TC IN

TC OUT

TITLES

01:00:01:15

01:00:10:10

OVER BLACK TEXT CARD:

All the subjects in this film have willingly agreed to participate.

01:00:42:22

01:00:44:11

A twenty-two year old girl

01:00:44:21

01:00:48:16

was transferred here with a ruptured womb in the 17th week of her pregnancy.

01:00:51:07

01:00:55:12

Her ultrasound reported that the fetus was still alive.

01:00:56:04

01:00:58:01

So the doctor writes down,

01:00:58:01

01:01:02:15

"Live embryo - must wait until deceased to induce."

01:01:03:15

01:01:06:03

That afternoon, she went into septic shock.

01:01:07:17

01:01:12:20

Her mother was asking us -

01:01:09:05

01:01:12:20

- Why aren't you doing anything to help my daughter?

01:01:14:03

01:01:17:17

Because of the law Ma'am.

01:01:15:14

01:01:17:17

- and if she dies.

01:01:19:16

01:01:22:11

Then you can go to the government

0 01:01:22:18

01:01:24:04

and ask them,

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"Why has my daughter died?"

01:01:30:20

01:01:34:01

She died that night.

01:01:36:05

01:01:38:22

We have to live with this,

01:01:39:10

01:01:42:13

because we complied with the law, not the medical norm.

01:01:44:23

01:01:57:11

OVER BLACK INFORMATIONAL TEXT CARD:

Nicaragua is one of five countries in the world

where any termination of a pregnancy is illegal.

01:01:50:19

01:01:54:04

OVER BLACK INFORMATIONAL TEXT CARD - part 2: There are no exceptions,

not in cases of rape,

incest or to save a woman's life.

01:01:59:01

01:02:02:13

ADRENALINE FILMS PRESENTS

01:02:08:16

01:02:12:06

IN ASSOCIATION WITH CHICKEN AND EGG PICTURES

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01:02:18:04

AND BRIGHT & DANGEROUS PRODUCTIONS

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01:02:41:11

A FILM BY HOLEN SABRINA KAHN & ALESSANDRA ZEKA

01:02:47:03

01:02:53:04

TITLE: A QUIET INQUISITION

01:03:18:12

01:03:28:11

Super: Dr. Carla Cerrato

Department of Obstetrics and Gynecology

01:03:33:16

01:03:38:23

Super: Public Hospital Aleman

Managua, Nicaragua

01:03:51:08

01:03:54:05

Maternity Ward - Birthing rooms

01:04:05:00

01:04:07:00

Does this hurt?

01:04:08:11

01:04:10:02

Here in emergency,

01:04:10:10

01:04:13:19

it's hard to know who is in grave condition,

who is just bad.

01:04:16:02

01:04:18:13

They arrive full of anxiety, full of fear.

01:04:20:21

01:04:24:22

Sometimes they exaggerate

their symptoms and their pain.

01:04:27:07

01:04:31:09

And then on the contrary, sometimes

they arrive relaxed, calm and serene,

01:04:31:22

01:04:34:08

and they're about to give birth.

01:04:38:12

01:04:40:01

Good bye, be well.

01:04:40:14

01:04:43:16

Everything passes.

Good things and bad things - they all pass.

01:05:04:09

01:05:06:22

You are ready dear?

01:05:08:23

01:05:10:16

This is Sugein.

01:05:10:19

01:05:12:20

She's 13 years old.

01:05:13:04

01:05:17:11

She's been diagnosed witha serious case of pre-eclampsia.

01:05:17:23

01:05:22:09

Pre-eclampsia is when your blood pressure

is very high during the pregnancy.

01:05:23:08

01:05:25:23

It's frequently seen in adolescents.

01:05:28:23

01:05:31:11

Do you see many girls her age?

01:05:32:12

01:05:35:05

How many do you think (Nurse) Fatima?

01:05:35:14

01:05:38:00

13 year olds in a month?

01:05:38:02

01:05:40:21

About 7 a month.

