The dire reality of "universal health care" in North Korea

[As Heard in North Korea]
Unification Media Group  |  2015-06-02 10:43

"As Heard in North Korea" articles contain the content of Unification Media Group [UMG] broadcasts into North Korea. UMG is a consortium created by Radio Free Chosun [RFC] and Open Radio for North Korea [ONK], shortwave radio stations targeting North Korea; The Daily NK, an internet periodical reporting on all aspects of North Korea; and OTV, an NGO-based internet television channel.

It is time for In-depth analysis, where we discuss the status of the Korean Peninsula and related news with experts. Today were going to examine the North Korean medical system and disease control practices with Cho Su Ah, who worked as a surgeon in North Korea and is preparing to become a certified healthcare professional here in South Korea. 

1. As we mentioned earlier, recently there have been many articles promoting free medical care in North Koreas Party-run Rodong Sinmun. These stories are along the lines of a fatally ill patient recovers as a result of the public health care and such health recovery is all thanks to socialist practices. Can any North Korean citizen, regardless of location and socioeconomic status, receive public health care benefits? 

Honestly, I am not convinced at this point. I came to South Korea 7 years ago and back when I was in North Korea, the medical conditions were so frail that you couldnt receive medical treatment even if they were to be charged. In fact, public health care was a policy proposal during the 1970s, targeting children and pregnant women with actual implementation.  However, the system took effect for short five years then started to crumble [namely following the fall of the Soviet Union and a huge loss of cross-sector support needed to prop up the state].

I believe stories that appear throughout North Korean media are very special cases. Kim Jong Un would visit a specific hospital and order doctors to treat a certain illness. Then, the hospital follows the order because it would only dignify their reputation. From the patients perspective, it is a true fortune. He or she was ill and hospitalized, and thanks to the Generals mercy, theyre cured! At this moment, it is practically impossible for North Korea to provide free medical care to its citizens. 

2. You mean, besides the fact that the public health care system does not reach every citizen equally, it is highly poor in quality as well, correct? 

I swear, North Korea cannot even provide 100g of corn as a meal to its citizens at this point. How does a public health care system make sense, then? 

3. How do North Koreans treat a common cold or enteritis?

When the government distributes rations, hospitals are activated. The government even sends doctors to search for medicinal herbs in the mountains for forty days every spring and fall. The doctors used to gather forty different kinds of herbs, pound them in a mortar and turn into medicine, and hand them out to cold patients. But now, everyone is out in Jangmadang [marketplace] because there isnt enough food. So whos going to go to the mountains and gather herbs? 

4. Despite all the contradiction and controversy, North Korea continues to consistently promoting its public health care system. How would North Korean citizens who are not receiving any benefits from the system react to such advertisements?

When North Koreans see these articles, they only go so far as to say "People in Pyongyang receive all these benefits from the General. When will those of us living in the country ever be treated like that?"

And because hospitals are so frail, even when people read such articles--honestly only 1-2% of North Koreans read the Rodong Sinmun. My father was a high-ranking official, so the paper was delivered to our home every day, but regular citizens dont have access to the publication; they simply dont know about these issues.   

So these people dont really know how the North Korean society is functioning. Every now and then they would hear about Kim Jong Un on the Nine O' Clock Chosun Central News Agency broadcast, but this would most like be something involving the leader making an onsite-visit somewhere. The mind and the heart are separate, you know? 

5. The photos in Rodong Sinmun show very clean hospitals that look very up to date. For example, theres Pyongyangs Taesongsan General Hospital, Ryukang Dental Hospital, and Okryu Childrens Hospital. All of these facilities on the look sanitary, and you can also spot modern equipment. What percentage of the Norths hospitals would you say are like these? 

Only about 0.001 percent -- a handful. In fact, only two or three. There is only one medical college hospital per province, and even for smaller hospitals, there are only one or two in each county. 

The only reason why a number of modern devices exist is because of wealthy foreigners who are curious about North Korea. As you know, there are many who wonder why North Korea does not collapse despite being so isolated. Its said that a lot of people like that want to visit Pyongyang once in their lifetime, and when they come, they supply medical equipment rather than cash or fertilizers. They send samples of medical devices to a few hospitals in Pyongyang. Electricity is necessary to run these devices, but having lived there myself, I can tell you, it is not like you get a steady supply of electricity. 

