Unification Media Group: Reports have emerged describing the parasitic infection found in the North Korean soldier who defected by running across the Joint Security Area recently. The soldier’s health has renewed interest in the North’s general hygiene conditions. NGOs have reported that North Koreans have above average infection rates for such parasites. Today, we will speak with reporter Seol Song Ah to learn more about health conditions in the reclusive state of North Korea.
Seol Song Ah (Seol): South Koreans have been shocked to hear about the poor health of the North Korean soldier who recently ran across the JSA to escape from the North. He was shot numerous times and has since undergone two rounds of surgery. Rare parasites were discovered in the soldier’s stomach, casting light on the sad state of North Korea’s healthcare system and sanitary conditions. One of the reasons for the high infection rate is the fact that human waste is used to cultivate fields for human consumption. Vegetables grown in this manner can often have roundworm eggs attached to their seeds.
Another common infection vector is contaminated drinking water. Teenagers who are forced to participate in agricultural mobilizations regularly consume water from streams adjacent to the fields. Such water is often contaminated by human waste, making it an easy transmission point for infection. They also eat the produce being grown on site.
UMG: Can you tell us more about the sanitation conditions in North Korea?
Seol: I’ll start by discussing the water and sewage situation. Even the capital city of Pyongyang has deteriorating infrastructure. Outside of the major cities, the water supply is intermittent and unreliable. And the water that does emerge is not adequately sanitized. The wells and purification systems are primitive and the situation is exacerbated by the fact that central water supplies are contaminated with sewage.
From the 1990s, residents from the rural regions began to use ground pumps to source their own drinking water. Larger apartment buildings (five to seven stories) typically pooled money from each family to set up a common-use pump near the building. However, these pumps were often located near public bathroom facilities, permitting contamination with human waste.
Before I defected from North Korea, I lived in an apartment building in South Pyongan Province. One of my neighbors told the neighborhood watch leader about the problem, saying, “Doesn’t this mean that we are drinking water contaminated with feces? Can’t you notify the county office that we should move the public bathroom?” The director of the local county office responded with an irrational retort: “The drinking water is pulled up from 15 meters underground, so even if it does make contact with human waste, it will get purified.”
UMG: The county office is subordinate to the City People’s Committee. Is this the normal response given by local officials to address these problems?
Seol: I recently spoke to someone who lives in my hometown by phone. They said they’re still pumping the drinking water and that this same problem also occurs for single homes as well. Most of the dwellers of single homes build their own bathrooms because they need to capture and store the waste for farming.
In the cities, the homes are located closer together. The public bathroom facilities are built approximately five meters away from the homes. Nearby residents say, “We don’t need these public bathrooms, so I wish they would come and just remove them for us. I told the inminban [neighborhood watch] leader this, and it was communicated to the director of the county office, but the people’s committee rejected it. The authorities responded that the decision to install public bathrooms in the villages came from the top leadership, so it is not possible to remove them.”
UMG: You mentioned that the residents store their own waste for manure. I imagine that this is an easy way that infection spreads.
Seol: Yes, that’s true. The start of each new year brings about the “manure battle,” during which factories and students are forced to contribute manure to the authorities. Starting in the spring, residents put their waste out in the street to dry so they can store it and contribute later. Without the proper equipment, these residents are exposed to roundworms, threadworms, hookworms, and other parasites.
A vicious cycle is created when human feces is used to cultivate produce for consumption. Roundworm eggs live on the seeds of vegetables, and enter the human body upon consumption. Some of the most vulnerable parts of North Korean society, the young people mobilized to do farm work and soldiers who do not receive sufficient rations, eat radishes and other produce from the farms and get infected. In North Korea, it is not common to wash one’s hands before eating.
At the more privileged middle schools, the children are instructed to wash their hands, but there are no facilities available to allow them to do so. In school bathrooms, waste is exposed and produces foul odors. There are also no sinks available in the bathroom to wash your hands. The pale and yellowish skin of the students’ faces is testament to the malnutrition and poor sanitation conditions that many children are subjected to.
UMG: Even children are exposed to these poor sanitation conditions. Do the authorities have no preventative policies in place?
Seol: The UN and other international organizations have been supplying pharmaceutical products to the North. Starting from a few years ago, most students have thus been provided with anti-parasite medication about every six months or so.
According to one South Pyongan source the regional hospital located near the relevant schools dispatch a doctor who enters the classrooms and gives each student a large pill. After the students take this medication, the parasitic worms come out of their bodies in a lump. However, since the students live in unsterile conditions and eat snacks from their pockets while mobilized to do work outside, they easily catch the same parasites again.
We were informed that there are no policies in place by the authorities to alleviate such problems. Up until the 1980s, the inminban [neighborhood watch] would provide information on parasite reduction measures to each family at the local hospital. Moving into the Kim Jong Il and Kim Jong Un era, however, the free universal medical system has virtually collapsed. These days, there are merchants selling anti-parasitic medication in the official marketplaces.
UMG: Can you tell us a little more about this medication?
Seol: The roundworm medicine is imported from China, Russia, Germany, and the UN. There are also some brands produced in North Korea. Among the foreign medicines, the UN variety is most popular. A medicine called “albendazole” sells particularly well.
Albendazole sells for 2000 KPW per pill (about US $0.25). This is about the same price as 500 grams of rice in North Korea. It’s also the approximate monthly take-home pay for a factory worker employed by the state. So for many of North Korea’s impoverished residents, the price of anti-parasite medicine is too high. As a result, the lower rungs of society are more exposed to parasites and less able to deal with the consequences.
There is also a domestically produced medicine called “SsantoniSsuk.” It is sold in powder form and tends to be cheaper than the international variety, but is not very popular because people say it doesn’t work very well.”