01:05:42:09

01:05:46:17

See the teenagers are gynecologically

divided into 3 groups.

01:05:46:21

01:05:48:15

Under 14.

01:05:48:19

01:05:50:09

Between 14 and 16.

01:05:50:10

01:05:52:12

And older than 16 years.

01:05:53:05

01:05:58:06

The risks are of course higher,

the younger the patient, like her.

01:06:00:10

01:06:03:23

It's better if she can have a natural birth,

so she won't lose as much blood.

01:06:04:12

01:06:06:11

And her husband can be there.

01:06:06:14

01:06:09:11

If it's a cesarean,

he won't be allowed to be with her.

01:06:10:03

01:06:13:21

The company of the husband

is always good news

01:06:14:13

01:06:17:05

for the patient and for the baby.

01:06:18:18

01:06:22:00

Did you plan this? What happened?

01:06:22:19

01:06:26:17

I told her that it could be

risky for her to get pregnant,

01:06:27:13

01:06:30:16

but she said she didn't care.

01:06:30:21

01:06:34:08

That what she wanted

is a baby and that's it.

01:06:35:02

01:06:36:07

How old is she?

01:06:36:07

01:06:37:17

13

01:06:37:18

01:06:38:13

And you?

01:06:38:19

01:06:40:20

24

01:07:04:10

01:07:08:07

We won't need to do a cesarean. We're going to give you a chance.

01:07:09:23

01:07:12:04

You're doing perfect.

01:07:16:13

01:07:18:18

Let's go.

01:08:02:20

01:08:06:02

It's important to be vigilant now, especially now after the birth.

01:08:06:06

01:08:10:02

You can't unglue yourself from a kid like this, you can't.

01:08:10:19

01:08:15:01

Every 5 minutes monitoring the little heart beat of the baby.

01:08:16:06

01:08:18:04

Encouraging her.

01:08:44:09

01:08:46:18

She's 9-10 centimeters dilated. She's ready.

01:08:49:10

01:08:52:13

If we see 60 patients between 7AM and 3PM,

01:08:53:09

01:08:54:23

I see 30 of them.

01:08:55:22

01:08:58:02

And I supervise the other 3 [doctors].

01:09:02:18

01:09:05:14

You had a child two years ago at 16.

01:09:05:22

01:09:09:00

This will be your 2nd. You had a cesarean?

01:09:10:09

01:09:13:19

Most of my patients are teenagers.

01:09:13:19

01:09:17:20

The other part of my schedule is family planning.

01:09:18:11

01:09:22:16

So part is with adults, and part with pregnant teens.

01:09:26:08

01:09:28:16

You told me you had a pregnancy test

01:09:28:16

01:09:32:18

that came out positive with your mother about a month ago?

01:09:33:08

01:09:37:01

So that came out positive? This is another one, let's see how it comes out.

01:09:40:03

01:09:41:22

So does she already have a child?

01:09:41:22

01:09:43:15

One miscarriage (spontaneous).

01:09:44:06

01:09:47:11

This would be a second pregnancy.

01:09:48:06

01:09:50:14

The first one was when you were 13?

01:09:51:08

01:09:52:10

When was it?

01:09:52:12

01:09:53:21

A little while ago.

01:09:53:21

01:09:56:12

And then you got pregnant again right after that?

01:09:56:12

01:09:59:02

February last year?

01:09:59:02

01:10:01:08

That's recently my queen.

01:10:02:12

01:10:04:13

It was last year.

01:10:04:13

01:10:07:14

So then you were 13?

01:10:11:05

01:10:13:03

Are you worried?

01:10:14:19

01:10:17:23

That it will come back positive or negative?

01:10:19:18

01:10:21:14

Positive.

01:10:21:14

01:10:24:18

You worry it will be positive?

3 01:10:28:16

01:10:31:05

It's going to come back negative. You'll see.

01:10:32:10

01:10:35:06

They come praying for it to be negative.

01:10:36:20

01:10:40:13

It will be ready in a minute. I'll be right back.

