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Version 5 Version 6
'Every patient had malnutrition' – on a medical mission in North Korea 'Every patient had malnutrition' – on a medical mission in North Korea
(5 days later)
2.37pm BST14:372.37pm BST14:37
That’s a wrap! Here’s a parting note from Josiah, who’s promised to answer more of your (great) questions in the comments:That’s a wrap! Here’s a parting note from Josiah, who’s promised to answer more of your (great) questions in the comments:
Thank you everyone for taking the time to look through my photos or partake in the Q&A.Thank you everyone for taking the time to look through my photos or partake in the Q&A.
I hope this has been somewhat informative and perhaps give you a better grasp on the current state of North Korea’s health care system. You can understand that there are many holes and shortages in the system – but there are strides and measures taken to counter illnesses and malnutrition in the DPRK, which often go unnoticed. With this information, I hope you can also get involved in supporting various medical NGOs helping communities in North Korea.I hope this has been somewhat informative and perhaps give you a better grasp on the current state of North Korea’s health care system. You can understand that there are many holes and shortages in the system – but there are strides and measures taken to counter illnesses and malnutrition in the DPRK, which often go unnoticed. With this information, I hope you can also get involved in supporting various medical NGOs helping communities in North Korea.
Updated at 2.38pm BSTUpdated at 2.38pm BST
2.29pm BST14:292.29pm BST14:29
How are hospital hygiene standards? If you could think of an era or decade that was in anyway similar to where NK is at currently, what would it be?How are hospital hygiene standards? If you could think of an era or decade that was in anyway similar to where NK is at currently, what would it be?
Hospital hygiene standards are shocking, seemingly absent. When I went to the Pyongyang General Hospital, the country’s centralised hub for complex cases and the conditions were appalling.Hospital hygiene standards are shocking, seemingly absent. When I went to the Pyongyang General Hospital, the country’s centralised hub for complex cases and the conditions were appalling.
When I visited the bathrooms, there was no light, no soap, no running water, no toilet paper, nor any toilets. Patients have to use holes in the ground and a stagnant mouldy bathtub to wash their bottoms and their hands. Sterilisation wise, the rusty scalpel can give a good picture of what it is like.When I visited the bathrooms, there was no light, no soap, no running water, no toilet paper, nor any toilets. Patients have to use holes in the ground and a stagnant mouldy bathtub to wash their bottoms and their hands. Sterilisation wise, the rusty scalpel can give a good picture of what it is like.
An era or decade? It’s difficult, but definitely not the 21st or 20th century. Anytime before that might do.An era or decade? It’s difficult, but definitely not the 21st or 20th century. Anytime before that might do.
Updated at 2.30pm BSTUpdated at 2.30pm BST
2.24pm BST14:242.24pm BST14:24
Please can you tell us something about the dental HC system they have? All the people one seems to see seem to have a full set of teeth or dental work done which does not look that dissimilar to what you get in other countries. Are they big on prevention, do dentists come to schools?Please can you tell us something about the dental HC system they have? All the people one seems to see seem to have a full set of teeth or dental work done which does not look that dissimilar to what you get in other countries. Are they big on prevention, do dentists come to schools?
There are North Korean dentists trained in country or neighbouring nations like China, Russia, or Eastern Europe. The western university, PUST, has established the first legitimate dental school and I believe, graduated their first class last year.There are North Korean dentists trained in country or neighbouring nations like China, Russia, or Eastern Europe. The western university, PUST, has established the first legitimate dental school and I believe, graduated their first class last year.
From what I saw, dental care isn’t much emphasised amongst the average citizens.From what I saw, dental care isn’t much emphasised amongst the average citizens.
Updated at 2.25pm BSTUpdated at 2.25pm BST
2.21pm BST14:212.21pm BST14:21
What is the attitude to public health measures, ie prevention of disease and maintaining good health. For example, are there programmes to encourage smokers to quit, to take more exercise, what is the uptake of vaccinations.What is the attitude to public health measures, ie prevention of disease and maintaining good health. For example, are there programmes to encourage smokers to quit, to take more exercise, what is the uptake of vaccinations.
