The NewsHour with Jim Lehrer

MARGARET WARNER: Good evening. I'm Margaret Warner. Jim Lehrer is on vacation. On the NewsHour tonight, financial turmoil in South Korea, three experts join us for another look; Mark Shields & Paul Gigot offer their regular Friday night political analysis; Lee Hochberg reports on a promising new drug treatment for strokes; and Elizabeth Farnsworth looks at Russia's struggling health care system. It all follows our summary of the news this Friday. NEWS SUMMARY

MARGARET WARNER: South Korea's stock exchange surged nearly 7 percent today. It was the first day of trading since Korea learned that another $10 billion in rescue loans would arrive by early January, sooner than planned. The country's president-elect, Kim Dae-Jung, said today layoffs may be necessary to spur economic recovery. A top labor leader warned that protests may result. A leading Korean economist urged the rest of the world to rally behind his country.

DR. KIM KYEONG WON, Samsung Economic Research Institute: If we go--Korea go out of the world scene, America, Europe, and also other Southeast countries will suffer very much, because they lose the kind of big trading factor, so world economy, if Korea drops out of this kind of relationship, world economy possibly will see a kind of minor economic growth for a long period of time in the future.

MARGARET WARNER: We'll have more on South Korea right after the News Summary. In Tokyo today the Nikkei Average slipped below the 15,000 point level over concerns about additional corporate failures. In this country retailers were counting on today's post Christmas shopping to boost lagging holiday sales. According to unofficial estimates business is up only 2 to 3 percent this month over December of last year. If that number is confirmed by official sales figures, it would make this the third straight year of lackluster holiday sales. Richard Bliss, the telephone technician accused of spying by Russia, is back in the United States today. He arrived in San Diego last night to a welcome from friends and relatives. Russia's Federal Security Service, known as FSB, charged Bliss with espionage last month. Hewas arrested for using global positioning satellite technology as part of installing a cellular phone system South of Moscow. He denied the charges. He spoke to reporters in San Diego.

RICHARD BLISS, Cell Phone Technician: We have offered a lot of evidence to show that there was no espionage or spying going on, that we were legitimate businessmen just going about our business. But I don't fault the FSB for opening the investigation to begin with. But now that all the information is out in the open, my innocence has been established, I'm looking forward to the charges being dropped as soon as possible.

MARGARET WARNER: Bliss was allowed to travel home for the holiday on condition he return in two weeks, or when summoned by Russian authorities. In Iraq today government officials warned the United States not to launch an attack on presidential sites in Baghdad. They accused the U.S. of planning air strikes that would plant evidence of biological or chemical agents at the suspected weapon sites. A White House spokesman called Iraq's charge "ridiculous." A Russian plane carrying food, medicine, and Christmas gifts for children was allowed to land near Baghdad today. The plane was chartered by a charity in Iceland. An earlier plane, carrying ultra nationalist Russian legislators and tons of medical supplies, arrived in Baghdad yesterday. Those supplies were delivered to a children's hospital today. In Algeria, the president's political party claimed a majority of seats in elections held yesterday for a new upper house of parliament. The creation of the new chamber, which can veto actions by the lower chamber, is designed to give President Liamine Zeroual more authority. Zeroual is trying to quash a five-year-old Islamic insurgency that has killed an estimated 75,000 people, mostly civilians. That's it for the News Summary tonight. Now it's on to the South Korea roller coaster; Shields & Gigot; a new drug treatment for strokes; and health care in Russia. FOCUS - MONEY IN MOTION

MARGARET WARNER: Now, South Korea's financial turmoil and to Phil Ponce.

PHIL PONCE: It's been a dismal few months for South Korea's currency and stock markets. The currency, the won, has been falling gradually all year but began to plunge in November and fell steeply in December, despite a $57 billion loan package arranged by the International Monetary Fund. It hit an all-time low Tuesday, down 60 percent, but on Wednesday, the won bounced back 7 percent when the World Bank promised Korea $3 billion dollars in emergency loans. And today, it jumped almost 20 percent--a record one- day gain--following news that the IMF, the United States, and other industrial nations would speed up the release of $10 billion. The South Korean stock market has also been falling the last few months. This Tuesday was the worst single day ever, when the Korea composite stock price index fell 7 1/2 percent. The index bottomed out Wednesday but came back by nearly 7 percent today after news of the U.S.-led loan speed up. Has Korea turned the corner: Joining us: Stanley Fischer is the first deputy managing director of the IMF. Hyuck Choi is the Korean Minister for Economic Affairs from the embassy here in Washington. And Andrew Kim is president of Sit/Kim International Investment Associates, A Wall Street firm that invests solely in foreign markets. And, gentlemen, welcome all. Mr. Choi, is the worst over in your government's opinion?

HYUCK CHOI, Republic of Korea Embassy: Perhaps pretty safe to say that it still too early to say anything definite. As we have seen, the stock market and foreign exchange market rallied today, and it will provide a good momentum for us to be a little bit more optimistic in resolving our current financial crisis.

PHIL PONCE: Mr. Fischer, your opinion.

STANLEY FISCHER, International Monetary Fund: Well, two things have happened in the last two days. First, we have, we, the IMF, have reached agreement with the Koreans to strengthen and accelerate the economic program they're implementing, and that's very important. They're going to open their markets quicker. They're going to fix up their banking system quicker. And secondly, the so-called second line of defense, part of the original $57 billion package, is being activated to help them. And this is a clear demonstration to the markets that the world stand behinds the Korean government, provided it intends getting on with fixing its economy, which is what it has made clear it will do.

