Archive for the ‘Epidemics’ Category

Amnesty International publishes report on DPRK

Thursday, July 15th, 2010

UPDATE: UN World Health Organization has criticized the Amnesty report.  According to the Associated Press:

The World Health Organization found itself Friday in the strange position of defending North Korea’s health care system from an Amnesty International report, three months after WHO’s director described medicine in the totalitarian state as the envy of the developing world.

WHO spokesman Paul Garwood insisted he wasn’t criticizing Amnesty’s work, but the public relations flap illustrated an essential quandary for aid groups in unfree states: how to help innocent people without playing into the hands of their leaders.

Amnesty’s report on Thursday described North Korea’s health care system in shambles, with doctors sometimes performing amputations without anesthesia and working by candlelight in hospitals lacking essential medicine, heat and power. It also raised questions about whether coverage is universal as it — and WHO — claimed, noting most interviewees said they or a family member had given doctors cigarettes, alcohol or money to receive medical care. And those without any of these reported that they could get no health assistance at all.

Garwood said Thursday’s report by Amnesty was mainly anecdotal, with stories dating back to 2001, and not up to the U.N. agency’s scientific approach to evaluating health care.

“All the facts are from people who aren’t in the country,” Garwood told reporters in Geneva. “There’s no science in the research.”

The issue is sensitive for WHO because its director-general, Margaret Chan, praised the communist country after a visit in April and described its health care as the “envy” of most developing nations.

Major global relief agencies have been quietly fighting for years to save the lives of impoverished and malnourished North Koreans, even as the country’s go-it-alone government joined the exclusive club of nuclear weapons powers and wasted millions on confrontational military programs.

Some groups may fear being expelled from the country if they are openly critical of Pyongyang, which is highly sensitive to outside criticism. Still, Chan’s comments were uncommonly ebullient.

Garwood and WHO spokeswoman Fadela Chaib insisted that Amnesty’s report was complementary to their boss’ observations, and sought to downplay Chan’s praise for North Korea. Instead, they focused on the challenges she outlined for North Korea, from poor infrastructure and equipment to malnutrition and an inadequate supply of medicines.

But whereas Chan had noted that North Korea “has no lack of doctors and nurses,” Amnesty said some people had to walk two hours to get to a hospital for surgery. Chan cited the government’s “notable public health achievements,” while Amnesty said health care remained at a low level or was “progressively getting worse.”

Asked Friday what countries were envious of North Korea’s health, Chaib said she couldn’t name any. But she highlighted the importance of maintaining the health body’s presence in the country, where officials do their best to save lives despite “persisting challenges.”

“We are an organization dealing with member states, and we respect the sovereignty of all countries,” Chaib said. “We need to work there to improve the lives of people.”

Sam Zarifi, head of Amnesty’s Asia-Pacific program, said the human rights group stood by its findings.

“We certainly have a lot of restrictions in terms of working in North Korea, but we did our best in terms of capturing the information we could verify,” Zarifi said. “We don’t take the WHO’s statements as criticizing or rejecting Amnesty’s findings.”

He said Amnesty had spoken to North Koreans as well as to foreign health care and aid workers, and relied heavily on WHO for information — including the assessment that North Korea spends $1 per person per year on health care, the lowest level in the world.

The U.N. estimates that 8.7 million people need food in North Korea. The country has relied on foreign assistance to feed much of its population since the mid-1990s when its economy was hit by natural disasters and the loss of the regime’s Soviet benefactor.

North Korea, ruled by Kim Jong Il, is routinely described by U.N. and other reports as one of the world’s most repressive regimes.

Garwood said Amnesty’s research added a needed element to understanding health conditions in North Korea, but added that it didn’t even mention recent improvements in the country as the result of a program funded by South Korea and aided by WHO.

The U.N. body claims that maternal mortality has declined by over 20 percent since 2005, and diarrhea cases and deaths in operations have also dropped. It says more than 6,000 doctors and nurses have been trained in emergency obstetric care, newborn care and child illnesses, while clinics have received better material for operations, blood transplants and other medical interventions.

As for Chan’s April claim that “people in the country do not have to worry about a lack of financial resources to access care,” Garwood said hundreds of field missions have been conducted in North Korea.

“None have come back reporting the kinds of things in the Amnesty report in terms of payment for services,” he said.

“I’m not saying they’re not credible accounts,” he added. “But it’s not taking into account some of the things that are happening today.”

Zarifi, of Amnesty, said the whole debate would be ended if North Korea’s government provided access to monitors so that everyone had a better understanding of the country’s health care system.

“Every indication we have indicates the state of health care in North Korea is dire,” he said.

ORIGINAL POST: Here is the introduction to the report (which you can download here as a PDF):

In the early 1990s, the Democratic People’s Republic of Korea (DPRK or North Korea) faced a famine that killed up to one million people in a population that at the time hovered around 22 million (the current population stands at 23.9 million). Food shortages and a more general economic crisis have persisted to this day. The government has resolutely maintained that it is committed to, and capable of, providing for the basic needs of its people and satisfying their right to food and a proper standard of health. The testimonies presented in this report suggest otherwise. The people of North Korea suffer significant deprivation in their enjoyment of the right to adequate health care, in large part due to failed or counterproductive government policies. These poor policies include systematic failure to provide sufficient resources for basic health care (North Korea had one of the lowest levels of per capital funding for health care recorded by the World Health Organisation in 2006). After nearly two decades, food insecurity remains a critical concern for millions of North Koreans. This has been compounded by the government’s reluctance to seek international cooperation and assistance, which the government is obligated to do when it would otherwise be unable to ensure minimum essential levels of food for the whole population, and its restrictions on the delivery of humanitarian assistance. This delayed and inadequate response to the food crisis has significantly affected people’s health.

