>> life expectancy in rwanda has doubled in the past decade, and the number of people dying of hiv, tb, and malaria has fallen by roughly 80%! all this thanks to the government's healthcare reforms. hello, and a warm welcome to "global 3000," our weekly look at issues and trends that shape our world. i'm amrita cheema. coming up in the show -- trouble in paradise -- living with climate change on the pacific island of kiribati. modern medicine -- signing up for health care in rwanda. and tuneful trash --

how a youth orchestra puts garbage to use. recent u.n. projections that sea levels will rise faster than previously thought due to global warming have sent alarm bells ringing in many regions. low-lying cities and islands are most at risk. among them, the pacific island nation of kiribati, east of australia. if water levels rise at the pace forecast, this spectacular island country would be one of the first to get submerged and disappear from the face of the earth. as the international community struggles to find consensus on how to deal with global warming, the islanders are taking steps to raise awareness on the issue of climate change at home. approach the international date line over the pacific.

we see a crescent-shaped sliver of an island in the vast ocean. we're headed for the island nation of kiribati. tarawa, the main atoll. but this south sea paradise is now under threat from climate change. >> it is very thin, it's low lying, so you can see the sea around the land. and with sea level rising kiribati might disappear in the near future. >> the situation could get critical after 2050, we are warned. this is koin etuati. her job within the regional intergovernmental organization is to manage climate projects on her native islands. while some experts claim the islands are still growing in parts, in some places the advance of the ocean is

unmistakable. and another problem is also emerging. the islands have to import practically everything, from cars to diapers and canned food. much of it ends up as trash along beaches. >> so you want to ignore your environment? >> no! no! no! >> ok! ♪ >> go green go green go green ♪ >> a message koin etuati is happy to hear. the project is funded by the international climate initiative. workshops involving children and disabled people pass on insights about climate change, and provide tips on saving energy and preventing unnecessary waste. for participants, it's a give and take experience.

>> i've learned a lot about climate change at the workshops. part of the solution includes passing on this knowledge, especially to the children. of betio. this place is nicknamed "red beach," after the bloody battle fought here between japanese and american forces during the second world war. today, betio is witness to a struggle of a different kind. over half of the 100,000-strong population of kiribati now lives on tarawa. many of them are climate refugees from the outer islands. this boy is eight years old. on weekends, he has to go out

and gather firewood for his family. koin etuati is relieved to hear that he is at least attending elementary school. she makes an effort to ensure more kids get an education. the family of this girl actually moved here because of the better prospects available to her. her father works on a ship and is often away, but he does have firm plans for her future. >> there are so many plans we already decided. my parents decided if i've finished school, they want me to became a nun. >> koin etuati is aware that for all her efforts to encourage education, those growing up here still face a very limited range of professions. family ties are close in kiribati.

that helps the island inhabitants overcome many of the hardships and difficulties of living here. >> i'm a former seaman, and i worked on german ships for 30 years, and now i look after my grandchildren to try to help what they need for this life in this town. >> not an easy prospect. down at the harbor, most of the little work available comprises menial jobs and is poorly paid. plus, the big trawlers prowling the waters make life very difficult for local fishermen. their catches continue to decrease. the resulting frustration sometimes leads to crime. this youngster stole a chicken and was fortunate to escape severe punishment.

the president of kiribati has agreed to an interview. anote tong is a high-profile figure in the international climate debate. his plans to relocate parts of the population to fiji caught media attention. but it's the erosion of society, as well as the coastlines, that concerns him. >> we have a very high proportion of young people, and so with this unemployment with that potential for social disorder, and so we are putting a lot of resources there, we are giving a lot of priority, and as you correctly state, climate change is something what we know and we must continue to do it. but at the same time we did not ignore the other ongoing challenges. >> kiribati is also making progress on the gender front as well. the parliament recently approved the creation of a ministry for women's affairs. more good news.