PHIL PONCE: We'll get into some of the issues regarding fixing the Korean economy after I ask Mr. Kim-- from an investor's standpoint, do you believe Korea has turned the corner?

ANDREW KIM, International Investor: Investor confidence appears to have turned the corner. In light of the great awareness on the part of the IMF and G-7 countries, on the one hand, and was important--the recipient countries' willingness to implement the IMF package.

PHIL PONCE: Mr. Choi, how about that, what kinds of changes is your government willing to make in its system, in the economic system?

HYUCK CHOI: Last Wednesday, my government has submitted a new strong economic program to the IMF, and it was duly announced in Korea. The program will significantly intensify and accelerate the macroeconomic policy adjustment and policy reforms to regain the confidence in the international financial market. We know that the regaining of the confidence of the international financial market will be critical in any credible long-term perspective for the recovery of Korean economy, but I think that basically all the important components are contained in our new strong economic plan, ranging from the monetary policy, a liberalization of capital markets, and it includes even new--possible new labor policies--and enhancing the transparency in publishing the relevant data regarding financial information.

PHIL PONCE: Mr. Fischer, of those things that Mr. Choi just referred to, which, in your opinion, are the most important?

STANLEY FISCHER: Most important are getting on with fixing up the banking system restructuring banks, closing down banks, which are bankrupt, and opening up the capital markets to let foreigners invest in Korea. Korea needs a lot of dollars, a lot of foreign money, and it has to let the private sector, as well as the public sector, contribute to their needs for foreign exchange.

PHIL PONCE: Mr. Fischer, do you sense a real willingness on the part of the Korean government to implement those changes?

STANLEY FISCHER: The biggest change in the last three weeks has been in the clear willingness of the Korean government to implement these policies. On the day we signed the original agreement with Korea, which was December 3rd, they were in a state of shock and resistance and resentment partly to the foreigners but more at their own leaders, and there were a lot of noises coming out of the government against the program. As the realization of what needed to be done grew, the public in Korea and the politicians in Korea and the president-elect from last Thursday, Kim Dae Jung, have made it absolutely clear that they will implement this program. For thelast week they've been asking us, how can we do it more rapidly? The first two weeks it was how can we avoid doing it, and that change is marked, dramatic, and critically important.

PHIL PONCE: And, Mr. Fischer, from the perspective of the IMF, why is it that a speed up was necessary? This was not the original plan, after all.

STANLEY FISCHER: The original plan spread some of these changes over a period of six to nine months. We would have liked them to have been done sooner. The Korean government at that point is very uncomfortable with the need to do that. And in a bargaining situation you don't insist on everything you think best, but on making good progress. Once they're willing to do more, which would have--which was an improvement, we were very, very happy to go along. It was also necessary to persuade others, who'd been asked to lend money to Korea, that the Koreans were absolutely firmly committed to doing what was necessary in this situation.

PHIL PONCE: Mr. Kim, what are you telling investors about whether or not their investments are in jeopardy?

ANDREW KIM: Well, we tell investors that it is not the government IMF package it is rescuing. It's the private sector economy, which has to make an adjustment. What I am talking about here is reducing, if not eliminating, over-capacity, which was made possible through over-leveraging and over-borrowing. So the essential ingredient here, we say, is consolidating, reducing over-capacity, are there any prospects for earning some kind of a return on the part of investors, given the risk profile we face today?

PHIL PONCE: And as of today, are you still investing in Korea? ANDREW KIM: We have made a long-term investment in Korea. We are watching to assess the currency risk, which we didn't factor into when we started investing 10 years ago.

PHIL PONCE: Mr. Choi, what do you say to people who wonder if the Korean government has been totally frank at this point about the extent of your liabilities?

HYUCK CHOI: Last Wednesday, for a press interview, our Deputy Prime Minister, he came out with a--for the first time--with a rather optimistic prediction about our capability to meet the short-term liabilities. According to him around 15 billion U.S. dollars will stand as our reserve and around same amount at the end of January and about 17 billion dollars at the end of February. It provided us with the level of reserve, which might be possible to successfully meet our short-term debt.

PHIL PONCE: Mr. Fischer, are you confident that at this point the international financial community has an accurate grasp of Korea's financial state?

STANLEY FISCHER: Yes. I am confident at this point. Teams in Korea have been working very closely with the Bank of Korea and with the finance ministry to get these data in shape. They will be issued, there on the external debt, in the next day or two. They're not very different from the data we've been working with for the past couple of weeks. And there's very little doubt now about what those--what those numbers are, and that the situation is manageable, provided the Koreans get on and do what I have no doubt they will do, which is to implement this program.

PHIL PONCE: Mr. Fischer, how do you respond to the very, very basic question of why should the international community bail out countries that, in the opinion of some, might have been less than careful with their resources?

STANLEY FISCHER: Because it's in the interests of the international community not to let an important country like Korea's economy go into free fall. The only way for Korea to get out of its difficulties would be to export. And the further we let it fall, the harder it will be for it to come back, and the more it will have to turn into an exporter and less than importer, and that is not something we all--we all want. Stability in Korea will contribute also to stability in all its neighboring countries, and there's a great fear of instability there, and that is important, and besides, there is some element of international solidarity. It is common, and we believe it's proper that countries help each other when they get into extreme difficulty. There is no reason any of us need to see why the people of Korea should suffer more than they will. And they will because they're going to go into very hard times economically for the next year or so. There's no reason they should be made to suffer more than is absolutely necessary when well thought out, safe loans can be extended to them to help them out of their difficulties.