Malnutrition serves as the stem of most health issues in the DPRK. Disease prevention awareness has not picked up till recently, and this has been spearheaded mostly by NGOs. DPRK has some of the highest rates of smoking in the world. Exercise amongst the elderly is stressed, so in Pyongyang we saw a lot of older people participating in some form of dance/yoga/stretching with some of the older men doing light jogging.Malnutrition serves as the stem of most health issues in the DPRK. Disease prevention awareness has not picked up till recently, and this has been spearheaded mostly by NGOs. DPRK has some of the highest rates of smoking in the world. Exercise amongst the elderly is stressed, so in Pyongyang we saw a lot of older people participating in some form of dance/yoga/stretching with some of the older men doing light jogging.
2.16pm BST14:162.16pm BST14:16
Outside worldOutside world
You got pictures of rusting scalpels, which told a strong story. Does publishing them put the doctors there and your minders in danger of punishment, for allowing you to see and photograph scenes which are damaging to the country's image?You got pictures of rusting scalpels, which told a strong story. Does publishing them put the doctors there and your minders in danger of punishment, for allowing you to see and photograph scenes which are damaging to the country's image?
I would never want to put anyone at risk so I confirmed, and re-confirmed many times that this was okay because I don’t want to jeopardise anyone’s life, career, or medical progress in the DPRKI would never want to put anyone at risk so I confirmed, and re-confirmed many times that this was okay because I don’t want to jeopardise anyone’s life, career, or medical progress in the DPRK
2.14pm BST14:142.14pm BST14:14
Fake X-rays?Fake X-rays?
I spoke to someone who had to take a colleague with a broken arm to a hospital in Pyongyang.I spoke to someone who had to take a colleague with a broken arm to a hospital in Pyongyang.
He told me the hospital staff 'pretended' to use an X-ray machine (with a plaque from a US charity) that didn't have electricity and they spent 30mins studying a blank screen before making a diagnosis...He told me the hospital staff 'pretended' to use an X-ray machine (with a plaque from a US charity) that didn't have electricity and they spent 30mins studying a blank screen before making a diagnosis...
Did you see this kind of thing happening?Did you see this kind of thing happening?
The X-rays we worked with were quite real, but that’s probably because our organisation had brought them from the US years before. We’ve also brought over microscopes and C-arms for surgeries.The X-rays we worked with were quite real, but that’s probably because our organisation had brought them from the US years before. We’ve also brought over microscopes and C-arms for surgeries.
The North Korean staff seemed to have no concern about hazardous rays and don’t bother wearing lead aprons or leaving the room. Most provincial hospitals don’t have X-ray machines at all.The North Korean staff seemed to have no concern about hazardous rays and don’t bother wearing lead aprons or leaving the room. Most provincial hospitals don’t have X-ray machines at all.
I can assume that your friend was treated with a brokenmachine, which is quite common with the unstable power conditions, poor maintenance and upkeep.I can assume that your friend was treated with a brokenmachine, which is quite common with the unstable power conditions, poor maintenance and upkeep.
2.10pm BST14:102.10pm BST14:10
Comparing caseloadsComparing caseloads
What kinds of cases did you see while there?What kinds of cases did you see while there?
We were primarily focusing on neurosurgical cases that were usually too complex for North Korean doctors to handle – either due to equipment or skill.We were primarily focusing on neurosurgical cases that were usually too complex for North Korean doctors to handle – either due to equipment or skill.
These patients had to wait several months for us to arrive and treat them. Common cases included fractures of the spine we also saw hematomas in the brain due to trauma, and various tumours that were too deep to be taken out by the NK doctors.These patients had to wait several months for us to arrive and treat them. Common cases included fractures of the spine we also saw hematomas in the brain due to trauma, and various tumours that were too deep to be taken out by the NK doctors.
