WHO Knew? North Korea’s health care system is nothing to envy.

north-korea-poster-560.jpgSo, aside from stultifying political repression, famine, forced labor, criticism sessions, neighborhood spies, propaganda speakers in every home, prison camps for dissenters, and the occasional public execution, what has Kim Jong Il ever done for us? Ask any Chomsky-parroting career grad student in the East Bay and she’ll say, “universal health care!”

Alas, those neocons at Amnesty International have come to crush their tiny, misshapen hippie souls with this extensive report:

The North Korean government has failed to adequately address the country’s ongoing food shortages since the 1990s. This failure has led to the current critical situation in which the population faces severe health problems associated with malnutrition. Compounding these problems, North Korea’s government has failed to provide adequate resources for its health care system, which as a result is wholly unable to cope with the growing number of illnesses and diseases of a population weakened by hunger.

According to the WHO, North Korea spent less than US $1 per person in 2006.

You do know what this means, don’t you? It means that Margaret Chan isn’t just a tool and an imbecile, she’s a liar. Granted, those options aren’t mutually exclusive. Either way, she should resign from her position:

In fact, North Korea had one of the lowest recorded per capita total expenditure on health in 2006 of any country in the world.105 The state’s paltry expenditure on health, in spite of the urgent need for medical training, access to medicines and public health education, violates North Korea’s obligation to provide for the basic health of its population.

Let me just express my relief that Amnesty can find North Korea on a map, because by the second year of any Republican president’s term, the question does tend to arise. And with that obligatory criticism dispensed with, Amnesty has actually written a good, hard-hitting, report.

The Associated Press picks up the Amnesty report and summarizes it this way:

North Korea’s health care system is in shambles with doctors sometimes performing amputations without anesthesia and working by candlelight in hospitals lacking essential medicine, heat and power, a human rights watchdog said Thursday.

North Korea’s state health care system has been deteriorating for years amid the country’s economic difficulties. Many of its 24 million people reportedly face health problems related to chronic malnutrition, such as tuberculosis and anemia, Amnesty International said in a report on the state of the health care system.

Oh, and North Korea’s universal, free health care is neither, but you knew that:

North Korea says it provides free medical care to all its citizens. But Amnesty said most interviewees said they or a family member had given doctors cigarettes, alcohol or money to receive medical care. Doctors often work without pay, have little or no medicine to dispense and reuse scant medical supplies, the report said. “People in North Korea don’t bother going to the hospital if they don’t have money because everyone knows that you have to pay for service and treatment,” a 20-year-old North Korean defector named Rhee was quoted as saying. “If you don’t have money, you die.”

But on the plus side, positively no death panels!

Many interviewees said they had to walk as long as two hours to get to a hospital for surgery, said Norma Kang Muico, an Amnesty researcher and author of the report. North Koreans are numbed to what was wrong with the health system, because “things keep progressively getting worse, or even staying the same but at that low level,” she told reporters in Seoul on Thursday. Amnesty blamed ….

Wait, wait. Don’t tell me. International sanctions that starve North Korean babies and infringe on its sovereignty! Right?

…. failed or counterproductive government policies and said North Korea should cooperate with aid donors to ensure transparency in the distribution of food assistance and guarantee that medical personnel are paid adequately.

Damn neocons.

Much of Amnesty’s report is about the root cause of the poor health of its people: the lack of food. Amnesty’s original report contains a good history of the regime’s frustration of transparent food aid distribution and monitoring, and this:

North Korea has an obligation to accept international humanitarian assistance when it cannot meet the needs of its own people. But the North Korean government has refused some urgently needed humanitarian assistance on political grounds.32 For example, in May 2008, the US government resumed food aid to North Korea for the first time in three years. But due to strained relations in March 2009, North Korea refused to accept any further food aid from the US and told five US humanitarian aid organizations33 to leave the country by the end of the month. In March 2010, the US government said it would consider resuming food aid to North Korea if the North retracted its refusal of humanitarian assistance.34

One 24 year-old defector from North Hamgyeong relates how he was hitching a ride on a freight train and fell off. Big mistake. His ankle was crushed, and the treatment wasn’t much better than the accident:

“Five medical assistants held my arms and legs down to keep me from moving. I was in so much pain that I screamed and eventually fainted from pain,” said the man, identified only by his family name, Hwang. “I woke up one week later in a hospital bed.”

