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 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 citiz s citizens. tonight weigh look at the developing world wore for many people finding even the 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 ever cervical kachbltioner in the region. world focus correspondent lynn scherr traveled there. >> reporter: coffee has transformed the life of fatima. >> translator: for women here, coffee is our life. >> reporter: she is general manager of a coffee co-op in nicaragua, a 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 innovative health program. 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 burnes has set up shop for the next week at the local health clinic here 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 burnes 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 son, 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 happen. >> 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: burnes 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, who is 29, who works here, 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 volunteer physician, does a visual information called via. if a lesion is spotted it can be frozen and tested cryogenically on the spot. the difference here, cells are rushed to the lab down the next corridor, d fixed and scanned under a microscope within ten minutes. the whole process, known as screen and treat, is relatively new. perfect for developing countries ke 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, speck u lums, 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 t 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 says giving women priority for the first time improves more than their bodies. trrnls if we can detect 5% pb 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 housewiv housewives. we were invisible. now we're cooperatives and we have a brand of coffee sold all around the world. we're reaching new levels. we're going to stay in central america for our ne 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 it's dramatically worse. "worldfocus" special correspondent lynn scherr 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. lee 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. waiwai ten age yoe five hours by call from guatemala city. for rural women and indigenous women whos trace back to ancient mayan times, maternal mortality is at least double, times three or four times the national average. and this was your wife? last may, this woman, 41, died of after giving birth to her eighth child in the tin-roofed hut that she shared with her eight children and husband, 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: she 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 or 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, for example, is near to the hospital -- >> reporter: to this woman of the population council, one solution is a house for expectant moms who arrive from distant villages just 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 this casa ma terna in waiwai tenango although part of the government's social services network, most of its financial support is private. win who cannot afford even a modest fee less than a dollar are not charged. maria traveled three hours to casa materna beca she had three miscarriages. 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. 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 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: he is charming proof along with his brother and 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 cari 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 correspondent martin seemungle talks about how they're going to extraordinary lengths to expand care and how ugandan citizens go to extraordinary lengths to get it. >> reporter: there are no signs to tell you how to get to the 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, 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 hand full with patients who have already been admitted. >> we 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 anti-natal 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 that he doing the work a doctor would do. and by western standards, their salary is incredibly low. >> about $100 a month. >> repter: now you can understand why there are no ugandan doctors around. it may look like a pretty grim situation. but as far as hospitals go in rural uganda, lalog i had is one of the better ones because it's getting outside help. mmf, doctors without borders is here. they arrived three years ago when this entire area was under siege by rebels, providing a couple of doctors, sometimes 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 the baby's color. the baby is working very hard to breathe. the oxygen 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 dead kafths ugandan health staff. people who work long hours for little money, sometimes even volunteeri, working for free. and this is the situation 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 seemungle in northern uganda. finally tonight, another global health issue that often gets overlooked. that ish is tuberculosis, a disease that the centers for disease controls tells us people around the globe and lio kills 2 million mum by, india has a 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 th. >> 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 this 19-year-old. >> resistant to all the first-line drugs, quite a few of the second-line drugs. such a nasty strain of tb, okay? >> reporter: xtrtb is a mutated strain of tb that takes one or two years of painful nauseating and expensive chemotherapy to cure. he was diagnosed with it 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. >> scar onend of the lung to the other as you see. >> reporter: doctors hope the risky operation will increase his chance of being cure. rohan shares a one-room apartment with seven family members. he explains how xtitb has affected his life. >> everything -- everything -- i cannot play. i used to play. i cannot play. i cannot walk like a normal person. >> reporter: before he got sick, rohan was studying computer sigh senses in college. he was expected to save his family from financial ruin. tb changed everything. >> my college -- i lost it all the way. totally hopeless. just lie down. i found myself getting behi, behind. >> 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. >> drug for tb. too expensive. 260. >> reporter: 260 rupees? >> 260 rupees. for three days. >> reporter: for three days? >> yes. >> reporter: at the heart of mumbai sits one of the world's largest slums with nearly a million people living in less than one square mile. this 18-year-old resident recently found out she has drug resistant tuberculosis and like rohan affording to the treatment is her biggest obstacle to recovery. her family had to scrimp to get enough money to pay for the diagnostic test. her next treatment is expected to cost 5,000 rupees, or $100. this doctor is her family doctor. >> 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 this doctor 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 sus septemberable tb through hundreds of do dots or direct observant treatment centers. but according to researchers like this doctor, the d.o.t.s program could be a source 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's a lot of side effects. >> reporter: when patients tom stop and start tb drugs or don complete the treatment, the bacterium become more and more resistant. there is a program aimed at providing treatment to drug resistant patients but it's not yet started in mumbai. this p doctor works as an executive health officer. 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. stant strains of facility where tuberculosis can be diagnosed for 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. >> it's affecting 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 martin savage in new 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 --