climate change is now firmly on the curriculum at local schools. ♪ the boys and girls here know the importance of joining forces to solve problems. ♪ >> i wish that people will continue to live on this beautiful islands, and that kiribati islands will not disappear from the impact of climate change. >> it remains to be seen whether kiribati is destined to sink into the ocean. the inhabitants of kiribati have the most immediate interest in ensuring that this tropical paradise is not lost entirely. >> we now turn to rwanda in east africa. it is believed to be the only sub-saharan country on track to meet the millennium development

goals. in particular, international organizations have praised rwanda's dramatic progress in the health sector over the past decade. health, as we know, has an impact on every aspect of development, including its productivity. after the 1994 genocide, which destroyed the country's social-economic fabric, the government made health a key priority. at the heart of its reforms is a health insurance scheme for its people. >> antoinette nimuruta is finally getting treatment at the hospital in kibuye. she's been suffering for daysndh cramps. her village, some 40 kilometers away, has just one clinic and no doctor. here at the hospital, she can get a proper examination and undergo tests. she would probably not have been treated today if she hadn't been

signed up to the country's public health insurance scheme. >> health insurance is very important, because it gives us access to medical treatment. without coverage, treatment becomes expensive. people can't afford to pay doctors' bills on their own. >> that access to health care has been enhanced by the arrival of new ambulances across rwanda. and the decentralized system gives doctors at the hospital more time for their patients. minor ailments can be treated at one of the 200 or so rural health-care centers serving villages. >> each facility also has a doctor present once a week to see to the more serious cases. >> antoinette's treatment today will cost her the equivalent of 20 euro-cents. the rest is covered by the insurance program. she also has to pay 10% of the cost of her medication.

>> we want to see more hospitals built. that way, patients don't have to travel such long distances to see a doctor. there are only a few people who, like me, can afford to buy a bus ticket for the journey. >> the hospital in kibuye is one of more than 40 in the country as a whole. rwanda has one doctor for every 18,000 inhabitants. many patients face a long trip just to reach a doctor. once there, however, treatment is available and affordable. the overall situation has improved. >> the changes to the health insurance system mean that people can get treatment when they're sick, instead of staying at home. that has made a big difference over the last five years. >> rwanda has enjoyed rapid

economic growth in recent years. parts of the health-care system are now financed by state funding plus revenue from health insurance. the minister of health, agnes binagwaho, explains how health-care services are now being used by well over 80% of those insured. >> we have made progress. people have more uptake of health services and of innovative tools we are providing. like vaccination, etc., family planning. but we still have a long way to go, and i prefer to focus on what we didn't achieve than what we have achieved, because we still have a long way to go. >> rwinkwavu in eastern rwanda is a case in point. the local hospital is now less dependent on foreign aid. the american ngo "partners in health" helped to build the facility.

the wards' capacity has increased to 110 inpatients. but most work here is now taken care of by rwandan doctors. partners in health still sends regular donations, however, to ensure ongoing improvements to the system. >> it helps the population, bringing health care and also social support. even the community support them to help them be more financially capable. some patients were poor, but they try to help them sustain the economy by some support. >> we work hand in hand with the hospital, to support them in areas that they would like for us to support. we discussed medical education is one of the areas of need. and for the time being, we are supporting in terms of building the capacity of the health professionals is a key.

>> the dividends from that international cooperation are visible on the ground and in the statistics. infant mortality and childbirth-related complications are declining. plus, the proportion of children surviving their fifth birthday is increasing. >> the government still has a lot of responsibility to provide for people who cannot pay. because it is a lot of people but i think the mutuelle system is building up itself to become a strong and autonomous entity. >> back to kibuye, on the shores of lake kivu. the government recently spent around half a million euros on this water ambulance. >> we have a plan for next year. for the time being, we take over because the aid has decreased but we have increased the quantity of care we are giving.

so it's another way to take over. we have recruited more than 1000 over the last two years, more than 200 doctors with our money. >> the plan also ensures that patients in less accessible areas such as lake kivu can be picked up by the aquatic ambulance. >> now we are off to visit a special lady in nepal. nirmala khati is a committed social worker who adores children. she talked to us about her hopes and aspirations just outside the capital, kathmandu. ♪ >> my name is nirmala khati. i'm 30 years old and live in the

lalitpur district. provide the children with the love of a mother. means. when they come to me and call me "mother," that makes me happy.

