Source: Agence France-Presse (AFP)
Date: 17 Feb 2003


Lives being lost in North Korea as public health care crumbles

by Peter Harmsen
PYONGYANG, Feb 17 (AFP) - Like much else in North Korea, the
public health care system is in tatters and lives are being
lost as a result, foreign aid workers warn.

While it is widely recognized that up to three million
starved to death in the late 1990s, the outside world knows
much less about the increasingly fatal consequences of
rapidly deteriorating health care.

"A lot of focus has been on the famine, but little attention
has been paid to public health care," said Eigil Sorensen,
representative of the World Health Organization in
Pyongyang. "Certainly, the health care system is really in
crisis."

Since North Korea's economy turned from bad to worse a decade
ago, clinics have been allowed to fall apart, medicine is in
short supply, and doctors and nurses use procedures that have
long been abandoned abroad.

"In the medium-term, these are urgent issues, because the
difficulties contribute to mortality in the nation," said
Sorensen.

In a country that treats most statistics as state secrets,
scattered data can only give an inkling of the extent of the
problem, but the time people get to live forms one
significant indicator.

"The life expectancy for women in North Korea has fallen from
73 to 70 over the past decade," said Jayanti Tuladhar, an
advisor at the United Nations Population Fund. "For men, its
69."

Pregnant women are among the groups of people who have been
particularly victimized by the governments inability to
provide ample health care.

"In the early 1990s, maternal mortality was very low for a
developing country," said Siri Tellier, a Beijing-based
representative for the United Nations Population Fund, who
visits North Korea regularly.

"But it has doubled in the past five to 10 years, and were
concerned about that," she said.

Between 500 and 1,000 North Korean women die every year in
child birth because of poor nutrition, because they are not
attended by skilled midwives, or because clinics lack
medicine to treat complications.

Among the survivors, many must live with debilitating
ailments for the rest of their lives, such as fistula, where
the reproductive tract breaks, causing permanent
incontinence.

Malaria and tuberculosis are other threats to a people that
has already suffered more than most.

The abject conditions are all the more striking because the
North Korean regime, in times of less hardship, made a point
out of building an extensive network of clinics and
hospitals, staffed by trained personnel.

This system, set up in the first four decades of communist
rule, provided cradle-to-grave health care free of charge.

In principle, seeing the doctor still does not cost any
money, although that is of little consolation to most North
Koreans.

"It doesnt help to have free health care if services are
limited," said Sorensen.

The system is still in place, the clinics are still standing,
and the doctors still go to work, but now they must struggle
with dramatically reduced resources.

"What strikes me when you arrive at the clinics is that its
cold, because theres no electricity," said Tellier. "People
are standing in their white uniforms, and its clean, but
theres no medicine."

One cause of optimism is that North Korea will not need to
build a health care system all over again.

"What they need is relatively little to get it up to par,"
said Tellier. "You don't need to build the clinics or educate
the staff from scratch. To me it's an opportunity."

Good chemistry with North Korean doctors is also making the
task easier for foreign aid workers.

"The doctors are interested in becoming better doctors.
They're technical professionals," said a UN official. "Any
doctor would like to know how to treat a patient better. That
is our window of communication."

ph/mp/nj AFP