Additionally, a currency revaluation plan in November 2009 caused spiralling inflation that in turn aggravated food shortages and sparked social unrest. In the first few months after the plan went into effect, the North Korean government exacerbated the situation by restricting the use of foreign currency, closing down food markets, and prohibiting small-plot farming. Many people died of starvation and many others lost their entire savings.

Amnesty International has documented how widespread and chronic malnutrition, which suppresses people’s immune system, has triggered epidemics and mass outbreaks of illnesses related to poor diet. Interviews with North Koreans depict a country that professes to have a universal (free) health care system but in reality struggles to provide even the most basic service to the population. Health facilities are rundown and operate with frequent power cuts and no heat. Medical personnel often do not receive salaries, and many hospitals function without medicines and other essentials. As doctors have begun charging for their services, which is illegal under North Korea’s universal health care system, the poor cannot access full medical care, especially medicines and surgery.

The interviews conducted by Amnesty International indicate that the North Korean government has also failed its obligation to provide adequate public health information. As a result, most of the interviewees were unaware of the importance of seeking proper medical diagnoses or completing a course of medication. And, because many hospitals no longer supply free services or medicines (despite government commitments to the contrary), many people normally do not visit doctors even when they are ill.

In a 2004 report, Starved of Rights: Human rights and the food crisis in the Democratic People’s Republic of Korea (North Korea), Amnesty International documented actions of the North Korean government that aggravated the effects of the famine and the subsequent food crisis, including denying the existence of the problem for many years, and imposing ever tighter controls on the population to hide the true extent of the disaster from its own citizens. It also documented the government’s refusal to allow swift and equitable distribution of food and its imposition of restrictions on freedom of information and movement, which exacerbated the population’s ability to search for food.3 Although some progress has been made since 2004, access to food is still a critical issue in North Korea. As this report demonstrates, the inadequate and sometimes counter-productive actions of the North Korean government over the country’s food crisis have had a devastating impact on the health of the population.

Under international law and standards, North Korea is obligated to protect the rights of its population to the highest attainable standard of health. This means that, at the very least, the state must provide for adequate health care and the underlying determinants of health, including food and nutrition, housing, access to safe and potable water and adequate sanitation, safe and healthy working conditions, and a healthy environment. North Korea’s responsibilities under international and domestic law will be addressed in greater detail in section 5.

To improve the situation, Amnesty International presents the following key recommendations to the government of the Democratic People’s Republic of Korea with more detailed recommendations in the conclusion of this report.

Amnesty International calls on the North Korean government to:

1. as a matter of priority, ensure that food shortages are acknowledged and effective steps taken to address these shortages, including acceptance of needed international humanitarian assistance;

2. ensure the need-based and equitable distribution of health facilities, goods and services throughout the country;

3. co-operate with the World Food Programme and donors, allow unrestricted access to independent monitors, and ensure non-discrimination, transparency and openness in the distribution of food aid;

4.ensure that medical personnel are paid adequately and regularly so that they may carry out their duties properly;

5. undertake information and education campaigns to provide accurate and comprehensive information on prevalent infections and diseases; their causes, symptoms and treatment; and the importance of medical diagnosis and effective use of medicines.

Furthermore, Amnesty International recommends to the international community, and in particular, major donors and neighbouring countries such as China, Japan, Russian Federation, South Korea and US to:

1. ensure that the provision of humanitarian assistance in North Korea is based on need and is not subject to political conditions.

This report has received wide coverage in the media.  Here are the links:

Barbara Demick, Los Angeles Times

Choe Sang-hun, New York Times

Yonhap

BBC

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Cato Institute panel on DPRK

Thursday, July 15th, 2010

This week the Cato Institute hosted a panel on North Korea.  Participants include:

Stephen Linton, Chairman and Founder, Eugene Bell Foundation
Karin J. Lee, Executive Director, The National Committee on North Korea
Doug Bandow, Senior Fellow, Cato Institute
Ted Galen Carpenter (Moderator), Vice President for Defense and Foreign Policy Studies, Cato Institute

You can see a video of the panel discussion here.  It includes an interesting fundraising video by the Eugene Bell Foundation.

UPDATE: Tad at NKnews.org has a write up of the panel here.

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Donor fatigue…

Tuesday, July 6th, 2010

According to Kang Hyun-kyong in the Korea Times:

As a veteran aid worker, Wolfgang Gerstner was weary of a vicious circle of escalating tensions between South and North Korea after the latter was found to be responsible for the sinking of the warship Cheonan on March 26.

According to the German consultant working for international aid group Caritas Germany, North Korea’s bellicose acts have led those outside the country who have tried to help it to harden their attitudes.

This has resulted in a decrease of donations, causing children there to live without vaccinations for example.

Gerstner, 53, went on to say that children and ordinary people living in the impoverished North, whose living standards couldn’t be worse, suffer the unintended consequences of the regime-led provocations.

“It is difficult for people living outside North Korea to separate ordinary people living in the North from the regime,” Gerstner, who oversees Caritas’s humanitarian aid program to North Korea (the CI-DPRK program), said last Thursday in an interview with The Korea Times at a hotel in Seoul.

Caritas relies on donations from individual and corporate members to sustain their humanitarian aid to less developed nations in Africa, Asia, and Latin America.