These were great opportunities to teach and educate new techniques or proper techniques to the North Korean surgeons.These were great opportunities to teach and educate new techniques or proper techniques to the North Korean surgeons.
What were the illnesses or health issues most common among those you treated? We read a lot about issues with malnutrition among children - did your experience of the patients support that?What were the illnesses or health issues most common among those you treated? We read a lot about issues with malnutrition among children - did your experience of the patients support that?
While we were mainly focused on surgical cases. I do know of the common maladies of the DPRK – every patient we encountered suffered from malnutrition.While we were mainly focused on surgical cases. I do know of the common maladies of the DPRK – every patient we encountered suffered from malnutrition.
Some of the more prevalent and widespread diseases include TB, Hep B, Malaria, various cardiovascular diseases and emphysema - due to smoking. Children are incredibly malnourished, especially in the provincial areas, some who told me they were of 13 years of age looked like they were 8 or 9.Some of the more prevalent and widespread diseases include TB, Hep B, Malaria, various cardiovascular diseases and emphysema - due to smoking. Children are incredibly malnourished, especially in the provincial areas, some who told me they were of 13 years of age looked like they were 8 or 9.
Updated at 2.11pm BSTUpdated at 2.11pm BST
2.06pm BST14:062.06pm BST14:06
Maeve ShearlawMaeve Shearlaw
Update: we’ve reached the end of our allotted time but Josiah will stay with us for another 30 minutes to get through your questionsUpdate: we’ve reached the end of our allotted time but Josiah will stay with us for another 30 minutes to get through your questions
Updated at 2.06pm BSTUpdated at 2.06pm BST
2.00pm BST14:002.00pm BST14:00
Outside privileged PyongyangOutside privileged Pyongyang
Outside of Pyongyang, that is if you were able to get into the provinces, what kind of access to medical care do people have? What is the availability and quality of palliative care also?Outside of Pyongyang, that is if you were able to get into the provinces, what kind of access to medical care do people have? What is the availability and quality of palliative care also?
I was able to go the provinces, mostly in the east . There are 10 provinces, 206 cities in the DPRK, with each province supposedly having a medical school and general hospital. I was able to visit some of the village hospitals but was not permitted to take pictures due to the substandard conditions.I was able to go the provinces, mostly in the east . There are 10 provinces, 206 cities in the DPRK, with each province supposedly having a medical school and general hospital. I was able to visit some of the village hospitals but was not permitted to take pictures due to the substandard conditions.
In terms of palliative and urgent care: some of the biggest diseases – aside from malnutrition which can also be a trigger – ) are TB, Malaria and Hepatitis B which are currently being targeted by the government. In recent years, laboratories and specific clinics have been set up not only in Pyongyang but also in the provinces.In terms of palliative and urgent care: some of the biggest diseases – aside from malnutrition which can also be a trigger – ) are TB, Malaria and Hepatitis B which are currently being targeted by the government. In recent years, laboratories and specific clinics have been set up not only in Pyongyang but also in the provinces.
In a Hepatitis B vaccination project (completed in 2012), an estimated 3.7 million children between 7 - 17 were vaccinated. A accomplishment considering the state of the healthcare system a few decades ago.In a Hepatitis B vaccination project (completed in 2012), an estimated 3.7 million children between 7 - 17 were vaccinated. A accomplishment considering the state of the healthcare system a few decades ago.
1.55pm BST13:551.55pm BST13:55
A round of quick fire Twitter questionsA round of quick fire Twitter questions
How scarce will sustenance get, regarding the looming drought & do you think it'd bring down the Govt.? -> Thank you very much @GuardianNKHow scarce will sustenance get, regarding the looming drought & do you think it'd bring down the Govt.? -> Thank you very much @GuardianNK
Drought and famine is extremely debilitating, with another large one predicted soon. This, or economic collapse are realistic reasons for bringing down the regimeDrought and famine is extremely debilitating, with another large one predicted soon. This, or economic collapse are realistic reasons for bringing down the regime
@guardian @GuardianNK How serious is the brainwashing, and the Meth problem. Are their Drug Cartels embedded within the 'Old' Military ?@guardian @GuardianNK How serious is the brainwashing, and the Meth problem. Are their Drug Cartels embedded within the 'Old' Military ?