PHIL PONCE: Mr. Kim, to what extent do you feel that there might be a change in the works as far as investor confidence in Korea?

ANDREW KIM: What we have to see is the combination of both Japanese and U.S. and European banks willing to ease this credit crunch in order to inject more liquidity. But this will have to come with the Korean government under new leadership dismantling this historic collusion between the government and business. And that is going to create a lot of pain, but maybe that's where investment opportunities lie for foreign investors.

PHIL PONCE: Mr. Choi, how willing is the government to make those kinds of changes, would you say?

HYUCK CHOI: The government--both the outgoing and incoming governments are fully committed to the reform, and our new president-elect, Dae-Jung Kim, was very quick to come out to assure international market that he will live up to the reform commitment agreed upon with the IMF. And we also have to note the strong support of our people behind the new president-elect. It means that we have both the political will, leadership, and consensus of our national--our people. And in addition to that, we have, as it was indicated by Mr. Fischer, strong support by the international community and international financial institutions. Those, in combination of those elements, I think Korea will continue to push forward with its reform, and as our president-elect has emphasized, will implement the IMF reform 100 percent, not less 1 percent of that.

PHIL PONCE: Gentlemen, thank you all for joining us. Have a good weekend. FOCUS - POLITICAL WRAP

MARGARET WARNER: Now, our regular end-of-the week political analysis with Shields & Gigot, syndicated columnist Mark Shields and "Wall Street Journal" columnist Paul Gigot.

MARGARET WARNER: Paul, how well do you think the administration has handled this Asian currency and financial turmoil so far?

PAUL GIGOT, Wall Street Journal: Well, Margaret, I remember at the Asian summit that the President attended, I think it was in Canada about six weeks ago, he was asked about the Asian crisis and he said, that, well, it was just a few glitches, and it really wasn't something we should worry about, and they'd handle it. Now, six weeks later, it's a full-blown crisis that we are being asked to spend American taxpayer dollars on, so anything that moves from a glitch to a crisis in six weeks probably has suffered some indifference, if not inattention. I think you can fault the administration for that. The other thing that I think is going to be a big debate in this country next year that's wrapped up in here is the administration's reliance on the International Monetary Fund, and their blend of policies, which include tax increases and currency devaluations, and obviously, they didn't stop at the crisis in Thailand; they hoped it would; didn't stop it in Indonesia; didn't stop it at first in South Korea; and now we have to hope that this does. So I think there's going to be a much-needed debate on that too. So I wouldn't give the administration very high marks on this one.

MARGARET WARNER: Do you give them high marks?

MARK SHIELDS, Syndicated Columnist: No. I don't think the administration gets high marks on it. Treasury Secretary Bob Rubin, Margaret, who is probably the most respected, popular, however you want to put it, cabinet officer, has been consistently--said it just a few weeks ago--that to--it would be a "moral hazard" to give in to bailing out the large investors, obviously which include U.S. banks, European banks, Japanese banks. And I think that's where the administration is vulnerable.

MARGARET WARNER: Just pointing out, it's U.S. and foreign investors who went in and loaned a lot of this money.

MARK SHIELDS: That's exactly right, and I think where the Democrats and the administration are vulnerable is perhaps where the Republicans can't explain it, and that is that they're bailing out investors, that I think Paul could make an argument, but I think there will be a number of Republicans who may be somewhat reluctant to attack a plan that does bail out investors.

PAUL GIGOT: Margaret, I love it when Mark talks economic language like that "moral hazard." I think--I think Mark is right; that some Republicans will be reluctant to do it, particularly Newt Gingrich and the leadership, because it means that the might feel they have to take responsibility if something goes wrong afterwards. But I think what you're going to see is not just the Pat Buchanan wing oppose this but you're going to see the free market Jack Kemp wing, and Jack Kemp has some credibility on economic matters, and so I think he's going to oppose this pretty vigorously, and that's probably good because we do need a debate over the role of the moral hazard question because we bailed out Mexico, remember, and that was supposed to have solved the problem. But I think you can make a really strong argument that when creditors saw what we did in Mexico, they said, hey, I can get away with that anywhere; they'll cover all my bets. So we need to debate about that.

MARGARET WARNER: It is an issue that could have some real populist appeal, couldn't it, even in the Democratic--

MARK SHIELDS: I think it could have real populist appeal, and I'd just point out that the Mexican bailout worked for (a) the investors and the lenders, they're paid back. Who didn't benefit from it were the Mexicans. Start with before the bail out there was a 30 percent poverty rate in Mexico among Mexican families. Now it's 50 percent, and wages have been cut by 25 percent. So it does come down to who is being bailed out. Is it the investors? Is it the lenders? Is it the banks? Is it the--the larger money, rather than aiding the farmers, the factory workers of Korea and their families?

MARGARET WARNER: All right, Paul, let's look now at the year in review, and what kind of a year do you think the President has had both politically and in terms of what he has achieved?

PAUL GIGOT: Well, politically, I think that he had the better of the year than the Republican Congress. I think that he managed to achieve on the budget deal most of what he wanted. I think the problem the President has is that it wasn't very much that he said he wanted to do in 1996. Now that he's achieved it, you can sense on the President's part and the press conferences and in his answers to questions a little testiness and frustration about his legacy when somebody says, is this all there is. But his approval rating has remained very high, remarkably high. I mean, all this ethical stuff just seems to go right underneath them, all questions about ethics don't seem to touch him. The Republicans clearly are intimidated by him in some ways. They're afraid to assert much of an agenda. But I'd say that the big winner politically this year is prosperity. The healthy economy has made the public a lot less angry about politicians, so that's helped all incumbents, and it's given a kind of immunity to President Clinton, I think, on the question of ethics because nothing's going wrong in the country. People feel good about the country again, at least about their economic circumstances, and that really helps people in Washington.

