PYONGYANG, North Korea
The Man Nyon Pharmacy is lined with rows of colorful packages containing everything from dried bear bile and deer antler elixir to tiger bone paste and ginseng. But the ancient "Koryo" medicine provided at this popular dispensary isn't just for minor aches and pains.
It has been integrated into the health system from the smallest village clinic all the way up to the nicest showcase hospitals in the privileged capital of Pyongyang. Both modern and traditional styles of healing have long been intertwined nationwide with doctors from both schools working in tandem under one roof.
North Korean physicians say many patients prefer traditional medicine to the Western kind, but it's difficult to determine the true situation in this closed and impoverished society where access is limited. Defectors, foreign aid workers and North Koreans agree that many Western drugs are scarce and say villagers still forage for plants in some areas to make their own herbal concoctions.
With the U.N. Security Council imposing its toughest sanctions after North Korea's third nuclear test in February, patients may become even more dependent on these homegrown remedies in a country of 24 million people where government health spending ranks among the world's lowest.
"Doctors are more interested in Koryo medicine rather than Western medicine because they can get it more easily," said Ri Hye Yong, who manages a concrete pharmacy opened by the government nearly three decades ago. "It's much cheaper."
The latest restrictions are meant to squeeze new leader Kim Jong Un and the ruling class by clamping down on access to foreign travel and luxury goods. The resolution is not supposed to block donor aid to those who need it most, including the two-thirds of the population who don't have enough to eat. But foreign aid workers say years of limitations have created a maze of red tape and approvals needed to ship in medical supplies. Some countries refuse to process payments for anything involving North Korea because of restrictions placed on banks, while some foreign companies and organizations simply do not want to be involved once they learn where the materials are headed.
"Even though the imposed sanctions clearly exclude humanitarian assistance, a negative impact on the levels of humanitarian funding has been experienced," the U.N. Resident Coordinator's Office in Pyongyang said April 29, adding nearly three-quarters of the $147 million needed this year has not been received.
The World Health Organization is lacking an estimated 60 percent of the drugs it needs for at-risk kids and pregnant women, while the U.N. Children's Fund is struggling to get vaccines and medicines to prevent the biggest killer diseases among children, it said.
International efforts to help boost the country's ability to produce its own vaccines were earlier affected when some technology and seed microbes were stopped over concerns they could potentially be used by Pyongyang for malicious purposes, WHO said.
Jang Jun Sang, a department director at the Ministry of Public Health, said that sanctions have cut imports of medical equipment and supplies. But he said North Korea was used to sanctions. "If we receive medical aid, that's good," he said. "But if we don't, that's fine, too. We're not worried."
North Korean factories have limited ability to produce pharmaceuticals, and many rural clinics lack electricity, running water and heating. By the government's own account, more than 80 percent of village clinics suffer from "chronic shortages of medicines and supplies at all levels of the system."
Traditional medicine is cheaper and easier to find. Some clinics have their own greenhouses, and herbs are harvested every year in the wild to be processed into teas and other concoctions. The government says Koryo medicine is used to treat more than half the patients in rural clinics. But shortages exist too. Patients are often prescribed a simple herb they are expected to get themselves, said Dr. Byungmook Lim, a professor at South Korea's Pusan National University School of Korean Medicine, who co-authored a study comparing traditional medicine in the two Koreas.
"They are somehow surviving through such harsh conditions," said Dr. Jongbae Park, director of Asian medicine and acupuncture research at the University of North Carolina, who co-authored the Koryo medicine study. "A lot of new ideas and new findings are coming from desperate efforts through challenges, so I am rather hoping that they would have reserved a new finding that the outside world cannot think of, particularly in coping with the main diseases."