This article is part of Global Geneva’s ongoing Focus series profiling film-makers and their projects.
The subject fascinated me and I found myself thinking about it for days after. One of the reasons is that my own grandmother had suffered from dementia in her old age. This presented enormous difficulties not just for friends and family, but for her. She was an exceptionally proud woman with an acute sense of culture, intellect and independence. And she treasured this. So it was hard to witness how she slowly began to lose her faculties and particularly her sensibilities, all characteristics which she had found so important in life. (See related aticle in The Guadian based on this story)
Nevertheless, we considered it important for her to remain at home in surroundings. This was something which she knew and which might help ensure that at least a certain familiarity remained. And then I read this article, which seemed to claim that certain people are simply ‘dumping’ their relatives in Thailand because it is cheaper. But as I read further, the photographs drew me in. I felt less infuriated. Somehow, the people radiated happiness. I decided to contact Martin Woodtli and asked him if we could chat. One thing lead to another. I felt that there was a film.
The Baan Kamlangchay Centre, located in Faham village a few kilometres outside of Chiang Mai, was set up by Swiss citizen Martin Woodtli in order to help care for people suffering from Alzheimer’s and dementia. He started the project in 2004 when his own father commited suicide, considering himself unable to look after his wife, an Alzheimer’s patient. Woodtli then assumed responsibility for her. Maintaining that no proper institutions existed in Switzerland capable of providing proper care, both medically and financially, he took her to Thailand, a country he knew well having volunteered there for Médecins sans Frontières. He slowly created a structure which is now shared with a dozen Swiss, German and Austrian patients living in several houses in the village itself.
I first make a short ‘reccy’, an exploratory trip to Thailand. I wanted to see whether the project was worthwhile doing. During this initial trip, I made friends with some of the centre’s inhabitants and carers. From their reflections and experiences, I started shaping a first draft of a potential script. Curiously, my final film was not far off this original draft.
The film itself was my first since completing my studies, so I had a very small budget. Right from the beginning it was clear that this could not be a pure factually-based, journalistic report. It had to be a proper documentary based on real encounters. It needed to offer a sense of atmosphere as to what is really happening. For this, however, one need a lot of time and, of course, funding.
But I was lucky to have a team who were equally smitten by the subject. When I first told Anne (the camerawoman) and Aljoscha (the sound technician) about the project they became so enthused that they immediately committed, even though our production fees were paltry. Then there was Nam, our Thai production assistant and interpreter. She joined us because she was also interested in the subject matter. She wanted to be part of it, so she fell in perfectly with our team.
Our budget did not even cover the return flights from Berlin to Chiangmai. We therefore decided to remain for a longer period by integrating our ‘vacation’ time into the trip. We did this by taking a break on one of Thailand’s beautiful, tropical islands, so it was an incredible opportunity for all of us. So we made the film as part of a group of friends.
Overall, we spent nearly two months on the ground. We began shooting almost immediately on arrival. Normally, I would wait before going into production but we wanted to use all the time available, such as getting to know better both the camera and various filming angles. Furthermore, our protagonists, the patients, often forgot who we were, and what we were doing, sometimes right in the middle of a conversation. We had to reintroduce ourselves everyday and to re-explain what we were doing. Of course this is very tragic, but we took these ‘Groundhog Day’ situations with a lot of humour as well.
Under normal circumstance, I consider it important to lend them a ‘feel’ for the film and how they would appear. Given their medical condition, this was obviously impossible. Even getting to know them was a laborious process. At the same time, one cannot simply dismiss or underestimate such individuals. We got to know them better day by day. This helped better understand and tolerate the usual irritations of filming under difficult circumstances. In fact, this proved to be our biggest surprise. Even when dealing with their dementia, it was possible to develop friendships.
Take Kurt, for example, with his mischievous sense of humour. I got to know him well enough that I could always make him laugh. Even if I had to renew our relationship almost every day, I believe that he saw in me an unknown woman whom he could in fact trust. We always managed to converse on normal terms. It was the same with others. Even Geri, who lived in a different world, sort of became my friend. In fact, they all became our friends. For me that the best present to emerge from the entire production.
Of course, outsiders then asked: what’s the point in becoming friends if they don’t even remember who you are? My response is that it’s not a matter of remembering. Experiences should not be based solely on memories. What remains is the feeling of happiness that would often emerge, if only for a short period. For the carers, most of them Thai nurses or helpers, this is also important. Even if everything is based on the ‘here and now’, the carers provided an unbelievable sense of warmth.
Then there were the amusing misunderstandings. One of them is incorporated in the film. Martin, one of the main figures, completely forgot within a span of 10 minutes the purpose of the microphone, which I had attached. Again and again, he would take the box out of his pocket and give it back to me with wonder. The only thing he really understood is when I explained that I wanted him to take care of it for me. The same goes for the large microphone. Anyone who knows what a film microphone looks like will understand why such confusion can arise. If you look at the film, you can see the protagonist looking up with no uncertain dismay at the microphone above him.
Medical Tourism: Is it really appropriate?