MARK SHIELDS: The old rule of politics, when the economy is bad, the economy is the only issue, and when the economy is good, the only way you beat an incumbent is on other issues where the incumbent might be vulnerable. As of January 1998, barring some cataclysm between now and then, the Wall Street Journal/NBC News poll will show that President Bill Clinton, beginning his sixth year in the presidency, has the highest favorable rating of any president in modern history, including such giants as Dwight Eisenhower, Ronald Reagan, the beloved. It's rather remarkable. It's a man who's twice been elected as a minority president. You got his performance in office, or his perceived performance obviously is rated very, very highly by Americans. So I think that is remarkable, and it does stand in stark contrast to the man he's picked to be his successor, the vice president. Paul's right. The president had nine months of rather unflattering stories on campaign finance. Al Gore, count 'em, had three days of the Buddhist nuns from Hacienda Heights coming and kind of making him look silly, and yet, his own popularity went to the lowest point in July of 1997 it's been in his entire public career, and you almost had the feeling that if Bill Clinton drove a convertible with the top down through a car wash that Al Gore would get wet.

MARGARET WARNER: Paul, how do you explain--I mean, many people both in the Democratic Party and the Republican Party say, but, Bill Clinton hasn't done much in the way of anything big picture, that's the criticism. Is that part of what makes him popular? What's the connection there?

PAUL GIGOT: I do. I mean, I think that the country doesn't want much from Washington and doesn't expect very much from Washington, and it's getting it, and it's happy. I think that is part of the--part of the secret here. I think that was part of the president's secret in 1996, when all of those small, little items, he wasn't threatening anymore. He wasn't threatening to nationalize the health care system. He wasn't threatening to raise anybody's taxes. In fact, he was going to cut them for specific groups of people. He wasn't going to try to rock the boat, and the country is still very skeptical of politics, still very skeptical of politicians, and I think when it comes to the ethical questions, the President benefits from this general public cynicism because, as Mark pointed out, I think the press and the Congress did make the argument that laws were broken on campaign finance; that the President was at least in many ways indifferent to some of those laws and to some of the people he hired, who probably did break the law, but he suffers a kind of--he gets a kind of a buy on it because the public seems to have bought the Democratic argument, the defense, which is, everybody does it; this is no worse than anybody else does it, so it's all those folks in Washington, so we'll just ignore them, and as long as they're not threatening our pocket book or doing too much mayhem, let 'em go, let 'em do what they want. We're happy enough.

MARGARET WARNER: Mark, what kind of a year do you think the Republican leadership has had in Congress?

MARK SHIELDS: Well, the Republican leadership, you could make the case that both sides have had good years in the sense that we've had the biggest tax cut since the Reagan era, a $95 million tax cut, finally capital gains, the Holy Grail of the conservative movement, has been reached, a cut in capital gains tax, a $500 child tax cut promised by the Republicans has been achieved. For the first time since 1969, the balanced budget is probably within reach. You know, it's really rather remarkable when you look at those achievements, you can say the President had tamed the Republican Congress, I think he did, 13 appropriations bills passed on schedule, with no close down or threatened shutdowns, the government--so I think New Gingrich had a roller coaster year. He started off paying $300,000 in fines, in ethical lapses, borrowed it from Bob Dole to keep the story alive for a little bit longer, and the faced a revolt from the game that couldn't shoot straight, his own leadership, who agreed that he should go but couldn't agree on who should take his place, and yet, at the end of the year he's talking about running for president in the year 2000, which is good news.

MARGARET WARNER: Paul, how do you explain though that the Republican leaders seem to have a much lower profile than they did even last year?

PAUL GIGOT: Well, first of all, it's great news for Mark if Newt Gingrich runs. I mean--he's just going to be in heaven.

MARK SHIELDS: I'm keeping my fingers crossed, Paul.

PAUL GIGOT: You were urging him to run, I remember, in '96, and you just can't resist urging him to do that again in 2000. The Republicans have a low profile because--in part because their leader, when he stands up in Congress, half of the country turns off the set, figuratively speaking. They just don't like looking at him, so they're not going to listen to what he says, and that's Newt Gingrich, and that's a fact of life. It's unfortunate, but it's a fact of life. Some of the other people who do speak up, they're not as well known, but I think in part this has become a much more traditional Congress, that is, with--the first two years power was centered in the speakership. You had a unique point in time in American political history where power in Congress was driven by one man through the speakership, with power filtering away from him, it's gone to the committee chairman, it's gone to the Ways & Means chairman, Commerce Committee chairman, people that the country doesn't really know anything about. So the President gets to dominate much more the political debate because there's nobody going head to head with him. And it's very hard to lead a political debate because nobody has that same--from Congress--because nobody has that same bully pulpit.

MARGARET WARNER: All right. Thanks, Paul. I'm going to have to stop leading this. Thank you both very much, and Happy New Year!

MARK SHIELDS: Happy New Year! SECOND LOOK - STROKE DRUG

MARGARET WARNER: Still to come on the NewsHour tonight treatment for strokes, health care in Russia, and a Roger Rosenblatt essay. Now a second look at a promising new drug therapy for strokes, the third largest cause of death in this country. This report, by Lee Hochberg of Oregon Public Broadcasting, first aired in August.

