Sandra Alvarez has spent her career directing and producing a wide spectrum of documentary and television programs for CNN, Netflix, Sundance Channel, History Channel, BBC America, A&E Network, and Discovery Channel. Her previous work includes serving as one of the directors of the Netflix original documentary series “Hot Girls Wanted: Turned On,” which premiered at the Sundance Film Festival in 2017. She served as a producer on CNN’s documentary series “The Nineties” and “The History of Comedy.”
“InHospitable” starts screening at the 2021 DOC NYC Film Festival on November 13. The fest runs from November 10-28.
W&H: Describe the film for us in your own words.
SA: This film answers the question that every American has been asking: Why are our healthcare costs so incredibly high — especially compared to other wealthy nations? “InHospitable” dives into this question by illuminating how hospitals in the U.S. have become a big business, and how we the patients, hospital workers, and surrounding communities are collateral damage.
In order to humanize this complex topic, we went to Pittsburgh, PA, and followed patients-turned-activists, advocates, healthcare workers, and elected officials as they stood up to UPMC [University of Pittsburgh Medical Center], a billion-dollar nonprofit hospital that was limiting their access and making healthcare unaffordable for hundreds of thousands of patients throughout Pennsylvania.
W&H: What drew you to this story?
SA: I knew that in order to tell a story about the effects of hospital consolidation, I would need to find a story that would make the viewers really connect with the subject matter. Hospital consolidation may not be one of the sexiest topics, but it impacts every single one of us when it comes to the cost and quality of our healthcare. It’s a life or death issue, but most people don’t know about the large impact of hospitals on our incredibly broken healthcare system.
I was very intrigued when I found out that PA Attorney General Josh Shapiro was suing healthcare giant UPMC, the largest non-governmental employer in the state, in February of 2019. It is historically very difficult for elected officials to stand up to hospitals, due to their incredible power in their communities. In many areas in the country, they are the largest employers in the region, and the hospital lobby is one of the most powerful lobbying organizations in the country.
Aside from that, most people have very warm feelings towards their local hospital, especially their doctors and nurses. When I started digging into AG Shapiro’s lawsuit, I learned UPMC had recently announced their decision to shut out hundreds of thousands of Highmark-insured patients from accessing their facilities. This was a result of a decades-long corporate feud with Highmark and many in the community believed that UPMC’s decision to cut them out was based on their desire for more market power. The AG’s lawsuit had been the result of a grassroots effort in which patients, hospital workers, and healthcare advocates were organizing and speaking out to the news, local elected officials, and anyone who would listen.
Many of these patients were in the middle of chemo and risked losing their cancer doctors. Their story was so heart-wrenching, but also empowering. They didn’t just roll over and let Goliath win — they fought back. I knew that this story was the perfect example of the collateral damage of the big business decisions hospitals executives were making.
W&H: What do you want people to think about after they watch the film?
SA: I want people to be angry. I want them to be as angry as I was while I was filming with the patients who were all very sick, and fighting for their healthcare. I was there when Beth was in the middle of very intense chemo treatment, and at the same time marching alongside healthcare workers and fighting her way into a UPMC board meeting just to be heard. I was there with Evie as she walked down the halls of the State Capitol in Harrisburg with her cane, knocking on the door of her state representatives while having to take many breaks just to catch her breath. I was on the plane with Maurice and his wife Vicki, after he was given a diagnosis of six months to live. He was forced to travel back and forth from Pittsburgh to Atlanta to get treatment because UPMC wouldn’t accept his insurance.
Maybe the most infuriating thing is that UPMC, along with most of the wealthy hospitals in this country, are technically nonprofit institutions. Meaning: They don’t pay taxes in exchange for providing benefits to the community. Beth, Evie, and Maurice were all taxpayers who had good insurance, and felt that they were being denied treatment at UPMC because its executives were more interested in market power than actually helping the residents of the community it was purportedly helping. Many hospitals all over the country have become near-monopolies and have incredible power over the community’s healthcare costs and access.
W&H: What was the biggest challenge in making the film?
SA: One the biggest challenges in making the film was how to balance the bigger picture story of what was happening with hospitals all over the country, with the personal emotional story in Pittsburgh. Our editor and producer, Stacy Goldate, and myself spent countless hours arranging and re-arranging our “pink” cards and our “yellow” cards — pink was for bigger picture, yellow was for personal. It was such a struggle to find that perfect balance where we were providing just the right amount of information, without losing the real heart of the film.
Of course, when we started leaning too much on the personal story in Pittsburgh, we started to lose the larger context — and really the goal of the film — which was that this isn’t just happening in Pittsburgh, it’s happening in our own backyards. In our test screenings, we found that there were always going to be “pink card” viewers and “yellow card” viewers — those who preferred one type of narrative over the other. After much, much re-structuring, we feel good about the balance we ended up with and think that the pinks and yellows will both have an enjoyable viewing experience. But it wasn’t easy!