The aid organization also receives funds from the German government and Catholic churches here in Korea for the vaccination campaign for North Korean children.

North Korea is one of the nations where the rate of child mortality is alarmingly high.

According to United Nations Children’s Fund (UNICEF), 55 of every 1,000 children in North Korea die before they turn five.

Child mortality can be largely preventable if young children are vaccinated.

The North issuing a threat, however, is a stumbling block to the international effort to save children there.

When recipient governments make threats, it is natural for people living outside those nations to harden their view toward them, making donors or potential donors rethink their contribution.

“I don’t have the exact figure regarding the loss in donations after the provocation, but it certainly does have an effect on the amount,” Gerstner said.

“Escalating tensions make it difficult for aid workers like me to convince our donors to contribute to humanitarian assistance for the people there.”

Catastrophic security

The German aid worker sat down with the reporter days after wrapping up his recent visit to North Korea from June 8 to 12 this year for the regular vaccination program.

During the four-day field trip, Gerstner and August Stich, a medical advisor working with the Medical Mission Hospital Wuerzberg in Germany, visited the Sadong Tuberculosis Center, the new national laboratory at the Pyongyang Tuberculosis Hospital.

The two-man delegation also met with officials from the North Korean Ministry of Public Health and experts in medical institutes in Pyongyang and in the neighborhood of the North’s capital.

They made the June visit after about 500,000 North Korean children aged from seven to 16 years old were vaccinated in three rounds from February to April, thanks to the Caritas program.

Since March 2007 when he was first called upon to handle the CI-DPRK program, Gerstner has been to the North approximately 20 times for talks with his North Korean counterpart — the Ministry of Public Health.

His most recent trip came at a time when tension on the Korean Peninsula has shown little sign of subsiding after a multinational investigation team concluded last month that a North Korean torpedo was responsible for taking the lives of 46 sailors.

The North has denied it.

In an attempt to teach North Korea a lesson that any criminal acts will invite punishment, South Korea referred the Cheonan case to the U.N. Security Council (UNSC) in early June, calling for retaliatory measures against the North for the unacceptable act.

North Korea has claiming it is “innocent” and further threatened to take “counter-measures” if the UNSC sides with the multinational team over the probe results and comes up with punitive measures against it.

The two Koreas’ engaging in a game of chicken in the wake of the sinking of the ship has led to international media headlines featuring the peninsula on the verge of a war.

A vicious circle

The security standoff has spillover effect on humanitarian assistance to the North.

Disappointed, individual and corporate donors have become skeptical about contributing money or goods for the improvement of living conditions in the North.

Lesley-Anne Knight, secretary general of Caritas, expressed her concern over the unintended consequences of rising tensions last Tuesday during a news conference held in Seoul.

“This tension, of course, makes it much more difficult for us as humanitarian actors to maintain a neutral and impartial interest at the international level for North Korea,” Knight said.

“When there is a bellicose act, when people start to feel concerned about conflict escalating, international attention and the sympathy perhaps of the international humanitarian community for the plights of the (North) Korean people tends to diminish, tends to wane.”

Knight went on to say that “that is the extreme concern for us.”

Caritas, which has spent a total of $33 million on humanitarian aid and development in North Korea since 1995, called for a continuation of assistance.

The reaction came weeks after the South Korean government’s halt of assistance to the North in retaliation for its torpedo attack on the ship.

“(Humanitarian assistance) is absolutely essential for us. The situation of the majority of the North Korean people is that most of them are struggling to get their daily basic needs. Most specifically, food and health,” Knight said.

‘N. Korean kids are brave’

In his previous visits to the North in March, Gerstner had opportunities of taking a closer look at the facilities of clinics, institutes, and primary and secondary schools, while monitoring the North’s implementation of Caritas’s vaccination programs.

“Compared with South Korean hospitals and their amenities, hospitals in the North are less modern. Doctors there have to rely more on traditional medicine as they don’t have necessary facilities and medicine,” he said.

He called North Korean children “very brave.”

“It happens in other countries that school age children cry when they wait for their turns in line for taking vaccination shots. But North Korean children never cried even when they took the shots,” he said.

Previously, Gerstner was involved in several emergency relief programs in Africa, Latin America and the former East Germany. He helped organize rehabilitation programs in the local community.

Gerstner said North Korean teachers and children were “friendly and open-minded” when meeting with him, although they never spoke.

He said the most difficult part when implementing the aid program to North Korea was access to information and communication.

“For planning, we need information and have to communicate with our counterpart. The ministry has no email account, making it more difficult for us to execute the program,” he said.

Read the full article here:
Donors turn their back on N. Korea for provocation, putting kids at risk
Korea Times
Kang Hyun-kyung
6/28/2010

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RoK to send malaria meds to DPRK

Thursday, June 24th, 2010

According ot the Daily NK:

South Korea has granted permission for an aid shipment of anti-malarial medication, the seventh shipment of aid to North Korea since the Cheonan sinking.

An Ministry of Unification said today, “We have decided to allow a shipment of anti-malarial medication worth $335,000, which was requested by the Korean Sharing Movement.”

Korean Sharing Movement is a well-known aid organization targetting North Korea.

The Korean Sharing Movement says it plans to send malaria diagnosis kits, mosquito nets and vaccines for pregnant women among other things to Jangpung, Geumcheon, Tosan and Kaesong, which are areas of North Korea adjacent to Gyeonggi Province, the province which surrounds Seoul.

