Unexpected Partnerships with North Korea

When North Korea makes international headlines, it is often about Kim Jong Un and his latest threats against South Korea and the United States. When human rights in the country are discussed, it is often in relation to labor camps and food shortages. However, what is often overlooked are humanitarian issues like tuberculosis (TB), a disease that has largely vanished from the developed world but remains the deadliest infectious disease in North Korea. In fact, according to the World Health Organization (WHO), North Korea’s TB incidence is four times the rate of its neighbors China and South Korea. This has been exacerbated by the fact that there are strains of TB in North Korea that are resistant to conventional medication—drug resistant TB—which are much more difficult to cure both physically and financially. Despite political animosity between NK and the developed world, organizations like the Eugene Bell Foundation have engaged the regime in a constructive way that allows them to put aside politics and work to combat this disease.
What is Tuberculosis?
Tuberculosis is an airborne, infectious disease, caused by a bacterium, which typically affects the lungs and leads to the death of approximately 2 million people worldwide per year. This has been made worse by antibiotic resistance and the growth of drug resistant strains of TB. Although regular TB takes about six to nine months to cure with drugs only costing $20, drug-resistant TB takes about two years to cure with drugs that cost approximately $3,000. In addition, the treatment is much more difficult with the latter. The drugs are more toxic and can cause permanent hearing loss, kidney damage, and psychosis, among other side effects.
According to a 2012 WHO report, TB has been steadily decreasing in much of the world. Since 1990, there has been a 41 percent decrease in the mortality rate of TB patients. However, this disease still runs rampant in the developing world, especially in its drug resistant forms. In an interview with the HPR, Professor Ted Cohen of Yale School of Public Health explained, “There’s a lot of uncertainty about drug resistant TB in most of the world. The diagnosis of the disease and access to drug testing are actually very small in the places with the highest burden of the disease. We are really failing to respond to the existing burden of the disease and what that means for the future is a really big question mark.” Additionally, Professor Eric Rubin of Harvard School of Public Health told the HPR, “you have to approach TB in an integrated fashion. You cannot treat drug resistant TB unless you diagnose it and unless you have the capacity for treatment. It’s a unified approach that you need and there are established ways of doing that if you have enough resources.” Unfortunately, impoverished countries that are most likely to be afflicted with TB often do not have the necessary funds or the infrastructure to treat the disease. Also, even in the developed world, effective control of drug resistant TB has required tremendous investment in both financial and human resources. 
The difficulties of diagnosing and treating drug resistant TB are often compounded by the poor quality of health systems in developing countries. Poor compliance with drug therapy can increase the rate of TB; in fact, not completing a regimen can induce drug resistance. Therefore, many health departments around the world use DOTS, directly observed therapy short course, in which patients are monitored and compliance is ensured. However, the amount of funding needed for this is just not available to the countries most susceptible to the disease.
The Curious Case of North Korea
The first signs of a TB epidemic appeared in North Korea during the Arduous March, a massive famine between 1994 and 1998 that killed hundreds of thousands of people. Those who managed to survive suffered from malnutrition and lack of basic necessities, which only made them more susceptible to TB. This situation has exacerbated to the point where North Korea now has one of the highest rates of TB outside of sub-Saharan Africa. To complicate matters even more, according to the North Korean Ministry of Public Health, 15 percent of TB patients are suspected of harboring an active drug resistant strain of TB.
A lack of a solid healthcare infrastructure has compounded the challenges TB poses in North Korea. Charlie Sands, Dean of the School of Public Health at the Pyongyang University of Science and Technology in North Korea, told the HPR, “On paper, the public health system in North Korea claims to have clinics and doctors in all provinces and all the villages. So they have the set up to handle it, but in the past, they have not really had the resources.” An inconsistent drug supply and inadequate funds to import medication has forced North Korea to rely on outside assistance. Much of the supply of drugs in the country comes from the Eugene Bell Foundation and Stop TB Partnership’s Global Drug Facility. Additionally, in 2010, North Korea’s Ministry of Public Health, Christian Friends of Korea, and Stanford University opened up a National Tuberculosis Reference Laboratory (NTRL) in Pyongyang to screen and diagnose TB cases that are drug resistant.
Indeed, in recent years these types of international NGOs have dramatically increased the amount of work they do on the ground in North Korea. In an interview with the HPR, John Park, Northeast Asia specialist at Harvard Kennedy School, said, “The work of organizations like Eugene Bell prove that partnerships are possible with the North Korean government, particularly in administrative health. One important myth to debunk is that there is a lack of coordination between NGOs and the North Korean government when it comes to common challenges like drug resistant TB.” In fact, the Eugene Bell Foundation reports that it routinely cures 70 percent of its patients in North Korea. It visits the country twice a year and runs twelve treatment centers throughout the country. Park went on to say that he believes these “existent models demonstrate how increasing the scale of impact is in the realm of possibility.” Despite conventional wisdom that North Korea is untrustworthy and unreliable, organizations like Eugene Bell, Christian Friends of Korea, and World Health Organization have managed to coordinate with the government in tackling TB.
Raising Funds, Raising Awareness 
“HIV is sexy,” Rubin stated, “It is so interesting and captivating. It captures people’s imaginations in a way that TB does not. Because it is more prevalent in less developed countries, TB is not the kind of disease to have an activist constituency. This does not mean that it isn’t important. It is still an enormous killer worldwide.” Unlike Ebola or the flu, which are epidemics that move quickly, TB moves slowly and does not create a sense of fear and panic. If it did, it could generate interest very quickly and get the medical resources invested in places that need them most, but this has not been the case. According to Cohen, “It is an imminently treatable disease that is killing huge numbers of people, and we need students to be the conscience that helps us refocus on this massive, unnecessary loss of life.” Shining a light on this problem, especially in a country like North Korea, is important to attract capable people who can help fight the disease.

For this reason, Human Rights in North Korea (HRiNK), a Harvard undergraduate group, is organizing a campaign called “5K for NK” to raise $5,000 this year to help the Eugene Bell Foundation cover the costs of drug resistant TB treatment for a North Korean patient. Esther Lim, coordinator of the campaign, told the HPR, “Even as college students, we definitely do have the ability to alleviate the suffering of these people, and it can all start with helping one patient through this campaign. We saw a video clip of our patient, who is around our age, thanking us for helping him fight the disease with him. How could we not help?” Agreeing with this point, Jong-Hoon Lee, Ambassador for Human Rights in North Korea, told the HPR, “Raising funds for the specific purpose of treating drug resistant tuberculosis is vital and international organizations are the way to approach this issue. The organizations have to sustain their expertise while dealing with this problem in a way that creates mutual trust and benefit for everyone.”
Issues like nuclear proliferation and labor camps may take up the majority of the public’s attention, but it is important to refocus on the individuals living in this country and specifically those suffering from this disease. It may seem like no matter how much effort, it will be impossible to make an impact on such a distant and isolated country. However, the work of these NGOs and their success clearly show that a transparent, sustainable, and effective partnership is possible even in North Korea.
Image credit: Wikimedia Commons / John Pavelka