6. So the medical equipment is useless without power? 

Exactly. That is why at the most they can only test-run them. The General (Kim Jong Un) has studied abroad and can speak English, so he points to the machines and talks about them, but thats about it. I think hes just using them as props for his pictures. 

7. Have you used any modern medical devices as a doctor? 

No, because the foreign language we learned was Russian. We learned Russian from when we were young. We were told that Americans are foes that we need to kill, so why would we learn English? 

We learned all the medical terminology in Russian as well. But the machines are all in English. Learning English has become a fad these days, and people are told that they must learn English in order to drive out South Korea. I went to medical school in South Korea as well, but learning English is not something you can do overnight. 

Its no use bringing machines to North Korea. For instance, a pastor from a large South Korean church sent machines to build a heart center in the North, but theyre all just sitting there. They cant use them. 

8. Then what rate of the population would you say receives free medical care from modern hospitals with proper equipment? 

Going to such hospitals would be expensive for people from other areas, even if they are high-ranking officials. So I would think that even one percent is a generous estimate. 

9. How about in other areas? If you look at photos of hospitals in rural areas, they look so dilapidated and unsanitary that it is hard to even call them hospitals. What was particularly shocking was a photo of patients receiving IV fluids from a beer bottle. Is this a photo of a current North Korean hospital in the countryside, or is this from decades ago? 

This is from when I was still in the North, during the period of 1995 to 2000, when the Arduous March [famine] took place. Its still the same now though. If you took this photo to Pyongyang, they will deny things like this exist in the country. 

But conditions are not much different in Pyongyang either. North Korean doctors and nurses like receiving glass syringes for wedding gifts. Because the system in the hospitals has collapsed, doctors sometimes purchase medicine on their own from markets, and treat patients with that when making house calls. Glass syringes can be sterilized, whereas plastic ones become discolored after a few uses. That is why glass syringes are popular, and to be honest, there are still no proper IVs in the North even now. 

10. South Korea and most other countries use disposable syringes, needles, and bandages because these items, which directly touch or penetrate someones skin, can cross-contaminate. As you just said, if the North reuses equipment like this, arent there high dangers of becoming subject to contagions? 

Yes, that is why bacteria do not die quickly. North Korean antibiotics are very strong. Because North Koreans are injected with such strong antibiotics, a lot of people have compromised livers. Once youre infected with something, it lasts a long time as well. 

In fact, medicine there is just strong in general. Being exposed to things like this is why the life span of North Koreans is so much shorter than South Koreans at large. 

11. Im sure youre well aware of this practice, since you were a surgeon in the North. Many North Korean defectors say it is common in North Korea to conduct surgery without anesthesia.

I say this as a surgeon who has directly led surgeries. If the country doesnt even have basic IV fluid or saline, where would it get anesthetics from? Most of the women who had double-eyelid surgery upon high school graduation or before getting married underwent the surgery without anesthesia. 

12. So there are double-eyelid surgeries in North Korea too? 

Yes, the standard of beauty is pretty much the same between the two Koreas.   

13. Is it still possible to do surgery like that without medical equipment? 

A lot of people receive surgery at private homes. North Koreans are good at sewing, since theyre good at things like embroidery. Some people illegally offer surgeries in exchange for things like corn. But those often lead to side effects, so many prefer to receive safer surgeries from doctors. Doctors sometimes have to stick patients thighs with things like sharp needles while they treat them for conditions like appendicitis, because they lack anesthetics.

14. I cant even imagine how painful that must be. 

The thing is, many North Koreans engage in farming, which entails digging the ground in order to plant corn or barley. There are also those who injure themselves while chopping down trees in the forest. So the most popular medical field was general surgery, because there are many patients who get hurt. There are not that many doctors in other fields, such as internal medicine. The second most popular medical field is obstetrics, because the state tells people to have more children and getting an abortion is illegal, so you would have to bribes for one. 

15. You must have been surprised to witness medical treatment in the South thats offered with proper anesthesia. 

Because there are so many anesthetics in the South, I kind of thought South Koreans just really liked them. Ive even wished that we could ship one-third of them to North Korea. I think South Korea uses them too frequently.   

16. Id like to turn to the subject of disease treatment. Both South Korea and the broader international community are quite concerned with infectious diseases such as tuberculosis in the North. Do you think you could say that medical authorities in North Korea have a system or a policy for treating tuberculosis? 

