Q&A with Director Mark Hopkins

Living in Emergency: Stories of Doctors Without Borders is a riveting documentary following four volunteer doctors serving in post-war Liberia and Congo. This is the first time Medecins Sans Frontiers/Doctors Without Borders (MSF) has allowed uncensored access to its field operations. The result is a real look at day-to-day operations in a field clinic with no overly romantic notions of the good that MSF does and overt clarity that MSF cannot solve every medical issue in the regions it serves.

Dr. Divinder Gill is 26 years old, serving in his first mission with MSF, and is stationed in a remote clinic where he is the only expatriate. Dr. Tom Krueger is a veteran surgeon who closed his 20-year-old private practice to serve his first mission with MSF. Dr. Kiara Lepora is a veteran MSF volunteer and is the head of mission in Monrovia, while Dr. Chris Brasher has worked for MSF for 9 years and reached his burnout period. Each of their stories is revealed with honesty and care as the doctors share their candid views on the importance of their work and the frustrations of the tough choices they must make, given the limits of available technology, supplies, and their own abilities.

This film is one of 89 Academy Award-eligible documentaries and has made it to the short list of 15 to be considered for a Best Documentary nomination. First-time director Mark Hopkins shared his thoughts with us about the film and MSF.

Where did the idea for the documentary come from?

[I thought] it was a fascinating environment, and not just from the cliché point of view …  The intersection of extremes, in terms of the extreme need and the urgency of the work that’s being done by the [expatriate volunteer doctors] who go from these fairly comfortable situations into these hell holes to do what they do.

This is the first time the MSF has provided uncensored access to a film crew. How did you gain that access?

It look a long set of negotiations because a lot of film companies have tried. I supposed it took about six months before they said the doors were open. It was a question of really building trust with the organization. They wanted to look at our motivations for why we were doing this and where we were really coming from, instead of examining our proposal in detail. I think part of the thing that won them over was that we didn’t want to do the sort of clichéd mythical hero stories that they hear a lot. Also, since one of the producers and I are from Kenya, I think they thought we’d bring a perspective that [MSF] hadn’t really seen before.

What was the fresh perspective that you wanted to achieve for the film?

I think it’s partly tied up with this idea that we all want this nice, easy “hero goes in and fixes things” type of story, but the reality is a lot messier than that, a lot more complicated, and I think, actually, a lot more interesting. They sent us on a test shoot to Niger, and then they saw the stuff that we had cut out of that and said, “Okay, these guys are fine and are really trying to get stuck into the reality of life in the field,” which is hopefully what people get when they see the film.

How did you meet the four doctors you focus on in the film?

We asked [MSF] if we could cast and they said no. So, essentially, we met people by going into the field and then filming hundreds of people. We started to narrow it down to the people we thought would be effective at communicating different stages of the MSF/Doctors Without Borders journey – two to represent a first mission and two to represent veterans.

Since the majority of MSF workers are hired from the local community, was there any interest in following some of the national MSF staff?

Yes, and halfway into the film you start to see more of the national staff. Baring in mind that the film is primarily for a Western audience, we thought that journey from the audience’s perspective is one where they are going to identify more easily with someone who comes from a similar culture. We had to wait until about halfway through the film when we felt that, hopefully, the audience is now somewhat familiar with the environment, where we could start introducing the role of the national staff. There is an entirely different film you could make just from the national staff’s point of view. We really felt it was important to provide that bridge through the expatriate experience, since that is sort of an extension from the audience’s perspective.

Did any local staff encourage you to show more of their story?

The people were very frustrated during the high pressure situations with some of the interactions between the expats and the national staff. Some of the national staff lumped us in with them, in the sense that, “Of course that’s what the white guys are doing. They are following all of the other white guys.” But getting to know some of [the national staff] and explaining that we are not trying to do the typical thing here, they became very supportive. I don’t think there was any resentment towards us. If anything, there was just resentment towards what was happening in the field and we were just a fly on the wall, so it didn’t really become an issue. In these situations, where there is extreme violence and there’s a class of cultures thrown into the mix, it’s understandable that tensions will arise.

Did anything surprise you during the course of production?

I wasn’t expecting the veterans to be quite so blunt and realistic about their work. I expected the veterans to still have some of that naive, outsider perspective. It became clear to me that after you’ve been in that situation for a couple of years, that naivety disappears. Every single one of them, after spending three or four years in the field, had a realistic, blunt understanding of basically where they fit into the overall scheme of things. The big trick for people staying on in the field is coming to terms with the fact that you’re just one person and you can only do so much. The people that succeed and carry on with the organization are the ones that can wrap their heads around the fact that just because you’re not saving the world doesn’t mean you shouldn’t do what you can for the patient in front of you.

Did you get a sense during the production as to which of the first-time volunteers would continue and which ones would not return?

