Ramona Diaz Explores Reproductive Justice in the Philippines

Through five feature-length documentaries, Ramona Diaz has amassed a body of work specializing in locating the stories of people from the Philippines, crossing borders, governments, and class. Diaz’s latest film, A Thousand Cuts, which is about Filipino journalist/crusader Maria Ressa, premiered at Sundance in January of this year. Her fourth film, Motherland, which aired on PBS's POV, was ITVS Open Call and Diversity Development Fund-supported, edited by her longtime collaborator Leah Marino, and executive produced by master Filipino filmmaker Brillante Mendoza. 

Motherland's title refers both to Diaz’s own heritage and to its subject, the daily happenings in the Jose Fabella Memorial Hospital, the world’s busiest maternity hospital, in Manila. (In fact, Motherland ends with a celebration of the birth of the 100 millionth Filipino citizen.) As a public hospital, its inner workings are a microcosm of society writ large.

All three of the main characters are in Fabella’s “Kangaroo Mother Care” program, a creative and stopgap solution for mothers to take care of their premature babies when there is a shortage of incubators. Because of this, their stay in Fabella lasts for several weeks, and their journeys naturally run the gamut of the hospital’s many services and spaces. Aira is a young teen mother, Lerma is an older woman who frequently dispenses advice to others and worries about her children that she’s left behind, and Lea seems at first at a loss before gaining confidence and emerging as the real star of the film.

This interview was conducted in early March 2020. We first discussed A Thousand Cuts" canceled festival screenings due to COVID-19, and what filmmakers were doing in response to or to combat the opacity of festival cancellations and decision-making processes. Like in all of her films, Diaz was concerned that power was being consolidated, and we talked about how these decision-making processes could be made clearer. That seemed like a great way to delve into Motherland, which we do here.

[Since this interview, Diaz has turned her attention to a collaborative project addressing COVID-19, while also appearing on several panels during May's APA Heritage Month virtual film festival offerings, bringing audience attention to short-term solutions to canceled screenings by warning against trying to fit a "square peg into a round hole." In addition, A Thousand Cuts is now streaming as part of Hot Docs' virtual offerings.]

Your films are about people in positions of power, or a relative lack of power, but they’re also about systems. Motherland, specifically, follows the arc of one mother, Lea, at the hospital from the beginning to the end of her time there, along with two others who emerge as characters. As part of the audience, we learn slowly through osmosis. What was your focus during shooting?

The larger theme was always reproductive justice, and like all of my other films, in or relating to the Philippines. The very first version of this film was actually called The Bill, and it was about a bill on reproductive rights, moving through Congress, that was gaining traction for the first time. Society was waking up to the fact that we have to sever our ties to the Catholic Church—I thought the country was turning a corner with regards to its relationship to the Church. So I went to the Philippines to do research and realized that this was a really dull film. The person I thought was going to be the main character fell apart on camera. I realized that this was not going to work. 

Then, someone told me to go to “the baby factory,” which was Fabella. The minute I got there I realized, here, the film lives. I could stick to the story and hit all the themes you could want to examine or explore. I think the film is more an exploration than anything. 

That first visit to Fabella, the staff allowed me to just be in the ward. I sat on beds, and nobody questioned why I was doing that. I thought, if I could capture this on film, this is it. I will live here, and it’s right here. I didn’t want to go home with the women afterward—that’s been done in other films. So, from that first visit, I knew I wanted to make the film in a completely observational way.

Did you film anything on that first visit?

I had to go to the Minister of Health, who I knew from previous films, to get permission to film and to lay tracks in the hospital—which is not easy!—to get the traveling shot through the main room at the beginning of the film. 

The bad news, then, was having to go back to funders and tell them that this is the film, but it’s not The Bill. Instead, it’s going to be situated in a hospital, and we can get really close, and it will be completely observational. But, you know, people say they will shoot films in an observational way all the time and it’s not truly verité.

There’s always interviews and voiceovers and music.

And music! Happily, when we reached out to all the funders, they all got it—this, by the way, was pre-ITVS [Open Call] for this project. I then went back [to Fabella] and shot for 6-7 weeks with DP Nadia [Hallgren, who shot Trouble the Water, Trapped, and many other acclaimed docs.]

You received ITVS Open Call as well as Diversity Development Fund [DDF] support for Motherland, right?

Right, funders like Sundance, Catapult, and Chicken and Egg came in very early. DDF was about the same time. That’s how I was able to do research and development. I’ve gotten lucky; I’ve gotten to a point in my career where I can raise money without shooting a frame. I think it’s really important to be on the ground and present for R&D.

For the main shoot, my production company fronted a lot of money. Then we secured Open Call, then POV boarded the project. But it was very different in terms of form [compared to The Bill], and if I had come back with a different theme, [the funders] wouldn’t have been open to it. All the things I wanted to touch upon—the lack of contraception, the power of the church—were organic to the story that I found.

Everything was a leap of faith, as I only had a few scenes. You know, I had never worked with Nadia—we had common friends, and everyone said, “you’ve got to call Nadia right now, because she’s the right person!” But, actually, the first time we met was at the airport in Manila.

The first two days, she still asked me, do you want to get a few words from the nurse? I told her, it is purely observational. If I get an interview, my editor [Leah Marino] will be tempted to use it!

Nadia would still bring this up the first few days. But then she got it. It was so key when Nadia was on board and excited about it [being observational]—then we flew, we were off to the races.

