The dire reality of “universal health care” in North Korea

It is time for “In-depth analysis,” where
we discuss the status of the Korean Peninsula and related news with experts.
Today we’re going to examine the North Korean medical system and disease control
practices with Cho Su Ah, who worked as a surgeon in North Korea and is
preparing to become a certified healthcare professional here in South Korea. 

1. As
we mentioned earlier, recently there have been many articles promoting free
medical care in North Korea’s Party-run Rodong Sinmun. These stories are along
the lines of “a fatally ill patient recovers as a result of the public health
care” and “such health recovery is all thanks to socialist practices.” Can any
North Korean citizen, regardless of location and socioeconomic status, receive
public health care benefits?

Honestly, I am not convinced at this point.
I came to South Korea 7 years ago and back when I was in North Korea, the
medical conditions were so frail that you couldn’t receive medical treatment
even if they were to be charged. In fact, public health care was a policy
proposal during the 1970s, targeting children and pregnant women with actual implementation.  However, the system took effect for short five years then started to crumble [namely following the fall of the Soviet Union and a huge loss of cross-sector support needed to prop up the state].

I believe stories that appear throughout
North Korean media are very special cases. Kim Jong Un would visit a specific
hospital and order doctors to treat a certain illness. Then, the hospital
follows the order because it would only dignify their reputation. From the
patient’s perspective, it is a true fortune. He or she was ill and
hospitalized, and thanks to the General’s mercy, they’re cured! At this moment,
it is practically impossible for North Korea to provide free medical care to
its citizens.

2. You
mean, besides the fact that the public health care system does not reach every
citizen equally, it is highly poor in quality as well, correct?

I swear, North Korea cannot even provide
100g of corn as a meal to its citizens at this point. How does a public health
care system make sense, then?

3. How
do North Koreans treat a common cold or enteritis?

When the government distributes rations, hospitals
are activated. The government even sends doctors to search for medicinal herbs
in the mountains for forty days every spring and fall. The doctors used to
gather forty different kinds of herbs, pound them in a mortar and turn into
medicine, and hand them out to cold patients. But now, everyone is out in
Jangmadang [marketplace] because there isn’t enough food. So who’s going to go
to the mountains and gather herbs?

4. Despite all the contradiction and
controversy, North Korea continues to consistently promoting its public health
care system. How would North Korean citizens who are not receiving any benefits
from the system react to such advertisements?

When North Koreans see these articles, they
only go so far as to say “People in Pyongyang receive all these benefits
from the General. When will those of us living in the country ever be treated
like that?”

And because hospitals are so frail, even
when people read such articles–honestly only 1-2% of North Koreans read the Rodong Sinmun. My
father was a high-ranking official, so the paper was delivered to our home
every day, but regular citizens don’t have access to the publication; they
simply don’t know about these issues.  

So these people don’t really know how the
North Korean society is functioning. Every now and then they would hear about
Kim Jong Un on the Nine O’ Clock Chosun Central News Agency broadcast, but this would
most like be something involving the leader making an onsite-visit somewhere.
The mind and the heart are separate, you know?

5. The photos in Rodong Sinmun show very clean hospitals that look very up to date. For example, there’s
Pyongyang’s Taesongsan General Hospital, Ryukang Dental Hospital, and Okryu
Children’s Hospital. All of these facilities on the look sanitary, and you can
also spot modern equipment. What percentage of the North’s hospitals would you
say are like these?

Only about 0.001 percent — a handful. In
fact, only two or three. There is only one medical college hospital per
province, and even for smaller hospitals, there are only one or two in each

The only reason why a number of modern
devices exist is because of wealthy foreigners who are curious about North
Korea. As you know, there are many who wonder why North Korea does not collapse
despite being so isolated. It’s said that a lot of people like that want to
visit Pyongyang once in their lifetime, and when they come, they supply medical
equipment rather than cash or fertilizers. They send samples of medical devices
to a few hospitals in Pyongyang. Electricity is necessary to run these devices,
but having lived there myself, I can tell you, it is not like you get a steady
supply of electricity.

6. So the medical equipment is useless
without power?

Exactly. That is why at the most they can
only test-run them. The General (Kim Jong Un) has studied abroad and can speak
English, so he points to the machines and talks about them, but that’s about
it. I think he’s just using them as props for his pictures.

