A North Korean soldier who crossed over to the South offered a glimpse into the lives of North Koreans with the gruesome discovery of parasites in his intestines as well as other physical ailments last month. Despite the media frenzy surrounding the North Korean defector, an expert is cautioning against making sweeping generalizations of North Korean healthcare and welfare.

Dr. Lee Myung-ken, a North Korean expert renowned in the field of international aid, sat down with Korea Biomedical Review on Thursday to discuss his experience with North Korean healthcare, having worked directly with North Korean officials and residents for almost a decade.

Regarded an expert and specialist on North Korean issues both domestically and abroad, Dr. Lee is currently a professor at Yonsei University and the executive director of international medical aid group Global Together. He had previously served in various international aid organizations such as the Mercy Corps, United Nations Development Program (UNDP) and the U.N. High Commissioner for Refugees (UNHCR).

Dr. Lee Myung-ken explains North Korean healthcare in an interview with Korea Biomedical Review at Global Together headquarters in downtown Seoul Thursday.

Question: Does the North Korean defector’s condition reflect the health of North Koreans?

Answer: The whole defector situation is as if a foreign reporter came to South Korea and interviewed a homeless person, and then said that is what all South Koreans are like.

The defector was a soldier who served in the DMZ area. You have to remember that an army is a specialized unit that, like South Korea, does not have the freedom to do what individuals want. They rely 100 percent on the government. So it’s hard to say they reflect the general North Korean population.

But I can say that many in the North Korean army probably have the same conditions as the defector. But they are also likely in a better physical shape than the general population since they probably get more food and benefits. It makes sense because if you were the leader of North Korea, who would you support? Your army, of course.

Q: If the army is such a crucial resource, why didn’t the soldier get antiparasitic medication?

A: It’s most likely a distribution and priority issue. If high-ranked army officials placed a top priority on parasite treatment, then they could have solved the problem quickly. The medicine is not expensive; they can buy it from China. The South Korean government estimates around one million in the North Korean army. Last time I purchased antiparasitics in India, it cost 2 cents. So that’s $20,000 for the whole army – not a big issue.

But the army, as I said, is a unique group maintained by a hierarchy. They have a distinct policy to buy and distribute medicine. Antibiotics are most likely their top priority because they’re essential for treating injuries. But parasites? Nobody knew or paid attention to that.

That is my diagnosis. Many soldiers probably have the same symptom, but maybe not anymore these days. This event may have triggered high-level officials to buy and distribute parasite medication right away.

Q: Then what medicines are most likely on the high priority list in the North?

A: As I said, they prefer antibiotics because there are a lot of infectious diseases in the North. I’ve seen waterborne illness, foodborne illness, fevers, and lots of diarrhea-related diseases. Antibiotics and other primary medicine like Tylenol also function as essential treatment when they do not have vaccines provided by UNICEF and WHO. But they love to have any and all medications. As a donor, antibiotics are also our top priority.

North Korea can buy medicine from China at a meager price, but they prefer to buy it from South Korea, Japan, and the U.S. Medicines from these three countries are expensive, but the top priority for North Korea. Drugs from China are second. Domestically made medicine is the least preferred.

Q: How did they obtain medicine up till now?

A: Up until the end of the 1990s, the international society – South Korea, U.S., Japan and European countries – provided a lot of medical support. Tons of medicines were given to North Korea. I also supplied North Korea with lots of medicine from the U.S. The most I provided was 17 containers of medication.

Q: Are there any downsides to providing medical aid to the North?

A: Medical aid provides much support in the healthcare sector, but it also kills local capacity, meaning local pharmacies and companies. The period of international medical assistance lasted almost a decade. During those 10 years, North Korea relied on foreign aid, so local capacity was virtually gone.

The other problem was the perception of drugs. North Koreans now prefer imported products because of the quality and brand image. The “Made in (South) Korea” mark has become a brand in itself to North Koreans.

Dependency on foreign aid brought this kind of distortion to the healthcare delivery system.

Q: Then how should North Koreans decrease dependency on imported medication and supplies?

A: Think of it this way. If young children suddenly lost both their parents, can they survive on their own? Most likely not, because they do not have survival skills. They can go to their neighbor and ask for help and ask for food, but they don’t have the skills to survive alone, at least right away.

