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Continued: North Korea showcases best hospitals despite lack of power, running water outside capital

  • Article by: MARGIE MASON , AP Medical Writer
  • Last update: June 22, 2013 - 5:55 AM

Back at the Pyongyang Maternity Hospital, Mun, the facility's director of foreign affairs, steps off an elevator with flickering lights and begins spitting facts about the newly built Breast Cancer Research Center.

Here, it's like being transported to a heated exam room in the U.S. or Europe equipped with high-tech machines for mammograms, radiation and ultrasound. Mun refuses to say how much this new addition cost, adding only that one X-ray machine totaled 700,000 euros, or $910,630, and that the late leader Kim Jong Il and his successor son spared no expense. (Young Kim's mother is rumored to have died from breast cancer, but when asked, a hospital official declined to answer).

There was just one thing missing from the model health center: patients. A waiting room with rows of shiny chrome benches is deserted, while a lone nurse sits almost hidden behind a towering work station. Mun says 80 of the hospital's 100 beds are full, but only one room shared by three women is shown.

"This morning there were many patients," says Pak Hyang Sim, director of the hospital's diagnostic imaging. "They were all diagnosed. That's why it's so empty now."

Defectors and aid workers say hospitals everywhere are often eerily vacant. Bad roads, a lack of transportation and no money make it impossible for many to access health centers. Medicine and care are supposed to be free. But in reality, everything has a price.

"There's a saying in North Korea: If your relative has cancer then your entire family is ruined because everything will go to getting that medicine," says Jeon, a 24-year-old defector in Seoul who fled North Korea five years ago and asked that only one name be used to safeguard her father still living across the border. "Some families who can't afford the medicine have no choice but to watch their loved ones die."

Despite the new center, breast cancer is far from the top of the list of health problems gripping the country, revealing a disconnect between where the government spends and what the people really need.

Hunger remains perhaps the biggest health concern, with 16 million North Koreans — two-thirds of the population — not getting enough to eat. The resulting malnutrition exacerbates a range of health issues, from hijacking child brain development to maternal death.

In the famine of the 1990s, hundreds of thousands of North Koreans are believed to have died. The government launched a "let's eat two meals a day" campaign, and people foraged for bark, roots and grasses, according to the Amnesty International report.

The period, known inside the country as the "arduous march," left a devastating mark on its overall health despite food aid from the international community that continues today.

Child stunting rates remain high, at 28 percent nationally and 40 percent in the worst-hit isolated province of Ryanggang. North Korean men are up to 3 inches shorter than their South Korean counterparts, according to findings published two years ago by Daniel Schwekendiek, an economist at Sungkyunkwan University in South Korea. North Koreans also can expect to die around 12 years earlier than their southern neighbors.

However, some say the outside world's perceived picture of health may also be skewed. North Korea, for instance, has lower stunting rates than Cambodia, Indonesia, Laos, Myanmar and Nepal.

"We think it's a constant situation where you find malnutrition or you find undernutrition or you find people not well fed," says Gerhard Uhrmacher, program manager for the German humanitarian aid organization Welthungerhilfe, who has traveled extensively in North Korea over the past decade. "This is generally almost all over the country, but it's not to the extent where hundreds of thousands of people are dying. We don't believe that."

He says the government's propaganda machine also twists reality to fit its needs. He recalls foreign journalists a year and a half ago being shown a hospital "where they took children who were in very, very bad shape to reinforce their request for food aid."

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At the Kyongsang Clinic in Pyongyang, the impact of donor money is on display, along with pageantry and a heavy dose of propaganda. Plump children in pouffy bright traditional dresses and military uniforms howl in their mothers' arms, as nurses force crushed Vitamin A tablets and chalky deworming pills into their mouths. In a nearby nursery, children take the medicine and then go onstage to sing traditional songs praising the leaders.

The campaign, supported by UNICEF, reaches 1.7 million children twice a year. Eliminating parasites helps combat malnutrition, but it's clear none of these kids are going to bed with empty bellies.

The clinic does, however, showcase one of the bright spots in a generally bleak scene: A focus on prevention, which is central to the overall health system.

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