7. Have you used any modern medical devices
as a doctor?

No, because the foreign language we learned
was Russian. We learned Russian from when we were young. We were told that
Americans are foes that we need to kill, so why would we learn English?

We learned all the medical terminology in
Russian as well. But the machines are all in English. Learning English has
become a fad these days, and people are told that they must learn English in
order to drive out South Korea. I went to medical school in South Korea as
well, but learning English is not something you can do overnight.

It’s no use bringing machines to North
Korea. For instance, a pastor from a large South Korean church sent machines to
build a heart center in the North, but they’re all just sitting there. They
can’t use them.

8. Then what rate of the population would
you say receives free medical care from modern hospitals with proper equipment?

Going to such hospitals would be expensive
for people from other areas, even if they are high-ranking officials. So I
would think that even one percent is a generous estimate.

9. How about in other areas? If you look at
photos of hospitals in rural areas, they look so dilapidated and unsanitary
that it is hard to even call them hospitals. What was particularly shocking was
a photo of patients receiving IV fluids from a beer bottle. Is this a photo of
a current North Korean hospital in the countryside, or is this from decades

This is from when I was still in the North,
during the period of 1995 to 2000, when the Arduous March [famine] took place.
It’s still the same now though. If you took this photo to Pyongyang, they will
deny things like this exist in the country.

But conditions are not much different in
Pyongyang either. North Korean doctors and nurses like receiving glass syringes
for wedding gifts. Because the system in the hospitals has collapsed, doctors
sometimes purchase medicine on their own from markets, and treat patients with
that when making house calls. Glass syringes can be sterilized, whereas plastic
ones become discolored after a few uses. That is why glass syringes are
popular, and to be honest, there are still no proper IVs in the North even now.

10. South Korea and most other countries
use disposable syringes, needles, and bandages because these items, which
directly touch or penetrate someone’s skin, can cross-contaminate. As you just
said, if the North reuses equipment like this, aren’t there high dangers of
becoming subject to contagions?

Yes, that is why bacteria do not die
quickly. North Korean antibiotics are very strong. Because North Koreans are
injected with such strong antibiotics, a lot of people have compromised livers.
Once you’re infected with something, it lasts a long time as well.

In fact, medicine there is just strong in
general. Being exposed to things like this is why the life span of North
Koreans is so much shorter than South Koreans at large.

11. I’m sure you’re well aware of this
practice, since you were a surgeon in the North. Many North Korean defectors
say it is common in North Korea to conduct surgery without anesthesia.

I say this as a surgeon who has directly
led surgeries. If the country doesn’t even have basic IV fluid or saline, where
would it get anesthetics from? Most of the women who had double-eyelid surgery
upon high school graduation or before getting married underwent the surgery
without anesthesia.

12. So there are double-eyelid surgeries in
North Korea too?

Yes, the standard of beauty is pretty much
the same between the two Koreas.  

13. Is it still possible to do surgery like
that without medical equipment?

A lot of people receive surgery at private
homes. North Koreans are good at sewing, since they’re good at things like
embroidery. Some people illegally offer surgeries in exchange for things like
corn. But those often lead to side effects, so many prefer to receive safer
surgeries from doctors. Doctors sometimes have to stick patients’ thighs with
things like sharp needles while they treat them for conditions like appendicitis,
because they lack anesthetics.

14. I can’t even imagine how painful that
must be.

The thing is, many North Koreans engage in
farming, which entails digging the ground in order to plant corn or barley.
There are also those who injure themselves while chopping down trees in the
forest. So the most popular medical field was general surgery, because there
are many patients who get hurt. There are not that many doctors in other
fields, such as internal medicine. The second most popular medical field is
obstetrics, because the state tells people to have more children and getting an
abortion is illegal, so you would have to bribes for one.

15. You must have been surprised to witness
medical treatment in the South that’s offered with proper anesthesia.

Because there are so many anesthetics in
the South, I kind of thought South Koreans just really liked them. I’ve even
wished that we could ship one-third of them to North Korea. I think South Korea
uses them too frequently.  

16. I’d like to turn to the subject of
disease treatment. Both South Korea and the broader international community are
quite concerned with infectious diseases such as tuberculosis in the North. Do
you think you could say that medical authorities in North Korea have a system
or a policy for treating tuberculosis?

No. They merely isolate those who were
exposed to the illness, and because most of the medicines are sold in the
markets, they “treat” patients by telling them to buy drugs at markets. There’s
nothing doctors can do about it.