The same applies to North Korea. The North Korean economy collapsed with the fall of the Soviet Union and other communist countries. The years 1997 and 1998 were the worst for them – more than 1 million people died because they did not know how to survive independently. Now, most North Koreans know how to survive on their own. This is a significant change.

Q: What is the North Korean health care system like now?

A: North Korea still maintains the national healthcare system, which is all “free.” But “free” means the hospital relies on the government budget. The government usually does not have enough money to allocate funds to hospitals to get new machines, CT scans, or technology.

Q: How do North Korean hospitals operate while lacking government funds?

A: There are many ways to survive. One way is to get more support from the government. In this case, it’s always a struggle because organizations are competing with one another to get more from the government. If they receive enough, then it’s no problem. But most agencies and especially hospitals don’t get enough. So what can they do?

North Korea has been exporting their doctors and nurses to Africa. Thousands of North Korean doctors and nurses work in other countries. Thousands of North Korean doctors are working in Tanzania because Tanzania has 50 million people but 5,000 doctors.

South Korea did the same thing by exporting nurses to Germany, Iran, Saudi Arabia and the Middle East 30 years ago. Now the South Korean economy is better, so nobody wants to go to that area for the money. But the North is still doing that. The several thousand doctors and nurses who work there are sending back hard currency to North Korea, contributing to the economy.

Sometimes hospitals engage in trade. For example, I saw a hospital in the coal mining area provide medical services to coal miners in exchange for coal used for heating and exporting to China. So it’s currently like a semi-capitalistic system.

Q: It seems like hospitals are for-profit, then.

A: Almost. Officially no, but sometimes some doctors will tell their patients something like, “Oh we don’t have antibiotics, but if you go outside the hospital, you will see a woman in red. Ask her for medicine, and you can buy it from her. She’s my wife.” It’s a form of corruption.

Q: So medical services are sometimes sold under the table.

A: Yes. For doctors can’t charge money to the patient in the hospital under the communist system where everything (education, medical care, etc.) is supposed to be all “free.” When the government provides medicine, some doctors take a portion and sell them privately for profit. Many doctors can make a lot of money to sell drugs this way. Surgeons will also give top priority to those who give them bribes but delay the operation without the kickbacks.

It is corruption, but human beings are the same no matter where you go. I’m sure it’s identical for some South Korean doctors. Some doctors here violate moral or medical laws for personal gain. North Korean doctors are also human beings. Some are not good, but many are skilled. For the most part, they care about their patients deeply. Most North Korean patients love their Korean doctors.

Q: Can you compare North Korean doctors with their South Korean counterparts?

A: You’ve been to a South Korean doctor, right? You know well the infamous three-minute consultation. “Do the lab, CT-scan, X-ray, see you tomorrow” – it’s quick and routine. But North Korean doctors spend 30 to 40 minutes per patient and are more sympathetic. Nine out of 10 North Korean defectors preferred North Korean doctors.

If I were to manage a hospital, then I would staff the place with North Korean doctors. South Korean doctors know how to use machines, but it has made them reliant on technology and extremely specialized.

North Korean doctors are more dexterous, too, being less dependent on technology. There are only 5 CT scans and one MRI machine nationwide, all located in Pyeongyang.

So if I were in the Grand Canyon or somewhere in the wilderness and heavily injured and had to choose between a North Korean and South Korean doctor who happened to be there, I would prefer the North Korean doctor. I think he would be far better at operating in the situation where there are no medical tools. I’m not saying they’re far better than South Korean doctors, but North Koreans do have their strengths so we can train them.

Q: Then do you believe North Korean doctors can work with South Koreans in case of reunification?

A: I love talking with South Korean doctors about this issue. Every South Korean doctor protests the idea of giving North Korean doctors a medical license. I say okay then, how many doctors are in South Korea? About 150,000. North Korea has a similar number with half the population. If North Korean doctors are not given licenses because of circumstances out of their reach that barred them from being able to use modern technology, then we will have to provide medical services for free to the North Korean population, which means spending of more taxpayer money.

Instead, we can learn from Germany, Vietnam by giving licenses to all doctors and nurses from the other side. Many doctors and nurses will be able to work with us upon reunification. We need to provide them with permits, which will contribute to the nation's healthcare system.

One way to ease into it is to make a law upon reunification, which limits North Korean doctor to work only in North Korea, and South Korean doctors to work in South Korea while implementing exchange programs that increase the interactions between the two sides, and gradually expanding them as years go by.

yjc@docdocdoc.co.kr

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