One issue that immediately arises with such a film is how does this all fit in with the concept of medical tourism? Perceived as a form of cheap health care when compared to most western countries, the industry is steadily expanding in countries such as Thailand, India or Sri Lanka. People fly in for Los Angeles, Paris, London or Sydney in order to benefit from relatively inexpensive but usually high-quality medical care or dentistry. Such medical trips are often combined with holidays. The cost is often one quarter of what is offered in Europe or North America. International hospitals and health centres specifically designed for expatriates are now a standard feature in Bangkok and other main centres in Thailand and providing significant employment for many of its well-trained medical personnel.
Martin Woodtli is very aware of this. A material imbalance clearly exists in today’s world, notably that health care is far cheaper in such former developing world countries. I also fully understand anyone who questions this with skepticism. Should one build a business model on this reality? Should one even cultivate a for-profit health business?
To my mind, we should not only crtically explore the system, but also take into consideration how individual patients themselves feel, particularly given the fate that they are now forced to endure. Martin’s project is small and – as he himself admits – it responds to a niche need. Both he and his Thai wife Nid pay attention to the fact that their project should not become too big – and possibly impersonal. For the carers and other employees, he is a reliable employer. The village also sometimes contributes to the way the Dementia Project is presented. At the same time integrating with the local community is an exciting challenge.
It is a different situation with other medical or health care options. The moment major, impersonal investors with purely commercial interests get involved, such concepts become problematic. The important thing is that local populations are not overwhelmed. They need to be involved, at least partially. One also needs to be able to weigh – again and again – the interests that emerge.
As far as the relatives are concerned, they have my complete compassion and understanding. No one finds it easy to send a parent or partner so far away. The reality, however, is that the care is incredibly good. The decisive element is the 24-hour, one-on-one care that is provided. For this reason, patients do not have to take calming medication. From I have witnessed, it is not a matter of ‘dumping’ but rather a matter of often painfully weighed decisions to send one’s loved ones away.
For the patients, most of them probably have little or no idea where they are. Without doubt, this is ethically difficult. Even the exotic surroundings of being located in this distant part of the world is often disconcerting. At the same time, no ideal solution exists. What is important is what’s best for the patient. My feeling is that this is precisely what is happening. According to Wootli, he has far more enquiries than places available. So people are actually trying to decide what decision is best. No one wishes to keep someone there if they are not happy.
This is not a matter of idealizing the situation. There are clearly many problems for the patients, such as grasping what is really happening or dealing with language, a new environment or the lack of familiar faces. During stay, however, Kurt completely opened up. Given that most of the caregivers only spoke a smattering of German, this was a point of frustration for him. He appeared delighted to be able to speak German with us. This was great for him – and actually helped him remember more. Language is obviously one of the downsides of living so far away from home. Yet while the carers can’t speak German, some of them were making the effort to learn it in their spare time, something that is very evident in the film itself.
The key issue, however, is their state of dementia, the real culprit in this tragedy. One needs to constantly weigh what is best and to ensure that one is responding to the real needs of the patient.
Producing documentaries: Never an easy process
As with most independent producers, it is not always easy to operate. In fact, it’s very difficult. Anyone obsessed by the dream of making films needs to be aware of this. It always takes an incredibly long time to put the funding and other elements into place. One is constantly forced to compromise, or at least be ready. When people provide funding, they always want something in return, such as demands on content, length and format. So these things need to be worked out.
The German public, for example, is often completely different from other countries. But so are international cinema audiences. The same goes when dealing with streaming platforms, such as YouTube or Netflix. One is constantly dealing with even more different target groups, so everything needs to be tailored.
Similarly, one needs to be conscious of one’s own life challenges. This means being flexible, constantly prepared to improvise, particularly projects based on personal passion and love. It’s very hard to make a decent living from such initiatives. Or even remain in the profession. You cannot imagine how many kitchens, restaurants and bars I have worked in. At the same time, it is the best profession that I can imagine. I have no intention of stopping. Plus there are opportunities linked to the job which offer possibilities to at least continue with film-making, such as making commercial productions. It’s all a matter of survival.
Recently, for example, I worked on a journalistic format that was more appropriately aimed at the 18-28 year-old age group. Initially, it was not clear what this entailed. I wanted to produce a series of one-minute story segments that had be disseminated more effectively. It was hard at first, but then you learn to work more with graphics, plus interact more directly with audiences. I started to enjoy it.
For me, the ideal place to watch a film remains the cinema. This is where you can allow yourself to be absorbed by the story or unusual film experiences, letting one’s inhibitions to leave the room. Watching films on TV or streaming is totally different. You can zap when and where you like. Nevertheless, I think the long, artistic films will continue to exist. There are many festivals and other occasions that celebrate this.
At the moment, I am working on a project about technology, science and pets. Once again, it is an intercultural topic. Most of my films are about bringing the viewer closer to other worlds enabling one to embrace different perspectives. It’s very similar to dreaming – only perhaps even more surprising. Being based in Berlin is great for film-makers; it’s still very affordable and packed with highly creative people. But it never stops moving, so sometimes just to leave in order to shut yourself off and not be overwhelmed.