UN tuberculosis aid to North Korea – where does it go?

Monday 17th August, 2015
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Image via the Eugene Bell Foundation.

DOTS medication popular among North Korean residents.

North Koreans remain misinformed when it comes to tuberculosis. It is still widely believed to be a genetic condition, and triggered by malnutrition. According to refugee Kim In-Sook (38), North Koreans generally believe children have tuberculosis genes passed down from their parents.

Through interviewing recent refugees, we looked into some of the causes, treatments and rehabilitation methods for TB that are trending in the North Korean health consciousness.

The system in place for combating tuberculosis appears well thought out, at least in form. Throughout North Korea there are “No. 3” treatment clinics that specialise in tuberculosis, providing testing, diagnosis, and regular medication. In addition, there are also “No. 3” sanatoriums for tuberculosis patients, and clinics specialising in the treatment of tuberculosis in children.

In the past, tuberculosis used to be regarded as a hereditary condition. It was thought that nothing much could be done about these cases. But it was also believed that tuberculosis triggered by malnutrituion could be cured by following a good diet.

During the 70s and into the early 90s, patients diagnosed with tuberculosis were referred to hospitals for treatment. In more recent years, and with increasing contractions, North Koreans have become desensitized to tuberculosis. They do not become alarmed or curious about the illness anymore, because it is regarded as so common.

In response, the South Korean government along with the UN agencies have made efforts to supply North Korea with tuberculosis drugs that are free of charge. But refugee Kim Ji-Soo (46) is one of many whose testimonies reveal that very few North Korean patients may find such drugs free of charge.

What happens to drugs that have been supplied free of charge for humanitarian purposes, and why are they not often used to treat patients in a direct manner?

North Koreans commonly refer to tuberculosis medication as ‘DOTS drugs’. In past years, these drugs were available to some extent at “No. 3” tuberculosis treatment clinics to registered long-term patients. The DOTS drugs also became popular and favoured among the general population.

Refugee Kim Cheol-Jin (56) says he was a registered long-term tuberculosis patient at one of these clinics. Upon hearing that a shipment of UN supplied tuberculosis had arrived and was being made available to registered patients like himself, he went to the clinic.

The doctor confirmed the news but told him that the number of patients outnumbered the amount of available drugs, and that the clinic would be prioritizing patients by severity of illness.

Kim says he waited for several months, but there were no further updates from the clinic. However, the famed DOTS drugs appeared quite conspicuously in the informal markets and in privately-run pharmacies, sold at a steep price. Although his clinic had said there was not enough supply even for registered long-term tuberculosis patients, they managed to be passed into the hands of businesspeople who had sold them into the private market at a tidy profit.

Officials working in the health departments are well positioned to embezzle medications before the clinics can distribute it to patients. Colluding with local doctors and supervisors, it is not unheard for forgeries to be made of charts displaying how patients have been treated with the drugs. The embezzled drugs are sold to middlemen and private traders on the market in return for cash.

Genuine concern may have led the UN and the South Korean government to send the aid shipments, but in the maelstrom of embezzlement, corruption and misinformation, many of their intended beneficiaries do not receive the medication as humanitarian aid, if at all.

Reporting by Park, Sun-Hwa.

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