LEE HOCHBERG: In January, Orvin Anderson was rushed to a California emergency room. He had fallen down and the left side of his body wasn't working.

SPOKESMAN: He doesn't see well to the left. He has a weakness of the left side of his face. He's clumsy with his left arm, clumsy with his left leg, doesn't quite feel it.

LEE HOCHBERG: Anderson had suffered a stroke, suddenly impaired blood circulation to its brain. It's the No. 1 disabler of adults in this country, and there has been no emergency treatment for it. A half a million Americans have strokes every year; 2/3 never recover, and 150,000 die every year.

SPOKESPERSON: You need the tubing over here with the drug and the pump. Yes, now.

LEE HOCHBERG: But Anderson may recover fully from his stroke because of a new drug. Dr. Richard Atkinson of Mercy Sacramento Hospital.

DR. RICHARD ATKINSON: We've seen people get better while we're giving the drug. I mean, we know that that can happen. We'd love to see it in the next half an hour.

LEE HOCHBERG: The drug is called Tissue Plasminogen Activator, or TPA. It's been used for years to dissolve blood clots related to heart attacks, but it's now being used on clots in the brain that cause stroke. Half of the patients who've received it have recovered fully within three months.

MARY DOMREIS, Stroke Patient: I'm just fine. I don't have any residual from the stroke that I know of at all.

LEE HOCHBERG: Seventy-five-year-old MARY DOMREIS walks a mile and a half through her Portland, Oregon, neighborhood every day, only months after she suffered a severe stroke while driving.

MARY DOMREIS: At the intersection, there was a police car coming from the--on the right side. He was parked, ready to turn. And that's all I remember until I woke up in my car just a few minutes--a minute or two later with a policeman outside the car trying to open the door, and I couldn't talk.

LEE HOCHBERG: Paramedics rushed Domreis to the stroke center at Oregon Health Sciences University.

MARY DOMREIS: My son explained it to me the next day. He said that my mouth was all twisted to one side.

LEE HOCHBERG: She received TPA, and within 12 hours she could speak almost normally. She progressed so well she was released that week and never even went through rehabilitation.

MARY DOMREIS: I'd always thought that after you had a stroke you'd have to be bedridden probably and would not be able to talk. It feels to me that somebody didn't think I needed to die yet.

LEE HOCHBERG: Despite success stories like this, TPA is only being used on about 3 percent of stroke patients. That's because the drug needs to be administered within three hours of the onset of stroke. If it's used later than that, it may cause bleeding into the brain. And administering it within that three-hour time window is proving difficult. Oregon Stroke Center neurologist Dr. Helmi Lutsep says its rare that patients even get to the hospital within three hours. While many Americans recognize full-blown stroke symptoms, like paralysis and impaired speech, only half can identify the immediate, more subtle signs.

DR. HELMI LUTSEP, Neurologist: People can develop minor symptoms like subtle numbness, for instance, or loss of vision, which they may not recognize as indicating a stroke.

LEE HOCHBERG: Domreis says she was lucky a police officer, who saw her veer off the road, got quick help.

MARY DOMREIS: That's the reason I'm still here probably because if the policeman hadn't been on the corner immediately--I'm just really lucky that they were there.

AD SPOKESMAN: It used to be called stroke. Today we call it a brain attack.

LEE HOCHBERG: The National Stroke Association is trying to speed up public reaction to stroke and generate more of a crisis response by giving stroke a new name.

AD SPOKESMAN: Explosive headache. A brain attack is a medical emergency.

LEE HOCHBERG: Experts say faster response could enable 1/3 of stroke patients to be treated with TPA. But they add it's not just the public that needs to respond faster. Doctors and hospitals have to too. Lutsep says most emergency rooms are unprepared to process stroke patients quickly.

DR. HELMI LUTSEP: The patient may sit there--you know, presumably, they could sit there for an hour or two while they're waiting their turn.

LEE HOCHBERG: Even a stroke patient.

DR. HELMI LUTSEP: Even a stroke patient. The trouble has been in the past that we didn't have emergent therapies for stroke, so stroke cases were considered to be, you know, sort of further down the line in terms of acuteness of their care. And they may not have been brought to the attention of a physician very quickly.

LEE HOCHBERG: The Oregon Stroke Center has adopted new emergency room protocol to treat stroke patients faster. It gives them quick access to neurologists and radiologists and leaves gathering of some medical histories for later. Lutsep says the process can save a crucial hour.

DR. HELMI LUTSEP: I need to make sure when this started. Okay. When did the stroke start?

LEE HOCHBERG: Still, there are problems. Lutsep and a translator tried hard to determine if a Chinese woman had gotten her husband to the hospital within the three-hour time window.

TRANSLATOR: About 8:30. So we only have a few more minutes if we're going to be able to give medicine if he needs it. So I'm going to have to go kind of quickly now.

LEE HOCHBERG: As if to emphasize how treating stroke patients quickly goes against the grain, even at the Stroke Center, even as the three-hour deadline approached, Lutsep had to hustle along an ER worker, who had other priorities.

DR. HELMI LUTSEP: We've only got 15 minutes if we're going to get blood, so we's going to have to wait. I'm sorry.

ER WORKER: He's got an extremely distended bladder.

DR. HELMI LUTSEP: I know, but we can't get the TPA in after 15 minutes from now.

ER WORKER: And I can't put a catheter in after you put TPA in either.

DR. HELMI LUTSEP: A hospital can't wait and take time in doing the next step. It needs to happen very quickly.