North Koreans are not stupid. Brainwashing is in effect, but opinions often unvoiced. Smoking and drinking are more of a problem than narcoticsNorth Koreans are not stupid. Brainwashing is in effect, but opinions often unvoiced. Smoking and drinking are more of a problem than narcotics
@GuardianNK Did the health of any of the patients you treated suggest they were malnourished, or had gone through any specific hardship?@GuardianNK Did the health of any of the patients you treated suggest they were malnourished, or had gone through any specific hardship?
Yes. Malnourishment is the primary source of all maladies there. Children are very stunted, a quater live on less than $1 a dayYes. Malnourishment is the primary source of all maladies there. Children are very stunted, a quater live on less than $1 a day
How is NK humour? Slapsticky, pun-driven or ironic and self-deprecating? @GuardianNKHow is NK humour? Slapsticky, pun-driven or ironic and self-deprecating? @GuardianNK
My jokes usually elicited an awkward silence. I mistakenly told my guide that I had a bitch in Korean when I meant dog. They died of laughter. Very punnyMy jokes usually elicited an awkward silence. I mistakenly told my guide that I had a bitch in Korean when I meant dog. They died of laughter. Very punny
Updated at 1.55pm BSTUpdated at 1.55pm BST
1.51pm BST13:511.51pm BST13:51
Koryo remediesKoryo remedies
Do ordinary people, who live away from the elite in Pyongyang, use local herbal remedies and other forms of treatment like acupuncture? If so is this encouraged and supported by the regime or do they regiment this like so many other aspects of ordinary life?Do ordinary people, who live away from the elite in Pyongyang, use local herbal remedies and other forms of treatment like acupuncture? If so is this encouraged and supported by the regime or do they regiment this like so many other aspects of ordinary life?
The concept and practice of herbal, traditional, oriental medicine is a fascinating topic that has pervaded DPRK healthcare. They take pride in their resourcefulness ( which compensates for deficiencies in medicine and equipment) and great pride in their herbal medicine called Koryo.The concept and practice of herbal, traditional, oriental medicine is a fascinating topic that has pervaded DPRK healthcare. They take pride in their resourcefulness ( which compensates for deficiencies in medicine and equipment) and great pride in their herbal medicine called Koryo.
The doctors in the rural areas may actually employ this as their primary way of treating patients, especially when they can’t do anything else. Acupuncture, teas/root drinks, and special herbs are emphasised. However, we must remember that the main source of health problems in the DPRK stem from malnutrition. Koryo medicine cannot solve this issue decisively.The doctors in the rural areas may actually employ this as their primary way of treating patients, especially when they can’t do anything else. Acupuncture, teas/root drinks, and special herbs are emphasised. However, we must remember that the main source of health problems in the DPRK stem from malnutrition. Koryo medicine cannot solve this issue decisively.
1.48pm BST13:481.48pm BST13:48
Are sanctions justified?Are sanctions justified?
In light of what you experienced, do you think that the West's sanctions are justified?In light of what you experienced, do you think that the West's sanctions are justified?
Personally, and ideally, they work well to keep a dictator and his regime in check. However, upon visiting the country, you do see some of the effects on the nation. One cannot blame sanctions for the demise and debilitation of the country alone.Personally, and ideally, they work well to keep a dictator and his regime in check. However, upon visiting the country, you do see some of the effects on the nation. One cannot blame sanctions for the demise and debilitation of the country alone.
