North Korean photos, newspapers, and tokens of appreciation cover one of Dr. Niaz Banaei’s desks in his office at the Hillview branch of Stanford Medicine. As the director of the medical school’s Clinical Microbiology Laboratory and a long-time expert in tuberculosis (TB), Dr. Banaei has been working to establish North Korea’s first TB diagnostic laboratory. Since the 1990s, North Korea has been struggling to contain its raging TB epidemic. In early 2008, North Korean physicians approached members of the Bay Area TB Consortium for help to diagnose and treat the disease. Since then, teams of physicians and scientists have been periodically flying to the National TB Reference Hospital in Pyongyang, the nation’s capital, to work with local lab members to train them in diagnostic care. Though my original interview goal was for Dr. Banaei’s projects developing point of care diagnostic tests for TB (soon to come article!), I found the North Korean project fascinating, and I wanted to learn more.
Dr. Niaz Banaei’s interest in tuberculosis (TB) began many years ago when he was a medical student at Stanford. In Mexico and South Africa, Dr. Banaei discovered firsthand how devastating the impact of the disease burden is in developing countries. Approximately one third of the world’s population is infected with TB, and spread of TB throughout the body has a high fatality rate in untreated patients. Aside from the bodily destruction TB inflicts on its victims, the disease causes social isolation through cultural stigmatization of the epidemic. In North Korea, infected patients are shunned by society to the point where they are banned from marriage. In a nation wracked by TB, where individual’s lives are ruined due to this disease, a better diagnostic and treatment plan, current projects Dr. Banaei are working on, holds promise of a future culture shift.
Dr. Banaei’s stories about the state of the North Korean lab shocked me. The project has taken so long and moved so slowly because the North Korean lab members do not have the fundamental background of labwork, so they are essentially building the lab from ground zero. Concepts of lab operations are still being taught, such as developing standard protocols for diagnostics and understanding the latest scientific technology. Perhaps the most unfortunate of all, there is no way to communicate with the outside world once the Americans leave because of governmental regulations – the Internet is a foreign concept in this country except for internal government usage. The situation puzzled me; what are the qualifications needed to become a scientist at the country’s “expert” hospital on this disease? These scientists must be some of the brightest in the field, who are chosen to work with Stanford physicians on this important project. Yet how do they have so little background and training, and how are they expected to get this training with no continuous outside contact?
The conditions of the hospital also seemed very paradoxical to me. On the one hand, the hospital is building a new lab, collaborating with a world-renowned institution halfway around the globe. On the other hand, the hospital does not have a steady source of water, heating, or food. In 2010, the Christian Friends of Korea, the NGO that the Bay Area TB Consortium is working with in North Korea, funded the routing of a cable that now delivers reliable electricity to the hospital. When one of the team members from America got in an accident doing an electrical rewiring project in the operating room, not a single suture was found in the entire hospital to sew up his wounds. How could a hospital exist with no sutures? A BBC article published last year uncovers an Amnesty International report titled “The Crumbling State of Health Care in North Korea”, on hospital conditions in Pyongyang. According to the World Health Organization, Pyongyang spends less than $1 per person per year on healthcare. Witnesses told Amnesty International that “If you don’t have money, you die.” Medicines were not administered at clinics but rather procured through the black market. The report contained a horrific story of a patient who endured an hour long surgery for appendix removal without anaesthetic. The TB epidemic is growing larger and more devastating in its effects, aggravated by food shortages. The Amnesty International report described countless episodes of TB patients who were misdiagnosed and had to suffer the effects of chronic infection. Doctors worked long hours for little pay, with few resources at their hands, and oftentimes by candlelight throughout the nights.
The question that boggled my mind throughout the entire interview was how could a nation be so rich as to have the nuclear power to threaten countries all over the world, yet have such limited knowledge and resources for its citizen’s health? According toGlobal Zero, a UN-endorsed anti-nuclear weaponry group, conservative estimates of North Korean spending on nuclear weapons technology are between $500 to $700 million US dollars this year alone. This spending represents 8% of North Korea’s total spending on the military, estimated at $8.8 billion dollars. Just imagine the difference $8.8 billion could make for hospitals and its patients! I also do not doubt that there are highly trained scientists and researchers in North Korea; these specialists are just not being placed in medical fields. I am very hopeful that the Bay Area TB Consortium can continue helping the diagnostic lab at Pyongyang, so that the nation can finally get on its own feet in addressing the immense health problems that plague its citizens.