Emmy-winning filmmaker Adam Friedman has traveled all over the world making movies and TV shows—from Mardi Gras to Broadway, from NASCAR to the Kentucky Derby, from the final launch of the NASA Space Shuttle Atlantis to embarking with the US Navy on a hunt for pirates in the Gulf of Aden—but he has never made a film quite like SHOUT GLADI GLADI before. “Doing a movie about humanitarian work presents some special challenges, because so many have been done before,” he says. “I never wanted to do one unless I could bring something new to it as a director.”

In 2013, Friedman was introduced to Scottish philanthropist Ann Gloag, through his sister, TV news anchor Roma Torre. “I was bowled over,” he says. “Here was this very petite person who is an incredible powerhouse—a true force of nature. She had built a billion-dollar company out of literally nothing, and now she is in her 70s going around into the most horrible places in the world, completely indifferent to any dangers. And she wasn’t just distributing money—she was diving in and doing the dirty work herself.  I had to know more.”

There was one problem: Gloag did not want to be in a movie. Through her decades of success as a businesswoman and philanthropist, Gloag had given almost no interviews, and wasn’t interested in the prospect of being followed around with cameras for weeks. Friedman gave her an ultimatum: he wouldn’t make a film if she wasn’t in it. After some thought, and very reluctantly, Gloag gave in. “I didn’t do it for myself,” she says. “There are women and girls who are outcasts of society and don’t have a voice: I feel a responsibility to speak for them.”

Gloag started helping others when she was a young girl growing up in the small town of Perth, Scotland. While her family barely had enough to take care of themselves, her mother instilled Ann and her two brothers with the imperative of giving. “We’d knit little woollen squares to make blankets for people who were poor,” she says. “After the war there was a shortage of wool, so when we were finished with our sweaters we’d take the old wool and wash it to make more blankets.”

Young Ann always knew she wanted to be a nurse. “All my dolls were sick,” she says. By the time she was 22, she became the youngest Scottish nurse to ever be put in charge of an operating room, where she worked in the burn unit. “It was hard, but I loved being involved,” she says.  

Gloag’s engagement with African charities started almost by chance. She first came to Nairobi, Kenya in 1989 to review a bus company that she and her brother had recently acquired for their transport company, Stagecoach. Soon after her arrival, Gloag discovered there was a lot of diesel disappearing from their warehouses, and she decided to do some sleuthing. While exploring a ten acre site at 4:00 am, she suddenly bumped into one of the workers. “I got a terrible fright when he came around the corner,” she says. “And then I saw that he had a newborn baby in his arms.  I asked him where he got it and he said, ‘Oh, they leave them on the bus all the time.’” Gloag wrapped the baby in her scarf and took it to the local orphanage, where she encountered sixty children who hadn’t been fed in two days. The next day, Gloag made certain that the children had plenty to eat. Today, Gloag runs that orphanage—and it is well known for taking abandoned babies. 

The night she encountered that newborn baby set Gloag on a path to over two decades of philanthropy in Africa, from the orphanage to clinics, hospitals, and schools. She became acquainted with the ravages of obstetric fistula while working on a floating hospital operated by one of her favorite charities, Mercy Ships. She called her long-time associate Lois Boyle and said: “I’ve just met the most vulnerable people in the world.  And we need to help them.”

The lives of the two million women and girls who suffer from obstetric fistula are doubly harsh. Not only must they suffer through the pain of constant incontinence, skin infections, kidney disorders, or even death if they remain untreated— they can also be shunned by the people in their villages, even by their own families. What’s particularly upsetting about their plight is that it doesn’t have to happen—all these women need is adequate maternal care at birth. And because obstetric fistula is a tragedy that only exists in poor countries, few in the west have ever even heard of it. Gloag started the Freedom From Fistula Foundation in 2008 to eradicate this scourge and to raise awareness.  Since then it has grown to include: the Aberdeen Women’s Centre in Freetown, Sierra Leone, which is composed of a fistula clinic, a maternity unit, and a children’s clinic; The Fistula Care Centre in Lilongwe, Malawi; and two fistula clinics in Nairobi, Kenya.  All the maternal care at the clinics is provided for free. Unlike most charities, Gloag pays all the administrative costs of the Freedom From Fistula Foundation herself.

Adam Friedman and his crew filmed for eight weeks in Malawi and Sierra Leone during the spring and summer of 2014.  As there were so many people they wanted to interview, they generally worked in two units, one led by Friedman and the other by co-director Iain Kennedy. There were numerous challenges that the production team had to overcome, notably language. “As a documentary filmmaker,” says Friedman, “you want to engender sympathy and understanding, and it’s very difficult when you have to go through a translator.”  Says Kennedy: “One of my tasks was to go into the wards and just try to let them get used to me, because we knew that after being ostracized they would be sensitive about telling their story. To bridge that gap we had to show the women that we were trustworthy, and understand what they had gone through.” The difficulty gaining trust was amplified by the fact that the women were not only unfamiliar with cameras—they hadn’t even seen movies.  Says Kennedy: “One of the icebreakers for us was to take a picture or even shoot a little bit and then show it to them.  Then they would see what was going on and would respond to that.  In fact, sometimes they would start posing, and we’d have to get across that we wanted them to behave normally.”