17. Tuberculosis can be completely treated
with modern medicine. But the disease remains a problem, but you’re saying it’s
a problem in the North because they don’t know how to manage the disease?

The more pressing issue is that conditions
are exacerbated due to the lack of food, which weakens the immune system.
People have trouble getting enough food, clothes, and shelter for their daily
lives. Also, hospitals lack medicine because, for example, drugs sent by the
United Nations are sold by doctors to private market vendors. So the patients
suffer while the medicine keeps being circulated.

18. So shouldn’t the international
community actively monitor the use of medicine after sending supplies to North
Korea to ensure aid is being transparently distributed?

There are expiration dates for vaccination
medicines. Because people sell these medicines to rake in profits, by the time
they reach people in rural areas, most of the drugs have expired the date by at
least a fortnight. We do still use the medicine though, since it was provided
by the United Nations.

Of course, the medicine is not sent to
foreign countries such as China. It circulates within North Korea. But it does
not immediately reach North Koreans upon arrival in the state, and instead is
buried underground as war supplies. They are buried and swapped out every three
years. So even if there is an influx of a lot of medicine, a lot of them are
bought on markets by individuals as home emergency supplies.

19. North Korean authorities had regulated
the border area and limited foreigners’ entry into the country from late last
year to early this year in order to prevent the Ebola virus from entering the
state. I can’t help thinking that tuberculosis and malaria are bigger problems
in North Korea than Ebola. It’s hard to tell whether the North understands the
gravity of infectious or contagious diseases.  

I used to believe this too when I was in
North Korea, but most North Koreans believe that the North is the wealthiest
country in the world, since they do not have access to outside news. The state
issues booklets and material, which are used to educate people. For instance,
the booklets will contain a message saying that people should boil water before
drinking it in the summer because of cholera. The thing is, North Korea has had
the experience of the entire country suffering from cholera and typhoid. I think
Kim Jong Un is putting on a show, to show the rest of the world that North
Korea is taking care of people’s health.

20. When you attended medical school in
North Korea, did you believe in the government’s claims that North Korea boasts
an advanced medical system that the rest of the world envies?

Yes, I actually believed that North Korea
had the best medical system in the world. Even if our x-rays did not function
and there was rust on devices, we were proud of merely having such equipment.
We were proud because we thought that compared to South Koreans, who cannot
even go to hospitals because they can’t afford to, we are living happily. When
I first came to Korea, I thought South Koreans were exhibiting the greatest
medical devices in the world to put on a charade in front of us. But as time
passed, I realized that the disparity between the North and South is

21. When you talk about the wide disparity,
you’re referring not only to medical aid or medicine but the system itself,
right? There must be various differences, but what is the biggest difference
between the medical systems of the two Koreas?

I would say medical appliances. They are so
flashy in South Korea that it feels like it’s all part of a fantasy. I would
think, ‘I wish we had a device like that.’ But because the medical system in
South Korea is quite developed, I think doctors can be less attentive and
provide mediocre service to their patients, since they have highly developed
medical equipment. But whereas there are no medical appliances in North Korea
and doctors have fewer patients, they can be more attentive to each patient.

22. Medical care is not free in South
Korea. Of course, senior citizens and those of low-income families receive free
healthcare, but most citizens are provided with partial medical insurance and
aid from the government, and they have to pay the rest with their own money.
Was it hard to get adjusted to this system when you first arrived?

Yes, that was quite hard to get used to.
Even though the government is providing a lot of benefits, and I end up having
to pay only 10,000 KRW for what would have been 300,000 without government aid,
that 10,000 KRW still felt like a hefty sum. But now when I think about it, the
cost patients have to bear does not seem like much because medical expenses are
computed based on one’s income in South Korea. I think it is actually better
because even though I am paying more, I am receiving better-quality service and
living a healthier life.

23. I think you might be one of the first,
if not the first person to have been a doctor in both Koreas. You must have a
vision about what the medical system should be like on the Korean Peninsula
after reunification.

We never learned of rare illnesses in North
Korea, and people really don’t know what to do. When I dream about a unified
medical system for Korea, there are still some things that remain in North
Korea, like home visits. I know it would be hard to change the medical system
all at once, but I think we can gradually supplement the system by introducing
the strengths of both countries.

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