Funding for the project has been provided by the government of Gyeonggi Province.

Most previous, post-Cheonan shipments have been aid for infants and children. Earlier this month, two aid consignments of infant-related aid were sent.

The Unification Ministry in Seoul, upon granting permission for the previous shipments, explained, “While South Korea will hold off on inter-Korean business projects on principle, we will continue providing purely humanitarian aid for the weak, such as infants and children.”

Including today’s shipment, the total cost of aid sent since punitive measures against North Korea were announced on May 24 has been approximately $603,000.

The current shipment of anti-malarial medication is being sent, the Ministry of Unification explained today, because malaria has the potential to spread into South Korea during the summer months.

Read the full story here:
Rok to send malaria medication to DPRK
Daily NK
Chris Green
6/24/2010

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WHO launches health initiative in DPRK

Monday, April 26th, 2010

UPDATE:  According to the Associated Press (Via Washinton Post):

North Korea formally launched a medical videoconference network Tuesday aimed at giving smaller, rural hospitals access to specialists in the capital Pyongyang with the help of the World Health Organization.

WHO has been providing cameras, computers and other equipment to North Korea to help the reclusive, impoverished country connect a main hospital in Pyongyang with medical facilities in 10 provinces. The system is designed to allow doctors to talk to each other to provide additional services to rural patients.

On Tuesday, North Korean health officials and visiting WHO Director-General Margaret Chan held the formal inaugural ceremony for the system at the Kim Man Yu hospital in Pyongyang, according to footage from broadcaster APTN.

“This is an excellent vision because it meets the needs of the government,” Chan said.

Chan, clad in a white gown, later tested the system by talking with provincial doctors via video link.

One unidentified doctor at Jagang province, about 150 miles (240 kilometers) north of Pyongyang, told Chan he is satisfied with the system because it’s too far for his patients to visit specialists in the capital.

She arrived in Pyongyang on Monday, becoming the U.N. agency’s first chief to visit the communist country since 2001.

WHO opened its office in Pyongyang in 2001 and has coordinated the purchase of medical equipment and supplies for North Koreans. The world’s health body says on its Web site that it is currently focusing on strengthening the North’s health infrastructure.

ORIGINAL POST: According to the Associated Press (via Taiwan News):

World Health Organization Director-General Margaret Chan arrived in North Korea on Monday on a rare visit to the isolated country.

The U.N. body has said Chan will spend two days in the reclusive communist country _ the first chief to go since 2001 _ to tour health facilities and meet the country’s health minister.

The WHO has not provided details of Chan’s itinerary, but the Korean Central News Agency said in a dispatch that Chan arrived in Pyongyang on Monday.

The dispatch said the government held a reception for Chan, who arrived the same day as Red Cross and Red Crescent officials. It was not clear if the visits were connected.

The North faces chronic food shortages and has relied on outside assistance to feed much of its population since a famine believed to have killed as many as 2 million people in the 1990s.

Malnutrition, dysentery, and vitamin and iodine deficiency are believed to pose serious risks among children in the country, which also faces a shortfall of hospitals and lacks an efficient state health care system.

Read the full stories here:
WHO chief arrives in North Korea on rare visit
Associate Press (Taiwan Times)
4/26/2010

NKorea launches telemedicine network with WHO help
Associated Press (via Washinton Post)
Kim Hyung-Jin
4/27/2010

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US doctors help DPRK open TB lab

Monday, March 1st, 2010

UPDATE: Some additional informtaion from Paul Costello:

Stanford researcher Sharon Perry PhD, an infectious disease specialist, has been working in North Korea with a team of American health specialists to develop the country’s first diagnostic laboratory to test drug-resistant tuberculosis. The Democratic People’s Republic of Korea, as the hermit country is formally known, witnessed a resurgence of TB in the 1990s after famines plagued the country.

The TB Diagnostics Project is being led by the Bay Area TB Consortium, which Perry directs, and the Nuclear Threat Initiative, a Washington nonprofit group working to strengthen global security. The program came about after a team of North Korean health officials visited California and met with Stanford and Bay Area tuberculosis experts in 2008.

It’s unusual for any outsiders to visit North Korea, but extremely rare for Americans. Safe to say that it’s an unprecedented partnership between U.S. researchers and health officials in North Korea. So far, Perry has ventured there three times and is soon to return for a fourth visit.

I spoke with Perry for a 1:2:1 podcast about her work in North Korea. It’s a candid, revealing interview that pulls back the curtain a bit from this most mysterious nation. I found it fascinating to hear Perry describe the work there and talk about collaborating with officials from the Ministry of Health on this significant health crisis for the nation. The porous nature of geographical borders and the ability of disease to spread easily from one country to another clearly illustrates that we’re one planet and all in this together.

ORIGINAL POST: According to the New York Times:

With help from scientists from Stanford University’s medical school, North Korea has developed its first laboratory capable of detecting drug-resistant tuberculosis, scientists involved in the project said last week.

Tuberculosis surged in the Democratic People’s Republic of Korea during the famines of the 1990s. (Starvation suppresses the immune system, allowing latent infections to grow.) But the country cannot tell which cases are susceptible to which antibiotics, meaning more dangerous strains could push out strains that are easier to kill, as has happened in Russia and Peru.

The project began after John W. Lewis, an expert on Chinese politics at Stanford participating in informal diplomatic talks over North Korea’s nuclear threat, realized how serious a TB problem the country had. In 2008, doctors from North Korea’s health ministry visited experts in the San Francisco Bay area. Last month, a Stanford team began installing the new diagnostics lab at a hospital in the capital, Pyongyang.

