Eugene in South Korea

Eugene: A potential framework for approaching North Korea

I have been thinking a great deal recently about the best way to approach work in North Korea. Outlined below is a putative framework for approaching such work:

The recent nuclear test performed by the Democratic People’s Republic of Korea (DPRK) has drawn the attention of the international community back to the ongoing struggles and affairs that have remained unresolved on the Korean peninsula. As a single event, the test was a critical catalyst to attract international attention to the DPRK, but more importantly, the incident represents a nadir to deteriorating diplomatic efforts with North Korea. For over a decade, the DPRK has negotiated with international parties over critical issues, including nuclear arms proliferation. The failure of these efforts in halting the development of nuclear weapons indicates an essential failure of diplomacy. As a result of these deteriorating diplomatic efforts, the DPRK has become increasingly isolated, antagonized, and neglected.

The United States government has played a particularly influential role in diplomatic efforts with the DPRK. At the six-party talks held on September of 2005, North Korea agreed to halt its nuclear defense program if the United States agreed to stop isolating the DPRK. Another hope of the North Koreans in that agreement was to initiate official diplomatic engagement with the United States. Regrettably, the agreement flopped: official diplomatic communication between the two parties never developed and the North Koreans’ weapons program persisted. This deteriorating diplomatic relationship has been further strained by recent sanctions that have been supported by the United States in response to the nuclear testing of the DPRK.

South Korea has also been a key player in diplomatic efforts with the DPRK. Ever since the cease-fire on July 27, 1953, the Korean peninsula has been split into two halves- the North and South. The lack of complete resolution following the Korean War accounts for the ongoing tension between the two governments. In the last decade, however, there have been promising steps towards peaceful resolution. On June 23, 2000, at a landmark summit involving the South Korean President Kim Dae Jung and Secretary General Kim Jung-Il of the DPRK, Koreans were given hope for peaceful resolution to lasting conflict. For the first time, eventual reunification of the two sides was considered a possibility. Growing support for reunification plans contributed to the formation of the Ministry of Unification of the South Korean government as well as its counterpart in the North. By improving communication and cultural exchange, the government agencies have strived to enhance the homogeneity of the two divergent groups in preparation for future reunification. Unfortunately, this budding relationship has been strained recently by the unified international front against the North Korean nuclear tests. Even South Korea has agreed to support sanctions against the North.
Yet another major party that has been deeply involved with the politics of the DPRK has been China. Koreans often describe the relationship between China and North Korea using the expression “Soon Mang Chi Han.� The expression is an analogy that represents North Korea as the lip protecting China’s teeth. In other words, North Korea is often portrayed as a buffer zone between South Korea (and its American presence) and mainland China. This benefit may, in part, explain the historical support by China of the military regime in North Korea. Especially during difficult periods in North Korean history, the Chinese have provided critical economic support for the DPRK. Just recently, however, Chinese policy towards North Korea has started to shift. Following the test launch of several missiles by North Korea, the Chinese government agreed to sign a UN treaty in response to the actions of North Korea. They have also agreed to sanctions in response to the nuclear weapons test. However, the shift in policy may have started much earlier. Back in April 2004, the Chinese suspended provision of oil and food to North Korea. At the time, 60-70% of such supplies came from mainland China, so the decision had a dramatic effect on the North. Regardless of the timing of this shift, the important point is that the Chinese government is providing less support for the regime in North Korea. Since China has such a crucial role in the economic stability of North Korea, the notable shift in support will have important consequences for stability in Pyongyang.
With all of this in mind, the diplomatic outlook is remarkably bleak. The international community has developed a unified front against the DPRK, and the sanctions imposed on the DPRK serve to further isolate North Korea from the outside world. By supporting sanctions, the governments of the United States, China, and South Korea have antagonized the North Korean regime, complicating subsequent political and diplomatic efforts that will be necessary to improve the situation. This strained relationship between political bodies presents a daunting challenge to effective diplomacy and suggests a possible role for grassroots efforts to improve relations and work towards resolution.

A potential source for such a grassroots movement may lie in a unique ethnographic feature common to the United States, China, South Korea, and North Korea: each has a significant population of Korean citizens. To the North Koreans and South Koreans who view Korean-Chinese and Korean-Americans as Diaspora, there is a profound sense of nationalism that crosses national and even political borders. With this sense of common heritage, Korean citizens in each of these countries will be critical players in bridging divides, improving relations, and meeting the immediate and future needs of the North Korean people.