LEE HOCHBERG: There's another barrier. The new drug can actually worsen the condition of some patients, even causing death. Though most strokes are caused by a blood clot in the brain and TPA works well on those, the drug can aggravate 15 percent of strokes that are caused by a brain hemorrhage. Doctors need to do a CAT scan quickly to determine which kind of stroke they're treating. At most hospitals the wait for the CAT scan machine is lengthy. Oregon Stroke Center has tried to change that.

DR. HELMI LUTSEP: The stroke patient used to have to wait their turn to get on the scanner. And now we've got the advantage that the stroke patient is given, if not highest priority, very quick priority after some of more severe trauma cases.

LEE HOCHBERG: Quick access to a CAT scan is problematic at many smaller hospitals which often don't have radiologists on call 24 hours a day. And Lutsep says even at some larger facilities doctors unaccustomed to treating stroke as an emergency are resisting the new demand of overnight calls. Stroke centers are also finding they need to retrain 911 dispatchers to make stroke a higher priority. They're teaching dispatchers to call the ambulance that's closest to the stroke patient. And ambulance services are being urged to transport patients to hospitals that have streamlined stroke protocols in place.

DR. HELMI LUTSEP: Insurance is starting to become problematic as well; that if a patient's insurance dictates that they go to a particular hospital, that's the hospital to which they go to.

LEE HOCHBERG: Whether or not that hospital has a CAT scanner?

DR. HELMI LUTSEP: That's correct. And I don't think right now that there's a mechanism in place to send a patient to the one with a CAT scanner.

LEE HOCHBERG: Cost is yet another barrier to accessing TPA. A dose of the drug can run as high as $5,000. Even at that cost neurologists contend it will reduce expenditure on stroke by cutting the $30 million a year now spent on rehabilitation. Oregon Stroke Center neuroradiologist Gary Nesbit.

GARY NESBIT: Rehabilitation costs over a year anywhere from thirty to fifty thousand dollars, or even more. And so when you look at the cost effectiveness, if we can get patients out of rehabilitation hospitals, out of nursing homes and back home, not only will it make them better, but we also decrease costs.

LEE HOCHBERG: Oregon doctors are experimenting with drugs that might get around TPA's problems. This man arrived at the Stroke Center last year practically brain dead nine and a half hours after his stroke. Dr. Wayne Clark injected a drug called Urokinase directly into the blood clot.

DR. WAYNE CLARK: By the next morning I still was not hopeful, but when we came in and saw, he was now moving his arms and was responding to verbal commands. So it--overnight, he had made a remarkable recovery.

LEE HOCHBERG: The man went home after six weeks of therapy. Patients at 50 hospitals nationwide have undergone this new treatment with three out of four able to return home. But doctors say using TPA in the first three hours, as they did with Orvin Anderson, is still the better course. Anderson's home now in Sacramento, doing fine. The challenge is to remove the barriers that prevent many other stroke victims from similar recoveries. FOCUS - SHATTERED HEALTH

MARGARET WARNER: Now, a look at health care problems in the former Soviet Union. The breakup of the USSR in 1991 shattered the public health system in Russia and the other former republics with dramatic results. The life expectancy for a Russian male, which used to be in the mid 60's, has dropped to 58. The life expectancy for an American male is 74. In 1995, Russia's death rate was one and a half times greater than its birthrate, triggering an unprecedented declined in population for a peacetime era, and a Russian child is two and a half times more likely to die before age five than an American child. To find out why all this is happening Elizabeth Farnsworth recently interviewed Newsday Correspondent Laurie Garrett. She traveled to Russia earlier this year and completed a major series about the problems there.

ELIZABETH FARNSWORTH: Thanks for being with us, Laurie. Why did you do this? What did you see? What kind of figures were you seeing that made you devote eight months of your life to this?

LAURIE GARRETT, Newsday: Starting in 1991 and '92, UNICEF started releasing these reports, calling this the most dramatic shift in peacetime history, comparing what was going to what happened in the United States during the Great Depression in terms of all your basic health markers, life expectancy, infant mortality, child mortality, birthrates. The numbers were so astonishing I said we have to find out what's going on here. It's too easy to just say it's because of social change.

ELIZABETH FARNSWORTH: Why? Why did the break-up of the Soviet Union lead to this?

LAURIE GARRETT: Well, first of all, we now know some of this preceded the break-up. Some of it's because of policies going back to the Soviet period. But we also can see that there have been severe economic transformations and the collapse of the essential infrastructure, which used to be very centralized, very Moscow, dictated down to all the little republics all over the system, now those are all independent nations, and pieces of the system don't work anymore.

ELIZABETH FARNSWORTH: Let's begin with the hospitals and clinics. You tell really--to me, it was very surprising stories about the lack of infection control, even in hospitals and clinics in the big cities. Tell us about that.

LAURIE GARRETT: It's fairly startling. Under the Stalinist system any larger infrastructure, which medicine certainly qualified as, had to have a parallel policing infrastructure that would keep eyes on the other guys, make sure they didn't deviate from the party line. Parallel infrastructure in the case of medicine was something called sanitation and epidemiology. And SANAP would basically function like cops. So there was tremendous contention between the very people you would want to be spotting infectious disease problems and alerting them, alerting the physicians to make the appropriate changes. Instead, these people were viewed as cops. They would come marching in, and they would take samples off the walls of the hospital, on the floors, and the ceilings, and go back to the lab and culture them, and if they found streptococcus, for example, some doctor got in big trouble. So the result is that tremendous amount of energy is spent even now scrubbing the walls. You can walk into a hospital that will reek of chlorine and yet, when you see the procedures, the physicians will wash their hands, if they wash them, with a commonly-shared bar of soap, a commonly-shared towel. You will see bare-handed nurses changing IV drips, changing catheters, and changing shunts--bare-handed. There's just not a sense that this is your most likely mode of transmission of disease within a hospital.