The project “represents an unprecedented level of cooperation” between North Korean and American doctors, Professor Lewis said. It is supported by the Nuclear Threat Initiative, a nonprofit global security group led by former Senator Sam Nunn, Democrat of Georgia, and by Christian Friends of Korea, a humanitarian group.

Although it will soon be able to grow and test TB strains, North Korea right now has none of the more expensive antibiotics that attack drug-resistant TB, said Sharon Perry, the epidemiologist leading the Stanford team. Without outside help it will also run out of routine first-line antibiotics by July, she said.

Read the full article here:
Tuberculosis: North Korea Develops TB Laboratory With Help From American Doctors
New York Times
Donald McNeil, Jr.
3/1/2010

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S. Korea to deliver anti-viral sanitizer to N. Korea next week

Tuesday, February 16th, 2010

According to Yonhap:

South Korea said Tuesday it will send 1 billion won (US$866,000) worth of hand sanitizer next week to North Korea to help the impoverished neighbor combat the spread of the H1N1 flu virus.

The shipment of 200,000 liters of sanitizer, scheduled for next Monday, comes after South Korea delivered some $15 million in anti-viral medications to the North in December in the first state-level cross-border humanitarian aid in nearly two years.

North Korea first acknowledged cases of Influenza A virus infection on Dec. 9, but it has yet to report any flu-related deaths.

The hand sanitizer will be transported to the North Korean border town of Kaesong on South Korean trucks across the military demarcation line and handed to the North there, Unification Ministry spokesman Chun Hae-sung said.

“North Korea agreed to accept the aid on Feb. 22,” he told reporters, adding about 20 25-ton trucks will likely be mobilized to deliver the aid.

The Tamiflu aid in December marked the first humanitarian assistance provided by the South Korean government to North Korea since conservative President Lee Myung-bak took office in Seoul in early 2008. Lee cut off the unconditional aid that his liberal predecessors had shipped to the North over the past decade, conditioning exchanges on progress in the North’s denuclearization.

Read the full story here:
S. Korea to deliver anti-viral sanitizer to N. Korea next week
Yonhap
2/16/010

UPDATE: The shipment has been delivered

SKorea sends 2nd batch of swine flu aid to NKorea
AP via Business Week
2/23/2010

South Korean trucks have crossed the border into North Korea to deliver a second batch of swine flu aid.

Unification Ministry spokeswoman Lee Jong-joo says South Korea sent 52,840 gallons (200,000 liters) of hand sanitizers to North Korea on Tuesday.

South Korea sent enough doses of the antiviral drugs Tamiflu and Relenza for 500,000 North Koreans in December in its first direct humanitarian aid to the communist country in nearly two years. North and South Korea have remained in a state of war since 1953.

North Korea acknowledged in December that swine flu had broken out in the country though hasn’t mentioned any virus-related deaths.

Tamiflu is made by Switzerland’s Roche Group. Relenza is a procuct of GlaxoSmithKline.

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DPRK responds to US intelligence report on public health

Sunday, January 25th, 2009

In December 2008, the office of the US Director of National Intelligence issued a report titled, “Strategic Implications of Global Health (ICA 2008-10D).”  In this report, the DNI made the following comments about the state of public health in the DPRK and its effects on economic growth and military preparedness:

North Korea (p.46)
WHO Ranking of Health Systems (out of 190 countries rated): 167
NCMI Ranking of Health Care Capabilities: 5 (Unsuitable)

1. Economic crisis and famine of 1990s fueled breakdown of once-efficient health-care system.
2. Lack of medicine, equipment, sanitation, and reliable energy supplies make quality healthcare virtually unobtainable outside of Pyongyang.
3. Persistent refusal of international health expertise and assistance makes significant short-term improvements unlikely.

Most Urgent Health Problems:
1. TB, scarlet fever, and measles particularly prevalent, although Pyongyang’s secretiveness makes outbreaks extremely difficult to verify and track.
2. Chronic diseases account for an estimated 40 percent of deaths.
3. Even after the widespread famine of the 1990s, prolonged and severe malnutrition persisted; more than half of North Korean children are stunted or underweight, while two-thirds of young adults are malnourished or anemic. The World Food Program currently warns that a new food crisis is in the making as the result of floods and North Korea’s refusal to accept food aid from a new South Korean government that is highly critical of Pyongyang.

Other:
1. North Korean-manufactured illicit drugs—an effort to earn hard currency—increasingly used by citizens of that country as substitutes for scarce medicines or to relieve hunger or boredom.
2. HIV/AIDS prevalence is negligible.

Strategic Considerations:
1. Widespread malnutrition and accompanying physical and cognitive disabilities among DPRK children and young people likely inhibitors of economic growth—with or without opening to the outside world or reunification with the South.
2. If reunification occurs, South Korea will face costs not only of incorporating an economic void, but also those of a huge health-care burden. Seoul could look to other countries or to multilateral organizations to help defray expenses.
3.  Poor health is weakening military readiness because capable new recruits are in short supply. Loyalty may also erode over time, according to Eurasia Group; even when soldiers are well fed, they may be concerned about their malnourished family members.
4. The famine of the 1990s destroyed absolute state control of food rationing, internal movement of citizens, and information as North Koreans were compelled to defy state restrictions in their struggle for survival—and as those who had escaped to China in search of food and work returned with news of the outside world, according to Human Rights Watch.

