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Science Reporter in North Korea Investigates Efforts to Fight Tuberculosis

The rise of tuberculosis (TB) in North Korea has been swift. According to a 2012 report by the World Health Organization, reported cases went from fewer than 50 per 100,000 people in 1994 to 380 cases per 100,000 people in 2011. Today, the incidence of TB in North Korea is second only to that in sub-Saharan Africa.

Making matters worse, the country’s health ministry estimates that up to 15 percent of patients with TB fail to respond to commonly used first-line TB drugs, suggesting these patients carry multidrug resistant (MDR) strains of TB. Indeed, North Korea is a newly recognized hot spot for MDR tuberculosis, which is difficult to treat even at top-tier health programs.

Last month, Science International News Editor Richard Stone traveled to urban and rural parts of North Korea, or the Democratic People’s Republic of Korea, to investigate efforts being made in the fight against TB. “This was my fifth trip to DPRK,” Stone said, “and my first opportunity to experience the bleakness of life in the countryside. The TB epidemic only adds to the hardship of villagers who depend on government food rations for survival.”

A mural in the TB pediatric ward in Pyongyang, North Korea. [Image courtesy of Richard Stone]

Stone visited four rural rest homes, where TB patients go for care, as well as two special facilities in Pyongyang: a pediatric ward of a TB hospital and a special lab called the National Tuberculosis Reference Laboratory (NTRL). The NTRL is the only facility in the country capable of detecting strains of MDR tuberculosis; it will play a critical role in fighting North Korea’s TB cases.

Several complicating factors have allowed tuberculosis to take such a strong hold here, the first of which was a four-year famine that started in 1994 and left the malnourished survivors highly susceptible to TB infection. A shortage of TB drugs at the time and a tendency of patients not to comply with the therapy recommended by doctors have only made matters worse.

But ongoing efforts show promise, including the establishment in 2010 of the National Tuberculosis Reference Laboratory. Built with the help of the Stanford University-led Bay Area TB Consortium and the country’s Ministry of Public Health, it provides a rare example of scientific collaboration between the United States and North Korea. The collaboration was made possible, Stone reported, by Christian Friends of Korea (CFK), a humanitarian organization that has been supplying aid to North Korea for 18 years.

In March, Stone visited the NTRL lab along with several CFK members including CFK Executive Director Heidi Linton. The article about Stone’s trip appears in the 26 April issue of the journal Science.

Also on this trip was Stanford microbiologist Kathleen England, whose priority is to see that the NTRL facility wins international accreditation. She hopes this will happen by 2015. If it does, the lab can join the global fight against TB.

While England said she is happy with the lab’s progress so far—the facility has begun molecular testing, and it recently acquired a machine used to detect multidrug resistant TB strains—she acknowledges that much remains to be done to bring it up to speed and make inroads into the MDR problem.

In addition to visiting the National Tuberculosis Reference Laboratory, Stone visited the pediatric ward of a TB hospital in Pyongyang. Though the pediatric ward wasn’t very crowded during Stone’s visit, staff explained that they expect to see more patients later in the spring, when people who stay huddled during the winter months are willing to come out. One physician working at the hospital pointed out that children are easier to treat than adults because they are eager to follow doctors’ orders.

A patient in the tuberculosis (TB) pediatric ward in Pyongyang, North Korea. [Image courtesy of Richard Stone]

Much farther afield from Pyongyang, Stone visited four rural rest homes. Linton came along to assess the health of these small facilities, evaluating things like how many doctors, patients, and beds each one had, and whether drug stocks were sufficient. To supplement the limited diets of people in these homes, CFK donates several tons of canned meat each year.

In one rest home Stone visited, he found mixed news. The number of MDR cases had stabilized, but patient conditions had worsened. Scientists are not sure what strains are circulating in North Korea, and continued work is needed to identify them so that effective treatments can be developed.

Stone noted that his trip to North Korea came at a delicate time, as South Korea and the United States were conducting annual military exercises that included stealth bomber flights over South Korea.

“Our visit took place during heightened tensions with the West. It didn’t escape our attention that the seven of us were the largest group of Americans there at the time,” Stone said.

He said he didn’t feel overly anxious, however. “Our hosts with the Ministry of Public Health seemed genuinely concerned about our welfare. I came away with the feeling that the scientists we encountered have good hearts and a real desire to help their countrymen.”

The efforts of these scientists will be critical in fighting the TB epidemic in North Korea, particularly as multidrug resistant strains proliferate. Indeed, some hope that the presence of the National Tuberculosis Research Lab will be a building block, paving the way for opportunities for scientific collaboration between North Korea and other countries participating in the global TB fight.

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