Archive for the ‘Health care’ Category

Tuberculosis in North Korea

Wednesday, April 11th, 2018

Benjamin Katzeff Silberstein

Some interesting (and disturbing) numbers and facts in this article by Bloomberg. One wonders just how many TB treatments one of Kim Jong-un’s yachts could pay for…

While the rogue state’s nuclear ambitions have long inspired angst—and led to economic sanctions—the threat of TB, the planet’s biggest infectious killer, has garnered less attention. With more than 100,000 cases in 2016, North Korea is on the World Health Organization’s list of nations with the greatest incidence of the deadly lung disease, and doctors warn that an explosion in multidrug-resistant strains could be coming.

In February, the Global Fund to Fight AIDS, Tuberculosis and Malaria, the biggest financial contributor to TB control in the Democratic People’s Republic of Korea since 2010, announced that it will close its programs there in June, citing challenges working in the country. The closure of programs is likely to lead to “massive stock outs of quality-assured TB drugs nationwide,” wrote Harvard Medical School doctors in an open letter to the Global Fund, published on March 14 in the British medical journal the Lancet. Such privation in the past has “led to the rapid creation of drug-resistant TB strains, as doctors ration pills and patients take incomplete regimens,” they wrote.

Infections that can’t be cured with standard drugs are already rife in the country. No nationally representative survey has been conducted to measure the incidence among North Korea’s 25 million people, but according to WHO estimates, 5,700 of the country’s 130,000 TB infections in 2016 were caused by bacteria resistant to the antibiotic rifampicin or at least two other key TB medications.

That may be a gross underestimate, according to a study published last year in the Journal of Korean Medical Science that analyzed hundreds of patient sputum samples. More than three-quarters of those that tested positive for TB contained multidrug-resistant strains, and two samples contained extremely drug-resistant strains—a form almost impossible to treat in resource-poor countries such as North Korea. Treatment for patients with multidrug-resistant TB, or MDR-TB, commonly lasts two years or longer and typically involves six months of daily injections and a regimen of about 14,000 pills, including some that are toxic.

Treatment regimens that are too short or rely on inferior or inappropriate medicines are the fastest route to drug resistance, says Jennifer Furin, a Harvard-trained doctor and researcher, who’s cared for TB patients for 23 years. Cutting funding to programs in North Korea, she says, will undermine disease-control efforts beyond North Korea.

“This will be a disaster that the global health community will pay for later,” Furin says. “This is a politically created problem that will turn into a health catastrophe, not just for the people living in the DPRK, but for everybody in the region.”

Chinese authorities are on alert for cases among migrant workers from North Korea. Still, many people who’ve been exposed to TB develop a latent infection with no symptoms, making it difficult to stop at borders.

Dandong, a city in China’s northeastern Liaoning province and separated from North Korea by a river, is a main entry point for migrant workers. Quarantine officials identified 33 TB cases among 9,500 North Koreans screened from 2012 to 2014, according to a government report published in 2014 that recommended heightened surveillance in the Dandong area. Local authorities pledged in December to beef up border screening and epidemic management.

Just as HIV has helped spread TB in sub-Saharan Africa, chronic malnutrition is fueling the epidemic in North Korea, according to Kwonjune Seung, who was among the authors of the open letter to the Global Fund published in the Lancet. Seung visits a dozen TB centers in North Korea twice a year as medical director of the Eugene Bell Foundation, a Christian charity focusing on treating North Korean patients. A spillover of MDR-TB from North Korea “would take decades to clean up and could detrimentally affect the public health of bordering countries like China and South Korea,” Seung and his colleagues wrote in their letter.

More than 38 countries contribute to the Global Fund, including South Korea and the U.S.; in late March, Congress approved $1.35 billion in funding for the 2018 financial year. The Global Fund defended its decision to suspend its programs in North Korea, saying in an email that it was fully aware of the risks that might arise from disorderly closure of its grants and that it’s working with Unicef to accommodate mitigating actions. The decision to withdraw from the country wasn’t taken in response to pressure but rather influenced by concerns about the “unique operating environment” in North Korea, it said. The closed environment prevents donors from properly assuring effective use of grants and resources and managing risks. As of last August, the Global Fund’s internal performance reviewers gave the North Korea program a B1, or “adequate,” rating.