W&H: How did you get your film funded? Share some insights into how you got the film made.
SA: The film was independently funded, without any studio/distributor financing. We also didn’t need to do any crowdsourced fundraising.
W&H: What inspired you to become a filmmaker?
SA: I remember the first piece I produced. I was about 10 years old and I interviewed my grandmother about what it was like to be a Cuban immigrant living in Miami. I remember wanting to document her experience so that my friends could see life through her eyes.
I have always felt that way about real stories, and their incredible power to cut through all of those surface-level belief systems and get to the heart of what it is to be human. It’s a cliché, but in my experience, authentic storytelling has an amazing way of bringing us together.
W&H: What’s the best and worst advice you’ve received?
SA: I’m always terrible at a “best” and “worst” list, but I can definitely tell you one of the things I am constantly thinking about when I am directing. It came from Errol Morris: “Consciousness is a reenactment of the world inside of our skulls. And the task is how to get back to the world from that reenactment inside of our skulls.” This advice is in reference to the criticism he received early in his career about using reenactments in his documentary films — of course, reenactment has become so standard it’s interesting that someone would question it.
What I like about his statement is the idea that there are no universal truths when it comes to documentary filmmaking. We are already making up our own version of the story we are experiencing in real time, and then we somehow have to take our version of the story and edit it down and present it to viewers who will have their own experience of it. I think it’s important to constantly remind ourselves of this fact that there are many different “truths,” so that we can be very intentional about our decisions when we pick a story, point the camera, and edit a scene.
An example of bad advice is this idea of creating a template or outline for a shoot, and then sticking to it to ensure that you “covered your bases” and/or that you didn’t waste time and money on a production. Early in my career it took me a while to become confident enough to just be able to go out on a production and cover the unfolding story in the moment, instead of the content that I had planned to film.
W&H: What advice do you have for other women directors?
SA: This is a hard one because I can think of so much advice I have for directors in general, but if I have to specifically think of advice I would give just to female directors, it would be: find your people. Find a group of filmmakers who can support each other in any way that makes sense to you — whether it’s a monthly in-person check-in, or an email list where you can recommend crew and locations, or a Facebook group where you can navigate tricky issues you are facing in the industry, or all of the above!
Three friends and colleagues of mine and I created a group called Womxn in Documentary Filmmaking eight years ago. We have an email list and a Facebook group, and it’s extremely supportive and collaborative. If any womxn or non-binary doc filmmakers would like to join, they can contact me through my website.
W&H: Name your favorite woman-directed film and why.
SA: My favorite woman-directed film is “The Rider” (2017) by Chloé Zhao. As a documentary filmmaker, I am constantly thinking about how to include my films’ participants so that they feel as though they have agency in the story that is being told about them. It’s a difficult line to ride because if they become too involved in the filmmaking process it could lead to some tricky moral and ethical issues. I was so inspired by Zhao’s representation of Brady Jandreau’s story.
If you haven’t seen the film, it’s a hybrid about the real-life story of an indigenous bronco-rider with a brain injury named Brady. Jandreau himself also plays the main character in the film. Most of the cast is comprised of Jandreau’s real friends and family. What I loved about this film is that since it’s technically scripted, they were able to put aside all of the typical limitations of a documentary when it comes to the “subject.” As an actor in a movie about his own life, Jandreau was able to have an enormous amount of agency [in the telling of] his story. In a lot of ways, the outcome felt so much more authentic and realistic than many documentaries I have watched. Plus, the cinematography was absolutely gorgeous.
W&H: How are you adjusting to life during the COVID-19 pandemic? Are you keeping creative, and if so, how?
SA: It’s great to be able to be at home with my six-month-old and two-and-a-half-year-old, but of course that comes with it’s own challenges. I am currently working on a branded content project for a multi-media platform that creates content for children to teach them yoga, meditation, and emotional regulation, so that has been really fun and rewarding — and it pays the bills!
W&H: The film industry has a long history of underrepresenting people of color onscreen and behind the scenes and reinforcing — and creating — negative stereotypes. What actions do you think need to be taken to make the doc world more inclusive?
SA: I think the problem with industry gatekeepers is absolutely a real one. One of the issues is just the simple act of trying to get stories about underrepresented people past that bottleneck. It’s such a struggle to convince the (mostly white male) gatekeepers that the film is interesting to a larger audience, and not just to what they consider a niche audience. The second issue, which is probably more difficult but also one of the solutions, is getting underrepresented folks into those positions of power. Inevitably they will be able to see the value in other underrepresented stories and the proverbial floodgates could be opened.
It’s always going to be more difficult, especially in an industry that has a “scarcity” mentality, where the idea is that there isn’t enough room at the table for everyone. I don’t know the answer to how exactly we can get these folks into these gatekeeper positions, but I think groups like Brown Girls Doc Mafia have helped push these issues into the forefront, and have started to call out a lot of the bad behavior.
