Transcripts For WHUT Worldfocus 20100323 : vimarsana.com

tonight on worldfocus. on this special edition of worldfocus, we look at health care challenges around the world. from the battle against cervical cancer in nicaragua to helping more women survive childbirth in guatemala. we ll also look at the struggle to get even the most basic health care in africa. and a disease largely eradicated in the western world, tuberculosis, still takes a heavy toll in india. from the different perspectives of reporters and analysts from around the globe, this is worldfocus. major support has been provided by rosalind p. walter and the peter g. peterson foundation, dedicated to promoting fiscal responsibility and addressing key economic challenges facing america s future. and additional funding is provided by the following supporters good evening. i m martin savidge. thank you for joining us. as health care overhaul becomes a reality in the united states, we continue our look this week at health care around the world. last night we reported on the experience of other developed countries that provide coverage to most or all of their citizens. tonight we re going to take a look at the developing world where for many people finding even basic health care is often a struggle. we begin in central america in nicaragua and the battle against cervical cancer. unlike the united states where early detection has cut the death rate substantially, nicaragua has one of the highest rates of cervical cancer in the region. worldfocus special correspondent lynn sherr traveled there. and looked at the job of reversing that trend. reporter: coffee has transformed the life of fatima ismael. translator: for women here, coffee is our life. reporter: she is general manager of the soppexcca coffee mountain community several hours from managua whose fine beans and brisk production have made it the coffee capital of the country. and now coffee, its number one source of income, has also become the source of an innovative health program aimed at one of this nation s worse problems. cervical cancer is the number one cancer killer of women in latin america. here in nicaragua, more than 800 cases are diagnosed each year. 354 women die. that s almost one every single day. we know what it s caused by. we know how to prevent it. we know how to cure it. if we can catch it early enough. reporter: that s why august burns has set up shop for the next week at the local health clinic here in jinotega to screen female members of the local coffee co-op, many of whom have never before had a medical examination. her vermont-based nonprofit grounds for health grew out of an american coffee buyers concern over the health of his female suppliers. 12 years later burns and her volunteers have seen some 15,000 women in three coffee-producing countries, saving lives along the way. she was lured more like commanded to nicaragua after fatima was diagnosed with cervical cancer five years ago. translator: i made the mistake of bringing my 8-year-old son with me to get my results. to get that news with my so he was so small and he was my only support. reporter: it s a very emotional thing for you to talk about. translator: yes, it s very emotional. but it s also the push that keeps me going in my fight for women s health. reporter: fatima found august at a coffee convention. and she came to me. she looked straight at me. and she said, i want you to bring your program to my community. she was absolutely clear that this is something that needed to happ translator: and from the very first moment we laid eyes on each other, i knew i had found another woman who was committed to the fight against cancer. reporter: burns and her volunteers bring equipment and medical expertise. the coffee companies, through local cooperatives, provide financial support like transportation. last month these coffee workers traveled three hours for their exams. 500 would be seen in the five-day period. are you nervous about your test? translator: i am nervous. reporter: teresa picks coffee and hasn t been tested in seven years because she can t afford it. margarita spinosa, 29, who works here at soppexcca, has come here for her second annual exam. this year she goes through the same low-cost, surprisingly effective, and very simple procedure. her cervix is washed with a vinegar solution. then the provider, here an american vunteer physician, does a visual inspection. it s called v.i.a. if a lesion is spotted it can be frozen and tested cryogenically on the spot. every woman also gets a pap smear, the gold standard for the developed world. the difference here, cells are rushed to the lab down the next corridor, stained and fixed and scanned under a microscope within ten minutes. the whole process, known as screen and treat, is relatively new. perfect for developing countries like nicaragua where expansive technology for pap smears is not available. it s very different, but it s adequate. what we have is adequate for screening. and that is a table, a health professional, whether that be a physician or a nurse, speculums, something to take a pap and cotton and vinegar to do a v.i.a. reporter: and that s all you need? and ganis, animal spirit, yes. reporter: it s not just a band-aid. the volunteers train