Eaten yet? Depending on your answer, you may want to skip past this part:

Na, a 21-year-old man from Onsong, North Hamgyong province, worked with his mother from the age of 8 to 12 years at the local coal mine. Since the early 2000s, he suffered from chronic digestive problems and tried to ameliorate his pain through self-medication by taking aspirin65 at night. He recounted how intestinal or maw worms (Ascaris lumbricoides) “30cm in length” emerged from his mouth. Although Na took anti-worm medication, the worms continued to re-appear due to “poor hygiene”. According to him, the low level of hygiene was due to his work environment, coupled with living in close proximity to farm animals, open sewer and waste that was not properly disposed.66

A 2010 report by South Korea’s Korea Centres for Disease Control and Prevention (KCDC) looked at medical exams of North Korean settlers who had arrived in South Korea in 2008. It revealed that nearly half of young North Koreans, aged between 13 and 18, were infected with parasites, such as maw worms. The overall rate of infection for that year was 29 per cent.

I’ll give you one last quote, from Barbara Demick of the L.A. Times, who has written plenty about the quality of North Korean health care in her recent book:

“I was screaming so much from the pain, I thought I was going to die. They had tied my hands and legs to prevent me from moving,” said a 56-year-old woman from Musan who had an appendectomy performed without anesthesia. [....]

A 17-year-old girl from Musan, a city near the Chinese border, who defected in February of this year said people often used illegal drugs, particularly “ice,” a highly addictive methamphetamine that is manufactured inside North Korea. “You do drugs if you have a cold, a stomachache, for whatever is wrong,” said the girl, who was interviewed in March by The Times. The Amnesty International report also said North Koreans were using morphine and opium derivatives to medicate themselves for lack of proper pharmaceuticals.

What else emerges from the report is that North Korea’s medical system is a hollow infrastructure — one with a lot of clinics, doctors, and nurses, but no instruments, supplies, equipment, or medicine, and one where the only people who get treated are the privileged or the new rich. That means it’s a system that could be coopted. An underground religious, political, or humanitarian group could help its supporters or beneficiaries inside North Korea get medical care by paying doctors and nurses with money and medicine. The doctors and nurses need the money, and initially, they wouldn’t know and might not care who was paying the bills, at least until they realized they were also incriminated.

14 comments

  1. james says:

    i don’t think it’s just margaret chan. i think the whole WHO organization is culpable.

    http://www.google.com/hostednews/ap/article/ALeqM5gjWsuw-k56sl9zaRm91DlvbnBhRQD9H02MTG0

    “Chan said the communist country provides universal coverage and is the “envy” of developing nations.

    ……..

    Asked Friday what countries are envious of North Korea’s health, WHO spokeswoman Fadela Chaib said she couldn’t name any.”

  2. KCJ says:

    And this is the condition of Norks outside the gulags.

  3. j says:

    as you pointed out:

    while i’m delighted the amnesty report is getting some press, we have been aware of these public health issues for years (yes, WHO knew). and the report has the same trite, ineffectual policy recommendations that have been floating around reports for years. so the latent giant of the human rights industry interviewed a couple defectors to tell us what we already know – big whoop. releasing one report every couple of years is no substitute for substantive advocacy.
    did these frauds really think they could just cover up and anesthetize their profound abandonment of north korean human rights issues?

  4. j says:

    as you already pointed out:

    while i’m delighted the amnesty report is getting some press, we have been aware of these public health issues for years (yes, WHO knew). and the report has the same trite, ineffectual policy recommendations that have been floating around reports for years. so the latent giant of the human rights industry interviewed a couple defectors to tell us what we already know – big whoop. releasing one report every couple of years is no substitute for substantive advocacy.
    did these frauds really think they could just cover up and anesthetize their profound abandonment of north korean human rights issues?

  5. Jack says:

    Of course, just because “universal health care” in North Korea is a dismal failure, doesn’t mean it can’t work in other countries – especially if you move away from single-payer systems. ;)

  6. David Woolley says:

    The report explains the use of meth.