01:10:42:10

01:10:45:04

No need to suffer.

01:10:48:23

01:10:51:09

She is so tender.

01:11:17:19

01:11:21:03

Right now I'm waiting on my daughter's test results from

01:11:21:13

01:11:25:12

a transvaginal ultrasound that will say if the membrane around the baby is broken or not.

01:11:25:23

01:11:28:06

If the membrane is torn,

01:11:28:06

01:11:31:00

then this baby has no hope.

01:11:33:09

01:11:36:05

My daughter wants to save the baby's life.

01:11:37:14

01:11:40:16

If they say that with treatment,

01:11:40:20

01:11:43:13

and always with God's help,

01:11:44:02

01:11:47:03

then we will give this child everything until it is fine.

01:11:47:03

01:11:50:10

But if she starts to get an infection, and other complications,

01:11:50:10

01:11:53:13

and she's going to lose her uterus - a girl of just twenty-eight years old...

01:11:53:13

01:11:56:00

then I say lets act quickly.

01:11:56:09

01:11:58:02

I'm still a Christian but

01:11:58:08

01:12:01:09

but that does not divide me.

01:12:06:15

01:12:09:22

In my opinion, save my daughter.

01:12:10:18

01:12:14:08

If there is no hope for this baby,

01:12:14:08

01:12:17:10

that it's like a fish out of water,

01:12:17:15

01:12:22:09

then she'll get infected and lose her uterus.

01:12:23:07

01:12:26:20

But, I need this to be clear, it's not the doctor's decision.

01:12:27:00

01:12:28:03

No, no. I know but...

01:12:28:03

01:12:30:14

but in my time, they used to say sign here,

01:12:30:18

01:12:33:10

you signed and went through the procedure.

01:12:34:00

01:12:36:17

Yes, at that time they provided...

01:12:36:17

01:12:39:12

provided therapeutic abortions.

01:12:39:14

01:12:42:12

But she'll get an infection.

01:12:43:02

01:12:44:01

Now...

01:12:44:09

01:12:47:14

here...we can't induce an abortion.

01:12:48:01

01:12:50:23

I know, but... if now we get this diagnosis

01:12:51:17

01:12:55:19

that her membrane is perforated,

01:12:55:19

01:12:57:19

and the fluid all gone,

01:12:58:01

01:13:00:23

that we are still going to wait for the child.

01:13:01:08

01:13:03:00

Then we are risking my daughter.

01:13:03:04

01:13:06:12

In this moment, if you say, "my daughter or her baby?"

01:13:06:15

01:13:10:01

We will cry for both, but we will choose our daughter.

01:13:10:08

01:13:12:13

Preserve the life of my daughter.

01:13:19:18

01:13:24:09

Is there any way for this pregnancy to be successful?

01:13:24:09

01:13:26:01

No.

01:13:26:11

01:13:29:07

We have to wait

01:13:28:10

01:13:31:12

Super: Dr. Zamora,

Department of Obstetrics and Gynecology.

01:13:30:01

01:13:32:21

for the embryo to spontaneously release

01:13:33:05

01:13:36:11

and hope there is no infection.

01:13:38:23

01:13:40:14

So we are at a...

01:13:40:20

01:13:41:20

Crossroads...

01:13:41:23

01:13:42:23

at a crossroads...

01:13:43:14

01:13:46:12

because of a law that impedes us

01:13:46:16

01:13:50:12

from inducing a pregnancy or making a determination

01:13:50:15

01:13:55:09

that can prevent further complications in the mother.

01:13:57:18

01:14:00:13

Nobody, nobody can say they are exempt

01:14:00:14

01:14:02:02

truly.

01:14:02:02

01:14:04:09

No one can say that they'll be free of

01:14:04:11

01:14:08:03

the possibility of a pregnancy with congenital malformations,

01:14:08:16

01:14:11:18

or where the membrane breaks before they get to nine months.

01:14:12:07

01:14:14:02

It's a legal situation.

01:14:14:11

01:14:17:03

Who is going to protect us?