While the Fistula Centre in Malawi was a relatively calm place for the filmmakers to work, Sierra Leone was the complete opposite—vibrant, loud and considerably more poor. “Sierra Leone is much worse,” says Boyle, “but if you’re a woman or girl suffering from fistula, it doesn’t matter what country you’re in—your life’s miserable no matter where you are.” While the filmmakers had largely stayed in the wards in Malawi, there was much more to do in Freetown, from the maternity and fistula wards at the Aberdeen Women’s Centre to the children’s clinic and following the caregivers doing outreach into the devastatingly poor slum in Kroo Bay.

One challenge that all caregivers in Africa must confront is the dependency culture commonly fostered by charities. This is very dramatically illustrated in the scene where the children and adults in the neighborhood demand t-shirts that are intended only for the Sierra Leone dance troupe. The situation quickly becomes precarious, simmering on the edge of violence.  “Once people have things given to them, they feel entitled,” says Friedman. “And when they don’t get them—they get mad at you for not giving them.”

Says Gloag: “I think this culture of dependency has been very damaging overall, because we just hand out money, with very little accountability.  Huge numbers of charities pay large salaries to the locals, and then when there’s no more money they pull out and leave very discontented people.  There’s no point in going in there to do damage by raising expectations you can’t maintain.”

To this purpose, the Freedom From Fistula Foundation approach seeks to make all their efforts self-sustaining.  More than 90% of the staff at the clinics are locals, and are supported by international staff and volunteers where necessary.  Says Boyle: “Our goal is to put ourselves out of business, because we’ll either have treated or cured all the fistula patients in the countries in which we’re working or we’ll have created sustainable projects that the national governments and staff will continue with.”  In fact the Aberdeen Women’s Centre has been completely run day to day by staff in Sierra Leone for almost a year, and was one of the few non-governmental medical facilities to stay open during the Ebola epidemic.

Gloag’s commitment to sustainability exemplifies her unique approach to philanthropy:  a combination of a nurse’s compassion with a tycoon’s extraordinary business acumen.  Running hospitals, schools and orphanages is not that different from running businesses: Gloag assembles and motivates a strong staff, insists on budgets, cultivates relationships at the highest levels of local governments, and keeps an eye out for the corruption so common in Africa.  While going through the books at the AWC, Gloag realized that the fuel bills for the electric generators were way too high. After some exploration, Gloag discovered that someone had connected a cable underneath the generator and dug it underground all the way to a nearby shantytown—the AWC was lighting half a slum!  “They might get away with it for a week or a month, but we’ll get them,” says Gloag. “Unfortunately with other charities it’s not so common to have someone like me going out in the middle of the night checking on stuff.”  

Doing things herself is a hallmark of Gloag’s approach. She is never happier than when she’s put on scrubs and takes her place in the operating room. “I think that’s just my personality,” she says. “That’s where I get most job satisfaction, and I always feel I get the best results when I work closely with people. I’m saying, ‘Look, I’m willing to work with you. I’m not willing to do it all, but I’m happy to show you how to do it.’ And you can impact people in a way you’d never be able to if you approached them from a distance.”

The women and girls are not only provided with medical care at the clinics—there are programs in place to empower them by providing them with training and empower them economically and socially.  They are given courses in basic literacy and taught skills to enable them to provide for themselves when they go home, like sewing, knitting, tie-dying, and arts and crafts.  “We always try to look for small businesses for them, and try to tie them into microfinance,” says Gloag. “For example, we show them how to go to a bank and get the money for a sewing machine.”  The microfinance project that has had the most impressive results for the Foundation is the BBOXX, a small electric generator powered by a solar panel.  “The BBOXX allows these women and girls to go back into the villages, where they’ve been scorned,” says Friedman.  “And they become very powerful people within these villages because they make it possible for their neighbors to charge their cell phones.”

The clinics are also places that the fistula patients can call home.  Says Friedman: “They find people who have been through what they’ve been through, and a feeling of safety, and encouragement and love.”  Says Gloag: “If you go late at night to the wards, sometimes you’ll see them sitting in the veranda together.  Sometimes one of them is sick and the others take care of her.  I think they probably make friends for life.”

Choosing the seven women and girls who would ultimately appear in the film presented a great challenge for the filmmakers.  Says Friedman: “They all had moving stories and it was very hard to pick the best, but there were two important things we wanted to do: first, show a range in ages, from the very young ones like Mary and Tomolero to Vanesia, who is in her 70s; and also present a mix of positive outcomes and ones that didn’t turn out so well.”  Says Kennedy:  “Isatu is a success story that shows how good things can work out, and Mary is more ‘this is what you can go through.’  It wouldn’t be accurate to present it as all gloom and doom, because this film is really a story of hope.”