Even with sanctions, there are a lot of NGOs and organisations like the UN, WHO, CFK, Eugene Bell, and PUST that have been providing so much care that is often overlooked. I urge you to look more in-depth at smaller NGOs that are making incredible impacts on the ground.Even with sanctions, there are a lot of NGOs and organisations like the UN, WHO, CFK, Eugene Bell, and PUST that have been providing so much care that is often overlooked. I urge you to look more in-depth at smaller NGOs that are making incredible impacts on the ground.
1.46pm BST13:461.46pm BST13:46
MedicinesMedicines
Does North Korea produce its own pharmaceutical products? From aspirin to penicillin i am curious about Rx access and distribution. Thank you.Does North Korea produce its own pharmaceutical products? From aspirin to penicillin i am curious about Rx access and distribution. Thank you.
Great question. For the past decades, North Korea had factories in producing very limited pharmaceutical products, however, recently they have shut down – I believe this is due to the shift in government funds from healthcare to elsewhere. An estimated 70% of essential medicines outside of Pyongyang are provided by NGOs, a staggering figure.Great question. For the past decades, North Korea had factories in producing very limited pharmaceutical products, however, recently they have shut down – I believe this is due to the shift in government funds from healthcare to elsewhere. An estimated 70% of essential medicines outside of Pyongyang are provided by NGOs, a staggering figure.
Conditions were much worse in the earlier years of the genesis of the communist regime, and fared badly in the 1990’s during the famine. A lot of drugs are provided by NGOs or are purchased/donated from neighbouring nations like China, Russia, or Japan.Conditions were much worse in the earlier years of the genesis of the communist regime, and fared badly in the 1990’s during the famine. A lot of drugs are provided by NGOs or are purchased/donated from neighbouring nations like China, Russia, or Japan.
1.41pm BST13:411.41pm BST13:41
How do people get to hospital?How do people get to hospital?
Are ambulances regularly seen on the streets, or is it a case of "you must make your own way to hospital should you need to go"?Are ambulances regularly seen on the streets, or is it a case of "you must make your own way to hospital should you need to go"?
I saw a couple of ambulances driving through the streets with their sirens – though they did not emit any sound, there wasn’t much traffic to navigate through anyway. The ambulances were Soviet-style, old-fashioned and compact. But most patients have to make their way to the hospitals themselves. In the rural areas, if patients are immobile, doctors make house visits.I saw a couple of ambulances driving through the streets with their sirens – though they did not emit any sound, there wasn’t much traffic to navigate through anyway. The ambulances were Soviet-style, old-fashioned and compact. But most patients have to make their way to the hospitals themselves. In the rural areas, if patients are immobile, doctors make house visits.
1.39pm BST13:391.39pm BST13:39
How anti-American were the general population?How anti-American were the general population?
Also on email Sarah Haug said: I went to high school with Josiah, I know that the majority of his time there was spent in medical centres, but can he tell us about any anti-american sentiment he ran across there? What kind of propaganda did he see? Also, if he had any interaction with students his age there, what kind of access to higher education and research opportunities do they have? Any kind of impressions he could give me on these things would be great.Also on email Sarah Haug said: I went to high school with Josiah, I know that the majority of his time there was spent in medical centres, but can he tell us about any anti-american sentiment he ran across there? What kind of propaganda did he see? Also, if he had any interaction with students his age there, what kind of access to higher education and research opportunities do they have? Any kind of impressions he could give me on these things would be great.
First of all, the North Koreans have no bitter or hostile feelings toward the people of their enemy countries, only towards the governments. Surprisingly, Americans are not commonly deemed as North Korea’s #1 enemy, the South Koreans have taken that throne.First of all, the North Koreans have no bitter or hostile feelings toward the people of their enemy countries, only towards the governments. Surprisingly, Americans are not commonly deemed as North Korea’s #1 enemy, the South Koreans have taken that throne.