Potential Opportunities:
1.  Health cooperation (amelioration of North Korea’s heavy health burden) could serve as a means of “diplomacy through the back door.”

Other Comments:

Widespread ill health in the youth cohort may reduce a country’s pool of healthy and capable military recruits, a phenomenon that is currently playing out in Russia and North Korea. Deployed military forces will continue to be vulnerable to the ravages of infectious diseases, and the capability of a government to provide adequate health protection for its troops will significantly impact its ability to project force abroad. (p.5)

Malnutrition-related cognitive disabilities among North Korean children and young people likely will impact future economic growth in that country regardless of when Pyongyang opens to the outside world or reunifies with the South. Nationwide malnutrition has compelled Pyongyang to lower minimum height and weight requirements for military service, and an estimated 17 to 29 percent of potential North Korean military conscripts between 2009 and 2013 will have cognitive deficiencies disqualifying them for service. (p.6)

Along these lines, it is likely that malnutrition-related cognitive disabilities among North Korean children and young people—resulting from the 1990s famine, as well as the widespread hunger that persists to this day—will inhibit future DPRK economic growth, with or without opening to the outside world or reunification with the South. (p.24)

As a consequence of early childhood malnutrition, an estimated 17 to 29 percent of potential North Korean military conscripts will have cognitive deficiencies severe enough to disqualify them for service by US standards (This figure does not include individuals who are mentally capable but have physical conditions disqualifying them from service). The National Center for Medical Intelligence estimates that mental fitness of North Koreans subject to military conscription will be at its weakest during the period 2009-2013 as children born during the severe food shortages and famine of the 1990s reach military age. (p.28)

For the record, the UN WHO ceased publishing the Ranking of Health Systems in 2000 due to the “complexity of the task.” My suspicion is that it was actually ended because member governments did not appreciate being ranked in this field.  However the DPRK’s score of 167 dates from the final publication eight+ years ago. I am unable to investigate the DPRK’s score from the NCMI because this report is not publicly available (as best I can tell).

Although this report offers a decent summary projection of the effects of poor health on the DPRK’s strategic options, there is not much new, or newsworthy, about the report (at least as it pertains to the DPRK).  Most of this information has been floating around the public domain for some time. In fact, I probably never would have heard of this study if the North Korean’s had not publicly complained about it in KCNA. (Click here to read KCNA story

Quoting from Yonhap:

“They floated the cock-and-bull story,” the KCNA said, “It is an open secret that the ill-famed intelligence and plot-breeding institutions of the U.S. including the CIA are hell-bent on releasing false reports about its hostile countries.”

“It is the unpopular healthcare system in the U.S. which should be overhauled or replaced by a new one,” the report said.

“However, they released the false report, finding fault with the advantageous healthcare system in the DPRK in a bid to hurt the prestige and dignity of the DPRK in the international arena and stir up ‘ill feelings’ in society,” it said.

This report is 55 pages long and the portions on North Korea (listed above in full) barely fill two pages.  I am not sure why the North Korean’s chose to draw attention to it by complaining in KCNA.  

You can read the Yonhap story here:
N. Korea condemns U.S. intelligence report on its combat ability
Yonhap
1/24/2009

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A Dangerous Opportunity in North Korea

Thursday, July 31st, 2008

United Methodist Church: Kentucky Annual Conference
Dr. Bill Moore
7/31/2008

Dr. Bill Moore, the pastor of Southern Hills United Methodist Church in Lexington, was in North Korea May 14-29.  The son of United Methodist missionaries, he is a member of a humanitarian aid group called Christian Friends of Korea.  He offers a perspective on a deepening crisis.

I traveled to North Korea during the last two weeks of May as a member of a six-person delegation from a non-government organization (NGO) called Christian Friends of Korea. We flew into the capital city of Pyong Yang to confirm the arrival and proper distribution of donated goods, to deliver donors lists and greetings, and to build relationships and trust. The Board of Directors for this group, of which I am a member, is composed of former missionaries to Korea, the children of missionaries, and others with a concern to relieve the suffering and hardships of the people of this grim Communist dictatorship called the Democratic People’s Republic of Korea.  It is often hard to see the suffering faces of the 23 million North Koreans hidden behind the headlines of international diplomatic struggle and nuclear intrigue.  Famine, floods (two devastating events in 2007), and mismanagement have left the nation in economic ruin. Christian Friends of Korea (CFK) has been quietly working in the DPRK for 13 years, meeting some of the most basic needs of thousands of people struggling with the life-threatening, but curable disease of tuberculosis. CFK’s efforts to show love and compassion to people who continue to endure food shortages, poverty, disease, and oppression are building trust and chipping away at long-standing hostility.   
 
North Korea is a beautiful place in May.  Everything had greened up nicely.  The cottonwood trees had deposited wind-blown piles of downy fluff in the roadways, blanketing the bushes and spider webs.  The guest house on the banks of the Taedong River near Pyong Yang where our Christian Friends of Korea Team stayed for most of the visit had a dense backdrop of vegetation, populated by ring neck pheasant, which appeared unfazed by the foreigners nearby and sounded off regularly.  The acacia trees were in full bloom.