Eugene: Korean American Physicians and North Korea

I met with a pediatrics resident at UCSF last week to brainstorm ways to approach work in North Korea. We are both consumed with a desire to help the North Koreans but are unsure how best to approach it. With his experience having traveled to North Korea this past summer and my own experiences with North Koreans in South Korea, we have both learned important lessions regarding potential work in North Korea.

One salient point made during the conversation involved the role of Korean-Americans in serving the North Korean people. From his conversations with North Koreans, the resident learned that natives to North Korea believe that the Koreans in the United States should play a key role in improving the situation in North Korea. I felt this same sentiment when speaking to the North Koreans in South Korea. To the North Koreans, Koreans are all one people, whether in the North, the South, or in the West.

It was an obvious statement but one that struck me at the time.

From this sentiment, we generated an idea to develop improved dialogue between Korean physicians across the globe. Through educational exchange and teamwork, Korean physicians from the North, the South, and from the United States would gain the opportunity to engage pressing health issues in a collegial spirit. It is only a thought at this point, and we are unsure how exactly it will materialize.

On a related note, I recently communicated with Jim Kim from Partners in Health, who may be interested in engaging the issue with us. With the help of other interested parties, these ideas will hopefully materialize into work that will be helpful to the North Korean people.

Eugene: Epilogue to my time in Korea

I want to thank the Center For Education In Family And Community Medicine at Stanford Medical School for funding my experience in Korea. I would especially like to thank Dr. Samuel LeBaron for his dedication to mentoring and his open mind in supporting the developing visions of his students. Thank you so much.

Eugene: Final lessons from a veteran

On my last day here in Korea, I met with Dr. John Linton at Severance Hospital of Yonsei University. Dr. Linton is a physician who was raised in South Korea and was the first Caucasian to be licensed as a physician in South Korea. Dr. Linton has made numerous trips into North Korea as a part of humanitarian efforts organized by the Eugene Bell Foundation in the United States. Although the support work of this physician and the organization has covered a broad range hitherto, of note recently have been efforts to address the escalating TB epidemic in North Korea.

As a veteran in the field of North Korean humanitarian aid, I met with him to discuss my hopes and aspirations in the field. The more I discussed with him, the more I realized how I wasn’t clear about my vision for working in this field. When asked the simple question, "What do you want to do?", I had no answer.

I still have no answer.

However, my conversation with Dr. Linton helped me to identify important questions I have to wrestle with as I contemplate further work in this area. Of these, one question I need to ask myself is whether I want to work with North Koreans outside of their country (in China and Korea) or with the North Koreans in their native country. Both populations have needs that need to be addressed, and I wonder which I should try to serve.

I would like to say that our conversation made everything clear, but quite the opposite, I am now more confused than I was before. The same can be said about my time here in South Korea the past few weeks: the more I have learned, the more confused I am about what to do. Despite my confusion, I am more motivated now more than before in wanting to do something. We’ll see what exactly that is when the time comes.

Eugene: Home, sweet home

7.09.06

On my last day working with the NGO, I was invited to visit the apartment of North Korean family. The unit I visited was home for an older couple that had immigrated several years ago and had gotten married here in South Korea. The small apartment was on the 10th floor of a large apartment complex that houses a large number of North Koreans. The government owns units in these large apartment complexes and rents them out to North Korean migrants as they resettle in South Korea. These complexes provide a much-needed community for the North Koreans as they resettle in a foreign country.

I caught a glimpse of that community at work as I walked into the apartment today. As I came into the unit, I was invited by three older North Korean women who were huddled in a tight circle. They were old enough to be my grandmother, but had such energy and vibrancy as they chatted away with each other about just about anything and everything.

At one point, I remember chuckling to myself as they talked about how North Korean women decorate the interiors of their homes. They laughed as they remembered when they first picked up discarded furniture from the street. The furniture never matched, leaving the living rooms of these North Korean women a hodgepodge of clashing colors. To top it off, when the women finally had enough money to replace these used articles, they had to pay for the government to throw them out. One woman laughed as they told the others how she would avoid this fee by bashing up her old furniture and throwing it away in the regular trash.

For most of my time at the apartment, I observed the women as they conversed. I realized at that time just how important community is for North Koreans resettling in a foreign land. I was so thankful to have been invited to take part in it, although I sat in silence most of the time.

Eventually, however, my cover was blown, and they noticed that I was not joining in on their conversation. I was asked to speak up and was invited to ask questions to the women. At that point, I asked a simple question to the women gathered there:

"I know that in North Korean people are socialized to believe Americans are evil. Now that you are here in South Korea, what do you think of Americans? What do you think of me as I sit here before you?"

As the mood suddenly became very serious and contemplative, I realized that the women were preparing to give me an honest answer. Two of the women were very vocal in their response. They talked about how they have been learning more about the historical events surrounding the situation in Korea. As they learn more about the United States and its actions, they no longer think of Americans as the enemy. They also mentioned how they saw me as one of their own people. Although I am American by birth, I have a Korean ancestry. There was no denying that.

I did notice that not everyone was involved in the discussion, however. There was one woman in particular who never opened up to me from the time I stepped foot in the door. She never looked at me directly and didn’t speak to me. She didn’t answer my question and gave no input to what the others were saying. Perhaps she was not as prepared to accept me and to accept Americans.

As I left the apartment, I reflected more on the perceptions of North Koreans on Americans and on Korean-Americans, such as myself. Although the recent migrants have a better idea of the nature of their supporters across the seas in the States, the people of North Korea have no such knowledge. Whether I work with North Koreans in South Korea or in North Korea, I realize that accurate perception is critical. With all the confusing politics and propaganda circulating on both sides of the globe, this realization will be invaluable in my future endeavors with North Koreans.

Eugene- A lesson in communication: The Ministry of Unification

North Korea has often been nicknamed The Hermit Kingdom by the outside world. Largely secluded from the outside world by purposeful policy of the military regime, the nation and its people are out of reach for outsiders. Recently, however, there have been notable advances in the communication and exchange between the North and South.

These advances are due, in large part, to the efforts of the Ministry of Unification in South Korea and its Northern counterpart. The Ministry of Unification is a department of the South Korean government that oversees numerous programs aimed at strengthening the relationship between the North and South. More specifically, there is a branch within the Ministry -The Office of South-North Dialogue- that is directly involved in improving communication and exchange between the North and South.

In a lengthy conversation with Chong-Ryul Ryoo at the Office of South-North Dialogue, I learned a great deal about the exchange between the North and South.

In Korean, "The Office of South-North Dialogue"

The Office of South-North Dialogue facilitates all official communication between North and South Korea. At the demilitarized zone (DMZ) between the North and South, there is an area called Pan Moon Jum. Under the auspices of the UN, this area is a physical space that literally spans the border and serves as a physical space for communication. The central Office of South-North Dialogue is in constant communication with this site at the demilitarized zone.

In addition to this site, there are two other sites along the DMZ that facilitate exchange between the North and South. There is a site near the Western border that abuts the city of Gaesang in North Korea. Gaesang houses a large industrial complex that is run by South Koreans and staffed by North Koreans.

In exchange for work, South Korea gives a salary of 60$/month for each North Korean worker at the facility. Since these funds are not given directly to the workers but rather to the North Korean government, some critics (including the U.S.) have accused this facility of providing funds to the growing military campaigns of the Northern regime. Whether or not this is the case, the facility does serve as a crucial site for economic exchange between the North and South.

Another site of exchange is at the Eastern side of the border, near the Gumgan-san mountain of North Korea. At this site, South Koreans are allowed over the border to travel as tourists to Gumgan-san. The tourists are strictly monitored and are allowed only on the permitted routes to and from the mountain. In a way, this site thus facilitates cultural exchange as South Koreans are allowed to enjoy one of the cultural landmarks of the North.

These three sites thus serve as gateways for exchange between the two nations. As a result, about eighty South Koreans are in North Korea at any given time. This number includes a small number of NGOs that have been allowed access to the North. Presently, about fifty such NGOs have been allowed access to North Korea.

This improvement in communication and exchange is in striking contrast to the present situation of other international parties. In contrast to the growing communication between North Korea and South Korea, communication between North Korea and other international players has deteriorated. North Korean policy towards international NGOs serves is illustrative of this contrast and helps explain why this difference arose.

Following a devastating series of flooding and drought in 1995, North Korea opened up its borders to numerous international NGOs. For the first time since the end of the Korean War, international spectators were given a view into the secluded country. Following the entry of these parties, some of the intervening nations began to speak out against particular issues that were reported back through the NGOs.

Of note was a report in 2000 by a German lawyer who spoke out against the human rights violations of North Korea. Shortly following this specific incident, North Korean began to close its borders to the outside world and also kicked out the parties that were already providing support in North Korea.

In contrast to this growing distrust for international support, South Korea has been able to maintain and even improve its dialogue and relationship with the North.

As I learn more about the health situation of North Koreans, this political backdrop will provide invaluable insight as I ponder the most effective ways to improve the situation in North Korea.

Eugene: The Korean CDC

As I have investigated the emerging issues regarding North Korea, I have learned that that the South has already begun a number of programs to prepare for future reunification and also to serve the increasing number of North Koreans that are entering South Korea.

