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Doctors Within Borders

March 27, 2025 by Chus Arrojo Leave a Comment


The portrayal of the doctor-patient relationship in films is rather interesting. When the film is a documentary, such portrayal is also revealing, as is the case with “Fire at Sea,” directed by Gianfranco Rosi in 2016. The documentary is set in Lampedusa, the largest of the Pelagie Islands in the Mediterranean Sea and a crucial landing point for African migrants due to its proximity to the North African coast. The Mediterranean Sea has long served as an escape route for displaced people, and it has also become a graveyard for many of them due to the perils of a sea journey in highly precarious conditions. This is the context for the film. 

It is nighttime, the sky is cloudy, and the sea is dark. Giant radio antennae gyrate as a voice over a speaker says, “Your position” to obtain the boat coordinates. Of course, the question can also serve as an interpellation for the spectator on their position on the issue. Rosi’s camera accompanies members of the Italian Coast Guard as they rescue migrants from the waters near Lampedusa. Some are not just soaked in water but also soaked and burned by fuel. A doctor, Pietro Bartolo, tends to the migrants. Dr. Bartolo’s assessment of the entire situation is summarized in a single sentence: “This makes me so angry that it leaves a hole in my stomach,” which stays with you throughout the film. 

A young boy, Samuele Pucillo, a neighbor of the doctor, undergoes an eye exam. He is diagnosed with a lazy eye and prescribed an eyepatch. A scene shows Samuele making slingshots from sticks he collects and medical rubber bands and then taking them to a local field to shoot projectiles at cactus plants with his friends. He tries to put a mutilated plant back together using tape. But some things cannot be repaired, and some holes cannot be filled. At home, he avidly eats his pasta while the radio talks about the migrant crisis. 

Samuele’s eyepatch is a metaphor for life on the island, where life goes on while the migrant crisis unfolds before everyone’s eyes. With his camera, Rosi captures these two worlds that barely touch, with the doctor serving as the nexus between them. While at the doctor’s, Samuele complains about shortness of breath. Dr. Bartolo diagnoses him with anxiety: “You are a bit tense, you know…” The scene does not carry on with a conversation about it. It feels as though there is no need to discuss it as if an implicit mutual understanding speaks for itself. However, I have often wondered what that conversation would have been like, as I’m sure you do as well.  

Rosi’s documentary, while sparse in words, is rich in imagery. The deliberate portrayal of the two worlds as disconnected serves as a powerful counterpoint, creating a strong connection between them through scenes that are so perfectly aligned that they blur the line between documentary and fiction. The film lingers in your mind, a haunting reminder that some things, no matter how much we try to ignore them, leave an indelible mark.

I wonder what Samuele’s and Dr. Bartolo’s lives have been like since the documentary was filmed. Have they ever talked again about Samuele’s anxiety, discussed the cactus’s holes, the hole in the doctor’s stomach, or the migrant crisis?  My thoughts are with all the children who experience and witness the impact of death by geography, and my gratitude goes out to all the Dr. Bartolos of the world, whether they receive migrants who arrive by sea or through a desert. As I conclude this post, a crucial question arises: “Your position?” 

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About Chus Arrojo

Maria Jesus (Chus) Arrojo, MA, CAGS, LMHC, LMFT, is a Senior Behavioral Health Integration Manager at the Pediatric Physicians' Organization at Children's (PPOC) and the current blog editor for CFHA.
Feel free to share your thoughts on any of the posts and reach out if you would like to write a piece for the blog. Everyone is welcome to contribute!

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