MACHA, ZAMBIA — Chief Macha, of the Tonga people, has enough concerns of his own. The road that runs through his chiefdom and connects it to the nearest small town is rutted, rock-strewn, and when travelled by more than one vehicle at a time, enveloped in blinding clouds of dust. In this remote rural stretch malaria has been endemic, until recently killing about 50 children a year in a population of about 180,000 people. Malaria has also brought poverty, maternal deaths, anemia, almost all the problems, directly or indirectly, that have filled the nearby hospital in the past, putting young patients two to a bed and on the floor.

Macha also is home to one of the most successful malaria research institutes in the world, and to a very good hospital that has seen a sharp decline in the disease's impact in recent years. but even after its 50 years, and all its challenges and successes, getting there is no easier there ever. Chief Macha wants an ambulance, and he was hoping that would get mentioned in the newspaper article we had come to talk to him about.

That was one of the issues he wanted to discuss when a reporter and I stopped to see him on our way back from the hospital. But the other was this: "Why is it so hard," he asked, "to get health care reform passed in America?"

It was a good question, particularly as it had made it across the ocean and through all the worries and uncertainties of health care in the countryside of a nation where preventable and treatable diseases make average life expectancy  half a life -- at about 40 years. The news that makes it over from America to here tends to be distilled to essential elements -- Obama updates, sex scandals, and the death of Michael Jackson -- with the whole rest of the world sharing time to a much greater extent in news media here. Still, America's news made it to Macha, and he wants to understand it better, he said, because the need for health care is universal. Understanding why Americans can't agree on health care might help him to understand why solving problems here, in Macha is as hard as it is, he said.