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Sometimes following North Korea feels like reporting on travails of Biblical proportions (our favorite parallel: the plagues that Pharaoh inflicts on the Egyptians, and ultimately on himself). So we were saddened by yet another indication of the fragile health system: multidrug-resistant TB.
We reported earlier on some innovative efforts to address the TB problem in North Korea. The Eugene Bell Foundation has been doing incredible below-the-radar health work in North Korea for years and TB has been a particular focus. Stephen W. Linton, the Foundation’s highly knowledgeable and sympathetic chairman, just returned from North Korea and reports that there are now 600 multidrug-resistant patients in six medical centers in the North, with hundreds more on the waiting list.
TB is difficult to treat because of the intensity of the regimen and the importance of monitoring patient behavior: you have to take your meds. But with North Korea’s health system in steep decline, and patients unable to afford medications, the environment is ripe for the development of new strains. While standard treatments require 6-9 months, treatment of drug-resistant strains has to be tailored to the patient and can take up to three years. Moreover, the medicine for multidrug-resistant patients costs nearly 100 times the standard treatment, up to $1,600 a year. Bell is using a standard NGO practice of trying to personalize donor support, linking gift-giving to particular patients.
An additional tragedy of the story is that the patients include medical professionals.
The Global Fund has provided some bridge funding in recent years, but it appears that their contribution is set to decline. Incidentally, the WHO country site is an embarrassing mish-mash of aspiration, disinformation and outright propaganda. A sample:
“The Democratic People’s Republic of Korea is a Socialist country, with “Juche Idea”, the man-centered idea, as a guiding principle to be strictly adhered in all fields of the government activity and it is clearly manifested by free medical service system set up in 1953 and a good infrastructure adequately shaped to meet national need. As a result, the TB registration rate declined from 250/100,000 in 1968 to 38/100,000 in 1994.
However, since 1995, DPRK has experienced the worst in its history due to severe hits of natural disaster consecutively for several years, resulting in a sharp increase in case notification of TB subsequent to severe malnutrition and it awakened the national staffs to the importance of DOTS [Directly Observed Treatment Short course] introduction.”
Right, natural disasters. We have had our say on that myth with respect to food and see no evidence that the health story is any different. Like we said, think Pharaoh.
