Making one’s own medicine is an integral part of being a doctor in North Korea. Those living in warmer climates often grow cotton as well to make their own bandages. Doctors are all required to collect the herbs themselves; Dr. Kim’s work unit took off as much as a month in spring and autumn to gather herbs, during which time the doctors slept out in the open and washed only every few days. Each had a quota to fill. They had to bring their haul back to the hospital pharmacy, where it would be weighed, and if the amount was insufficient, they would be sent out again. Often, the doctors had to hike far into the mountains because the more accessible areas had already been scoured by ordinary citizens who sought to sell the herbs or use them for themselves. The most coveted was peony root, which was used as a muscle relaxant and to treat nervous disorders. Wild yam was thought to regulate menstrual cycles. Dandelion was used to stimulate digestion and ginger to prevent nausea. Atractylodes, which is also popular in Chinese medicine to strengthen immunity, was used when it was impossible to get antibiotics.
For years, North Korean hospitals had been using herbal remedies in combination with Western medicine. Instead of painkillers, the doctors used cupping, a technique in which a suction cup is applied to stimulate circulation to parts of the body. Another technique borrowed from the Chinese involved lighting sticks of mug-wort next to the afflicted area. With anesthesia in short supply, acupuncture would be used for simpler surgeries, such as appendectomies.
“When it works, it works very well,” Dr. Kim told me years later. And when it didn’t? Patients would be strapped to the operating table to prevent them from flailing about. For the most part, North Koreans were stoical about enduring pain during medical treatment. “They weren’t like South Koreans, who scream and holler about the slightest little thing,” Dr. Kim said.
For all its shortcomings, North Korea’s public health system provided the public with better care than they’d had in pre-Communist times. The right to “universal free medical service … to improve working people’s health” was in fact written into the North Korean constitution. Dr. Kim was proud to be a part of the health-care system and gratified by the service she provided her patients. But by the early 1990s, the deficiencies in the system became more pronounced. Much of the medical equipment was obsolete and broken down, with spare parts impossible to obtain since the factories in the Communist-bloc countries where they were manufactured were by now privatized. The pharmaceutical factory in Chongjin curtailed its production due to a lack of supplies and electricity. There was little money to import pharmaceuticals from abroad. The bag that Dr. Kim carried on her rounds had gotten progressively lighter until she had nothing inside but her stethoscope. All she could do for patients was write prescriptions and hope that they had a connection in China or Japan, or a stash of money to buy the drugs on the black market.
25 November 2014
Doctors and Patients in North Korea
From Nothing to Envy: Ordinary Lives in North Korea, by Barbara Demick (Spiegel & Grau, 2009), Kindle Loc. 1672-1694: