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You can find the current article at its original source at http://www.theguardian.com/world/live/2015/oct/08/north-korea-i-went-on-a-medical-mission-any-questions-for-me
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| 'Every patient had malnutrition' – on a medical mission in North Korea | 'Every patient had malnutrition' – on a medical mission in North Korea |
| (21 days later) | |
| 2.37pm BST | 2.37pm BST |
| 14:37 | 14:37 |
| 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 | Updated |
| at 2.38pm BST | at 2.38pm BST |
| 2.29pm BST | 2.29pm BST |
| 14:29 | 14:29 |
| 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 | Updated |
| at 2.30pm BST | at 2.30pm BST |
| 2.24pm BST | 2.24pm BST |
| 14:24 | 14:24 |
| 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 | Updated |
| at 2.25pm BST | at 2.25pm BST |
| 2.21pm BST | 2.21pm BST |
| 14:21 | 14:21 |
| 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 BST | 2.16pm BST |
| 14:16 | 14:16 |
| Outside world | Outside 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 DPRK | 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 DPRK |
| 2.14pm BST | 2.14pm BST |
| 14:14 | 14:14 |
| 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 BST | 2.10pm BST |
| 14:10 | 14:10 |
| Comparing caseloads | Comparing 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 | Updated |
| at 2.11pm BST | at 2.11pm BST |
| 2.06pm BST | 2.06pm BST |
| 14:06 | 14:06 |
| Maeve Shearlaw | Maeve 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 questions | Update: 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 | Updated |
| at 2.06pm BST | at 2.06pm BST |
| 2.00pm BST | 2.00pm BST |
| 14:00 | 14:00 |
| Outside privileged Pyongyang | Outside 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 BST | 1.55pm BST |
| 13:55 | 13:55 |
| A round of quick fire Twitter questions | A 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 @GuardianNK | How 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 regime | Drought 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 narcotics | North 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 day | Yes. 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? @GuardianNK | How 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 punny | 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 punny |
| Updated | Updated |
| at 1.55pm BST | at 1.55pm BST |
| 1.51pm BST | 1.51pm BST |
| 13:51 | 13:51 |
| Koryo remedies | Koryo 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 BST | 1.48pm BST |
| 13:48 | 13:48 |
| 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. |