I did see some anti-American propaganda on television. In world news America is seen as an aggressor nation with its invasions in the Middle East and Central Asia, all stemming from the history of the Korean War.I did see some anti-American propaganda on television. In world news America is seen as an aggressor nation with its invasions in the Middle East and Central Asia, all stemming from the history of the Korean War.
North Korea also produces its own “Korean dramas” that usually depict the Americans as enemies that soldiers need to rescue their women and children from.North Korea also produces its own “Korean dramas” that usually depict the Americans as enemies that soldiers need to rescue their women and children from.
1.28pm BST13:281.28pm BST13:28
The health of the nationThe health of the nation
Via email, Enedelia Obregón asks: why is it a common sight to see people bent-double?Via email, Enedelia Obregón asks: why is it a common sight to see people bent-double?
You may have seen other photos of North Koreans bent over, probablyof older women.You may have seen other photos of North Koreans bent over, probablyof older women.
The reasons two-fold: transportation and farming equipment are rather scarce in the rural areas. I saw very few vehicles on the road outside of Pyongyang, and the ones I saw were military convoys. Farmers/workers who traveled to the fields daily have to walk or bike miles up steep mountainous roads. Most of these workers are women, and elderly women at that, probably because many men are conscripted in the military. They have to carry back bundles of crops on their backs for miles, which permanently disfigures them.The reasons two-fold: transportation and farming equipment are rather scarce in the rural areas. I saw very few vehicles on the road outside of Pyongyang, and the ones I saw were military convoys. Farmers/workers who traveled to the fields daily have to walk or bike miles up steep mountainous roads. Most of these workers are women, and elderly women at that, probably because many men are conscripted in the military. They have to carry back bundles of crops on their backs for miles, which permanently disfigures them.
Updated at 1.29pm BSTUpdated at 1.29pm BST
1.22pm BST13:221.22pm BST13:22
More on sanctionsMore on sanctions
Given that the lack of resources is engendered by sanctions, does that harden attitudes to the west among staff and patients?Given that the lack of resources is engendered by sanctions, does that harden attitudes to the west among staff and patients?
It’s a two-way street. Though doctors are not able to voice their own opinions of the government’s assistance to health care, they do drop hints every now and then of the austere conditions they must endure to provide aid.It’s a two-way street. Though doctors are not able to voice their own opinions of the government’s assistance to health care, they do drop hints every now and then of the austere conditions they must endure to provide aid.
Health care funding has been dramatically cut in the recent decades, with these funds being allocated to other sectors in the government – primarily to sustain the military. The west alone is not blamed for the deficiencies, and they are aware of the imbalance that exists within their nation.Health care funding has been dramatically cut in the recent decades, with these funds being allocated to other sectors in the government – primarily to sustain the military. The west alone is not blamed for the deficiencies, and they are aware of the imbalance that exists within their nation.
1.20pm BST13:201.20pm BST13:20
Student doctorsStudent doctors
How would you compare your level of experience and knowledge as a Student Doctor to those working in North Korea? Thanks.How would you compare your level of experience and knowledge as a Student Doctor to those working in North Korea? Thanks.
North Korea mass produces doctors that may not receive the adequate training or proper education that can sustain them in their practices. Certainly, beyond education and training, they are not sufficiently provided with the proper equipment and resources to properly treat patients (this does not attest to the personal characters of the North Korean doctors, who are kind and committed health care professionals.)North Korea mass produces doctors that may not receive the adequate training or proper education that can sustain them in their practices. Certainly, beyond education and training, they are not sufficiently provided with the proper equipment and resources to properly treat patients (this does not attest to the personal characters of the North Korean doctors, who are kind and committed health care professionals.)
From my interaction with students, ( the bestin the country), they seemed to possess an extensive knowledge in medicine and science and the world.From my interaction with students, ( the bestin the country), they seemed to possess an extensive knowledge in medicine and science and the world.