In an open letter to the Geneva-based organization published on March 13 by the Korean Central News Agency, North Korea’s official news agency, Kim Hyong Hun, the country’s vice minister of public health, accused the Global Fund of bowing to the “pressure of some hostile forces.” President Trump has been trying to enlist other nations in a campaign of sanctions against North Korea.

“The decision to suspend the Global Fund projects in North Korea, with almost no transparency or publicity, runs counter to the ethical aspiration of the global health community, which is to prevent death and suffering due to disease, irrespective of the government under which people live,” Seung and his colleagues wrote in the Lancet.

Furin sees it as another dimension of the tensions between Trump and North Korean leader Kim Jong Un, whom the U.S. president nicknamed “Little Rocket Man” after the nation tested its missile capabilities in September. The two nations are slated to meet in an historic summit as early as May. “You can’t help but think global powers are very concerned about North Korea’s erratic behavior, and this is a way to punish the country,” she says. “But this is a weapon of destruction in and of itself. TB is an airborne disease. It doesn’t stay within borders.”

Article source:
North Korea’s Other ‘Weapon’ Is Poised to Explode
Fiona Li, Peter Martin and Dandan Li
Bloomberg News
2018-04-11

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Friday fun: More North Korean “viagra”

Friday, January 19th, 2018

Here is the scan of a box of North Korean “viagra” tablets:

I am not a pharmacist, so I cannot speak to the efficacy of the product. However, the Washington Post reviewed a similar product back in 2016 and concluded it may actually work because it contained sildenafil. This product also claims to contain sildenafil, though we do not know how it is formulated.

Perhaps most humorously, the dosage instructions caution the consumer to “take one or two capsule [sic], 30 min to an hour before married life”. Presumably “married life” is a euphemism for sexual intercourse. There is a great joke here but you have to actually know me to hear it.

The pills are manufactured by the Tongyang Koryo Medicine Factory (pictured below):

 

The name Tongyang shows up in several industries, so if they are all linked, the company may also be involved in mineral water, alcohol, building materials, and retail.

Have a good weekend.

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DPRK doctors earn hard currency abroad

Wednesday, November 25th, 2015

According to the Joong Ang Ilbo:

North Korea is making $15 million a year from deploying 1,250 doctors and nurses in 26 nations where they perform illegal medical practices such as abortions and injections of illegal substance, South Korea’s intelligence agency reported Tuesday.

Some 1,170 North Korean medical staff are working in Africa, according to lawmakers Lee Cheol-woo of the ruling Saenuri Party and Shin Kyoung-min of the opposition New Politics Alliance for Democracy. They were briefed by the National Intelligence Service (NIS) on Tuesday as members of a parliamentary intelligence committee. The NIS reported that North Korean doctors are engaged in illegal medical practices with a focus on earning foreign exchange. They also sell dubious medical products.

The NIS said the North was accused of bribing local officials to keep their illegal activities going. Citing a report by a local newspaper in Tanzania published on Feb. 21, the NIS said North Korea was caught trading sexual enhancer products, or aphrodisiacs, that contained mercury 185 times higher than international standards.

Dispatching medical operatives overseas appears to be part of Pyongyang’s long-running effort to earn foreign currency. The intelligence agency also reported that North Korea, which it said was accelerating its exports of labor, is earning $230 million a year on average from 58,000 workers in 50 different countries overseas. Pyongyang is also reportedly planning to export 3,000 new workers to labor in the fields of construction, medical and IT industries.

North Koreans sent abroad also work in logging, mining, construction and agriculture.

The two lawmakers also quotes the NIS as reporting a sense of disappointment among North Koreans after Pyongyang failed to deliver on its promise to improve people’s living conditions to mark the anniversary of the 70th foundation of the Workers’ Party. The Communist state is also suffering from an acute shortage of electricity, according to a NIS report.