the children. i'm worried about whether they'll be able to find a job and live a good, normal life. is made with rice with lentils, potatoes, cauliflower, and curry. i spend a lot of my spare time with the children. we watch tv together. and

i hope a lot more children find a home here soon. i look forward to taking care of them like a real mother. america and paraguay in the capital, asuncion, garbage is a big problem. huge amounts of it pile up in landfills every day. now, residents say when it rains, the garbage seeps into the ground and into the bay polluting the area. this problem has inspired a unique project in the country. with the motto "the world sends us garbage, we send back music," an orchestra has been created using instruments made entirely from recycled rubbish. >> it's rehearsal time for a music video, featuring a performance by what is probably

the world's most unusual orchestra. ♪ the musicians have been joined for the recording by a famous paraguayan guitarist. but the real stars here are the young people, teenagers from a slum area playing instruments made from recycled trash. the young musicians have plenty of talent and a passion for playing, like maria. >> life would be awful without music. i love music. it's my life. it's the most beautiful thing that's happened to me. >> afterwards, maria and her friends head home to cateura on the outskirts of asunción, the capital of paraguay. extreme poverty is rife here.

maria's slum neighborhood is home to two and a half thousand families, with no electricity, no running water, no jobs, and zero prospects. residents essentially live on top of a landfill. two years ago, favio chávez had an idea for getting kids off the streets, an orchestra. today, he's come with a government official and u.s. visas for maria and other members of the orchestra. the teenagers have never left their home city. and now, they have passports allowing them to play a concert in the u.s. the orchestra has made headlines across the world, thanks to its mix of recycled instruments and raw talent. >> you have to practice and make an effort. that's the only way to progress. otherwise, you won't achieve anything in life.

♪ >> there's one overwhelming priority for the girls, music! the fact that they have to play with instruments fashioned from the trash heap doesn't bother them. the paraguayan economy has been booming for years, but over a third of the population still lives below the poverty line. many eke out an existence from the refuse dump next door. that's also where instrument maker nicolas gomez finds every thing he needs. he's been working with trash for 16 years now. nothing makes him happier than hearing what used to be food cans emit the sweet sound of music. he loves the moment when he can hand over his creations to the children.

>> i can turn this piece of metal into the body of a violin and these old cans into guitars. and this can be used for making drums. >> gomez still makes traditional instruments on order. but the 54-year-old specializes in recycling trash into string instruments. right now, he's run out of raw materials, so he's off on another trip to the landfill to replenish his stocks. around a thousand people can be found here every day, sifting through the rubbish. most, however, are looking for things they can sell for cash or for leftover food. we asked gomez to describe his

most precious find and were somewhat taken aback by his answer. >> a new-born baby, suffocating, but still alive! >> the brutal reality of life in the suburban slums of asuncion. the baby survived. ♪ turning trash into music and despair into hope. the young performers are inspired and in turn inspirational. >> my instrument is made from an oil can. the neck is wood, found on the street. then there's a brush and a spoon and a comb. and here we have a meat tenderizer. >> kids from the slums playing scraps transformed into stradivari. the orchestra has had a number of invitations to play abroad, and also benefits from donations in the shape of funds and

conventional instruments. 16-year-old maria has dreams of a professional career in music. performing in the orchestra gives these young people the recognition they otherwise lack. >> officially, these people do not exist. they don't even get a birth certificate. they die without ever having been registered. the orchestra is set to change that. we want to make the kids visible so that they are acknowledged as part of the society. >> it's a big day in the lives of maria and her fellow musicians. a reception at the french ambassador's residence. the young artists from the recycled orchestra have been invited to provide musical accompaniment for the event. ♪

the setting is another world for these kids, but one they're glad to be a part of. >> people are watching me and applauding. that's so wonderful. we're showing what we're capable of and our determination to succeed. >> that hard-won success has now taken center stage. >> and that inspiring program wraps up the show for today. don't forget, you can go to our website for more information on those and other reports. the address is dw.de/global3000. from me, amrita cheema, and our "global 3000" team in berlin, thank you very much for being with us. looking forward to seeing you again next week. bye-bye. captioned by the national captioning institute --www.ncicap.org--

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