As we moved through the countryside, the workers on the collective farms were transplanting rice plants into the paddy fields.  This is a critical phase of life in the north, and everyone is expected to take part.  Backs bent, barefooted workers move slowly across the fields.  On the mud dikes of the water-filled paddies there are often patriotic slogans on placards, revolutionary red flags flying, and even sound trucks playing inspirational songs.  This idyllic picture of a worker’s paradise belies a truth that is not readily apparent.  The coming fall harvest, which is vital to a nation where one-third of the people suffer from malnutrition, is already in jeopardy.  Previous large shipments of fertilizer from South Korea have been withheld this year for political reasons.  China has pledged to fill the gap, but nothing has arrived yet.  Aid workers from other countries told us that the potato crop is already stunted, and predicted that the rice crop will be twenty-five percent less this year.  Even in years of good harvests, North Korea still falls about 1 million metric tons short of food, out of an estimated 5 million tons needed.    This year the shortfall is expected to exceed 1.6 million metric tons.  For those receiving rations, the daily government ration of grain per person was reduced from 250 grams to 150 grams in June.  Uncertain food aid, coupled with poor food security (effective agricultural production) means an increase among the populace in susceptibility to disease, particularly tuberculosis, which afflicts an estimated five percent of the North Korean people.  In fact, since last year, the registered cases of TB have risen from 52,000 to 100,000 cases.

This was the backdrop for our journey to the Democratic People’s Republic of Korea as an NGO working to provide medicine (specifically tuberculosis treatment drugs), medical equipment, farm machinery, vehicles, construction materials and food for the people of the DPRK.  The needs are real, and the urgency is intensifying. The Chinese character for “crisis” is composed of two other characters: “danger” and “opportunity.” As we traveled to fourteen different medical facilities, we could see that there is a “dangerous opportunity’ to make a difference in this land, and bring hope to many lives.

Our team was a diverse, ecumenical mix of six people.  Our Executive Director, Heidi Linton, grew up in Alaska, married into a famous Presbyterian missionary family, and has effectively immersed herself in the work of Christian Friends of Korea for the last 13 years.  By her indomitable spirit, genuine integrity, and meticulous attention to detail for providing aid and assistance, she has endeared herself to the North Korean leaders assigned to us through the Ministry of Public Health and forged a working relationship which is highly effective.  Dr. John Somerville, retired Presbyterian missionary, was our official Korean speaker on the trip.  A Harvard graduate in Asian studies, Dr. Somerville spent many years teaching in South Korea, and has visited the north on 10 previous visits.  Paul Moffett, a pastor at Lighthouse Christian Center in Puyallup, WA, is the great-grandson of pioneer Presbyterian missionary Samuel Moffett, who came to Pyong Yang in 1905.  Lee Wheeler is an agricultural engineer from Hesston, KS, representing the Mennonite Central Committee, a CFK partner.  He is a greenhouse expert who has also made 10 trips to the DPRK.   Terry Smith, Heidi’s able assistant, came from Memphis, TN and now lives in Black Mountain (headquarters of CFK).  I rounded out the team.  I’m the son of United Methodist missionaries, James and Margaret Moore.  My grandfather, Dr. Stanley Martin, was a Canadian Presbyterian medical missionary in China and Korea.  I grew up in Seoul, South Korea.

Our purpose in traveling to North Korea for Christian Friends of Korea was to make a “confirming” visit, checking to make sure that the supplies and equipment (more than three million dollars worth sent since January) had been properly received, inventoried and distributed; to present lists of donors to the facility directors; and to build relationships and trust with everyone with whom we had contact.  We were accompanied at all times by young government officials who were both personable and efficient, and escorted us to every location.  They shared with us a passion and concern for the welfare of their people.  Part of this work was to visit two warehouse locations to make sure supplies were moving out to the facilities.  This is important also to make way for incoming shipping containers.  It is noteworthy that our North Korean counterparts in the Ministry of Public Health value the aid assistance of CFK and a similar NGO so much that they actually built a spacious warehouse just for receiving shipments to be distributed to CFK ministry sites.  A forklift sent by CFK donors was in use there. The other main task of confirming was to visit the actual facilities, interview directors, staff, and patients, and assess the priorities and needs of each place.  These visits were the heart of our schedule.

A typical trip to one of the hospitals or TB rest homes began with a convoy of vehicles traveling to the locations scheduled for the day.  The road surface usually began with paved roads of varying quality that soon gave way to a washboard gravel road, a muddy track snaking up into the hills, or even a rocky stream bed that had to be forded.  Once we arrived, we were greeted by the director, doctors, nurses, and various local officials.  We would be seated around a table with refreshments provided for the visitors (strawberries, peanuts, tea), introductions would be made, the donor list presented in Korean with an explanation, and Heidi Linton would begin the process of inquiry.  What is the current situation in this place?  How many TB patients are there?   How did the devastating floods of 2007 affect the facility and patients?  What are your priorities here?  Is there enough food for the patients?  Local Communist party officials who attended the meetings were visibly uncomfortable about discussions of flood damage or food shortages.  Furtive glances were sometimes exchanged before hospital staff would answer such questions.  The stock answer: “The government provides us with food.” 

Questions would be asked about the arrival of vitamins, health kits, bedding, laundry soap, Pedialyte, doctor’s kits, hospital beds, and TB medicine.  Food shipments of canned meat, soy beans and dry vegetable soup mix were checked on.  A list of donors was presented to the directors at each location.  New equipment was sometimes delivered, including new electronic microscopes and a “Lab in a Suitcase,” a sophisticated package of diagnostic equipment to identify infected TB patients.  Some sites had cargo tri-motorcycles to transport supplies slated for delivery.  A new kind of greenhouse, which does not require an additional heat source even in frigid temperatures, was offered at each place.  A tour of the facilities meant a chance to meet the patients, to inquire about their health, and to offer best wishes and prayers for swift recovery.  Outside, the greenhouses, which are so important for supplementing meager government rations, would be inspected. Walking tractors and bicycles provided by CFK were noted.