On Choe Ryong-hae, secretary of the Workers’ Party who has vanished from the public view for nearly a month, was sent to a rural agricultural cooperative for “revolutionary re-education,” the NIS reported, citing a classified source of information.

The agency said Choe was removed from power partly to take responsibility for a partial collapse of a power plant in Yanggang Province.

Read the full story here:
Pyongyang’s flying doctors pull in $15M a year: NIS
Joong Ang Ilbo
Kang Jin-Kyu
2015-11-25

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German NGO establishing school for deaf

Wednesday, July 8th, 2015

According to the Associated Press:

In a country with zero kindergartens specifically for the deaf, Robert Grund wants to help establish the first — just a small suite of rooms for perhaps a couple dozen kids, in North Korea’s capital, Pyongyang, a city of roughly 2.5 million.

It’s a small step, but Grund, the Pyongyang representative of the World Federation of the Deaf and the city’s only full-time deaf foreign resident, sees it as part of a larger push to end isolation for the deaf here by helping them be heard, involved and empowered in projects about them.

He appears to be making progress.

Over the past few years, North Korean officials have grown more receptive to helping the disabled. Events have become more frequent and get a higher profile in the state-run media, while more cultural exchanges are being allowed abroad. Recent media stories played up a new all-deaf soccer team. The North last month held high-profile events to mark Disabled Persons Day.

The kindergarten project is also coming together.

Grund says officials have approved a location for the facility, several rooms in a now under-used nursery building, and appear keen on opening it in time for the 70th anniversary of the founding of the country’s ruling party on Oct. 10.

The kindergarten itself will be wholly paid for and funded by TOGETHER-Hamhung, a German non-profit Disabled Persons Organization.

“Nobody knows how many kids will come,” Grund said in a recent interview with The Associated Press. “If necessary, we can assign more rooms for children.”

The plan is to accept children from infancy on up until they are old enough to attend regular deaf schools. Grund hopes access will be based solely on need, but he is not sure whether the government will instead decide who gets to go.

“From our point of view, every deaf child has access,” he said. “Since this country strongly advertises the right of children to be in nurseries and kindergartens, it is probably not so much a matter of choosing, but a matter of information and spreading the word so that the families get to know the new option and dare to bring their deaf child, overcoming the traditional hiding in the family.”

___

To be deaf in North Korea is to endure a level of isolation that is hard to imagine.

For most of his childhood, Ri Jong Hyok was a shut in.

While his father went out to do construction work, he stayed at home in Pyongyang helping his mother make tofu. He didn’t go to school. He had no friends and, with no one to teach him sign language, essentially no way to communicate with them even if he did.

“I had never seen sign language before I came here,” Ri told the AP through a sign language interpreter during a visit to the country’s largest school for the deaf, in Songchon, outside of Pyongyang, last year.

Ri is lucky to have found the school.

He wants to be a barber, and the school has a classroom where the students practice cutting each other’s hair, with barber’s chairs and pictures of various hairstyles on the walls. With few other trades open to the deaf, the most common jobs are barber or tailor for men, and hairstylist or seamstress for women.

Of the eight schools for older deaf children in North Korea, none are located in Pyongyang, though statistically the deaf population in a city the same size in a developing country would likely be in the tens of thousands.

There are roughly 300,000 deaf people in all of North Korea, according to official estimates.

But while about 10-20 percent of deaf children in developing countries are able to study in deaf schools, according to the World Federation of the Deaf, that rate is just 2 percent in North Korea, said an aid worker who spoke on condition of anonymity because of worries that ongoing projects might be hurt.

North Korean officials dispute that estimate.

Ro Kyong Su, director of the Korean Economic and Cultural Center for the Deaf and Blind, said mainstream public schools or other special-needs facilities currently accommodate most deaf or hearing-impaired students. By his calculations, there are about 6,000 school-age deaf children who need to be in schools that are specifically for the deaf. He said about half already are, and the number is rising.

