hankyoreh

MD

By Kang Tae-ho, senior staff writer

Tuberculosis is one of the most serious public health problems plaguing North Korea, but South Korea is far from untouched by the disease. The country ranks first in a number of distressing statistical categories among OECD member countries: suicide rate, working hours, gender discrimination . . . and tuberculosis. South Korea is first on the list for tuberculosis incidence, prevalence, and death.

“The Korea Centers for Disease Control and Prevention (KCDC) keeps talking about stamping out tuberculosis, about how embarrassing it is to be ‘backwards.’ But it’s not anything to be ashamed of, or to call ‘backwards,’” said physician Kwonjune Justin Seung, 44. Seung, who is considered one of the top experts in multidrug resistant tuberculosis (MDR-TB), was speaking at a seminar on June 26 on the dangers of the condition in North Korea, as well as possible solutions. The event was organized by the Eugene Bell Foundation, chaired by Stephen Linton, and received support from the Ministry of Unification.

Seung compared the reactions to the disease in North and South Korea. In the North, the attitude is often that it should take a backseat to more pressing issues. In the South, however, there is a widespread belief that with the country’s advanced economy and health care system, treatment should be enough to take care of the problem.

The KCDC’s claims about “backwardness” were based on a 2012 report by the World Health Organization (WHO). Based on 2007 figures, it showed South Korea ranking first out of the OECD’s thirty countries in tuberculosis incidence (100 cases per 100,000 people), prevalence (149 cases, including both new and existing patients), and mortality (4.9 cases).

The contest wasn’t close, either. Second-place Estonia had respective rates of 25, 29, and 2.7 cases - not too far ahead of seventh-ranked Japan, where the numbers were 20, 26, and 1.7.

In addition, the situation is not getting better. The latest figures, from 2011, showed a death rate of 4.7, slightly lower than the 4.9 from four years prior. But the number of reported patients stood at 39,557, up by around five thousand from 2007.

Obviously, conditions are worse in North Korea. WHO figures released in March showed 99,074 cases reported there in 2011, with a death rate of 6.4 - respectively 2.5 times and 1.4 times the figures for South Korea.

But Seung is more concerned about MDR-TB than regular tuberculosis. As its name indicates, this strain is resistant to the standard drug treatment program. Although it is a form of tuberculosis, it is much more difficult to treat than the typical strain. Drugs are expensive, and patients often experience severe pain, prompting many to abandon their course. Treatment lasts for over two years, compared to around six months for ordinary TB. Hospitalization is required because of the severity of the side effects. And full recovery only occurs about half the time: the rate is 50-60%, compared to 90-95% for ordinary tuberculosis. The odds of it developing into “super-tuberculosis” - resistant to all treatments - are high.

Seung related accounts from MDR-TB patients in South Korea, showing the seriousness of the situation.

“In a joking tone, a patient said, ‘If you squeeze my body, you’ll get more antibiotics than blood. Friends? I can’t eat with people - I have to take the drugs in the middle. Suicide? I’ve always thought about it.‘ It was to the point where they were laughing as they said it.”

Needless to say, things are much worse in North Korea, where nutrition is poor and healthcare facilities and equipment are lacking. The biggest concern is contagion. People infected by MDR-TB patients become patients themselves.

“Bad treatment is worse than no treatment at all,” Song said. “Once you’ve turned someone into an MDR-TB patient, what happens next is they spread it through respiratory infection. So now you have more MDR-TB patients because you’ve botched the tuberculosis treatment, but if you use the conventional tuberculosis treatment, the number of MDR-TB cases continues to go up exponentially.”

The situation requires prompt diagnosis from the earliest stages of tuberculosis detection, whatever the costs or complexities. This prevents the possibility of additional infections once treatment has begun.“There is a great danger that North Korea might go the way of Russia, as a high-risk tuberculosis country. Among the nations that are categorized as high-risk tuberculosis countries, India has the most patients with 131,000, followed by China with 112,000 and Russia with 43,000. But it is just the opposite for the percentage of patients with MDR-TB. 20% of patients in Russia have MDR-TB, compared to 8% in China and 4% in India. The reason that the percentage in Russia is five times that of India is because they have just done standard tuberculosis treatment for a long time without any MDR-TB treatment. The longer the period of standard tuberculosis treatment, the greater the danger. Not only is the North Korean medical system similar to the system in the former Soviet Union, but North Korea has also only implemented standard tuberculosis treatment without preparing any measures for MDR-TB treatment.

The Eugene Bell Foundation, one of the best-known civilian aid organizations for North Korea, which has been providing aid for treating tuberculosis in North Korea since 1997. But in 2008, they changed their focus toward treating MDR-TB. As they dealt with the situation on the ground, they realized that just offering standard tuberculosis treatment was very dangerous.

Stephen Linton, chairman of the foundation, said that he was lucky to have met Seung. Seung, who attended Harvard University and later graduated from Stanford University medical school in 1998, completed an internship in internal medicine at the Harbor-UCLA Medical Center in California in 2001.

After this, he went to Peru, where he took part in the medical service project for poor areas organized by Partners in Health (PIH) for three years through 2004. This organization is an international NGO that was established with the object of providing preventative treatment for the poor in various parts of the world. The Global Journal, which is based in New York, and Geneva, Switzerland, ranked the organization as second among 100 NGOs in the world. The organization also has a close connection with Korea. Kim Yong, the current director of the World Bank, was one of the founders of the organization.

Seung is the person responsible for medical service in Lesotho, a small country that is surrounded by South Africa. His experience treating MDR-TB in Peru and Lesotho has been a great help for the Eugene Bell Foundation. Since the winter of 2009, he has played an important role in developing the treatment program for MDR-TB in North Korea, which includes the GeneXpert equipment that is used for quick testing of tuberculosis.

Last year, the Eugene Bell Foundation opened two new tuberculosis treatment centers, increasing the total number of centers it operates to eight. But it is still not enough. They are able to treat about 500 patients a year, and even that is limited to North and South Pyongan Province. ”While we don’t have the exact statistics, we estimate that there will be several thousand new cases of MDR-TB. For effective treatment, it is essential that we expand the scope of treatment,” Linton said.

In March 2013, despite the fact that inter-Korean relations had degenerated to a critical level, the South Korean Ministry of Unification allowed the Eugene Bell Foundation to bring US$530,000 of MDR-TB medicine into the North.

All of the media gave this major coverage, heralding it as the first aid project for North Korea adopted since Park Geun-hye became president. But all the South Korean government did was permit the medicine to be taken to the North; it did not donate a penny of aid.

Seung, who was in the North from the middle of April to the beginning of May, has a wish. “In order to run a detailed test on sputum samples we collect from the patients, we have to bring the samples to South Korea and run tests at a tuberculosis research center here. There are some MDR-TB patients who cannot be treated by medicine. About 10% of patients need an operation on their lungs. I wish that we could create a general tuberculosis center in some place like Kaesong [the inter-Korean cooperative industrial area in North Korea], a center where we could have regular diagnosis, testing, surgery, and treatment.”

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