[Nadia] listens to cadence, movement, body language—she’s keyed in there. Having a female cinematographer is key for this space because I didn’t want coverage. I wanted the sustained gaze of the lens. If Lerma was pleading to be let out [of Fabella], I don’t care about the doctor, I care that Lerma needed to get out. So I freed Nadia from coverage. Instead, we shot for emotion. I also trust Leah [Marino] so much. I know she’ll find what needs to be done.

The DP on pre-production [Clarissa de los Reyes] was not Nadia, but was someone who was open to things like the tracking shot. With Nadia, I told her, we need to be unseen and just drop in on conversations. Sometimes, we had a line producer there to get signatures for releases, but mostly it was just the two of us. 

This way of filming is really unique, to truly be present in a space, constantly, for a sustained period of time. Frederick Wiseman talks about the process of filmmaking a lot more as research and novel-writing. How were you navigating the space, and finding your subjects?

After getting bureaucratic permission, I pretended I had a job there in the way I approached filming because I knew I had to really talk to the staff. Without their understanding, it would never work. But if I go every day for a month, I will get them on my side. 

This was before Nadia arrived; we shot for another 6-7 weeks after I spent a month there by myself. Some of the doctors and staff had been there for decades. Fabella has been covered in the past by BBC and many other outlets, and those crews always stopped by for just a half a day, or a couple of hours, to get B-roll and interviews and then leave. So at first the staff didn’t understand why I needed to be there for so long. By the end, they understood what I was looking for. 

I gave myself a harder job because I wanted to concentrate on the mothers, not the staff. I was very aware it was not a room of equals, between the mothers and the doctors, and also with me. I had to make the mothers understand that they could say no to me and still get care—for them to see me separate from the administration. We were “casting” as we went along, but by then, the staff became my “embedded producers,” as I call them! 

For example, they knew I wanted a young mother, and someone older, and so they would give me a heads up whenever they checked in someone who fit those descriptions. 

They saw the gaze of the camera empowers them.

A lot of mothers turned down being filmed. And others, they came in during labor, and though they might give their permission, they also might not fully understand what it was I was asking. We always would tell them, after labor, "we’ll talk again, and if you say no, we’ll erase the image." In the end, for many of them, they saw the gaze of the camera empowers them. They like being the focus of the camera. 

Also, when we were filming, we would tell them, every day is not the same, just let us know what’s going on, just don’t disappear. If, yesterday, you were having a tough morning, just let us know, and we won’t be in your face today.

They found ways to let me know they’re ready, and then we circled back to them.

You film some very uncomfortable scenes about consent that also double as a metaphor for the process of obtaining consent for filming. For instance, there’s some consultations on tubal ligation to prevent further pregnancies, and the mothers are explicitly told they can withdraw at any time from the procedure, and one does. What were some of the challenges when filming scenes like that?

The staff’s concern was always for the privacy of the patient. I understood that. They were constantly having these conversations about contraception advice. The way I was able to navigate this—because I was there so much—I would ask the staff to give me a list of the people [they were] talking to tomorrow. I would talk to the people on the list and ask for permission to film their meetings beforehand. By then, we'd been filming so much that the mothers were as curious about us as we were about them. 

A lot of times we would put down the camera and just talk to them—they were very curious about Nadia: "is she Filipino, is she not?” Other women would gather around and listen to us. So they also understood that we were willing to put the camera down and just have a conversation. Sometimes, these side conversations could get really intense, and I would want to turn the camera back on again. More often than not, though, I would say "no, let’s let it go. We can circle back and ask if they would have a conversation about the same thing again."

You’re always second-guessing yourself when filming verité, but I always erred on the side of thinking they will give us more if we don’t film this. 

There are two incredibly powerful scenes: the lost baby and the “dead on delivery” (“DOD”). I’m sure, though, because of the scale of the hospital, that this wasn’t only time tragedy happened while you were filming. How did you choose to balance these scenes in the film?

For the lost baby—we were working such long days—by that point, Nadia and I wouldn’t even talk to each other when we got back to the hotel, we were so tired. In the beginning, I would translate during the day, or tell Nadia about some of what happened, but after that day, we just went to sleep. So when Nadia filmed that scene she didn’t realize how precarious it was. She understood the basics but not the nuance of it. 

After the film was done and she saw it at Sundance and realized what was actually going on through reading the subtitles, she told me she had no idea that they were still unsure about the baby’s identity at the end. But she was still able to shoot it, as she was very sensitive to mood and to what is happening.

There are only a few golden moments a film can take. We shot a handful of DODs, and we also shot a lot of births, and there’s just one of each scene in the film. For this [stillborn birth] that we chose to put into the film, the baby was fully formed, and we knew there couldn’t be more. I trusted that my audience would get it—that in a place like that, there would be other babies lost. 

There’s also the sense of the bureaucratic labyrinth, which, for all its confusion, also seems to work somewhat at providing social services.

There was so much dealing with bureaucracy. What’s in the film is Lea’s husband’s conflicts—I knew we had to put her husband going through the bureaucratic mess because he’s so clueless, he didn’t understand what he needed to do. It just got too much. We have some of that conversation and the intake with him, but really, when he showed up, finally, that was a huge surprise for all of us. But we couldn’t have two runarounds. Aira, the young girl, for instance, also had to do the runaround, but we decided to focus her strand more on her relationship with her mother. 

So you choose which one is more compelling. 

With Lerma, because there was this personal thing where she really wanted to leave against medical advice, we focused on the consultations. I really hope the audience understands that she has kids at home, and that this was the decision she felt she needed to make.

After streaming on PBS, Motherland is now available on Amazon Prime.

Abby Sun is a freelance programmer and critic.