    In recent times, especially from Good Friends, there have been weird reports of secret meth labs and sellers being detained and imprisoned — so I envisaged a hidden biker culture! No, it turns out from the Amnesty report that there are essentially (and only) four medications available for all illnesses and injuries — aspirin, penicillin injections, meth and an addictive Chinese opiate (jeong tong pyeon, which I assume is the old Tiger Balm.) So meth, pure or adulterated, is a people’s drug of choice — which is very bad.

    Methamphetamine is a seriously addictive drug, with rotten side effects that diminish the prospects for continued good health. In those earlier reports, there have been suggestions that meth production was official — so we now see a government that not only condemns its people to ill health, but actively makes it worse!.

    Finally, all those reports of the “common cold” appear to be euphemisms for the TB epidemic that is raging below the surface, that is itself caused by inadequate food supplies. The report suggests that Multiple Drug Resistant TB (the most dangerous kind) is prevalent in cities,

    The report identifies a society whose medical practices (and even medical challenges) are Victorian. I found the report amazing, considering its source — but it was basically written in UN-bureaucratese, with occasional glaring insights, so I wonder if there is an internal struggle at the WHO, and this is the counter-argument to Margaret Chan that can’t be officially published, so has been released externally by Amnesty?

  7. mike v says:

    TB is still epidemic across southeast Asia and Africa. I am doubtful that it is MDR TB or XDR TB.

    First line drugs for TB treatment are EMB, INH, PZA, RMP, and STM.

    MDR TB is resistant to at least INH and RMP. XDR TB is resistant to INH, RMP as well as some second line drugs quinolones (CIP or MXF) AND KM, AMK, or capreomycin.

    The good news for the world but bad news for North Koreans is that without access to even first line drugs it is unlikely that MDR TB has gained prevalence.

    When the regime collapses and assuming that south korea takes over it would probably be a good idea to seriously quarantine the north and deal with TB before allowing free movement. Given their isolation, with aggressive screening and treatment it should be possible to successfully reduce prevelance and prevent global outbreaks.

    [See this link. - Joshua]

  8. Theresa says:

    Ask any Chomsky-parroting career grad student in the East Bay and she’ll say, “universal health care!”

    I am assuming this is an Ahn reference.

    Hey, I am a native East Bayer and I don’t roll like that!

    :)

    [Are you also a career grad student with a tiny, misshapen hippie soul? Glad you've survived the latest riots, incidentally. Good readers aren't easy to replace. ;) - Joshua]

  9. David Woolley says:

    Amnesty, not I, states that MDR-TB is prevalent. At page 18 it states that AT LEAST 5% (an enormous number) of the entire DPRK population has TB — that 4% of new cases, and 23% of previously treated, cases are MDR-TB. It then goes on to explain why MDR-TB is increasing, because of the diabolically poor situation of basic medicine in the DPRK.

    Not even at the worst of the times at the end of the nineteenth century was 5% of the population of London or New York or Chicago carrying active TB. That’s the situation in the DPRK — and one person in four who is infected (a full 1% of the population, or a quarter of a million people) is likely to be a carrier of MDR-TB.

    Your point about quarantine is valid, Mike V — but we need it now, not later if the Amnesty statistics are even marginally correct.

  10. Theresa says:

    [Are you also a career grad student with a tiny, misshapen hippie soul? Glad you’ve survived the latest riots, incidentally. Good readers aren’t easy to replace. - Joshua]

    I am not one of them, but they surround me.

    I had one hour to get out of downtown Oakland (where I work) and it was a bit crazy, but the looting and rioting from the out of towners (75% non-Oakland residents) didn’t start till it got dark. I was long gone by then, and safe….in Berkeley. :)

  11. kushibo says:

    james wrote:

    i don’t think it’s just margaret chan. i think the whole WHO organization is culpable.

    In this significantly longer AP article, the WHO spokespeople seem trying to distance themselves from Dr Chan’s embarrassing praise.

    I’m still inclined to fault Dr Chan and not the WHO.

  12. Ernst says:

    Speaking of ‘Nothing to Envy’, this book can now be picked up from amazon.co.uk for less than 5 pounds. Might save your readers some money as it nearly triple in the US, ta.

  13. kushibo says:

    I was going to see if I could get her to give me a copy for review, but barring that, I was going to verify if Borders really does offer an electronic version for free if you purchase the print edition, as someone told me.

  14. [...] about the quality of the care?  One Free Korea has an extensive posting on North Korea’s health care system based on this Amnesty International [...]

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