We were lucky enough to catch a screening of the film Remote Area Medical and interview the film’s directors, Jeff Reichert and Farihah Zaman.
Now playing in Select Theaters.
Usvsfilm: I love how you approached the film almost as if it’s a lesson for students. The film could have gone in an opinionated direction, but it didn’t. How did you guys find out about RAM and how did you guys decide to approach the film the way you did?
Jeff: So we first heard about RAM in 2010. My aunt Sue, who’s a retired nurse, had seen a special on the news. I think it was 60 Minutes or something like that and she just said “I’m gonna go to the mountains in Tennessee and I’m gonna be a nurse.” We all thought this was crazy and she didn’t even know exactly where she was going, but she went. She came back and said it was the best experience of her nursing career. So in 2011 we went to Pikeville Kentucky which is not too far from where we filmed in Bristol. The things we were seeing and hearing kinda blew us away. You hear on the news that 44 million people are uninsured but what does that actually mean? We were registering patients in Pikeville and they had about 800 or 900 people come through. We only saw a fraction of those folks so you could imagine everyone had a story as heartbreaking as the one you just heard and imagine that magnified to the 44 million across the country. It really just seemed like a staggering thing.
Farihah: We knew going in that we wanted to focus on individual stories as opposed to politics. We didn’t want to create an essay, tell people how to think and vote. That’s in part of reaction to what was happening all around us. Again, in 2010, 2011, the ACA is not even beginning to be implemented yet. The conversation is constantly about healthcare, but it was from a very … I think, part of some political standpoint. You heard a lot of statistics, there’s lot of conversation about what the Republicans are doing wrong or the Democrats are doing wrong. It seems so divorced from humanity. That’s when we said, “How do we talk about healthcare in a way that answers a different question, which is what is it actually like to live without healthcare?”
As Jeff said, if you see that, can you continue to feel okay about letting people live like that? I think we wanted to strip it down to something more basic because I think it’s easy if in your circle, everyone already has the compassion for those who are living without a care or understands that the need is there. I know that I think I’m pretty engage and did not understand the depths of the need until we volunteered.
On top of that, there are people all over this country who just don’t actually agree with the statement that everybody deserves free care or the depths of that need. We wanted to address that rather than going into the hot button, political issues.
Usvsfilm: Was it always planned from the beginning to film in Tennessee or was there the option of going to another RAM stop a possibility early on?
Jeff: Once we decided that we wanted to make a film that dealt with what Remote Area Medical does, it actually took us a little while to hit on the idea of, let’s just focus on one clinic. Especially as our views were evolving and thinking about place and people. We felt if we’d filmed RAM at a bunch of different clinics across the country and then you work in urban areas too. Then do a clinic in Seattle, Los Angeles, Chicago. It would become, by necessity, you have to be a portion of the organization and the things they do as opposed to a place and what it’s like to live in that place and what the problems with that place are.
We hit upon the idea of doing one clinic. We volunteered. Right after we volunteered, we thought we want to go back to Appalachia. Let’s see what we can do in that region. We initially asked Remote Area Medical about filming one of their biggest clinics, which is in Wise, Virginia, in July every year. That was our first contact with the organization. They said, “No you can’t film. We’re not going to let you make this movie.”
We spent a long time trying to figure out, trying to convince them to let us to shoot the documentary. By the time that we had their approval, we’d seen their schedule for the next year and we saw there’s going to be a clinic in Bristol, we saw there’s going to be in NASCAR Speedway. We thought, “Wow. This is in the heartland of where we want to be.” It’s also in a NASCAR Speedway which tells you so much about our national priorities. We don’t have to say it. We don’t have to your nose in it and say, “Look at where we’re at. People are in a speedway getting their teeth pulled out.”
Usvsfilm: What I loved most about the film was the heartbreaking scenarios hundreds of people were living through and seeing how much RAM changed their life. However, there are hundreds more that we didn’t get to see on film. What are some stories you heard you may have wanted to put in the film, but didn’t make the final cut?
Farihah: I think it’s hard to say because we did talk a lot about it in the editing and there were so many stories. Particularly because in order to try and capture the magnitude of the event, but also make sure that we had the resources to tell really intimate stories about people home and things like that. We had 7 camera people. Neither one of us was with all of these teams all the time. When we went back and watched the footage, there were a lot of surprises. Even meeting somebody and learning their story at that time.
Jeff: It occurs to me, we did get them into the film and I can’t remember their names, but [Farihah] spent more time with them. It was the mother with her daughter and her daughter was married to the Latino gentleman who didn’t speak English. The mother-in-law couldn’t converse with her son-in-law because she didn’t speak Spanish, but they’re all there to get glasses, the 3 of them. I think they even had a couple of kids with them as well. I think his name might have been Hector. I can’t remember …
Farihah: They didn’t have kids.