“The other half will soon be able to go to school. We aren’t looking at a five-year or 10-year plan. It will be much sooner than that,” he said.

Officials involved in projects for the deaf acknowledge an outdated grasp of the size of the deaf community.

A major problem continues to be getting access to and diagnosing pre-school children, many of whom are shut in at home with families who have little awareness of hearing disabilities or the resources that might be available to them.

The government’s figures are also based on an old, somewhat ambiguous survey. Underreporting of disabilities is common, both because of a sense of shame and a fear among parents that, if reported, their children might be sent off to distant institutions, pigeonholed and channeled into an educational or career path with few opportunities. Nevertheless, a new survey is underway, which Ro believes will provide a more reliable picture.

___

Grund, possibly more than anyone else, has helped influence the change in attitudes toward the deaf here.

As a teenager, he watched a TV report in his native Germany suggesting there were “practically no” deaf people in North Korea. A fourth-generation deaf child in his own family, an incredulous Grund decided to go see for himself. Grund, now 30, has since devoted himself to improving life for deaf North Koreans. He works with the bureaucracy and with the deaf to train them to plan and lead their own projects.

Though funding is always a struggle, he has received support from Catholic and Protestant groups and private donors, mainly in Germany. The biggest individual contribution came from Michael Spavor, of Paektu Cultural Exchange and the organizer of former NBA star Dennis Rodman’s visit last year, who donated $20,000 to the deaf kindergarten project.

Grund’s mantra for empowering the deaf, “nothing about us without us,” often rankles with even the most sympathetic North Korean officials. In the country’s top-down system, hearing bureaucrats who often don’t understand the deaf experience are used to making decisions on their behalf.

Grund says he will continue to cooperate with deaf North Koreans — he currently works closely with about 20, up from just two in 2013 — to help them join mainstream society.

One priority is more schools for occupational training and educational opportunities for the deaf. Another is teaching more deaf children — and interpreters — how to sign. He also wants sign language interpretation made available at workplaces and meetings. But most of all, he wants to see signing on national television broadcasts, if just to raise awareness in the hearing community that the deaf exist and need not be hidden away.

“That has been my oldest dream, from the time I first came here,” he said.

Read the full story here:
German attempts to break down barriers for deaf in N. Korea
Associated Press
Eric Talmadge
2015-7-8

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“Dwarfism” in the DPRK

Wednesday, March 18th, 2015

This week I read the following report in the Washington Free Beacon (2015-3-13):

North Korea’s communist government has created a dwarf village in a remote part of the country where short people it regards as undesirables are prevented from reproducing and forced to fend for themselves within the harsh Stalinist system.

The abuse of North Koreans who have dwarfism, a genetic condition that produces short bodies and disproportionate limbs, is the latest disclosure of widespread human rights abuses within the country. A U.N. commission report a year ago charged the regime with “crimes against humanity.”

Several North Korean defectors disclosed the existence of the village, called Yeonha-Ri, and said it is located in Kimhyongjik County, a border region in northeastern Ryanggang Province. The province is named after North Korea’s founding dictator Kim Il-Sung’s father, Kim Hyong-Jik.

Dwarfs are persecuted by the regime under a policy that combines Korean superstitions about physical deformities manifesting from personal or ancestral sin, and the hardline communist regime’s demand that all citizens must work, according to North Korean defectors.

As part of the anti-dwarf measures, all people under 120 centimeters in height, or just under four feet, have been forced to relocate to the farming village at Yeonha-Ri.

One defector, who disclosed details of the village on condition of anonymity, said the North Korean government originally planned to exterminate the dwarfs as part of a policy of eliminating those within the population with undesirable physical traits. But concerns about international reaction to the population “cleansing” instead resulted in allowing the dwarfs to set up the farming village.

The goal of the separation is to prevent the dwarfs from marrying and reproducing. To that end, they are forced to undergo sterilization.

