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2009/12/14 06:00 KST
(Yonhap Feature) N. Korean patients hope for cure from deadly tuberculosis

By Kim Hyun
SEOUL, Dec. 14 (Yonhap) -- Bundled up in thick parkas on a cold morning, hundreds of North Koreans line up in the outdoor square of a small rural town, waiting for hours to give a phlegm sample in a last-ditch effort to be diagnosed and cured from drug-resistant tuberculosis.

   An elderly woman, standing beside her gaunt-looking daughter, says in front of a video camera, "She is a doctor too. She has a Ph.D from medical school. But she cannot cure herself."
Hundreds of North Korean tuberculosis patients, many of them resistant to drugs, lining up in a small town north of Pyongyang on a recent morning to get diagnosed. Courtesy of Eugene Bell Foundation

The young woman looks down helplessly. Her mother continues, "After I heard she can be healed here, I thought my dying daughter is coming back to life!"

   The World Health Organization (WHO) designates North Korea as a "special administrative region" because of its high death rate from tuberculosis, a disease of poverty. The deadlier form of drug-resistant tuberculosis there is higher than in other countries, probably because many patients get inconsistent or partial therapy, according to a WHO report.

   During a recent two-week visit to North Korea, a team from the Eugene Bell Foundation, a not-for-profit Seoul-based organization that has helped fight tuberculosis in the impoverished country since 1997, faced an unprecedented number of people lining up to receive treatment, said Stephen Linton, a doctor and chairman of the foundation.

   "We were really surprised, and North Korean officials were surprised," Linton said in fluent Korean. "The patients came from all regions on the biting cold morning to submit their phlegm, although they knew they have to wait six months to get medication."

   Linton and his team visit North Korea twice a year to collect samples of phlegm from tuberculosis patients. The samples are then sent to hospitals in South Korea, which diagnose each patient. On the next trip six months later, the appropriate medication is distributed to each patient, marked with their names and the local doctor who will oversee the therapy.

When the foundation began a pilot project to study the scope of anti-tuberculosis drug resistance in the country three years ago, North Korean health officials were reluctant to help, knowing such patients have little hope for a cure. But during their latest trip from Nov. 24 to Dec. 8, twice as many people as before gathered to give their phlegm samples, a sign of rising expectations for treatment, said Linton. His team collected about 600 samples from visits to about a dozen sanatoriums in the Phyongan provinces in the western part of North Korea.

   "It was severely cold, but they never complained and waited," Linton said, pointing to the crowd in the video clip shot at the Kwaksan Sanatorium in North Phyongan Province, north of Pyongyang. The video was shown at a recent press conference in Seoul.

   "The scene troubled my heart, but at the same time I was surprised," he said. "So many people came after they heard about our program by word of mouth. A son brought his father. Those who were healed came. I was grateful that they waited in order."

   North Korean officials even talked about building sanatoriums dedicated to patients with drug resistant strains of tuberculosis, he said.

   "We don't know, and it is impossible to know, the exact number of drug-resistant tuberculosis patients in North Korea," he said. "But what I found was that their interest in those cases has considerably grown. This means now is a really good time to tackle the disease in North Korea."

   Drug-resistant tuberculosis takes much longer to treat -- up to three years compared to six to eight months for standard tuberculosis -- and has a low cure rate of 60 percent, compared to around 95 percent even in advanced countries. In resource-poor North Korea, many patients stop taking medications after showing some signs of recovery or receive inconsistent therapy, reasons for the high emergence of untreatable strains. According to the latest WHO data available published in 2008, 3,472 multi-drug resistant tuberculosis cases -- 6.8 percent of all newly detected cases -- are estimated to have emerged in the country in 2006, marking one of the highest rates in Asia.

   The problem is not a drug shortage, but the lack of a consistent management system, says Kwon Jun-wook, an official at the South Korean Health Ministry who has worked with WHO.

   "North Korea receives drug assistance from WHO and other organizations, so drugs are not in short supply," he said. "But their roles should be effectively divided to avoid duplication of their efforts -- like some organizations provide drugs, and others take care of diagnosis and education."
Stephen Linton talking with a North Korean tuberculosis patient during his recent trip to the southern part of the country

WHO says 3,370 people died from tuberculosis in the country in 2006, compared to 2,300 deaths in South Korea, which is twice as populous as the North. As many as 5 percent of its 24 million people are believed to have been infected by the pulmonary disease, according to unofficial estimates.

   Linton, a well-respected figure who has taken a quiet approach to his aid mission, with more than 60 visits to North Korea over the past 30 years, made a rare pitch for donations, noting the unexpected turnout of patients and the North Korean officials' support. Eugene Bell runs on private donations, mostly from South Koreans and Koreans in the United States, and also support from the South Korean and U.S. governments.

   Meanwhile, all eyes are now on the outbreak of the H1N1 influenza in North Korea. Linton says the fatality rate of tuberculosis is "incomparable" compared to the lower danger of Influenza A, but added that he did not detect any sign of a flu outbreak, nor did he hear about it from locals, during his latest visit. The North has so far reported nine cases of the Influenza A virus.

   "We are making this special appeal for the first time because of the special situation we found in North Korea," he said. "When we go there in the spring, there will certainly be more patients waiting for us."