Al Jazeera – behind the scenes

Al Jazeera’s much-feted medical series The Cure brings science, society and the general public together on one small screen.

And independent filmmaker,  Daniel Nikolaison is regularly responsible for crafting The Cure stories that are true (without alienating), enlightening (without patronising) and complex (but under 15 minutes).  It’s a balancing act, and everyone wants you to carry something different.

Especially when it comes to a story as niche and complicated as safer surgery in a low-resource setting, debuting on Al Jazeera today.

Back in March, Daniel and a crack team – presenter Dr Javid Abdelmoneim and Al Jazeera Producer, Arwa Aburawa spent a week in Uganda, balancing the camera across the frontline.  From Kampala, to Mbarara, over the equator and back, they set out to tell a story that would show global surgery in action – and the innovations that are making it safer.

With the ink still drying on the World Health Assembly resolution re: surgery and anaesthesia as essential components of universal health coverage, there’s never been a more critical moment to drag safer surgery into the light.

Lifebox is thrilled to be a part of the story – and delighted as ever to catch up with Daniel before he and his camera hit the road again for a few months to document the elections in Myanmar.

Did you have doubts about taking on a story about safe surgery?

I was sceptical.

I’ve been known to do the sort of stories that have adventure.  This wasn’t taking motorbikes into the jungle, or putting massive injections into people for sleeping sickness.  As a television story, it was going to be very hard to tell visually.  To be honest it seemed…boring.

So why did you agree to direct?

Al Jazeera convinced me that this was a very important issue on the global health level.  I knew it was going to be difficult, but it was also a challenge I wanted to get right, knowing that it was so important.

Why is this a difficult story to tell?

There’s a number of components here, equipment, infrastructure, education.  There’s the Arbutus Drill Cover, which – story-wise – was a no brainer.  The Lifebox was more difficult for me.  It’s a product that does a thing some other products already do.  It was more about access.  Add in the Surgical Safety Checklist, and all in all it’s very conceptual.  That’s a very difficult thing to show and tell.

Does it surprise you that surgical safety is an issue in low-resource settings?  

No.  I’ve seen how healthcare can be at the district level in very poor countries.  It doesn’t surprise me at all that surgery is a global health issue. I just didn’t think that there was anything that could ever be done about it.

It does, however, surprise me how easily – distilled it is.  I would never have identified ‘essential surgery’ as a distinction – one that can really boil down how ‘safer surgery’ can be approached, recognising the fundamentals of orthopaedic surgery and maternal surgery.

And I think when you watch the episode you realise that these are very simple steps that can make a huge difference.  To see that it can be so simply fixed by some very basic steps like the Surgical Safety Checklist – the statistics are there.

Is there anything you’d change?

I regret that the checklist part of the story had to be told in Uganda.  We did the story there because the drill cover was there, Lifebox was there.  But the Checklist would’ve been more easily illustrated in a high resource hospital elsewhere – in London, in New York. Because the Surgical Safety Checklist is not about access.

What do you mean? 

Take leaving an instrument in the body – that doesn’t have to be an ‘African problem’.  So many times I’ve visited low-resource setting clinics and they’re really on to it despite the environment.  They’re trained in the centres, and these are skilled doctors who know what they’re doing, often operating in such limited conditions – I take my hat off to them.

Unsafe surgery is about human error.  And to that point, a doctor in the UK or USA is just as likely to forget a swab.

What were your first thoughts when you learned about the Checklist?

The statistics show what’s happening, that the sheer busy-ness in surgery leads to some very simple mistakes being made.  Human error happens everywhere – but in this case we’re talking about human life.

To be honest, I thought – are you kidding me?  This hasn’t been done before?

We’ve had road rules forever – at some point someone had to think about how to make the cars drive together.  The film industry has done it too with various crew specialities on set.  There are lots of industries were people have learned to work together. How old is surgery now?  It’s 2015!

What changed your mind?

I think the big word that sold it to me was the word ‘manifesto’.  Something that has had a great amount of thought, sitting and meditating for 40 days and 40 nights – something that’s been boiled down to a finite list.  That’s like editing a story.  And someone finally edited that story.

What’s your hope for the episode when it airs?

From a public perspective – I hope they’re fascinated by it.  I hope they enjoy it.  And they think oh! that’s a good idea!  I hope the attention puts the pressure on the medical community to put the pressure on governments – this bottom up effect of pressure and money that eventually creates change.  Governmental and global change.  And that’s probably the best hope we can have.

I’m glad that I did it in the end.  I’m happy about how it came together.

What’s your abiding memory from the shoot?

The Caesarean section, it goes without saying.  I’ve never seen a baby [dramatic face smushing gesture]…The surgeon and the nurse are tearing – actually tearing with their arms, one on either side, the conscious mother’s stomach apart.  I stood there, fearful, forgetting that the baby had actually been there for nine months thinking, get it out!  It’s going to suffocate!  I thought, everything is going to end in disaster.

The other memory is Sister Prospera, who we presented with the oximeter.  Seeing how much they were doing at Kitovu Hospital, how they did such a good job.  It’s a pretty limited set of resources, and to see what is capable in that setting.  And in this particular case, just knowing that a simple thing like Lifebox makes a difference.

New Zealand born documentary film maker, Daniel Nikolaison helms Landfall Media, a production company based in London. With a recent focus on health and environmental stories, he has covered Sleeping Sickness in DR Congo, Malaria treatment advances in Nigeria, and the 2014 Ebola outbreak in Sierra Leone. His pharmaceutical partnerships film, “Finding a Cure for Kala Azar” debuted on Al Jazeera this month.