their local counterparts so when they leave the country, the second poorest in the western hemisphere, some of the rest of the 200,000 women in this region will also have a chance to be screened. although grounds for health volunteers can only screen and treat a fraction of the women who need it fatima ismael says giving women priority for the first time improves more than their bodies. translator: if we can detect 5%, 10% or 15% of women with cancer, those are lives that we re saving. women s roles are being transformed. we used to be only producers or housewives. we were invisible. now we re presidents of cooperatives and we have a brand of coffee that s sold all around the world. we re reaching new levels. we re going to stay in central america for our next story. it s about maternal health, saving mothers during child birth. it s hardly something we think of as a serious medical problem in this country where 1 of every 4800 women giving birth dies. but in poor countries like guatemala the problem is dramatically worse. worldfocus special correspondent lynn sherr also traveled to guatemala to take a look at this issue. reporter: her daughter s little lungs are just 24 hours old, but this new mom knows she is one of the lucky ones. she gave birth here at a maternity hospital here in guatemala city with a trained physician. relatively few such facilities are used by pregnant women throughout guatemala, where more women die during childbirth than in almost any other country in latin america. translator: for our country compared to the rest of latin america, it is a pretty grave problem. reporter: dr. lisandro moran of the health ministry acknowledges the injustice at a time of increasing global medical progress. translator: the vast majority of these deaths could be prevented. so that means these women are dying unjustly. this is not just a health problem. it s a social problem. reporter: in this dirt-poor nation of 12 million, most women deliver at home, far from skilled medical care should a problem arise. the number of women who die of complications during pregnancy or delivery is 20 times those who die in the developed world. the numbers are even grimmer in remote mountain communities like this. huehuetenango five hours by call from guatemala city. for rural women and indigenous women whose roots trace back to ancient mayan times, maternal mortality is at least double, sometimes three or four times the national average. and this was your wife? last may, juana jimenez, 41, died just of after giving birth to her eighth child in the tin-roofed, plastic-walled hut she shared with her eight children and her husband luis morales domingo. a farm worker. translator: i met her. i liked her. and i made her fall in love with me. i took good care of her all her life. and sadly, she has died now. reporter: juana never saw a doctor during her ninth and last pregnancy. by the time luis got her to the nearest village, more than an hour away by foot and by car, she had bled to death. he says only god knows if she would have lived had she made it to a hospital. this casa materna, for example, is near to the hospital for ms. van dyke of the population council, one solution is a house for expectant moms who arrive from distant t before their due dates so they can immediately get to the hospital when the time comes. population council, an american nonprofit promoting global reproductive health has been studying the success of this casa materna in huehuetenango which has served women since it opened. although part of the government s social services network, most of its financial support is private. women who cannot afford even a modest fee less than a dollar are not charged. maria traveled three hours to casa materna because she had three miscarriages. a fourth baby died after just three days. now in her fifth pregnancy, she doesn t want to lose her child or her life. she is an example of a woman who understands there is a problem and comes here early. reporter: dr. marta julia ruiz runs the population council program in guatemala and has spent her life fighting to improve the lives of indigenous women. she is a medical doctor and indigenous mayan herself. one of eight children, she says her mother s life, including two miscarriages and two stillborns, might have been vastly improved with the benefits of casa materna. translator: i think her situation would have been very different if she had access to these services. the deaths might have been avoided. reporter: dr. ruiz says education is an equally important part of the program. in this predominantly catholic and very traditional country, birth control is rarely used. she says giving women like these unmarried teenagers information about family planning is vital so they can determine their own reproductive futures. it s also about teaching them to make decisions for themselves. many guatemalan women still must ask permission from their husbands or their mother-in-law to leave the house or go to the hospital. much of this is about giving women power, empowering women? translator: definitely. so an important part is for her to be equipped with information so she can make decisions about her own health. reporter: by all accounts, the program is working. this 28-year-old woman