Jeff: They didn’t have kids? Well anyway, they were all there as a group and we filmed with them for a while because we thought it was very interesting that the mother-in-law couldn’t speak to her son-in-law and they’re conversing with each other, they have a certain dynamic and they’re all there getting glasses together.
Usvsfilm: Films evolve through the creative process – definitely in the editing process. It’s really hard to reconcile the difference between what we imagined and what we achieved. Did you guys encounter that and how did you go about it?
Farihah: Always. I think that’s one of the best parts. I think there’s two really transformative moments in the life cycle of making the film. The first is when you start shooting and you start talking to people and you have to let go of what you expected to talk about. You can’t keep pushing what you wanted to talk about. That’s another [reason] why we didn’t really include a lot of politics in the film because people didn’t necessarily want to talk about it and we didn’t want to shape exactly where we went. Then the other is in the editing. Some filmmakers are great at editing themselves, particularly given the volume of footage that we had for this movie. I’m so glad that we had an incredible editor. His name is Sam Pollard.
Having that person brings his objectivity, because it’s so hard particularly in an emotional film like this one. To divorce yourself of the experience of being there. There were times when he had to tell me, “Yeah I know that this person had some charisma for you when you were with them or you remember them saying this thing, but that’s not actually on camera. We have to build with what’s actually there.” Then we go, maybe go back and follow up with some people.
There was definitely that debate a little bit where you get attached to certain people and we would argue about it or we’d argue with the editor about it.
One major change was we thought that the film would be entirely verite and that we would do those interviews mostly as a way of getting to know people because they’re in a really vulnerable situation and get them familiar with us, build a relationship, have them be comfortable in front of the camera and that would be it. Then we got into the editing room and started watching that footage and thought, “How can we leave this out?”. It’s such an important thing to hear them, tell their own stories about what it’s like to live there. Particularly in a region where people feel overlooked by the rest of American society. That was huge and it ended up being the backbone of the movie. It was like these interviews.
Usvsfilm: Desperate times call for desperate measures. We see that from some of the people trying to get treatment. Seeing how you guys had access to film lots of behind the scenes stuff, did uncomfortable situations come forth for you guys?
Jeff: We didn’t run into too many things like that. Because you could definitely imagine a situation where somebody would say, “Oh I’ve been filmed by this crew.” and use that as an opportunity to jump the line or get some care that they weren’t necessarily obligated or obliged to get. We didn’t see anything like that from our people.
Farihah: It’s awkward and heartbreaking in general that people are in this situation where showing up 30 minutes earlier 3 days ago means that you get to get into the clinic versus not getting into the clinic. That desperation, that moment were you think like, “Oh my God. I’ve been here. I slept in a parking lot overnight.” That was so hard to swallow my pride and do that and I’m still not getting in.
I think those moments were always tough. It breaks that third wall between you and the camera and this person when you’re like, “I know. I know you can’t get in. That’s terrible.”
Usvsfilm: What was the most important lesson you had to learn that has had a positive effect on your film? How did that lesson happen?
Jeff: I think one thing that we learned, both from volunteering and from shooting, is this idea of that health is much more complicated thing than we think of. It’s not just, do you have a cough? Do you have a fever? Or something like that. Your health is all sorts of different kinds of things. It’s what you eat, it’s the tings that you do, it is your vision, do you have glasses? Can you get to work? Your teeth may be rotting in your mouth, that may hurt a lot, but it may also be causing you diabetes.
Seeing all of those different problems and seeing the connections of those problems and how the specifics of a health issue relate to your ability to feel good about yourself, to kiss your spouse, to get a job, to be thought of as a method or not, these kinds of things. Learning that, I think it broadened my empathy for a whole range of situations. Once we come to that realization in the process of volunteering and actually shooting them, we really wanted to make sure that in the film that you do make sure, you do see how old this is a systemic thing. You do see a lot of people drinking sodas, you do see a lot of people smoking, even after getting a potentially life altering chest x-ray information.
We want to make sure that people see that because it is the culture down there. This is the way the people live and it’s not just having access to doctors isn’t going to make this all go away. It’s a class issue too, it’s not just a health issue. Seeing the inner connection of that really changed the way the film went.
Farihah: Also, we talk about things like education as a factor that determines class and class separation and so does access to healthcare. I think it’s a cycle where if you never have had a doctor be part of your life, you don’t learn to prioritize care and there’s the hopelessness. People in the film say it, “It’s my time to go, it’s my time to go. Because if something is wrong with me, I can’t do anything about it anyway.” I think if there’s that feeling of, “I can be taken care of.” These are the things that you do to help yourself to take care of your health because there are options for me. I think that changes slowly and overtime because that’s the way that education works. It could really be a powerful thing.