ELIZABETH FARNSWORTH: And in some cases you wrote that there's no money for gloves, no money for towels.

LAURIE GARRETT: No money for anything. I mean, many physicians have gone unpaid for six months to a year across the region. We're not just talking here about Russia--the whole region. And--

ELIZABETH FARNSWORTH: And we have a picture of this in Georgia, some of the--ways of washing. Tell us about that.

LAURIE GARRETT: This was a particularly horrendous episode. I came into a hospital in Central Georgia, the nation of Georgia. And there was a hernial re-sectioning procedure going on. In the middle of it the scrub nurse, who you see in the foreground in this picture, picked up a bunch of surgical instruments that were bloodied, walked over to this standing pot of water, dipped them in the cold water, sort of air-dried them, and came back, and they went right back into the patient.

ELIZABETH FARNSWORTH: And as a result of this, drug-resistant staph,for example, is killing people. Tell us about that.

LAURIE GARRETT: Well, when you combine the lack of appropriate infection control with widespread misuse of antibiotics, and, in fact, just massive antibiotic underground. What you end up getting is the breeding of drug-resistant strains of streptococcus, staphylococcus, every garden variety infection you can think of.

ELIZABETH FARNSWORTH: Let me interrupt you just one second. By misuse of antibiotics, you mean using them for not the prescribed time, or using three or four, or what do you mean?

LAURIE GARRETT: Well, you may not even have prescriptions. It's simply--(coughing)--I don't feel well, what should I take--well, here, try these third-generation Sulfalasporin antibiotics. Any physician listening to this will cringe at the idea that someone who simply is running a mild fever and coughing should be given what we consider, you know, top-of-the-line antibiotics, final stage treatment. And any time you misuse antibiotics you run the risk of creating a resistant strain.

ELIZABETH FARNSWORTH: And we have a picture of this to a drug-resistant--somebody who's suffering from staph. Tell us about this.

LAURIE GARRETT: This is little Irakli. He's so malnourished that it's hard to believe he's 15 years old, again, in Georgia. He got a streptococcus infection, probably just a standard garden variety cut, but he was given one round of antibiotics after another, and eventually, because of the poverty of his family and their inability to purchase adequate antibiotic treatment, the streptococcus mutated or developed resistance, and, as you can see, ate through the skin, into his bones, into his heart, and eventually, I'm quite certain by now he is deceased.

ELIZABETH FARNSWORTH: And you write about an epidemic of tuberculosis. Tell us about that.

LAURIE GARRETT: TB is out of control, positively, completely out of control. To put this in perspective in 1991 we decided we had an out of control TB epidemic in the United States when the incidence reached 9.2 per 100,000 in New York City, with a total nationwide of 26,000 active cases. There's 145,000 active cases of tuberculosis in Russia alone. You go across the region and TB is simply raging. In the Buryatia Republic, which you see pictured now, where the ethnic Buryatis of Mongolian blood for one reason or another--

ELIZABETH FARNSWORTH: It's just North of Mongolia.

LAURIE GARRETT: Just North of Mongolia on the East side of Lake Vaykal in Siberia. They are especially vulnerable. And right now the incidence of TB in that population is approaching being the highest in the world, beating out South Africa.

ELIZABETH FARNSWORTH: Why is this happening? Why is TB so much worse than it was before?

LAURIE GARRETT: Well, first, it was climbing, we now know, at a rate of about 5 percent a year throughout the 1980's. So the system was already beginning to fail to deal with TB then. It's an old-fashioned system based on sanatoriums. If I identified as a Russian physician that you, Elizabeth Farnsworth, had TB, you would no longer be able to work; you would be removed from your family; you'd spend a couple of years in a sanatorium until I could prove you're absolutely disease free, and then you might be allowed back on the job. Well, obviously, once you no longer have a totalitarian state, it's pretty hard to enforce such a system and make people say, oh, test me for TB because I'd like you to throw me away for two years. So you have more and more untreated TB that goes to very advanced stages, highly contagious stages, before gettingtreatment. You have massive drug shortages and inappropriate use, so they're breeding drug-resistant strains. And the final piece of that is about 30 percent of all the tuberculosis is in the jails, and the jail system is just woefully overcrowded because they're also trying to transform a criminal justice system, but they don't have a lot of people who know how to be defense attorneys, who know how to do trials and know how to sit in court, so at any given time 20 to 40 percent of people in prison have never had a trial. And so the jails are just packed with tuberculosis spreading inside.

ELIZABETH FARNSWORTH: You said some jails have--50 percent of the people have TB, is that right?

LAURIE GARRETT: Yes. In fact, there is at least one jail I can identify in Siberia that has 70 percent of the jail population had had TB.

ELIZABETH FARNSWORTH: And you write a lot about AIDS and how the incidence of AIDS is increasing. Tell us about that.

LAURIE GARRETT: The United Nations AIDS program has labeled the explosion of AIDS in the region to be at this time the most dangerous in the world, and the Ukrainian AIDS people referred to their explosion as an A bomb, it's growing so rapidly, so dramatically.

ELIZABETH FARNSWORTH: Mostly because of IV drug use?