No. They merely isolate those who were exposed to the illness, and because most of the medicines are sold in the markets, they treat patients by telling them to buy drugs at markets. Theres nothing doctors can do about it. 

17. Tuberculosis can be completely treated with modern medicine. But the disease remains a problem, but youre saying its a problem in the North because they dont know how to manage the disease? 

The more pressing issue is that conditions are exacerbated due to the lack of food, which weakens the immune system. People have trouble getting enough food, clothes, and shelter for their daily lives. Also, hospitals lack medicine because, for example, drugs sent by the United Nations are sold by doctors to private market vendors. So the patients suffer while the medicine keeps being circulated. 

18. So shouldnt the international community actively monitor the use of medicine after sending supplies to North Korea to ensure aid is being transparently distributed? 

There are expiration dates for vaccination medicines. Because people sell these medicines to rake in profits, by the time they reach people in rural areas, most of the drugs have expired the date by at least a fortnight. We do still use the medicine though, since it was provided by the United Nations. 

Of course, the medicine is not sent to foreign countries such as China. It circulates within North Korea. But it does not immediately reach North Koreans upon arrival in the state, and instead is buried underground as war supplies. They are buried and swapped out every three years. So even if there is an influx of a lot of medicine, a lot of them are bought on markets by individuals as home emergency supplies. 

19. North Korean authorities had regulated the border area and limited foreigners entry into the country from late last year to early this year in order to prevent the Ebola virus from entering the state. I cant help thinking that tuberculosis and malaria are bigger problems in North Korea than Ebola. Its hard to tell whether the North understands the gravity of infectious or contagious diseases.   

I used to believe this too when I was in North Korea, but most North Koreans believe that the North is the wealthiest country in the world, since they do not have access to outside news. The state issues booklets and material, which are used to educate people. For instance, the booklets will contain a message saying that people should boil water before drinking it in the summer because of cholera. The thing is, North Korea has had the experience of the entire country suffering from cholera and typhoid. I think Kim Jong Un is putting on a show, to show the rest of the world that North Korea is taking care of peoples health. 

20. When you attended medical school in North Korea, did you believe in the governments claims that North Korea boasts an advanced medical system that the rest of the world envies? 

Yes, I actually believed that North Korea had the best medical system in the world. Even if our x-rays did not function and there was rust on devices, we were proud of merely having such equipment. We were proud because we thought that compared to South Koreans, who cannot even go to hospitals because they cant afford to, we are living happily. When I first came to Korea, I thought South Koreans were exhibiting the greatest medical devices in the world to put on a charade in front of us. But as time passed, I realized that the disparity between the North and South is tremendous. 

21. When you talk about the wide disparity, youre referring not only to medical aid or medicine but the system itself, right? There must be various differences, but what is the biggest difference between the medical systems of the two Koreas? 

I would say medical appliances. They are so flashy in South Korea that it feels like its all part of a fantasy. I would think, I wish we had a device like that. But because the medical system in South Korea is quite developed, I think doctors can be less attentive and provide mediocre service to their patients, since they have highly developed medical equipment. But whereas there are no medical appliances in North Korea and doctors have fewer patients, they can be more attentive to each patient. 

22. Medical care is not free in South Korea. Of course, senior citizens and those of low-income families receive free healthcare, but most citizens are provided with partial medical insurance and aid from the government, and they have to pay the rest with their own money. Was it hard to get adjusted to this system when you first arrived? 

Yes, that was quite hard to get used to. Even though the government is providing a lot of benefits, and I end up having to pay only 10,000 KRW for what would have been 300,000 without government aid, that 10,000 KRW still felt like a hefty sum. But now when I think about it, the cost patients have to bear does not seem like much because medical expenses are computed based on ones income in South Korea. I think it is actually better because even though I am paying more, I am receiving better-quality service and living a healthier life.

23. I think you might be one of the first, if not the first person to have been a doctor in both Koreas. You must have a vision about what the medical system should be like on the Korean Peninsula after reunification. 

We never learned of rare illnesses in North Korea, and people really dont know what to do. When I dream about a unified medical system for Korea, there are still some things that remain in North Korea, like home visits. I know it would be hard to change the medical system all at once, but I think we can gradually supplement the system by introducing the strengths of both countries.

*Translated by Jiyeon Lee, Jihae Lee, and Suzy Park

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