When documentary filmmaker Kief Davidson was looking for crew members to accompany him to Rwanda and Sudan in February 2012, he warned them up front there was a good chance they might see a child die.
Davidson would be following eight children with rheumatic heart disease from Rwanda to a state-of-the-art hospital just outside Khartoum, the capital of Sudan, for high-risk surgery.
"Open Heart," which has been nominated for an Academy Award in the short documentary category and will be seen on HBO later this year, features Angelique Tuyishimere, a petite, bright-eyed six-year-old daughter of a Rwandan farmer who spent two years in and out of hospitals, her father falling deeper and deeper into debt paying for food, transportation, treatment, and time away from his crops. Another one of the children is Marie Claver, age 17, sick for close to 10 years, her father never far from her side; she's undergone numerous treatments and by early 2012 she had a hole in her aortic valve.
"We made the film because we were outraged by the situation," Davidson told ABC News. He worked with co-producer Cori Shepherd Stern. "Rheumatic heart disease is such a preventable disease, antibiotics are so cheap, and we wanted to bring attention to it. There's so much attention on AIDS and tuberculosis and malaria [in Africa], but very little on rheumatic heart disease."
Before 1960, it was a leading cause of death for children in the U.S. It begins with strep throat, which can lead to rheumatic fever if untreated, causing permanent damage to the heart valves and muscle. Today, with antibiotics, the disease is rare in children in the West, but according to the World Health Organization, 18 million people in Africa are affected by rheumatic fever or heart disease, two thirds between the ages of 5 and 15.
"I was 100 percent convinced that one of these children was going to die," said Davidson, who has a five-year-old son close to Angelique's age. "I was constantly trying to force myself not to become attached to them."
The Salam Center for Cardiac Surgery, 2,500 miles from Rwanda, began taking patients in 2007. Salam is the continent's only state-of-the-art, free-of-charge cardiac hospital, and the film depicts an immaculate facility, its white, navy and steel the epitome of professionalism, its grounds well-tended and a lush green. Salam is run by Emergency, an Italian-based nonprofit that provides medical care to victims of war, land mines, natural disasters and poverty.
Three quarters of Salam's funding comes from private donors, the remaining 25 percent from the Sudanese government.
Sudan -- with its repressive regime, genocide in Darfur, a bloody civil war and north-south animosity that's defined much of its postcolonial history -- is not a country associated with humanitarian impulses. (In the film, an appearance by the Sudanese president at the hospital warrants a title card: "Omar Hassan al-Bashir, president of Sudan, is wanted by the International Criminal Court for 'crimes against humanity.'") But its central location in Africa, bordering nine countries, and a promise from the government to provide funding and visas and keep politics outside the hospital, has made it work.
With four cardiac surgeons, Salam is set up for 1,500 operations a year; last year there were only 600 because of budget problems. Close to a third of the patients are under 14.
"What we are doing here is a seed, a drop," Dr. Gino Strada, a surgeon at Salam and a founder of Emergency, told ABC News. "But we are very proud to establish this drop." Talk to Strada for more than five minutes, and he passionately speaks out about the lack of penicillin available to the people he treats -- "a scandal" -- and how free access to good health care is a basic human right.
Strada has performed surgery in many of the world's hot spots -- Afghanistan, Iraq, Cambodia, former Yugoslavia, Sierra Leone. While Angelique and the other children from Rwanda were referred by one Rwandan doctor -- Dr. Emmanuel Rusingiza, the country's only public cardiologist -- there are "people who arrive at the door of the hospital, as an outpatient. Two hours later they're in the ICU, four hours later on the operating table."
Strada first sees the children he'll operate on in the OR. "I don't like too much to interact with the patients before. It's emotionally too challenging. It's not easy to go play with a kid -- 'How are you? Tomorrow I'm going to stop your heart and hopefully it will start again,'" he said, exhibiting a bit of gallows humor that has undoubtedly served him well as a war surgeon.
The film is moving, lingering over the relationships between daughters and fathers -- "They were the ones that were able to go to the hospital with their children, the mothers were home taking care of the other children," said Davidson. When the camera follows Angelique into the operating room, the scene is nothing if not tense. "My God, the heart is coming out of the chest," says Strada. "I don't even know if it makes sense to try a repair."
Yet he does repair it, and Angelique survives, as do the other seven, although Marie needs another operation and cannot return home with the group.
"After the surgery, all of a sudden I started to see their personalities emerge," said Davidson. In one scene at the lunch table, Angelique, who had been very lethargic before the operation, teases her peers and the filmmakers. "Angelique has a great sense of humor. She was always really curious. Everyone forgot about us, or were bored with us. Angelique liked having us around. She turned into an energetic, fun, sweet girl."
Returning home presents its own challenges. Many of the children will be on medication for the rest of their lives, and "local" health care is often hours away. But now, a year later, the children featured in "Open Heart" are doing well, according to Davidson. The doctors -- Rusingiza and Strada -- will be traveling to Los Angeles for the Academy Awards. And, if passport and visa issues are resolved, so too will Angelique and her dad.