A Film About U.S. Health Inequities Screens at School of the Arts

On February 22, 2024, the School of the Arts, along with the Division of Narrative Medicine, Columbia Vagelos College of Physicians and Surgeons, and Columbia Global, hosted a screening of the 2023 documentary, If Dreams Were Lightning: The Rural Healthcare Crisis. The 25-minute film documents the trials of several patients in the rural American South, as they seek medical care in the wake of rising insurance costs and rampant hospital closures. The screening preceded a conversation between the film’s writer and director, School of the Arts Film Professor Ramin Bahrani (CC ’96), and University Professor of Epidemiology and Medicine Wafaa El-Sadr, who is also executive vice president of Columbia Global.

School of the Arts Interim Dean and Parr Professor of English and Comparative Literature Sarah Cole gave opening remarks, and said the film is “startlingly effective and also troubling; in its short duration, it will open up whole worlds to many of its viewers.”

Hospital Closures in the Rural South and the Health Wagon

Bahrani, who is Iranian, was raised in North Carolina. Around the time that If Dreams Were Lightning––named after a lyric from John Prine’s “Angel From Montgomery”––was conceived, Bahrani had been reading up on hospital closures. In his childhood, he would often tag along with his father, a physician to whom If Dreams Were Lightning is dedicated, to remote clinics and hospitals across North Carolina and Virginia. When Bahrani came across the Health Wagon in his readings, he decided this topic was worth interrogating in documentary form.

“As hospitals close, communities are left to fend for themselves. For many, mobile clinics provide the only solution,” a screen blurb within the first five minutes of the film reads.

The Health Wagon is a nonprofit organization operating from mobile units in poverty-stricken Central Appalachia. If Dreams Were Lightning features an outpost managed by the buoyant Dr. Teresa Tyson––the organization’s president and CEO––and clinical director, Dr. Paula Hill-Collins, who both wax lyrically on screen about their close friendship. “It helps when there’s two of you there, standing together,” Hill-Collins says in the film. “It keeps you from going so weary.”

Bahrani recounted his first meeting with them: “Other than being inspiring, they’re also funny and captivating, and they’re performers. Their performance is part of how they raise money for what they’re doing. They had this amazing chemistry.” Since the Health Wagon’s founding in 1980 by Sister Bernadette “Bernie” Kenny, it has generated funding and forged a substantial network of patients, some of whom became Bahrani and his crew’s interview subjects.

The nonprofit, which does not bill for its services, is wholly reliant on donations from individuals, foundations, and corporations. The mobile units bear signs encouraging patrons to contribute, which prompted El-Sadr to ask Bahrani how these doctors do not succumb to despair. “Some of it is just how they were raised,” Bahrani replied. “Women in these communities are extremely strong; they tend to run a lot of things.”

Reflecting on how Tyson and Hill-Collins have managed to so effectively connect with their communities, El-Sadr said, “For a physician like myself, it highlights that we maybe forget the art of medicine versus the science of medicine.”

The Debilitating Nature of Health Insurance Costs

In one scene of the documentary, a man clad in all camouflage sits beside a woman in a bed, tucked beneath a colorful, snowflake-patterned blanket. Their background is spare, save for a turquoise-colored wall and a single hanging cross. The couple is introduced as Danny and Melanie Sturgill. Due to exorbitant health insurance prices, Danny has been relegated to the role of caretaker for Melanie, who is bed-bound as the result of five strokes caused by a pituitary tumor. Danny previously had good health insurance through his job as a meter reader, but was forced to retire to take care of his wife.

“We don’t get to do the things of the world: Fishing and camping and going to Dollywood and stuff like that—you know, living,” Danny says, as Melanie smiles beside him. He adds that if he were to have a medical emergency, he would either die or be in utter financial ruin from hospital bills. On screen, Bahrani mentions a fantasy Danny has shared of Melanie getting up and walking again. In response, Danny breathes deeply and starts to weep. “I’d give all I got, and all I’ve ever had, to see that,” he says between sobs.

The camera then pans to another wall in the Sturgill’s house, and a statement on the screen explains that three months after the interview, Danny unexpectedly and brutally murdered Melanie. In the next shot, another statement says: “In prison, Danny will finally have access to what has eluded him––healthcare.”

The American Dream: Healthcare vs. Prevention

One of the more striking aspects of If Dreams Were Lightning is its subjects’ unswerving allegiance to the American dream. One interviewee, Betty Deloris Jones, who has arthritis, diabetes, fibromyalgia, and chronic obstructive pulmonary disease, says, “I hope everybody realizes that we’re blessed to live in this country where we have freedom. A lot of countries don’t have freedom like we do.”

Mack Kiser, another Health Wagon patient interviewed by Bahrani, tearfully recounts his deployment during the Vietnam War. In addition to health complications sustained in the aftermath of the war, Kiser also developed aggressive prostate cancer, an illness detected by Tyson and Hill-Collins and not by Veterans Affairs, where Kiser first sought medical care. “If you walk into a hospital anywhere in the United States, you should be treated free, because it’s the United States, you know? It’s the greatest country on earth. But they don’t take care of their own people,” Kiser said.

The American dream, and how its sentiments prevail in rural communities, was a prominent talking point between El-Sadr and Bahrani. “It takes your breath away, the sense that these people still have faith,” said El-Sadr.

Bahrani and El-Sadr agreed that prevention is nearly impossible in rural America. El-Sadr said that the U.S. prioritizes healthcare over prevention, and that patients are forced to get treatment only when they’re very sick, with very complicated diseases. “Healthcare costs a lot more money than prevention,” she said. “Unfortunately, in this country, we have been seduced by the shiny healthcare system. It costs a lot and doesn’t produce the outcomes we want for the population, especially for these people in this part of the world.”

Optimism and Pessimism

Bahrani places a lot of importance on dreams, both in this film and in his life. “I can only be so moved by an article that tells me statistics; I’m interested in something else,” he said. “When I meet strangers and I talk to them, I often ask them about their dreams as children and their dreams now. It tells me a lot about them, about myself, and what’s going on around me.”

In discussing his documentary process, Bahrani said he pays attention to the facial expressions of those whom he interviews. “You learn not to talk too much,” he said. “You ask a question, and they answer it. I usually won’t say much for a long time. It’s a conscious choice to just let the camera sit there. You’re hoping for something magic to happen that would reveal [the subject’s] soul through their gesture and their look.”

There are several instances in the film that are contained by eerie silence, a doleful gaze from an interview subject. When asked what her dreams are, Betty Deloris Jones claims that she just wishes to be happy, then stares into the camera. Another patient, Linda Sheckles, responds to the same question by saying she doesn’t want to lose her home, after which she looks at the ground and begins to cry softly.

“There’s that expression, they ‘crumbled,’” Bahrani said to El-Sadr. “That was the first time I saw it in my life. It was overwhelming to look at Sheckles.”

After watching If Dreams Were Lightning, it’s easy to feel hopeless. El-Sadr asked Bahrani if, after finishing the film, he felt that way. “I always imagine it’s uphill, but that doesn’t necessarily mean I'm pessimistic,” he said. “I don’t think you can be a filmmaker and be pessimistic––it’s just too damn hard to do it. So, while I may not have romantic ideas about what’s coming at us, I would say I have to be optimistic, or it’d be hard to get out of bed.”

Lisa Cochran is an MFA candidate in fiction at School of the Arts.