Also, North Korean dwarfs face a greater risk of starvation because they are not given the same food rations as other North Koreas.

Travel is also restricted under the dubious claim that as little people the dwarfs could be crushed while riding on crowded train cars.

The Free Beacon article later references this article in the UK’s Daily Mail.

For what it is worth, Yeonha-ri, or Ryonha-ri (련하리) as the North Koreans call it, can be found on Google Earth at 41.418403°, 127.513423°. Here is a satellite image:

Ryonha-ri-2011-5-10

At its closest point, the village is just under 4 km from the Chinese border.

ryoha-ri-china-border-2011-5-10

Commission of Inquiry on Human Rights in the Democratic People’s Republic of Korea briefly mentioned dwarfism in the detailed findings document:

Another research institute based in the ROK reported that human rights violations against persons with disabilities include the segregation and forced sterilization of persons suffering from dwarfism.

The citation for this quote is: KINU, White Paper on Human Rights in North Korea (2013), pp. 442-444. You can download the report here (as well as the most recent 2014 report, which does not mention “dwarfism” but rather “midget persons”).

The 2013 KINU report is based on defector interviews, so it is subject to the usual caveats.

The KINU 2013 survey respondents identify three locations of a dwarf village in Kim Hyong-jik County.

The first is a village named “Sangchangri” (Sangchang-ri), identified by two defectors. I am unable to locate a village by that name in Kim Hyong-jik County. It does not appear on any of my North or South Korean maps. I am aware of two villages named Sangchang-ri, but they are in North and South Hamgyong respectively.

Three other defectors independently report that they knew of a village for little people near Koup-gu, which is just north of Ryonha-ri (though they specifically identify Jungri-dong which is just 2.5 km south of Ryonha-ri).

Jungri-dong

A third location was identified as Wolthan Worker’s District (41.408095°, 127.059341°) which is in Kim Hyong-jik county, but on the western side.

The KINU reports also go on to say that the current legal status of little people is much more complicated than the simple narrative of identification, sterilization, and isolation that is reported in the contemporary media–especially following the death of Kim Il-sung.

Previous KINU reports also describe villages for little people in other parts of the country.

The reports of mistreatment of little people, however, date back many years. Hwang Jag-yap, who defected to South Korea in 1997 reported:

Concentration camps [plural] for persons of very short stature were set up in Jungpyung, in South Hamkyung province, after express orders from Kim Il-sung to isolate them to “prevent dwarves from multiplying.”

Additionally, I have a declassified report (FOUO) titled “Translations on Korean Affairs” published on May 18, 1979. It also mentions a dwarf village (p35):

In North Korea, in order to prevent the proliferation of dwarfs (deformed dwarfs), they are all put in a cooperative farm near Kanggye, Chagang Province, which is completely isolated from the outside. Therefore you cannot see dwarfs anywhere else.

This report gives the impression that there was only one village for little people and it was not so close to the Chinese border.

So there is lots of information on this topic that goes back many years and is not very consistent. Maybe somebody with more time than me could do a timeline of all the data and try to standardize all of the geographic names given.

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ROK to resume training of DPRK doctors

Wednesday, January 28th, 2015

According to Yonhap:

South Korea said Wednesday it will resume a program to support North Korean medical doctors’ training in Germany.

The move, the first of its kind in seven years, is in line with the Park Geun-hye administration’s push for expanding humanitarian aid for the impoverished neighbor.

The unification ministry plans to provide a North Korea-Germany group with 90 million won (US$83,000) from the inter-Korean cooperation fund. It will be delivered through the (South) Korea Foundation for International Healthcare.

In 2001, the North Korea-Germany Medical Association launched a project to help train the communist nation’s doctors. A number of North Korean doctors were invited to Germany to learn the latest medical techniques for several months at local hospitals.

South Korea offered funds for the program in 2007 and 2008, but cut the assistance amid worsened relations with Pyongyang.

