>> hello and welcome to "global 3000," your weekly check on the global issues that matter locally. up for you on today's program -- being sick in the united states -- why living in a rich country doesn't necessarily help. south africa's new middle class -- what it's like to be one of the first. and clean energy for hospitals in kirgyzstan -- where technology makes a real difference. few issues have ever divided americans as much as the question of how far the state should interfere in health care insurance. on the one hand, mainly the republican camp wants to leave it up to each individual to

choose whether and how they want to be insured. on the other hand, there are those who say everyone should be able to get free medical treatment when they need it. for now insurance is often pegged to employment. so when an extra nine million people lost their jobs last year, the number of uninsured adults in the united states leapt to 52 million. that's more than the population of south korea. we meet a doctor desperately trying to work a broken system. >> it's 7:00 in the morning, and we're here to meet dr. cecil walkes. ever since he had to move his wife into a nursing home, he eats breakfast here alone. he's a remarkable doctor. >> when i was a little boy, i read of albert schweitzer. he was my role model. i always liked looking after people. i've never turned away anybody -- whether they had money or they didn't have any money.

>> dr. walkes says cancer and lung ailments are widespread here in the industrial belt of east texas. but, one in four people here has no health insurance. >> they can't get sick. they have to keep working. they can't get sick. >> dock workers, pizza makers -- millions of people here are excluded even from statutory health care cover. many of them come here. he's the last hope for many of them. dr. walkes gave up his private practice 24 years ago. for a modest fixed salary from the local hospital, he now treats patients here and tries to place serious cases in specialized clinics. but the economic crisis and lack of political action have made the situation even worse. he says he's often forced to stand by helplessly and watch as his patients suffer and even die. patients like paul senegal. until two years ago, he had a

job as dock worker and was in the best of health. but then his legs began to shake. a neurological disorder. >> dr. walkes, i used to at least stand on my legs. i can't even stand on my legs no more. >> you can't stand on your legs at all? >> no sir, i can't. >> clearly paul senegal is in bad shape. for the past two years, dr. walkes has tried in vain to convince specialists to at least look for the cause of paul's disorder. paul has come to the clinic on a lawn mower. his sister gave him $2 for gas. he has a car but the disease is gradually causing paul to go blind. he can hardly find the ignition. he carries all his important documents with him in a drinks holder. dr. walkes' team is helpless in

the face of paul's worsening condition. specialists and private clinics often refuse to treat sick patients for the low standard fee. >> you know the public doesn't really realize that there's a working population that cannot get health care, that cannot really get anything. and they're trying to do the best they can but they cannot get any medical care. >> even dr. walkes is forced to turn away every second patient because the local clinic's state-funded health-care program only provides for the bottom 20 percent of those below the poverty line. >> how much are they allowed to earn? >> $191 a month >> so a family who earns $500, which is also nothing -- they're not allowed to come to you? >> no. >> it's a tough system. he clearly doesn't want to talk about it. it takes paul senegal 40 minutes to get home. he renovated his sister's garage himself when he could still drive and work. his partner of many years used

to live here with him. friends used to drop in. but then came this mysterious disease that changed his life. since then, he spends all his time here. he lives and sleeps on the couch. he lives a lonely life. no visitors. there's a strong smell in the room. paul shows us his urine bottle. he can't make it to the toilet on the first floor without help. but he doesn't want to burden his sister with his ailment. she has her own life. >> and your girlfriend -- she walked away or what? >> i can't expect her to live like this. you know what i'm saying. i explained to her to go find somebody who could take care of her. >> i can't see.

>> i wanna be well, i don't want to be like this. i'm so ashamed of myself. you know, just me, period. i'm ashamed of me. >> we're in port arthur. dr. walkes comes here in the afternoons to the second local clinic. this patient has hepatitis c but no one will pay for the expensive medication she needs. in this clinic too, dr walkes can't do much more than diagnose patients and try to comfort them. most of his patients are poor -- but not poor enough. >> this should be removed, very soon. >> it developed over about a year. it was scary. we're very concerned about it. we're frightened.

>> they make too much money for our program. >> if we would get a divorce -- which we don't believe in. i'm concerned about my husband. we've been married 22 years. we got married in a catholic church, and i don't want to get divorced so that he can get medical help -- the help he needs. >> a year ago it would have cost $1000 to remove this melanoma but no one would cover the cost. dr walkes knows that it's probably too late now. we wonder how he copes with all these heartrending scenes? >> there are not many people who want to do this job. so i just come here. >> just hold on right? >> how old are you now?

