Q&A with Rob Tinworth, director of The Life Equation

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Sony Salzman

Sony Salzman is an award winning journalist living in Brooklyn, New York and the co-managing editor of GlobalHealthHub. She has been published in The Boston Globe, Al Jazeera America, The Body, WBUR and NovaNext. You can find her on Twitter, LinkedIn or email her directly at sonysalz@gmail.com.

Q&A with Rob Tinworth, director of The Life Equation

Crecencia and her family in Guatemala. Photo credit: Rob Tinworth

The Life Equation is a documentary about a impossible choices. When José meets Crecencia Buch, a mother of seven with late-stage cervical cancer, he must decide whether he should treat her cancer, which will cost about $10,000, or put that money to use to fund pap smears for thousands of women. Later in the film we meet Dr. Shree Ram Tiwari, a doctor who has stepped up to perform Cesearian sections in at a remote hospital in Nepal. Yet his expertise is expensive, and the hospital must decide whether to invest in one surgeon, potentially sacrificing other services.

Can number-crunching computers help public health workers make these hard choices? Wealthy philanthropists like Bill Gates certainly think so, and are increasingly turning to big data to help make decisions about how to save the most lives when resources are limited. The film explores how to save as many lives as possible without ignoring people like Crecencia.

What inspired The Life Equation?

When I started out, the film was going to answer the question: how do you do healthcare at the greatest extremes? In Nepal, the extreme was that it was geographically remote, and in Guatemala the extreme was that it was culturally remote because cancer is stigmatized.  

But after traveling to Nepal and Guatemala on scouting trips, another question struck me as even more interesting: in a setting where dollars and time are limited, how do you make the most impact? There are two competing models traditionally used to answer that question. One is to treat the patient in front of you, regardless of the cost. The other model is rooted in computer science. It’s the idea of an evidence-based way of directing health care dollars to make the most impact.

Ultimately healthcare is a limited resource, so the right answer lies somewhere between these two extremes.

Is it really possible to “Moneyball” global health?

It’s an impossible question, and that’s exactly why I became so interested in it. I have no good answer to that question, even after all this time. Ultimately, the simplest way of putting that question is José’s dilemma: should we fund Crecencia’s healthcare? I think it is an impossible question. At the end of the day I came away from this film more confused than when I started.

The reality is it has got to be a case by case decision. If you’re a doctor on the ground, you will treat the patient in front of you. If you are a health economist, you will have a different approach.

What was your main takeaway from the film?

The main conflict of the film is a social justice versus utilitarian approach to health care. The reality is which ever approach you take, the results are astonishing. The approach you take is less important than doing the work.

There are not very heroes or victims in the film. Crecencia is a flawed character. The reality is it’s really hard and really complicated to do global health. I do think big data should be an important part of the decision making process, but I don’t think computers can get it all right, and I don’t think they ever will.

What were some memorable moments from the shoot?

One moment that really stands out is that one of the scenes of the film that takes place at the hospital in Nepal. We were there to film women who might need a Cesarean section, and on the day we arrived we met a patient who needed an emergency C-section. It had taken her and her partner six or seven hours to get to the hospital.

When she went into surgery, the lights in the building went out at the critical moment they were pulling the baby out. The doctor passed the baby to me, because the nurses had left to go find the generator.

What is astonishing to me is that it was such a dramatic moment – there was no power, the baby wasn’t crying – but everybody was so calm. Ultimately everything went really smoothly and the baby’s life was saved. That outcome wouldn’t have happened six months ago, and that was an incredible thing to witness firsthand.


The Life Equation is available to rent or buy on Amazon or Vimeo. There is an upcoming screening in Melbourne, Australia on May 25, and you can learn about other upcoming screenings on Facebook.


Health Worker José Federico explains the plan for Crecencia’s upcoming treatment. Photo credit: Rob Tinworth.

Crecencia and her family in Guatemala. Photo credit: Rob Tinworth.

Dr Shree Ram Tiwari at a tea stop to break up the 14 hour jeep ride to his new office – a remote hospital in the far west of Nepal. Photo credit: Rob Tinworth.

The foundations are laid on a new structure at Bayalpata Hospital – a family home to encourage experienced doctors to stay. Photo credit: Rob Tinworth