As in so many episodes of Call the Midwife, the theme of this year’s Christmas special is spelled out by Vanessa Redgrave as the older Jenny Lee in the opening voiceover.
“The most precious gifts cost nothing whatsoever,” she says, before an episode that is all about selflessness and thinking of others. Exploring the power behind simply giving what you can to others isn’t something new to this show, but it’s a theme it can explore confidently and one that delivers the expected weight to the emotional moments. And even if this isn’t new ground for the drama, it hasn’t lost its ambition.
This episode makes a significant change by taking place in South Africa, many thousands of miles away from the show’s usual home in Poplar.
This episode sees a large number of the midwives travel to the country to help with the running of the Hope Clinic, a small mission hospital. They’re there to make sure enough care is provided in an area where the need for healthcare is even more desperate than Poplar, especially due to the recent death of a nun and how understaffed the place is. Because of this, the episode doesn’t have much time for Nonnatus House itself and the characters who don’t go on the trip don’t get much of the focus at all.
Viewers hoping for more development in plotlines about Patsy, Delia, or Sister Monica Joan may be disappointed, then, but almost everybody else ends up included. Tom and Fred even go on the journey too, Tom to assess the state of the clinic and Fred to help with the maintenance and running of the place. Sister Julienne, Trixie and Barbara are there, while Shelagh insists on joining Dr Turner as he coordinates a polio vaccination programme for the area.
Unsurprisingly, this is markedly different to other Christmas specials. You may be expecting the typical cosiness and cold weather, but it’s an episode that throws the characters into blistering heat at a struggling hospital where they witness problems they haven’t had to face before.
While it’s not the focus, the episode also doesn’t shy away from the cruelty shown towards black South Africans during the Apartheid-era. The patients at the clinic are disadvantaged black women who feel their worth is determined by their ability to become mothers and raise families.
This is particularly true for Roza (Sivenkosi Gubangxo), one of the women featured most centrally in this instalment. Her experience with a phantom pregnancy is one of the most heartbreaking moments, while we see the characters all relaxing at a “whites only” beach in a moment that subtly reminds us how easy it is for them all to be involved in something so casually discriminatory.
A constant presence of police, who break up a conversation between the midwives and their patients by deeming it an “illegal gathering”, is yet another indication of just how authoritarian the control is at this time. Making changes feels like something that is incredibly difficult, but the episode doesn’t allow us to forget how important and essential progress is.
The clinic is without clean water, and it requires a push from everyone involved to persuade a stubborn landowner to allow water pipes to run across his land, rather than around it, and to get water to the patients who most urgently need it.
Stubbornness ends up being something of a theme throughout. The doctor currently running the clinic, Dr Myra Fitzsimmonds (Sinead Cusack), is resistant to the advice of the newcomers and unable to readily accept their help or change the way she does things. This ends up being all the more important when she realises she feels unwell and Dr Turner is the only one with the expertise to help her. It’s a situation in which she has few options and has to make a leap of faith.
That’s exactly what Sister Julienne, Trixie and Barbara all have to do ultimately too. The episode’s most gripping moment comes when all the doctors are absent from the facility and uncontactable, leaving Trixie with the realisation that she herself will have to perform a Caesarean section to save the life of a mother and her baby. It’s a sequence full of urgency and suspense, but we also know how skilled Trixie is so we that she’s capable of saving lives in this difficult situation.
“Medicine is never about doing what’s easy, it’s about doing what’s essential,” Dr Turner says earlier in the special, and it’s something that holds true in the episode’s climactic moments.
This special pushes Call the Midwife forward towards something new, as its characters deal with unfamiliar challenges and more troubling circumstances than they typically face in London. That’s made clear with each and every circumstance here, whether it’s the lack of availability of reasonable healthcare or the lack of resources to provide it.
The episode is all about the small things, the things that don’t cost anything, and not only how the midwives both bring their knowledge and expertise to a disadvantaged community, but how they go home with more wisdom and insight than they arrived with.
Aired at 8pm on Sunday 25 December 2016 on BBC One.
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