came to casa materna on her own seven years ago after her first baby was stillborn. you came to casa materna because you wanted to be sure that your next baby would survive? si. reporter: jose is charming proof along with his brother juan carlos and a 4-year-old sister back home. all came into the world after their mom stayed at casa materna. today there are only two such facilities in the country. advocates say they need many more. the government has made maternal mortality a priority with plans for 20 expanded health centers around the nation, official acknowledgement that only by caring for and giving power to the nation s women will guatemala s future be assured. next we turn to africa to a country that is struggling to provide even the basics of health care. that country is uganda in east africa. worldfocus special correspo seemungal discovered how some uganda medical workers are going to extraordinary lengths to deliver care and how ugandan citizens are going to extraordinary lengths to get it. reporter: there are no signs telling you how to get to lalogi hospital. it s just there off a dirt road, the middle of nowhere, as it were, in northern uganda. but somehow everyone knows where it is and they come by the hundreds, rarely by car, often on foot, mostly on bicycles. they will travel like this for hours. the boy on the back of that bike has malaria. and when they arrive, they will wait for hours. i m not happy sitting here, she says. i came at 8:00 this morning. it s now 1:00. i m worried i m now going to have to wait until after the lunch break. inside, richard yako, one of the medical officers, is trying to keep up. the other medical officer in the only other examination room, is just as busy. it is hot outside, 80 in the shade. but all they can do is wait. the thing is, they don t have much choice. the nearest big town is miles away, another six hours on a bike. walking, unthinkable for a sick person to even consider. so they wait. medical care in uganda is free, which is important, because many of the people who come to this hospital don t even have enough money to buy food, let alone pay for medical care. this woman is here with her two children. if it were a service based on paying, i could not, she says. these children could even die. on the hospital ward the third ugandan health officer has her hands full with patients who have already been admitted. this child here we have admitted him because of severe malaria. came with a history of convulsions and loss of consciousness. so we re giving him treatment. now he s conscious and started eating today. reporter: over in maternity, we do a quick poll to see how far these pregnant women walked to come for their antenatal class. an hour? just a few raise their hands. three hours or more? just about everyone. and they still have to walk back home again. you ve probably noticed that we haven t used the term doctor yet, because there are no ugandan doctors at this hospital. jane and richard, as we ve told you, are health officers. which means they ve had basic medical training, but they re not doctors. even if they re doing the work a doctor would do. and by western standards, their salary is incredibly low. about $100 a month. something like that. reporter: now you can understand why there are no ugandan doctors around. it may look like a pretty grim situation. ral uganda, lalogi is one of the better ones because it s getting some outside help. msf, doctors without borders, is here. they arrived three years ago when this entire area was under siege by rebels, providing a couple of doctors, sometim nurses and recently a midwife. samantha perkins is on call 24/7. this call is serious. a newborn minutes old struggling to breathe. you can see from baby s color that baby is working very hard on breathing so the oxygen that supplies around the baby s circulation is very, very low. reporter: there is no oxygen at lalogi, so the newborn will be taken to another hospital in this four-wheel drive. the trip will last 90 minutes. the baby will get the oxygen it needs. and we hear later that it survives. the msf staff here say they re overwhelmed by the dedication of the ugandan health staff. people who work long hours for little money, sometimes even volunteering, working for free. and this is the situatn despite all the outside help. a year from now, things will be different. that rebel group is gone, so msf says it will be leaving, moving on to another emergency. will the people in this district have a hospital a year down the road? probably. the ministry of health is determined to keep things going. but the people will still have to travel enormous distances to get here. and for sure, the waiting isn t going to get any easier. for worldfocus, i m martin seemungal in northern uganda. finally tonight, another global health issue that often gets overlooked. that is tuberculosis, a disease that the centers for disease control tells us infects more than 2 billion people around the world each year and kills 2 million. as we hear now from independent producer lorin rudzer, mumbai india is confronting an epidemic of drug-resistant tb and has few ways to fight it. reporter: mumbai pulses with life. 14 million people call this tightly packed urban center home. the city