Filming at the front lines of health

Ann Silversides

doi:10.1503/cmaj.071465

It started out as a 6-week program, but turned into a life-changing experience for the handful of sometime-homeless young mothers who have learned to film, take photos, audiotape and maintain Internet blogs — among other accomplishments.

“It just gives you so much confidence,” says 23-year-old Adrienne, one of the 5 mothers who first documented their own lives and then turned to capture some key aspects of the lives of others.

Katerina Cizek, filmmaker-in-residence at St. Michael's Hospital (see page 1240), trained the young mothers to use digital cameras and keep photoblogs. Their work led to an image and text exhibit, I WAS HERE, that provided a window into their own lives and was launched at Toronto City Hall last January. In an artists' statement, the women said they hoped the exhibit would “take the judgemental edge off and change people's perceptions of us.”

Next, they organized a “speak out” and invited other young parents to talk about the problems they face and brainstorm about solutions. That led to an astonishingly comprehensive document, WE ARE HERE: A Declaration by Young Parents, that laid out changes the group wanted to see in areas such as social assistance, childcare, housing, healthcare and education. The declaration has been endorsed by the Society of Obstetricians and Gynaecologists of Canada and has been circulated among social assistance workers.

“As young mothers, we find it hard to speak out, with doctors, social workers and people on the street who stare at us” as if they think we are too young, says Jess. “So there is personal satisfaction about raising the issues, about ‚having said that' and letting the public know how hard it is,” the 20-year-old explained.

Armed with new skills and confidence, the young women were hired to conduct and audiotape interviews with homeless people on the streets of Toronto. The result, Street Health Stories, is a photo and sound exhibit that gives voice to the homeless that is now being mounted in various locations around Toronto. The interviewees tell stories about their lives. Nancy, one of those interviewed, observes: “If people were housed, they could take care of their medical problems more easily. You see all these condos going up and up and up, and nothing for the homeless.”

In another ongoing “video bridging” project, health care professionals are videotaped by filmmakers talking about the pressures and challenges of their work. These sessions are then screened to the young mothers, who in turn are filmed as they describe their issues with how they receive health care. Neither group speak directly to each other; the hope is that the safety of the process encourages honesty and understanding.

Cizek's tenure as filmmaker-in-residence is characterized by this sort of hands-on interaction with her subjects.

Cizek's vérité film, The Interventionist, follows a mental health nurse and a police officer as they respond to 911 calls involving “emotionally disturbed persons.” Image by: Peter Soos ©2006 National Film Board

In addition to the workshop with young mothers, Cizek has produced some more conventional “deliverables” that document St. Mike's rather unconventional, community-based, approach to health care for the disadvantaged. Her half-hour-long vérité film, The Interventionist: Chronicles of a Mental Health Crisis Team, follows a unique mental health crisis team comprised of a specially trained nurse from St. Michael's Hospital and a police officer, as they respond to 911 calls in downtown Toronto involving people who appear to be emotionally disturbed. The team's aim is to de-escalate crises and avoid unnecessary arrests and hospital visits by making referrals.

From the streets of downtown Toronto, Cizek journeyed to Malawi to focus on Pax Chingawale as he cycled from village to village fighting AIDS. The result was an award-winning short film, The Bicycle. (The link between downtown Toronto and Malawi is Dr. James Orbinski, a research scientist at St. Michael's Hospital, former president of Médecins Sans Frontières, and founder and president of Dignitas International, which runs the Malawi project.)

Cizek's documentaries have been broadcast on CBC and Showtime in the United States. To view these works, go to www.nfb.ca/filmmakerinresidence.

Filmmaker-in-residence at St. Michael's Hospital

A filmmaker at the front lines of inner city health? Interventionist media in a hospital setting? When St. Michael's Hospital agreed to allow the National Film Board to “embed” a filmmaker, it was a huge leap of faith. “The scary part was they could have found embarrassing things — there are always vulnerabilities,” says Dr. Art Slutsky, vice-president of research for the downtown Toronto Hospital.

This was the deal: the NFB would foot the cost of creating a filmmaker-in-residence program at the hospital but would also retain editorial control (hence the leap of faith). The filmmaker is Katerina Cizek, an award-winning media activist who tackles difficult subjects such as gangs and genocide and whose credits include co-directing Seeing is Believing and Handicams.

Meanwhile, the whole filmmaker-in-residence project — film clips, photos, and an ongoing filmmaker blog — would be featured online. That website (www.nfb.ca/filmmakerinresidence) won the 2007 Canadian New Media Award.

Developing the agreement between the NFB and St. Mike's took about 8 months, beginning in late 2004. The NFB and the hospital had to invent and hammer out a detailed agreement for the novel project, a document that addressed key issues about confidentiality and informed consent in order to protect the rights of patients and staff.

“As a filmmaker, I pride myself on my ethics, but with medical partners I have to say I learned a lot about ethics, and informed consent,” says Cizek. In regular documentaries and for television, subjects sign an agreement to give up their image, voice and likeness. “But this was not all about getting someone on camera … and a lot of our projects had to go through research ethics boards,” she added. The official contract was signed in July 2006, though by then Cizek had already filmed one documentary (The Bicycle) and begun another. “I consider the residency as beginning the moment I first entered the hospital, as many of the ideas were sparked early but took a long time to work out.”

A key aspect of the deal was that NFB would have complete editorial freedom. As long as the terms of the agreement were abided by, the hospital had no “rights” to change the end “products.”

For the NFB, the filmmaker-in-residence program is a digital-age revisiting of its famous Challenge for Change program of the late 1960s, which explored the role of film in a participatory democracy, involved “community film making” and aimed to reveal social problems through film.

The idea for this unique venture at St. Mike's all began at a cocktail party when Slutksy, who has a filmmaker son, chatted with Tom Perlmutter, the father of one of his son's friends and the current chair of the NFB.

“I told him about our work in inner city health, our focus on the disadvantaged, our outreach programs, and how this might be interesting for the film board,” Slutsky says. “I was just thinking maybe they'd make a documentary, but what developed is far more elegant and more interesting.”

The filmmaker-in-residence program will wind up at the end of 2007.