>> it's too much for the doctor. he's 76 years old -- too old to keep working. but he doesn't want to abandon his patients here. >> we'll keep looking for a solution. >> do the patients still believe him? they've been here so often. it's time to call it a day. but first dr. walkes wants to visit a patient who was diagnosed with pancreatic cancer over a year ago. >> after all time i'm afraid he might have had some spread either to his lymph nodes or to other organs in his body. >> they're looking for the man's home. could he have already died? they tried in vain to get him a place in a cancer clinic. but since he draws disability benefits, no one would have paid for his surgery.

yes, horas is alive. he tells us how he almost bled to death when his malignant tumor ruptured back then. but he was taken to a clinic and the doctors had to save him with emergency surgery -- that's the law. >> they told me they couldn't do anything else. my case was terminal, they gave me immediate surgery, saved my life. but they only gave me three months to live. >> he's 63, he'll be 64 next year. it's nothing, you know. some kind of help they should have gave him and they didn't give it. >> this is the type of things we're working with all the time. >> the doctors who horas visited when surgery could have saved him, demanded $300 for the first examination. but he didn't have the money. the emergency operation when it was too late for recovery cost 60 thousand. right from the start horas didn't have a chance. dr cecil walkes might have the

big heart of his role model albert schweitzer. but he's up against huge odds in a tough and unyielding health system. no surprise then that healthcare is one of the top concerns of americans for the upcoming presidential elections in november. >> most south africans also have few expectations when it comes to state care. more than twenty years after apartheid, most black people here are still poor, and being white still means being rich. slowly but surely a new middle class is rising from the townships. in the old days anyone who could afford it would leave soweto, the towship from where nelson mandela launched his struggle. these days increasingly affluent professionals decide to stay. a choice that brings its very own challenges. >> every day, louisa and oupa pore over their building plans and discuss further steps with pthe workers. two floors and four bedrooms

make the building shell already stand out here. it's the kind of house that's usually found in the white suburbs of johannesburg. but louisa and oupa didn't want to move there. so they're tearing down their old home and building a new one in its place. >> i need to develop this area so that our children can be proud of the area. our neighbors can be more confident -- there's no need for us to move and stay in the -- soweto is a better place. >> soweto is a very busy township. during the weekend, you'll find people going to clubs, going to restaurants, to the malls. so it accommodates all classes. >> louisa and oupa are better off than most here. they both have good jobs -- he works at the bank and she's in school administration.

they're part of the black middle class that has grown steadily over the last 15 years. soweto is in flux as well. the township has evolved into a city. complete with shopping malls and modern homes. at least for some. despite the emerging middle class, soweto has remained a poor black neighborhood. many are happy if they manage to get any work at all. enoch has been surviving on odd jobs for the last ten years. this shed in a former mine workers' building is his home. ten people live here in cramped quarters -- like during the apartheid era. back then there were clear divisions -- black meant poor

and white rich. enoch's world has become more complex, but not necessarily better. >> they've left us behind. when you look over there, you can really see the difference. us down here and them up there -- they live like white people -- white on the inside, black on the outside, they have money and they've left us behind. >> coconuts -- it's a word some people here use for black people who are seen to be living white lifestyles. people like louisa, the school inspector from soweto. louisa says this class is much too big, too many students. she's going to inspect it personally today. in the end, she approves an additional teaching position. that's her responsibility at the school authority.

she believes education is the only way out of poverty. she's experienced it personally. she's worked her way up from being a teacher for 20 years to being a school inspector. south africa's middle class is growing steadily. a third of the population of around 50 million belongs to it. the official definition of a middle class person is one who has a disposable income of more than two euros a day. >> here is the market place where i can buy meat, vegetables, butcher, materials i'm using now. so i usually buy here my vegetables. >> louisa shops at the market because it's cheaper than in a supermarket. and also because it fits better to her lifestyle.

if she knew that some people called her a 'coconut,' she would be insulted. soweto is her home even though she could afford to live in johannesburg. it's saturday afternoon. this is the vilakazi street in soweto. nelson mandela lived here once. and this is where the two worlds meet -- those who work in soweto and those who've broken out and made it in the white- dominated corporate world. >> monday to friday, yes, business forces us to be there. but weekends you will find us here. why? the community. people in soweto are very close. if i don't have a soap, i can go to my neighbor's house for soap or salt or a tea bag.

that's how sowetons are. you can't do that in santon. the wall is too high anyway. >> it's a world of high security fences and walls. louisa says that has no place in soweto. the people here, she says, are simply different. >> even when overseas, you can pinpoint somebody from soweto. in fact we are the trendsetters. >> sunday breakfast at louisa's. they've rented an apartment till their new home is finished. it's cramped but they'll all be moving out in three weeks. each of the kids will have their own room -- and that in the middle of soweto. the new house has also brought new problems. louisa and oupa have to think about security and an electric

fence -- they're issues south africa's middle class grapples with. >> since we've renovated this house -- we become the public target. people want to know where did you get money because you're working just like them. going to town, coming back at 4:00, 5:00 in the evening. the question they always ask themselves -- but this is a young couple. how do they manage? >> the aspiring middle class has wrought deep changes in soweto. for this church too. sunday mass no longer draws as many people as it once used to. it's the same complaint that's heard in the white suburbs. >> what does the future hold for all of us? we keep asking you, our viewers about your hopes and worries about globalization. and today we hear what life looks like from a farm in new zealand.

