The healthcare experience varies widely across the U.S., but few places feel the challenges around cost, quality and access to care as acutely as residents of rural America. Geographically removed from most major hospital centers and regional health systems, these individuals are often left to face an unforgiving, complex and expensive system on their own.

For filmmaker Ramin Bahrani, the healthcare-related pressures experienced by people living in rural Appalachia were more than just the basis for his short documentary film, If Dreams Were Lightning: Rural Healthcare Crisis. They reminded him of the stories he heard from his father, who started his medical career as a doctor in rural Iran before moving to the U.S.

Amazingly, his father’s experiences treating impoverished patient populations, many of whom had never received modern medical care on a consistent basis, is not one that aged out decades ago.

The protagonists of the 25-minute film are Dr. Teresa Owens Tyson and Dr. Paula Hill-Collins. They operate the Health Wagon, a free mobile clinic established in 1980 to service residents of Appalachia.

“When I came across these two women in Appalachia and their Health Wagon, I thought it was a modern American version of that same story of my father,” Bahrani says.

Throughout the film — the title references a line from John Prine’s “Angel From Montgomery” — Bahrani documents the lives of uninsured patients treated by Tyson and Hill-Collins. As Bahrani notes, the decay of reliable information and mistrust of medical institutions is not an abstract problem. It can, and does, have adverse downstream effects.

Take, for example, the story of a single mother and daughter who struggle so severely to make ends meet for their diabetic care that they consult a hypnotist who lifts people off the ground with his fingers. Then there’s the Vietnam War vet repeatedly told by the Veterans Administration that his bothersome symptoms were nothing to worry about, only to learn later that he had a highly aggressive form of prostate cancer. 

The film’s most moving narrative centers around Danny and Melanie, a couple that worked full-time and enjoyed health coverage until a series of strokes left Melanie bedridden. Danny had to leave his job to care for her, with the Health Wagon visiting to administer treatment.

After the film wrapped, their narrative took a tragic turn. Bahrani characterizes it as “overwhelming” but necessary to mention.

For Bahrani, If Dreams Were Lightning is a narrative of many layers, including the resilience of patients and the selfless nature of community support. However, he believes one of its most important themes is the darkly ironic nature of the American healthcare system — and that people living in the richest country in the world are not able to access needed treatment.

One scene towards the end of the film documents a remote area medical event, where hundreds of people wait in line for hours to be seen by Health Wagon staffers. Bahrani notes that these events were originally created by international aid groups to assist people living in jungle communities in South and Central America, but that they have also been utilized in locations like Appalachia.

“That’s kind of sobering and startling,” he says. “It’s a point echoed by the two doctors who say it’s a ‘third-world country.’ Whether or not that’s the right terminology, the point they’re making is true: These people in America don’t have basic care.”

If Dreams Were Lightning has been screened at several festivals and will make its debut on PBS Wednesday night. Bahrani is understandably honored that the Academy of Motion Picture Arts and Sciences shortlisted it in the Documentary Short category, and hopes the attention will boost his message of expanding access to care.

Throughout the film, Bahrani asks patients what their dreams are, eliciting often melancholic responses that paint a bleak picture of the American healthcare system.

When asked the same question, Bahrani had a direct response.

“It’s universal healthcare, plain and simple. No surprise there, it’s universal healthcare,” he says.