One of the highlights of the journey was to see the wonderful progress that has been made in the construction of modern surgical facilities at both the North Hwangae TB Hospital in Sariwon and the South Hwangae TB Hospital in Haeju.  The surgical suites, built with the expertise and direction of CFK Technical Teams, feature new anti-microbial tile on the walls, non-skid floor tiles, power conditioners and new electrical wiring, heating/AC, lighting, and new surgical equipment and supplies enabling more complicated procedures and greatly improved surgical outcomes.  One patient, who had been brought to Sariwon for an operation from a TB rest home, remarked when he saw the gleaming facility, “I feel like I am cured already!”  The result of the renovations is stronger confidence among patients that healing will occur, and the number of patients willing to undergo surgery has tripled.  Because of the sterile conditions, post-operative infection has been greatly reduced.  Eighty percent of the patients used to have post-op infections.  Now it is down to 1 in 5 patients.  We also saw the preparations for a similar renovation at the Kaesong Provincial Pediatric Hospital (serving 144,000 children) where the surgery area has been stripped to the bare stones in preparation for the $200,000 make-over made possible by a CFK donor.  In earlier days this was a Methodist mission hospital, visited by my grandfather who installed x-ray equipment there in the early 1920’s.  At Hwangju TB Rest Home construction is under way to build new facilities that will house150 or more patients.  The buildings will replace two others that were destroyed in last year’s floods.  They need a roof right away, followed by windows and doors.  This is a critical need, and participation from United Methodist Churches would be most welcome in raising funds for this vital construction need.

While there are very encouraging signs of progress at CFK projects, there are specific needs that must be immediately addressed.  There is an expected shortfall in TB medicine, especially in terms of DOTS (Directly Observed Treatment Short Course) drugs which, when given under supervision, are very effective.  Because of a loss of funding by the World Health Organization, CFK is being asked to provide 12,000 treatments in our regions (North and South Hwanghae and Kaesong) which will cost in excess of $245,000.  In response to the deepening food crisis, two 40-foot containers of canned meat will be shipped before the end of the year in a joint effort with the Mennonite Central Committee, who generously provides $500,000 worth of this commodity to CFK projects annually.

Everywhere the CFK Team went on this confirming visit there were expressions of gratitude.  When one director was asked what further assistance he needed for his facility, he exclaimed, “You have already sent a lot!”  Heidi Linton responded that God in His love had provided these things.  The director’s response: “Please send thanks to our Christian friends in America.”

You might be asking: what does the work of Christian Friends of Korea have to do with The United Methodist Church?  It is difficult to do any kind of Christian ministry in North Korea since traditional denominational mission work is not allowed, but an effort through a non-government organization makes it possible.  When needs are critical, we must find mission partners wherever we can.  The mission of CFK also addresses two of the priorities coming out of General Conference: engaging ministry with the poor (preventing starvation) and making the world malaria free, AIDS-free, and tuberculosis free.  Here’s a piece of good news—the US government is in the process of shipping a total of 500,000 tons of food to North Korea as a result of some movement in the nuclear negotiations.  The United Nations World Food Program will distribute 400,000 tons throughout the DPRK.  As a part of this initiative, on June 30 it was announced that the U.S. Agency for International Development’s (USAID) office of Food for Peace will work with 5 aid agencies to distribute 100,000 metric tons of food to 550,000 people at risk, mostly children, elderly and nursing mothers, in two North Korean provinces.  The agencies involved in this effort are World Vision, Mercy Corps, Global Resource Services, Samaritan’s Purse, and Christian Friends of Korea.

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North Korea deines epidemics

Friday, June 13th, 2008

RSOE Emergency and Disaster Information Service
Budapest, Hungary 

North Korea has denied rumors that avian influenza or hand, foot and mouth disease (HFMD) is spreading in the country, a radio report said on Tuesday [10 Jun 2008]. The North’s health authorities notified the World Health Organization (WHO) that there has been no single case of bird flu or HFMD reported to the authorities this year [2008]. The denial came in response to a report published a week ago by South Korean aid group Good Friends, claiming that a mysterious epidemic suspected to be bird flu or HFMD has been spreading in North Korean towns bordering China. The disease has already taken the lives in recent months of many North Korean infants already suffering from malnutrition caused by food shortages, the group claimed, citing unnamed North Korean doctors in the border area.

WHO has rendered technical and monetary support to North Korea to help prevent possible bird flu outbreaks since the communist state was hit by the deadly disease in 2005. No new case has been reported since then. Jai Narain, the director for communicable diseases at WHO’s South East Asia office in New Delhi, was quoted as saying that the international body is working closely with the North Korean health authorities to prevent any potential bird flu outbreak and that Pyongyang has submitted related reports to the organization on a regular basis. The France-based OIE (Office International des Epizooties, World Organisation for Animal Health) also said that the North’s latest report to the office included no information or reports of any bird flu outbreaks, the radio reported. North Korea has inoculated poultry against bird flu to prevent the spread of the virus from neighboring South Korea, according to the North’s state-run news media. South Korea has slaughtered over 8 million birds since early April 2008, when bird flu broke out there for the 1st time in more than a year. But no South Korean has died of bird flu. HFMD, meanwhile, has struck over 10 000 people resulting in 26 fatalities, all of them children, in recent months, according to Chinese media reports.)

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