A new HBO documentary exposes the harm caused by unqualified aid workers in Uganda, but its attempts to complicate the narrative ultimately fall flat.
Still from Savior Complex. HBO © 2023.
Halfway through the second episode of Savior Complex, a new documentary by HBO and Latchkey Films, a child has a seizure in a Ugandan clinic. Standing over the bed, a local nurse recommends diazepam to stop the convulsions. Her white employer disagrees, arguing for a dose of steroids or an epinephrine injection. The scene plays out like a medical drama, but there’s a dark twist. By this point, we know that the employer was operating with no medical license and with no medical training of her own. In the wrong dosage or the wrong circumstances, either of her suggestions could have caused serious and lasting harm.
This kind of malpractice is a running theme in Savior Complex, which tells the story of the Christian nonprofit Serving His Children and its controversial director Renee Bach. Between 2009 and 2019, Serving His Children operated a private facility in southeastern Uganda dedicated to treating child malnutrition. Bach acted as the facility’s director and publicist, but her critics claim that she also overruled the opinions of medical professionals and carried out dangerous procedures herself. In January 2019, the Ugandan human rights lawyer Primah Kwagala sued Bach over the deaths of two infants. The case was eventually settled out of court, but controversies about the facility’s standard of care persisted. According to Serving His Children’s own records, 105 children died at the facility over the course of its operation.
Savior Complex uses archive footage to investigate the claims against Bach, and what it finds is often extraordinary. In 2019, the case against Bach had relied on eyewitness testimony from former employees and Bach’s own blog. An independent investigation by the Uganda Medical and Dental Practitioners Council in the same year found no evidence that she treated children directly. Savior Complex, by contrast, shows Bach questioning diagnoses, instructing medical staff, and even inserting IV drips with a stethoscope around her neck. In one scene, Bach is shown discussing a child’s condition with a Ugandan doctor. When the doctor identifies ascites, a symptom of cirrhosis that requires careful treatment, Bach assumes that the term is simply the local name for the disease.
Detailed interviews also give Bach the opportunity to incriminate herself. At one point, she claims that she was not responsible for a failed blood transfusion in 2011 that resulted in the permanent scarring of the patient. She claims that she had no way of knowing about the child’s secondary infection and that the facility’s head nurse was present during the procedure. The interviewers, to their credit, point out that this conflicts directly with the head nurse’s testimony. They also uncover a medical report correctly identifying the secondary infection, which Bach had evidently ignored. In a moment that borders on comic relief, the interviewers ask Bach to respond to the idea that her work in Uganda was a form of neocolonialism. Struggling to pronounce the word, she admits that she’s never heard it before.
However, Savior Complex also tries to complicate the case against Bach. “People on the internet love stories that are black and white”, director Jackie Jesko told The New York Times in September, “[but] everything has shades of grey.” Much of the nuance in the documentary comes from its treatment of No White Saviors, the social media advocacy group that played a key role in fundraising for the suit against Bach in 2019. The campaigners are certainly a fair target. In 2019, their articles on Serving His Children were characterized by unverified rumors and published photographs of victims without parental consent. After a dispute with Kwagala, the group also claims to have bribed Ugandan police to encourage them to investigate Bach for homicide. In 2022, the campaign’s American co-founder Kelsey Nielsen quit after accusations of bullying and racism toward Ugandan staff members.
It’s here that the narrative starts to fall flat. In comparison to Bach’s medical malpractice, Nielsen’s self-aggrandizing activism comes across as relatively trivial. Yet Savior Complex insists on drawing comparisons between the two, emphasizing conflicts within the No White Saviors and the role of exploitative social media posts on both sides. This often comes at the expense of more obvious protagonists. Nielsen is introduced three minutes into the documentary and features throughout, but the mothers of deceased children only appear in the third and final episode. At times, the framing of the documentary also lends weight to Bach’s own perspectives. In one interview, Bach accuses Nielsen of harming Ugandan children by contributing to the closure of the malnutrition facility. Bad aid, she believes, may still be better than no aid at all.
This is a theme which runs through the documentary. In the second episode, Bach’s mother cites an academic study from 2013 investigating the standard of care at the Mwanamugimu Nutrition Unit at Uganda’s Mulago Hospital. The mortality rate for children in the study was 14%, while the same rate for the Serving His Children facility over its ten years of operation was only 11%. Savior Complex takes this claim at face value. The scene marks a turning point in the narrative, beginning a long investigation of underfunding and understaffing in Ugandan healthcare and interviewing Mulago staff. In the weeks since the documentary was released, Bach’s defenders have made frequent references to these two rates as evidence that she provided better care than would otherwise have been possible.
In reality, however, the comparison is deeply unfair. As the 2013 study makes clear, the Mwanamugimu Nutrition Unit is Uganda’s leading facility for the treatment of Severe Acute Malnutrition, and most cases in the study were complicated by a secondary infection. Of the 119 children featured, 97 had oral thrush and 112 had a fever , both of which correlated significantly with the risk of death. Serving His Children, by contrast, claims to have turned away children with secondary infections and encouraged them to seek professional medical assistance. Savior Complex also ignores the fact that Bach’s facility also had a significantly higher mortality rate than the Mwanamugimu Nutrition Unit between 2009 and 2012, with mortality ranging from 18%-20%. At that point, Serving His Children was operating without a license or a single qualified doctor on staff.
Medical professionals also disagree with Bach’s argument that poorly delivered care is better than no care at all. In a 2019 interview with NPR’s Goats and Soda, UNICEF malnutrition specialist Saul Guererro points out that malnutrition care requires extremely careful treatment. Even putting a child on an IV drip carries a significant risk of death in the wrong circumstances. Savior Complex shows footage of Bach administering IVs and suggesting medications but doesn’t seem to be aware of just how dangerous that could be. Instead, it continues to entertain the idea that Serving His Children may still have been better than nothing, ending the series on a weak note with a suggestion that aid work needs more accountability in the years to come.
Savior Complex sets out to tell a complicated story and fails to recognize that it’s telling a simple one. In its attempts to create narrative tension and balance, it underplays its most impressive discoveries and leaves some of Bach’s most significant claims unchecked. While the documentary begins to investigate the wider culture of white saviorism that made Serving His Children possible, a lack of medical and political context ends up lending weight to paternalist ideas about humanitarian aid in Uganda.
Like Bach herself, Savior Complex ultimately has trouble distinguishing the symptoms from the disease.