They were proficient in English and other languages, and I was able to converse with some in Russian (I am fluent). Some things they did not appear to know , though I’m not sure if this is attributed to deficiency of knowledge or language barriers.They were proficient in English and other languages, and I was able to converse with some in Russian (I am fluent). Some things they did not appear to know , though I’m not sure if this is attributed to deficiency of knowledge or language barriers.
Many older North Korean doctors have been trained in Eastern Europe or Russia or neighbouring countries like China or Japan They do have the right training and are skilled in what they do. However, because they remain closed to leading medical nations like the US or other countries in the West, they are unexposed to new techniques and equipment available to other nations.Many older North Korean doctors have been trained in Eastern Europe or Russia or neighbouring countries like China or Japan They do have the right training and are skilled in what they do. However, because they remain closed to leading medical nations like the US or other countries in the West, they are unexposed to new techniques and equipment available to other nations.
1.08pm BST13:081.08pm BST13:08
Bedside mannerBedside manner
What was the most moving event that you experienced? Were you able to get an insight into their lives, families and backgrounds, or was the discussion limited to symptoms and treatment?What was the most moving event that you experienced? Were you able to get an insight into their lives, families and backgrounds, or was the discussion limited to symptoms and treatment?
Good question! There were several poignant and profound moments. Our team made history in that we set up the first medical student conference between North Korean and international medical students.Good question! There were several poignant and profound moments. Our team made history in that we set up the first medical student conference between North Korean and international medical students.
I spoke with 45 North Koreans who were, surprisingly, proficient in English. We had an opportunity to speak for about an hour and a half unburdened by the presence of authoritarian figures. There was laughter and mirth in those conversations, as both sides were able to clear up a lot of ridiculous misconceptions of each other’s nations.I spoke with 45 North Koreans who were, surprisingly, proficient in English. We had an opportunity to speak for about an hour and a half unburdened by the presence of authoritarian figures. There was laughter and mirth in those conversations, as both sides were able to clear up a lot of ridiculous misconceptions of each other’s nations.
The students were incredibly hospitable and cordial. They provided the best food that they could and even prepared about half an hour’s worth of singing and musical performances for us. Afterwards, we played an intense game of volleyball, where after each volley, they gave me a hug.The students were incredibly hospitable and cordial. They provided the best food that they could and even prepared about half an hour’s worth of singing and musical performances for us. Afterwards, we played an intense game of volleyball, where after each volley, they gave me a hug.
Probably the more sorrowful feelings came from seeing the village life outside of Pyongyang and the plight of those livings in the more impoverished, rural areas.Probably the more sorrowful feelings came from seeing the village life outside of Pyongyang and the plight of those livings in the more impoverished, rural areas.
And the most dramatic instances were in the hallways of the hospital for the common citizens. I cannot go into too much detail, but this was definitely the most memorable and, dare I say, traumatic instance that I’ve seen in my life.And the most dramatic instances were in the hallways of the hospital for the common citizens. I cannot go into too much detail, but this was definitely the most memorable and, dare I say, traumatic instance that I’ve seen in my life.
Updated at 1.10pm BSTUpdated at 1.10pm BST
1.04pm BST13:041.04pm BST13:04
Are sanctions justified?Are sanctions justified?
To what extent do sanctions have an impact on the healthcare system? I've seen medical missions arriving with large quantities of equipment and supplies, and assume that this is part of their contribution.To what extent do sanctions have an impact on the healthcare system? I've seen medical missions arriving with large quantities of equipment and supplies, and assume that this is part of their contribution.
Sanctions are controversial and North Korea has suffered under the embargoes. They have extensive consequences on the ability of NGOs and other medical organisations in supplying medicine, equipment, and also indirectly: medical services.Sanctions are controversial and North Korea has suffered under the embargoes. They have extensive consequences on the ability of NGOs and other medical organisations in supplying medicine, equipment, and also indirectly: medical services.
