a selling tool. It doesn’t matter!”
HtN: It’s actually a good trailer. It plays well. I’m not saying it’s a trailer that accurately represents your film in all ways, but it’s an engaging trailer.
RD: Which was the point. I mean, that is what we were going for, I guess. At the end of the day, I have to say “we,” because I signed off on it, right? But there were things I fought. I thought it was too happy. (laughs) I said, “We’ve got to put the losing of the baby there. We’ve got to put the shot of the mother and daughter crying. And … do you really have to have music?” That last one I lost. You know, at some point you lose battles. They said, “No, it’s a selling tool.” And I said, “Fine!” And that’s why the music is in. [Baltimore filmmaker] Matthew Porterfield saw the trailer and said to me, “I thought it was a purely vérité film. Is there music in it?” And I said, “No! There’s no music!” (laughs)
HtN: (laughs) Last question: filmmakers and others from outside Baltimore really seem to like the Maryland Film Festival a lot. Do you have any insight into why that is? You live here, of course, but maybe you’ve talked to the ones who don’t and can offer an opinion on what makes the festival so special?
RD: Because it’s a great non-competitive film festival. First of all, I think it’s really well-programmed – really well-curated – but aside from that, they treat filmmakers well. And since it’s non-competitive, you can finally see films. Because in all these other film festivals, you never see films! But this is a festival where you can rest, you can meet other filmmakers and have real conversations with them, and see films. I love Sundance, but the bigger festivals do not engender that kind of collegial feeling.
HtN: Good! Well, congratulations on the film!
RD: Thank you so much, Chris!
– Christopher Llewellyn Reed (@ChrisReedFilm)