01:14:17:03

01:14:18:17

Unfortunately,

01:14:18:17

01:14:22:07

we are in a no man's land

01:14:22:07

01:14:27:00

because with these laws doctors have no protection.

01:14:29:02

01:14:31:08

We have no recourse.

01:14:34:08

01:14:51:00

INFORMATTONAL TEXT CARD:

Therapeutic abortions are performed

to preserve the health or life of the mother.

01:14:40:22

01:14:51:00

INFORMATTONAL TEXT CARD -part2:

Prior to the current abortion law, this procedure

was legal in Nicaragua for over 100 years.

01:14:55:02

01:15:00:01

The medical standards were developed by

people who understand medicine.

01:15:00:11

01:15:04:00

That's the difference between the medical standards and the law.

01:15:06:06

01:15:08:21

In any case where we cannot guarantee the life (of the fetus)

01:15:12:20

01:15:16:21

the (medical) norms are super clear.

01:15:19:02

01:15:21:20

It is better to interrupt the pregnancy than endanger the life of the mother.

01:15:22:23

01:15:27:01

But there exists a contradiction between the law and the norm.

01:15:27:17

01:15:31:17

There are norms that we have been

01:15:32:23

01:15:35:16

trained to comply with.

01:15:38:11

01:15:35:21

So we comply with these norms.

01:15:39:05

01:15:43:22

We are like soldiers.

01:15:45:20

01:15:48:22

A patient arrives bleeding or convulsions,

01:15:48:22

01:15:50:22

we don't think about it.

01:15:50:22

01:15:53:18

Afterwards, maybe we think,

01:15:53:18

01:15:58:10

"We did this procedure while the fetus was still living."

01:15:58:22

01:16:00:10

But that's after.

01:16:00:14

01:16:04:13

The patient has arrived convulsing, bleeding, severe enough to die...

01:16:05:20

01:16:08:16

So now there is a law that tells us

01:16:08:22

01:16:12:21

that under no circumstances can you interrupt a pregnancy with a life inside.

01:16:14:08

01:16:17:20

We don't know what to do? Comply with the law or comply with the norm?

01:16:18:00

01:16:20:10

We talk about this among ourselves,

01:16:20:18

01:16:23:16

But what can we do? What can we do?

01:17:02:13

01:17:07:08

SUPER: Niquinohomo, Nicaragua

01:17:08:23

01:17:12:03

I was born here.

01:17:14:22

01:17:17:07

My mother died eight years ago.

01:17:19:00

01:17:22:03

No one has lived here since.

01:17:24:15

01:17:27:05

I work in Managua, my kids are in Managua,

01:17:27:17

01:17:29:03

but I am of this place.

01:17:31:03

01:17:32:21

Before the Revolution,

01:17:33:00

01:17:35:10

this was a very quiet town.

01:17:35:20

01:17:38:15

Nothing happened here.

01:17:40:09

01:17:43:19

Remember that the Revolution was won in 1979.

01:17:44:14

01:17:47:06

I think we were having dinner when we heard it.

01:17:48:12

01:17:49:22

We said, "What is that sound?"

01:17:50:09

01:17:51:23

We didn't know the sound of bullets.

01:17:54:15

01:17:57:12

And my brother said, "Those are projectiles."

01:17:57:18

01:18:00:02

He said, "everyone fast get to the ground."

01:18:00:07

01:18:02:13

Because the front door was open.

01:18:02:19

01:18:05:00

And then,

01:18:05:13

01:18:09:15

I don't know what kind of heroism got into me,

01:18:09:19

01:18:12:15

but I jumped up and ran to close the door.

01:18:12:18

01:18:14:15

I remember it well,

01:18:14:15

01:18:16:15

I ran to close the door.

01:18:16:17

01:18:18:19

Because the bullets were flying.

01:18:19:06

01:18:23:02

So that's when the war of liberation came to Niquinohomo.