>> hallo, mein name ist warren suckling. >> hello. my name is warren suckling i live on the north islands of new zealand in a little place called dargaville. i am 64 years old. >> i live on a farm and i grow kumara. aaround the world, they call them sweet potatoe, but here in new zealand, we call them kumara, actually the named by the maori people of this country >> i have a wonderful life. i am here living on my farm and i have my son and my daughter, on each side, in a house each side, with my grandchildren around me and they come and play

on my farm, every day. >> that's a hard one. you are not filming are you? >> the times of just packing up your own little kumar everyday is gone by the board. we have to join to together, we have to do whatever it takes to be a coop or whatever to survive nowadays. >> i have a a little train set up, it's part of my hobby and if i do have any spare time i'd like to take people for a little tour around my farm and show them what we actually do here i had an inspiration to build a little church.

we go there for prayers sometimes, possibly the smallest in new zealand >> there you go. you saw it here first. kyrgystan is poor, mountainous, and has a long dramatic tradition. most of the country is over 1000 metres above sea level. so glaciers and snow dominate the country's mountain ranges . to run a clinic here means to battle the forces of nature. a new approach tries to work with instead of against nature by tapping into one of kirgyzstan's greatest riches -- an average of around 300 days of sunshine per year. the remote and bleak mountains of kyrgyzstan. the soviet union once delivered electricity and light here. to isolated communities like at- bachi. but the power supply isn't

reliable -- it's often affected by snowstorms, avalanches and floods. it's a huge problem for the local hospital. that's why the staff eagerly awaited these solar panels. they'll end the hospital's dependency on the power grid. it's a pilot project by the world health organization. artur buyuklyanov is responsible for the logistics. >> this is a mountainous region. the people generally live at an altitude of over two thousand five hundred meters. and there are extreme temperature fluctuations. that's why such regions feel the negative impacts of climate change the most.

>> senior consultant muratbek aliyaskarov works under tough conditions. there are only 150 beds in this clinic for the entire region. an increasing number of patients are suffering from circulation problems or infectious diseases. the weather extremes are to blame. the number of people falling ill is rising every year. last winter was unusually long and spring has been too wet so far. the farmers at the at-bachi market are worried about their next harvest. zhildisbek kaparov has begun sowing late because the fields and meadows are still wet. he's worried that he won't have enough fodder for his horses. >> the weather's changing. last year for example we had the harvest, we hadn't yet taken in the hay.

suddenly one day in fall, we had our first snow. it covered everything. and we had no fodder for our cattle during the winter. yes, we certainly notice the climate changing. >> and the farmers need to buy food because they can't produce enough to cover their own needs. artur buyuklyanov from the world health organization knows that families often tend to save on food. he gives the people here tips about how they can save money and electricity. >> people are very interested. they can hardly get enough information. it's difficult to get it here -- many people don't have internet access, sometimes there are tv campaigns. but i think that talking directly face to face -- that's what helps the most. >> in the face of such challenges, renewable energy and energy efficiency are only slowly gaining ground in kyrgyzstan.

the solar panels on the roof come from china, the convertors from europe. artur buyuklyanov has to grapple with logistical as well as technical problems. >> next time we'll be able to avoid a lot of the difficulties that we experienced with this project. when the next solar panels are installed, it'll all go smoothly. >> the hospital in at-bachi is a step in the right direction. muratbek aliyaskarov's team and his patients will certainly stand to benefit. the doctors will soon have a reliable supply of electricity. even when the power from the grid is disrupted through extreme weather or avalanches. >> we then don't need to spend any money on fuel for our emergency power system.

we'll get electricity free of cost. so we'll save a lot. and that will naturally help to save money for the entire country. >> this hospital is just the beginning. once these panels are installed, further hospitals in kyrgyzstan are due to convert to clean solar energy, too. >> and that's all we have time for on this edition of "global 3000." thanks for watching and don't forget to tune in again in seven days' time. until then from me and the entire global team here in berlin, bye bye! captioned by the national captioning institute --www.ncicap.org--