Read the full story here:
S. Korea to support N. Korean doctors’ training in Germany
Yonhap
2015-1-28

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Eugene Bell expands TB work in DPRK

Tuesday, November 11th, 2014

According to Yonhap:

A U.S. charity group said Tuesday it has agreed with North Korea to expand its medical aid program in the impoverished nation.

Under the deal, the Washington-based Eugene Bell Foundation will construct three new wards at tuberculosis (TB) treatment centers in Pyongyang.

It is the fruit of a three-week trip to the communist nation by a group of 13 officials from the foundation.

“The number of patients at those treatment centers has grown as the activity of our foundation is increasingly known,” a foundation official said. “Every treatment center suffers a severe lack of wards.”

The foundation has long provided medical humanitarian assistance to North Korea, especially for multidrug-resistant tuberculosis.

In a new program, it is sending 770 million won (US$750,000) worth of TB medication to the North.

Read the full story here:
U.S. charity group to expand medical aid program in N. Korea
Yonhap
2014-11-11

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German Government offers TB assistance to DPRK

Tuesday, August 26th, 2014

According to Yonhap:

The German government has provided North Korea with US$600,000 in medical aid via [Caritas International], a U.S. media reported Tuesday.

The Roman Catholic group Caritas International, which was launched in Germany in 1897, has been campaigning to help the needy in the impoverished communist nation, especially those infected with tuberculosis (TB) and hepatitis.

“The German government is providing 450,000 euros [$600,000] to be used for the TB patients in the DPRK,” Reinhard A. Wurkner, a Caritas official in charge of Asia, was quoted as telling the Voice of America. DPRK is the acronym for the Democratic People’s Republic of Korea, North Korea’s official name.

Caritas began its North Korea project in 1996. It has since offered medical and nutritional assistance to TB and hepatitis patients in the country.

Read the full story here:
German gov’t offers US$600,000 in N. Korea aid
Yonhap
2014-8-26

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Eugene Bell offers TB assistance to the DPRK

Monday, July 28th, 2014

According to Yonhap:

The Eugene Bell Foundation, which provides medical assistance to the impoverished North, will send 770 million won (US$750,000) worth of TB medication to the communist country, ministry officials said.

In February, the foundation shipped 720 million won worth of TB drugs to the North in an attempt to tackle the growing issue of multidrug-resistant TB in the country.

So far this year, the South has approved 11 shipments of civilian aid worth a combined 2.82 billion won to North Korea.

The latest approval comes after Seoul announced on July 15 that it will provide Pyongyang with humanitarian aid worth 3 billion won through civilian organizations.

It marks Seoul’s first state-funded aid to North Korea since the North torpedoed the South Korean warship Cheonan in the Yellow Sea in 2010, killing 46 sailors. Following the incident, Seoul imposed a blanket ban on cross-border economic and other exchanges.

Read the full story here:
Gov’t OKs civilian medical aid to N. Korea
Yonhap
2014-7-28

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AmeriCares sends aid to the DPRK

Friday, July 25th, 2014

According to Yonhap:

A U.S. humanitarian group has sent US$800,000 worth of medical aid to North Korea as part of its continued effort to help the impoverished communist nation, a news report said Friday.

AmeriCares, a nonprofit organization based in Connecticut, shipped a package of medicine, sanitary goods and other medical aid in June, the Voice of America (VOA) reported.

The shipment will arrive at the end of this month, the aid group’s communication director, Donna Porstner, told the VOA.

The supplies will be distributed to six hospitals and clinics in Pyongyang, Pyongan Province, and North Hwanghae Province, it added.

AmeriCares said it delivered $1.8 million in medical assistance to North Korea earlier this year.

“Despite the challenging political context, AmeriCares — in its mission to help people in need irrespective of their race, creed or political persuasion — is committed to helping the people of North Korea, who have suffered from acute food shortages, natural disasters and isolation,” it said on its website, www.americares.org.

“A limited number of economic, political and social ties often means that the country faces shortages of key medical supplies,” it added.

Read the full story here:
U.S. NGO ships US$800,000 worth of medical aid to N. Korea
Yonhap
2014-7-25

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