01:18:26:07

01:18:39:05

INFORMATIONAL TEXT CARD:

In 1979 the Sandinista National Liberation Front (FSLN)

Overthrew Dictator Anastasio Somoza, Ending a 40 year family dynasty.

01:18:31:12

01:18:39:05

INFORMATIONAL TEXT CARD - part 2:

The Sandinistas held power from 1979 to 1990.

01:18:34:15

01:18:39:05

INFORMATIONAL TEXT CARD- part 3:

Sandinista leader Daniel Ortega served as President from 1984 to 1990.

01:18:39:23

01:18:46:15

INFORMATIONAL TEXT CARD:

Daniel Ortega lost the subsequent three elections returning with a successful campaign in 2006.

01:18:48:13

01:18:51:16

I know I owe a lot to the Revolution.

01:18:52:04

01:18:55:12

Without the Revolution I would not be a doctor.

01:18:55:22

01:18:58:10

It was too expensive...inaccessible.

01:18:59:07

01:19:03:21

When I entered there was this huge swell of people matriculating.

01:19:04:19

01:19:10:02

Everything was changing very quickly.

01:19:11:23

01:19:14:04

At that time

01:19:15:01

01:19:18:17

to speak of gender all was very new.

01:19:19:15

01:19:21:23

To say that

01:19:21:23

01:19:25:09

both men and women could study medicine.

01:19:25:17

01:19:28:13

That is was not just for men.

01:19:28:18

01:19:32:13

We started to see women become carpenters, electricians, and more.

01:19:33:21

01:19:36:15

My formation, my character, my personality...

01:19:36:22

01:19:39:15

All of who I am was forged in the 80's.

01:20:00:08

01:20:02:05

I believed it. It was a dream.

01:20:02:10

01:20:04:22

I was a girl of 16 years old.

01:20:05:12

01:20:08:17

We spoke of better treatment of the poor.

01:20:09:22

01:20:12:15

The fight for the poor.

01:20:12:22

01:20:14:21

For the poor to have power.

01:20:15:06

01:20:18:06

Education for all. Healthcare for all.

01:20:18:06

01:20:21:06

Who doesn't fall in love with that.

01:20:59:09

01:21:01:05

Over in emergency.

01:21:01:18

01:21:04:23

Put your name on the pediatric list.

01:21:07:06

01:21:10:05

Tell her I'll take care of it personally.

01:21:15:21

01:21:19:04

Good morning. Good morning.

01:21:27:06

01:21:28:22

So?

01:21:29:00

01:21:31:12

In the morning or the afternoon?

01:21:43:16

01:21:46:12

The results are not there.

01:21:56:14

01:21:59:20

For the HIV tests, the results should be in another office.

01:21:59:22

01:22:03:17

You have to speak to the nurse. She should have the results.

01:22:04:04

01:22:08:10

Let me look here properly. Sometime they put them in a different place in the file.

01:22:09:01

01:22:11:12

I also wanted to say,

01:22:11:14

01:22:14:11

that my parts...that all of my life,

01:22:14:15

01:22:18:16

because I was raped from the time I was 7 by my stepfather,

01:22:18:20

01:22:23:12

and I have this white discharge.

01:22:24:10

01:22:27:01

Since I came here from Costa Rica

01:22:27:03

01:22:29:17

I have not had relations with anyone.

01:22:29:19

01:22:32:12

But I always have this discharge.

01:22:32:16

01:22:35:23

In Costa Rica you told someone about this?

01:22:36:02

01:22:37:14

No.

01:22:37:19

01:22:40:23

She was born and raised in Costa Rica.

01:22:41:15

01:22:45:18

Yes. Yes, but has shoe spoke to someone about this there?

01:22:45:23

01:22:50:22

Yes, with my daughter. I am 16 and have a 3 year old daughter.

01:22:51:02

01:22:56:00

And you told them about your infection, about the discharge?

01:22:56:02

01:22:57:15

No I didn't.

01:22:57:17

01:22:58:15

But they saw you?

01:23:00:01

01:23:02:11

Because I wa