s dense population and poor sanitation provide the perfect breeding grounds for the spread of tuberculosis. tb is by far the biggest health care problem. reporter: this doctor is a chest specialist in mumbai. many of the tb patients he sees during his weekly two-hour free clinic have a hard-to-cure form of the disease. one of his patients is 19-year-old rohan gola. resistant to all the first-line drugs, quite a few of the second-line drugs. you follow? so it s a nasty strain of tb, okay? in fact, an xdr strain. reporter: xdr-tb is a mutated strain of tb that takes one to two years of painful, nauseating and expensive chemotherapy to cure. rohan was diagnosed with xdr-tb six months before this visit. we initially gave him the drugs. his smear went from positive to negative and at the right time it maximizes their chance of cure. reporter: 16 days ago he had half his left lung removed. nasty scar from one end of the lung to the other as you see. reporter: doctors hope the risky operation will increase his chance of being cured. rohan shares a one-room apartment with seven family members. he explains how xdr-tb has affected his life. everything has changed. i feel breathless. i cannot play. i used to play cricket. i cannot play. i cannot walk like a normal person. i cannot run. reporter: before he got sick, rohan was studying computer sciences in college. he was expected to save his family from financial ruin. tb changed everything. my college. i lost it all the way. i feel totally hopeless. i used to always lie down 24/7. i found somewhere myself lagging behind, behind, behind, in this competitive world. reporter: rohan s mother s job as a house cleaner is the family s only income. she makes roughly 2,500 rupees or $50 a month. rohan s monthly medical expenses are more than three times that, costing about 8,000 rupees or $160. this is a drug for tb. cyclocevin. this is too expensive. 260 rupees. reporter: 260 rupees? 260 rupees. reporter: for how many? for three days. reporter: for three days? yes. financially it s been really difficult. reporter: at the heart of mumbai sits dharavi, one of the world s largest slums with nearly a million people living in less than one square mile. 18-year-old dharavi resident samina banoo recently found out she has drug-resistant tuberculosis and like rohan affording the treatment is her biggest obstacle to recovery. her family had to scrimp to get enough money to pay for the diagnostic test. paying for all the medications and her chemotherapy cocktail will be nearly impossible. her next treatment is expected to cost 5,000 rupees, or $100. we have never have enough money to spend on the medicines. reporter: this doctor is her family doctor in dharavi. not only one patient. there are so many other patients with this diagnosis. and they are going to die without getting the proper line of treatment. reporter: experts like dr. shingan are quick to say that since the poorest in mumbai are often the hardest hit by this disease, the government needs to do more. currently, they only offer treatment for regular drug susceptible tb through hundreds of d.o.t. s or direct observe treatment centers. at this center there are a total of 118 patients. reporter: but according to researchers, the d.a.t. s program could be a soue for treating drug-resistant tb. contrary to what it says on the television, it s hard to get a patient to complete their entire d.o.t. therapy because there are a lot of side effects even in the first-line drugs. reporter: when patients stop and start their tb drugs or don t complete their treatment, the tuberculosis bacterium become more and more resistant. there is a d.o.t. s plus program in the works aimed at providing treatment to drug-resistant patients but it s not yet started in mumbai. this doctor works for the city of mumbai as an executive health officer for the tuberculosis control society. the city of mumbai has been slow to react to this growing public health concern because no one knows the actual size of the city s resistant population. without a public facility where resistant strains of tuberculosis can be diagnosed r free, people are left to pay the high fees of the private hospital. most patients can t afford the test. not only are an unknown number of infected indians going without treatment, they are putting those around them at risk of catching drug-resistant tuberculosis. xdr s are infecting their work mates. they re infecting people around them. there are no precautions. there s no barrier or nothing in hospitals. and these patients pass it on. so it is an emerging problem. it s going to get worse, not better, over the next decade, unless something major is done. and that is worldfocus for tuesday evening. a reminder that you can find much more news and perspective on our website at worldfocus.org. i m martinew york. as always thank you for joining us. we hope to see you back here tomorrow and any time on the web. until then, good night. captions by vitac www.vitac.com major support for worldfocus has been provided by rosalind p. walter and the peter g. peterson foundation, dedicated to promoting fiscal responsibility and addressing key economic challenges facing america s future. and additional funding is provided by the following supporters