In North Korea, everyone is a doctor
In most countries, a person who is sick chooses to go to a hospital. They receive a diagnosis after relevant examinations are done. The doctor may then prescribe drugs or other kinds of treatment based on the results of the examinations.
In North Korea, those who are sick choose to see their local ‘black market doctor’ or head to private homes that sell black market medicine, instead of going to a hospital.
The ruling party in North Korea proudly boasts of its free medical care. There are indeed hospitals in every province, city, and county, and even in the outlying regions, there are maternity hospitals.
On top of that, each neighbourhood has a health clinic. There are even railway hospitals for railroad workers.
But since North Korea’s economic collapse in the mid-1990s, drugs, medical supplies and medical equipment became the responsibility of the patients. A hospital could no longer offer more than a place to lie down and take body temperatures.
As the state ration system broke down, those who were in the medical profession had to resort, as with everyone else, to making a living through the underground economy. Some of them eventually set up business of selling medicine from their homes – neighbours could trust a former doctor over a random stranger who offered medicine.
These black market supplies are siphoned off from the military or smuggled in from China. Even medicine sent by the UN for specific illnesses can only be obtained by ordinary North Koreans via the underground economy, as the supplies must first pass through the hands of Party officials, who then sell them onto private drug peddlers and then into the underground economy.
North Koreans know it is better to go to an underground pharmacy and buy their drugs this way, than waste time by going to a hospital where there are no drugs.
In the outside world, medicine is normally prescribed by a doctor or pharmacist. But in North Korea, the burden of deciding on the diagnosis and treatment falls on the patient. But even after purchasing the relevant medicine, its quality is not always guaranteed.
Park Sung-hye escaped from North Korea in 2013. She describes her experience: ‘I bought penicillin from an underground pharmacy when my daughter had fever. But after she received the shot, pus started to form where the needle had entered. I bought the shot to reduce her fever, but as the pus began to grow in size, the fever increased.’
‘When I went to a hospital, I was told that the medicine must have been a fake. My husband went back to the underground pharmacy and demanded that they pay for the cost of drugs that my daughter could use while in hospital.’
‘But the pharmacy owner said that many people bought medicine from him, and not one person had come back to say the drugs were fake. I returned with a local security agent, but the owner said there was no evidence that I had bought fake medicine from his house.”
‘As there was no prescription or receipt, I couldn’t do anything about my bad luck. In North Korea, anyone can sell fake drugs to earn a living.’
But ordinary North Koreans have no choice but to seek medical treatment in the underground economy. Not only do patients have to bring their own supplies when going to a hospital, they must offer cigarettes and food for the nurses and the doctors in charge. If it is winter, they must also offer firewood; going to a hospital is a desperate last resort.
And hospitals do not necessarily guarantee better standards of care. Kim So-yeon, who escaped in 2012, describes her experience: ‘Many people see side effects after using IV drips in the hospitals. Why would you bother going to the hospital when you can use them in your own home?’
‘Before our escape attempt, my mother-in-law came down with acute diarrhea, but we did not go to a hospital. We bought a 5% IV and contacted a local woman who was known to be good at finding a vein and giving shots. We brought her home, fed her a meal, and then had her administer the drip. We thought we could get rid of the diarrhea bacteria by flushing it out with an IV drip.’
She adds, ‘It’s normal outside North Korea for the symptoms of the patient to be examined first and then have a professional prescribe treatment. But because North Korean patients have to prescribe for themselves, they just rely on the informal advice given by those they know.’