The most dramatic story was “Tomolero,” the 9 year old girl who arrived at the Aberdeen Women’s Centre paralyzed after being violently raped and beaten by her uncle and aunt.  Scans from the hospital showed that her pelvis was broken and damage had been done to her spine.  After shooting was completed, Ann Gloag asked Friedman to take her out of the movie, to protect her privacy.  Says Friedman: “I told Ann that we have to find out a way to use her because she is so important—the worst off of anybody in the film.”  A compromise was struck that her face would not be seen and a pseudonym would be used.  Despite the severity of her injuries and her contracting lymphoma, Tomolero’s story had a relatively happy ending.  She is now in remission and on the way to recovery. 

The filmmakers were excited to include the voices of Melinda Gates, Nobel Prize winning author Wole Soyinka, Dr. Jeffrey P. Wilkinson,  and the Haikal Institute’s Hawa Hawatouri in the film. “Melinda Gates was very important for us to have in the film,” says Kennedy.  “First, because the Gates Foundation has such a major role in Africa, but also because one of the major ideas that drives her work is a point we needed to make—that if you can stabilize the women in these very unstable countries, you can decrease the mortality rate for everyone. You can increase the opportunity to change things everywhere.” Friedman was stunned to find out that a world famous writer and activist like Nobel laureate Wole Soyinka would turn out to be living nearby, teaching at Loyola Marymount University in Los Angeles.   “As soon as I heard him speak I felt immediately that he was so wise, humane and outspoken on issues related to contemporary Africa that I knew he’d be perfect.”  Says Kennedy: “We weren’t sure he’d want to be involved because he’s more involved in Nigerian politics, but he lept at the chance. It was something he’d witnessed in Nigeria and felt very strongly about, and he was so knowledgeable and poetic about the crippling emotional and economic situations of these women and girls.” Wilkinson and Hawa Hawatouri provide the perspective of dealing with the problem directly: “Dr. Jeff” informs us in what is directly involved in curing a patient of obstetric fistula, and Hawatouri speaks with authority from her years of mentoring the women and girls along the pathway from cure to social reintegration.

Friedman’s dream was for Meryl Streep to narrate the film, and, after she saw an early cut, she quickly agreed. “I was so taken with the story of how one woman’s determination could help ease the unspeakable pain and mortification of fistula and related disorders for underserved communities,” says Streep. “Ann’s understanding of the medical challenges, and her compassion and respect for the women of this story made me want to contribute in some way that would help inspire others to similarly help. The healthcare givers whom her organization enlists to do this work are some of the most heroic people I’ve encountered, and I am proud to help bring their inspired stories to light.” Friedman was awed by Streep’s professionalism in the studio. “I booked six hours,” he says. “It was a 16 page script and she was out of there in less than an hour!”  Friedman was so moved by what Streep did that he went back and re-edited the film to match it.  “The way the final cut looks is completely predicated on the wonderful participation of Meryl Streep,” says Friedman. 

The title of the film comes from the Gladi Gladi ceremony that marks when the fistula patients “graduate” from the clinics, and are ready to return home.  It’s a time of joyous singing and dancing that celebrates how far they have come and their optimism about the future.  Says Gloag: “When you see these women and girls come in, their heads are down, they’re walking tucked into the wall, and they’ve got no self-esteem. They can hardly speak, or look you in the eye.  And when you see them dance in the Gladi Gladi ceremony, they’re just extroverted, normal girls.  I’m quite touched with the idea that in the Gladi Gladi ceremony they actually burst through the door into the town, and run out dancing and singing.  It is like birth.”

The words “Gladi Gladi” don’t have a direct translation—“Glad Glad” only expresses part of their meaning.  “Gladi Gladi” also communicates a sense of uplift, and proclaims their faith and heartfelt gratitude.  One thing that is striking about the women is that they show little bitterness about the horrors they’ve suffered—in fact they are more likely to be cheerful than not.  “The truth is that they are thankful for what they do have and they don’t focus on what they don’t have,” says Friedman.  “They are focused on getting help; they’re not focused on the fact that they’ve had fistula for 40 years.  And they have had the faith that over all the years they’ve suffered, that help would come one day.” 

“I know that people have compassion fatigue,” says Gloag. “There’s so many problems, so many television stories, so many disasters every year, that it’s quite hard to think that our cause is hugely different. But I think what makes this different is—it is all unnecessary.  It’s not difficult to fix. And if these women and girls had decent or even semi-decent health care they never would have had this happen to them in the first place.  I find it hard to imagine that there aren’t women in the Western world who wouldn’t want to help somebody avoid this horrible disorder.”

Gloag continues: “My message to women is:  it could be you.  You are just blessed that you live in a country where you were able to get the right kind of medical assistance.  Some of these girls are only 13 or 14 years old, but if we weren’t there to do the surgery, their lives would be over.  They’re kids!  And we can give them their lives back. “