LAURIE GARRETT: Yes. IV drug use is the driving force, though, there is also a huge prostitution component, and the terror of it is that when you look at the IV drug use, it's fourteen to twenty-two year olds; it's kids. You see horrible things. This picture shows you in Odessa, where I saw the highest rate of drug use I've ever seen anywhere in the world as a reporter, there in one hour I counted 500 kids walking past me buying opiate derivatives and shooting them up right in front of me in an open field.

ELIZABETH FARNSWORTH: And using the same needles over and over again?

LAURIE GARRETT: Using the same needles; sharing needles; and the hepatitis rates are astronomical. HIV is soaring in this population group, and they're kids.

ELIZABETH FARNSWORTH: What do people there say about this? Is this something that a myth--this must be something that Russians or Georgians or people in the other republics are very aware of? What did they say to you about what's happening?

LAURIE GARRETT: Well, it depends on their politics. If they come from the old Communist line of thinking, they say, you see, this just shows, we never should have allowed the West in; look what they brought us. We never had this drug abuse problem under Communism. If they come from a more--shall we say future thinking--21st century way of looking at the world--they say, it's a tragedy that we have no idea how to deal with this because our old system was you rounded up drug addicts; you locked them up; and that's the last they ever saw of the world. We don't know how to do outreach programs. We've never tried to do programs related to public health that reached out to teenagers and convinced them to change their behavior; and we need to learn how to do these things. It's an altogether new science for them.

ELIZABETH FARNSWORTH: Is some of that happening? Are people learning? Is there any good news?

LAURIE GARRETT: Well, there's a difficult point that we're at right at this moment because the key professional age group that's most enlightened, most interested, are those who grew up during perestroika and are now in their mid 30's roughly. Professionally, they are more likely to have had exposure to western medical literature, but they're also far more likely to have decided to leave the region and emigrate here or to Europe. They've lost thousands and thousands and thousands of physicians and scientists, a massive brain drain. And you can see that the time is short, very, very short for intervention in assistance because soon all that generation will have left if they can find work elsewhere.

ELIZABETH FARNSWORTH: Laurie Garrett, thanks very much for being with us.

LAURIE GARRETT: Thank you. ESSAY - NEWS OF THE SOUL

MARGARET WARNER: We close tonight with some thoughts from essayist Roger Rosenblatt about the relationship between art and the news.

ROGER ROSENBLATT: There may be nothing better for an age that depends on journalism than the publication of a great collection of short stories. The great collection recently published is that of the late Bernard Malamud, complete stories, a rich, thick volume of sad, touching, sometimes perplexing tales of mostly Jews leading private lives in mostly New York in mostly the 1940's. They represent the unnoticed moments in cities everywhere, stories of people that are revealed when the walls of their apartments are peeled away and the roofs lifted off. They are almost always about the significance of insignificant lives. They are not novels. They have no magnitude, Aristotle's daunting word, in the sense of sustained development of character, or the leisurely exploration of a grand theme. It is for this reason that the short story is so good for an era in which journalism has become the most prominent way for understanding people and events, for journalism is really inadequate to that assignment. Like short fiction, the news usually has a limited number of characters, minimizes exposition, skims over a social or historical context, and comes into being only at the end of an event or the climax of an action. To wit, the short story of the murder of businessman Nelson Gross, or the short story of a pitcher's performance in a crucial game, or of a scandal, or a hurricane. But the news is a series of short stories without the art of short stories. If the art is missing, so is the soul. The short story has been most successful in the hands of writers who were clearly connected to the worlds in which they worked. Chekhov's Russia was the microcosm of that vast, confounding place, Hemingway's America the same. Frank O'Connor's story, "Guest of the Nation," told more about Ireland's war against the British than any story before or since. Eudora Welty, Faulkner, Joyce, Katherine Ann Porter, Flannery O'Connor, J.D. Salinger, Cheever, each knew the current events of his or her territory. They saw under the events and under the territory, but they also knew that life is generally meaningless or without discernible meaning, and that to take it in in bite sizes is the most we can digest at a sitting. What those writers did then, what Malamud does so beautifully in his collection, is to find the small telling incident at the center of a person's pain, or joy or humiliation or disappointment, the center of his soul. This is what journalism does not do, cannot do, which is why a great book of short stories offers valuable parallel reading in an age that pays so much attention to the news. Malamud writes of a Russian Jewish grocery store owner in New York City, at odds with his German-American supplier of goods, of his desperate powerlessness as he learns of France's capitulation to the Germans. In the wider world, German tanks are rolling into Paris, but they are also rolling toward the grocer. That is the story's news. Short stories may parallel the news, but they also make the news moral. Some yearsago the news told the story of the police beating of Rodney King in Los Angeles. It was all very stark, and it came and went as a matter of fact. The story looked only at the outside and asked who was right and who was wrong. But for me there was an echo of a different and more probing tail, such as one that Malamud told. In "The Apology," a policeman who has harassed a peddler later helps him to recover his goods. Yet, he is still hounded by the man. The peddler seeks more than his goods; he seeks an apology. Eventually, the policeman apologizes to him. The man goes away, and the policeman misses the man's moral presence in his life. The news of the soul. I'm Roger Rosenblatt. RECAP

MARGARET WARNER: Again, the major stories of this Friday, stocks in South Korea surged on news the next payment of rescue loans would arrive sooner than planned. And the U.S. telephone technician accused of spying by Russia returned home for a holiday visit. We'll be with you on-line and again here Monday evening. Have a nice weekend. I'm Margaret Warner. Good night.