South Korea has the highest incidence rate of tuberculosis (TB) among members of the Organization for Economic Cooperation and Development. To shed the shameful label, the government has rolled out comprehensive measures to control TB for years. However, such means have not been very effective.
According to the OECD’s 2017 data, Korea had 77 TB patients per 100,000 people, seven times higher OECD’s average of 11. Korea’s figure was about double the number of Latvia, which had 37 patients.
In North Korea, the problem is expected to be far worse. Experts say the North must control TB before revitalizing inter-Korean healthcare exchanges. Without adequate preparation, TB could spread in the entire peninsula and put the healthcare sector in danger.
TB accounts for 60% of infections in N. Korea
According to the World Health Organization’s 2015 data on TB incidence by country, North Korea ranked second in TB reporting with 449 out of 100,000 people reporting TB cases. South Africa topped the list, with 527.
In the following year, South Africa’s TB reporting went down to 423 per 100,000, and the North’s ranking went up with 444. In the same year, South Korea’s TB reporting was 72, or one-sixth of that of the North.
However, the North’s status in the fight against TB is worsening. The North’s TB reporting and incidence have been steadily increasing to date from 187 per 100,000 in 2000, to 232 in 2006, and to 561 in 2015. The gap between TB incidence and TB reporting has been widening since 2006.
Another problem is that among North Korean TB patients, there are many with resistant TB, including multi-drug-resistant (MDR) TB and extensive-drug-resistant (XDR) TB. The WHO estimates that 3,500 resistant TB cases occur in the North every year.
Among resistant TB patients, XDR TB took up as high as 30 percent which is more difficult to treat. According to 2012 data of Eugene Bell Foundation, a Christian charity, 194 (68.6 percent) of the 283 resistant TB patients suffered from MDR TB. Another 89 (31.4 percent) had XDR TB.
In the North, TB accounts for a whopping 57 percent of all the infectious diseases, including malaria, hepatitis B, and parasitic infections. However, experts in the South said the reality in the North would be worse than the statistics.
Total crisis from drug-resistant TB bacteria -- limited control, lack of infrastructure
Then, why has the TB issue become so bad in the North?
Experts attribute it to multiple reasons; the TB virus is difficult to treat and easily become resistant to drugs, North Koreans tend to take medicine incorrectly, aid to the North is limited, and the North officials are incapable of controlling TB.
“TB is more like a chronic disease so self-reported symptoms do not appear quickly. It starts with nonspecific symptoms such as lack of energy or feeling tired. After symptoms get worse, respiratory symptoms appear,” said Joh Joon-sung, head of the internal medicine department at National Medical Center.
“This is why people get treated belatedly. In the South, too, TB patients visit hospital only after they have problems in lung functions. Not only that, TB has a slow incubation period, and the durations are all different, making it difficult to track from whom the patient got infected.”
Lee Hye-won, head of the family medicine at Seoul Medical Center who also serves as director of the Association of Healthcare for Korean Unification, said, “TB is a chronic disease that requires drug taking more than six months. This means that there is time for the TB bacteria to respond in the first six months.”
To treat TB, patients should take 10 medications every day for six months. MDR TB patients should take them for 18 months to two years. However, experts point out that North Koreans with TB have poor drug compliance, not taking drugs regularly during the period and progressing into MDR TB.
“TB drugs supplied to the Third World are likely to be supplied for six months stably. Often, however, patients distribute the drugs among family members or stack them at home,” said National Medical Center’s Joh. “If they don’t take the medicines regularly, their TB becomes MDR TB.”
When supporting TB treatments for the North, monitoring on the guidance for drug taking should be accompanied. However, it is difficult to do so because the process of aiding the North is not disclosed, he added.
Another problem is that the North is incompetent in diagnosing TB. To prevent the spread of infectious diseases, it is necessary to diagnose quickly and accurately. However, physicians in the North are only able to diagnose whether it is tuberculosis or not, according to Seoul Medical Center’s Lee.
“It is important to discover patients in early stages and whether they developed resistance when diagnosing infectious and chronic diseases,” Lee said.
Lee went on to say that although international organizations have supplied microscopes for the North, there was no supply of reagents for medical equipment. “To diagnose MDR TB, we need equipment called ‘GeneXpert’ to test it quickly. But in the North, there is no transparent system to discern whether a patient has resistant TB or not,” she added.
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