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November 10, 2011

North Korea Struggling to Fight Epidemic of Drug-Resistant TB

North Korea is grappling with a strain of the deadly lung disease tuberculosis that is resistant to conventional treatment.  Humanitarian workers say the impoverished communist country, which already has one of the highest rates of tuberculosis outside of sub-Saharan Africa, is unable to cope with the outbreak.  Most victims could die of the disease within years.  But some help is coming from an outside foundation.



TB, resistant to treatment

The disease is known as multi-drug resistant (MDR) tuberculosis. It resists treatment by the two most powerful front-line TB drugs.

Stephen Linton, chairman of the Eugene Bell Foundation in Seoul, recently returned from North Korea, which he has visited nearly 70 times for humanitarian work since 1979. "North Koreans have told me that tuberculosis is their number one, number two and number three primary public health concern," he said.

Conditions in North Korea are ideal for the spread of TB. The climate is cold. Most citizens live and work in small spaces, and lack proper nutrition to maintain a strong immune system.

Linton says his foundation is now primarily focused on combating the multi-drug resistant TB outbreaks in North Korea.

It is treating 600 patients in the country at a cost of two thousand dollars annually per case. It is an intense multi-year regimen of several second-line drugs that produce severe side effects.

Grim prognosis

Linton says the prognosis is grim for those who cannot get access to the expensive program. "It's the fate of a resistant patient anywhere who doesn't get medication. I think their average life expectancy would be no more than five years. To make matters worse, there's a very good chance that they would pass this resistant form of TB on to their families, to their co-workers, whoever comes in contact with them," he noted. "So it becomes not only a personal tragedy but a serious social problem at the same time."

Linton, who suffered himself from TB as a child in South Korea, says it is difficult to know how widespread the epidemic is in the North.

"I don't think anybody knows because the primary research hasn't been done. And all we're doing is looking at it through these keyholes of six different institutions. But, for instance, the North Koreans can identify patients that they suspect are MDR. And when we test them 95 to 98 percent are MDR. They have enough patients already on waiting lists to double this program," said Linton. "So I would imagine that MDR patients in the thousands would be quite easy given their present situation."

As a South Korea-based American citizen devoted to assisting ill North Koreans, Linton tries to avoid the political sensitivities in all three countries that affect the aid flow.

But his foundation does insist on visiting any facility in North Korea to which it provides assistance.

Empowering caregivers

The authorities in Pyongyang, who tightly control visits to the country, have welcomed Linton perhaps more times than any other American citizen. However, even he has not been allowed to take up residence there to supervise his life-saving work. Linton says, instead, the foundation has focused on training North Korean caregivers to manage the program themselves.

The Washington DC-based Korea Economic Institute says North Korea's diplomatic isolation hinders its access to large-scale internationally funded programs to fight MDR tuberculosis.

That is partly due to economic sanctions imposed on the country by the international community for its nuclear weapons and missile development programs.

The institute says the sanctions have had the unintended consequence of exacerbating North Korea's public health crisis.