It’s not impossible, but it has made bringing equipment more difficult. The indirect consequence is the strained relationship between the DPRK and the United States and South Korea with individuals or groups that desire to provide medical aid to the DPRK. There is a very complex pathway in the government to procure the legal means to enter the country as well as bring in medicine and equipment.It’s not impossible, but it has made bringing equipment more difficult. The indirect consequence is the strained relationship between the DPRK and the United States and South Korea with individuals or groups that desire to provide medical aid to the DPRK. There is a very complex pathway in the government to procure the legal means to enter the country as well as bring in medicine and equipment.
Updated at 1.09pm BSTUpdated at 1.09pm BST
12.59pm BST12:5912.59pm BST12:59
Maeve ShearlawMaeve Shearlaw
Hi all,Hi all,
Just to let you know the Q&A is about to start.Just to let you know the Q&A is about to start.
Please continue to leave your questions in the comments and on Twitter @GuardianNK and Josiah will get to as many as he can in the next hour.Please continue to leave your questions in the comments and on Twitter @GuardianNK and Josiah will get to as many as he can in the next hour.
And (if you haven’t already seen them) here’s some pictures to get a flavour of his trip.And (if you haven’t already seen them) here’s some pictures to get a flavour of his trip.
Related: Scenes from a North Korean hospital – in picturesRelated: Scenes from a North Korean hospital – in pictures
ThanksThanks
5.27pm BST17:27 5.00am BST05:00
Maeve ShearlawMaeve Shearlaw
Universal healthcare is one of North Korea’s founding promises. Whether or not citizens enjoy it depends on who you ask.Universal healthcare is one of North Korea’s founding promises. Whether or not citizens enjoy it depends on who you ask.
When Kim Jong-un opened a new hospital in Pyongyang last year he boasted that the people would “live in luxury and comfort under socialism in good health”. Just last week he was spotted examining a shiny factory making medical supplies, and the Pyongyang maternity hospital is an attraction regularly shown to visiting foreigners.When Kim Jong-un opened a new hospital in Pyongyang last year he boasted that the people would “live in luxury and comfort under socialism in good health”. Just last week he was spotted examining a shiny factory making medical supplies, and the Pyongyang maternity hospital is an attraction regularly shown to visiting foreigners.
But testimonies from North Koreans who have recently escaped paint a picture of a health system crippled by international sanctions. They say hospitals lack equipment, standards of treatment have plummeted and medical supplies are scarce, with people turning to crystal meth to numb the pain of their aliments.But testimonies from North Koreans who have recently escaped paint a picture of a health system crippled by international sanctions. They say hospitals lack equipment, standards of treatment have plummeted and medical supplies are scarce, with people turning to crystal meth to numb the pain of their aliments.
Related: North Korean health system crumbling as shortages and sanctions biteRelated: North Korean health system crumbling as shortages and sanctions bite
One student doctor witnessed the reality first hand when he joined a medical mission to the country last year in which foreign medics worked with their North Korean counterparts.One student doctor witnessed the reality first hand when he joined a medical mission to the country last year in which foreign medics worked with their North Korean counterparts.
Josiah Cha, a Korean-American whose grandparents escaped North Korea during the war, also observed a crumbling system but a committed group of staff doing their best for the patients.Josiah Cha, a Korean-American whose grandparents escaped North Korea during the war, also observed a crumbling system but a committed group of staff doing their best for the patients.
Any questions?Any questions?
As part of our three-day look at North Korea as it turn 70, Cha has agreed to answer your questions about the state of the country’s hospitals, and what that says about the health of the nation.As part of our three-day look at North Korea as it turn 70, Cha has agreed to answer your questions about the state of the country’s hospitals, and what that says about the health of the nation.
Join him live today, 8 October, from 1-2pm BST, using the comments section below to post your questions. Alternatively you can tweet them at @GuardianNK or email maeve.shearlaw@theguardian.com.Join him live today, 8 October, from 1-2pm BST, using the comments section below to post your questions. Alternatively you can tweet them at @GuardianNK or email maeve.shearlaw@theguardian.com.