The writing was pretty much on the wall with Dr. Gill. If you tell anyone with any MSF experience the profile - 26 years old, first mission, stranded in the bush - and they’ll tell you he’s never coming back. Every once in a while, people fall through the cracks like that, and it’s a very tough first mission that he had to go on, and no one will hold it against him. There was a freak rain, the road got cut. That’s really some bad luck to be on the first mission and be that stranded. As for Dr. Krueger, when we started filming him, he was only in the country for a few days and he was already analyzing and processing things in such a way that you got a sense that here was someone who was obviously overwhelmed and shocked, but was able to digest it in a more mature way. He seemed to be hardening himself for the long haul.

Have any of the doctors you followed seen the film? What are their impressions?

I have spoken to all of them. It is important to know that MSF had no control over the final cut, but once we were done, we showed it to MSF and all of the doctors. That was a nerve-wracking experience because you never know how someone is going to react to themselves on the screen. And overwhelmingly, and not wanting to be immodest, they were pleased with the end result and how they came across. That has been quite gratifying actually.

At one point, Dr. Lapore refers to Dr. Gill as suffering growing madness similar to the protagonist of Heart of Darkness. Did any of the other doctors express that sentiment about themselves or others?

I think the whole situation was quite insane and I think she was trying to sort of contextualize it a bit - again, not holding it against Dr. Gill. I think anyone in that situation would have gone slightly bonkers, but I think she was a little upset that one of her lines in the film, which is actually a Freudian quote, she got misquoted as having uttered it herself.

How did you decide to focus on Congo and Liberia?

We filmed in Pakistan for a couple of months after the earthquake there, and in Malawi for the HIV mission. For lots of Americans, the key idea is, when the bomb goes off, or the war starts, they go barreling in. But when the war ends, they have the difficult process of extracting themselves because they are an emergency organization and they have to go to the next hot spot. They can’t fix the underlying and terrible situations in countries like Liberia. To contrast conflict in a post-conflict setting, we felt some importance to add weight to that idea. It’s a painful process to choose where you are going to focus on. Unfortunately, Pakistan and Malawi did not make the cut.

Has this project changed you in any way?

I could have never anticipated how all-consuming it was going to be. Having grown up in Kenya, I’ve been on the periphery of war zones, but never really in the midst of one. It’s a very full on “all your senses turned up to 11″ type of sensation. All of the aspects of the human experience are exaggerated. Friendships are formed very strongly. You can get very angry and all those sorts of things. There’s no way I could have prepared for all of that. It was definitely a life-changing experience.

What do you want your audience to take from the film?

We are deliberately not trying to preach or send a message in the sense that we are hopefully not the typical “cause” documentary, where everything is wrapped up in a nice bow at the end. So it’s more that hopefully people get a sense of being really immersed in the field, in this crazy situation. If anything, hopefully people get a sense of their own good fortune that they are a patient in a rich country or they are not living in a war zone. We are not trying to dictate any sort of message.

Do you maintain contact with MSF? Do you have any insight into the operations in Haiti?

I know a bunch of people who have been sent out [to Haiti]. We spent two months filming the earthquake in Pakistan, so there are a lot of similar dynamics. In any sort of natural disaster, I think there is a tendency for it to get media-cized and people want a quick fix – here’s a disaster, now let’s fix it. The reality is a lot messier than that, and a lot more complicated. People want to help, which is great, but actually there is a real limit. Even if you have all of the resources on earth, logistically being able to get supplies to people remains an issue. It was happening in Pakistan, it’s happening in Haiti. It’s always confusing to me why medical supplies aren’t really put on top of the list. To me, it would make more sense, especially since caseloads of earthquakes tend to have a lot of injuries, that if untreated, become very life threatening. Why is priority given to food? Of course people are hungry, but if they are not alive to eat the food, I’m not sure why medical supplies would not be at the front of the queue. And that’s a frustration that I know MSF feels as well. I’ve heard they’ve had one of their planes turned back five times or something, which is probably very frustrating for people on the ground.

When dealing with countries that don’t have the infrastructure, there will be big hiccups like that.

I was talking with someone the other day who was asking why these things seem to always happen in poor countries. Well, I think it’s just that most of the world is poor, so statistically, a random event like that is more likely to happen in a poor country than in a rich country. I think it’s great when people are saying “let’s help.” But I think it also would be interesting for people to try and find out what it’s like for the people on the ground, trying to actually work in that situation, because it is absolutely insane.

Anything else you want our readers to know?

I hope they find it an engaging film experience. It takes a long time to make [documentaries], and I hope that people feel their 90 minutes takes them to a place they haven’t been before.

How can people see the film?

We did a digital HD satellite beaming into theaters in December, and we are working to have more presentations. We keep our website and Facebook pages up to date.

Visit the Living in Emergency website for information on future screenings and to get connected on Facebook and MySpace. Academy Award nominations will be announced on February 2.