Nonetheless, I have encountered very little from the standpoint of public health that the South has been pursuing in this regard. Has the South begun designing strategies on how to change the Korean healthcare system in the event of reunification? Are there plans for immediate provision of care following reunification? Does the South have knowledge on the pressing health issues of the North?

To find some answers to these questions, I visited the Center for Disease Control and Prevention (CDC) of Korea.

The Korean CDC was established with the following mission:

“Korea Centers for Disease Control and Prevention (KCDC) is newly established(in January 2004) to protect the public from various diseases and to foster safe and healthful environments. To this end, we conduct research to identify etiology and to find effective control, prevention, diagnosis, and treatment for communicable and non-communicable diseases.

Our primary goal for the 21st century is to confront emerging and reemerging diseases with more advanced and specialized surveillance system, protect the health of all Koreans and alleviate disease burden. In an attempt to achieve our goal, we build a close partnership with governmental agencies, international organizations, research institutes, private health corporations and academic society. At KCDC, we pledge to do our best to enhance the quality of life and the health of all Koreans.�

I met today with Dr. Young J. Hur, the Director of the division of Epidemic Intelligence at the Korean CDC. As a part of its work in South Korea, the division engages specifically with the public health issues of North Koreans in the South.

The 6,000+ North Koreans that have entered the South are not only informative indicators of how best to treat the growing population of migrants, but they also provide vital information about the health status of North Koreans. Considering the highly-restricted nature of this population, this information is instructive on many levels.

To learn more about the health of North Koreans, the Korean CDC screens each refugee as they enter South Korea. More specifically, a complete medical screening is provided for the refugees as they go through more general screening at Dae Dong Gong Sa during their first two weeks in the South. These screenings provide vital information for the government to best provide for the pressing health needs of this migrant population and also give a glimpse into the situation of their North Korean compatriots.

One of the research laboratories of the Korean CDC

Eugene: The personal side of my experience

A couple days ago, I met a young North Korean girl who was admitted to the hospital for a hepatitis B infection. Her family lives at the southeast tip of Korea and traveled almost half a day to bring the girl to the hospital in Seoul. Since her father works, he had to travel back the same day she was admitted. This left the little girl all alone in a hospital.

The VP of the NGO and I went to visit her the day she was admitted. We gave her our phone numbers and told her to call whenever she felt lonely. The very next day, we got several calls from the lonely girl. Unforunately, I have to travel with the VP to a remote site outside of Seoul, and we were not able to get back to her until around 5.

Here is a picture I took with her the day we first met:

I have decided to bloop out her eyes for her safety. Anyways, she really likes giving the peace sign when she takes pictures and insisted I do so as well. She says it is a requirement. Of course, I quickly gave in to her request.

As we were going to visit her at the hospital today, we asked her if she needed/wanted anything. She asked for some slippers to wear at the hospital. The VP and I went to the market and bought her some princess slippers... take a look...

Guess who picked them out? :) They are sparkly pink with pretty little butterflies on them. She was a little embarrassed when we first showed them to her in front of the other kids in the ward... but I think that she really likes them :) She wore them out as we were saying goodbye.

Eugene: Interview with a reporter

I met with a reporter from a well-respected news agency today to discuss the politics involving North Korea. The reporter, who wishes to remain anonymous, was previously a columnist for unification politics in Korea and is now a reporter for international affairs. Having interviewed top-ranking officials in China, North Korea, and South Korea, the reporter has an informed perspective on the politics of North Korea.

The following are some of the topics we discussed:

CHINESE POLICY TOWARDS NORTH KOREA

The Koreans often describe the relationship between China and North Korea using the expression “Soon Mang Chi Han.� The expression is an image that represents North Korea as the lip protecting China’s teeth. In other words, North Korea is often portrayed as a buffer zone between South Korea (and its American presence) and mainland China. This benefit may, in part, explain the continued support by China of the military regime in North Korea.

This support of the North Korean regime accounts for the harsh Chinese policy towards North Korean defectors who escape to China. In fact, Chinese officials have historically refused to consider the North Korea escapees as refugees and instead have referred to them as economic migrants. North Koreans who cross the border into China have thus been ineligible for protected under international refugee laws and have been repatriated back to the North.

Just recently, however, Chinese policy towards North Korea and its migrants has started to shift. Following the test launch of several missiles by North Korea a few weeks ago, a Chinese official publicly admitted that some captured North Korea escapees were wrongfully labeled economic migrants.

In addition to this, the Chinese government agreed to sign a UN treaty in response to the actions of North Korea. These recent occurrences stand in sharp contrast to previous Chinese policies, and have thus led some analysts to attribute the change in Chinese policy to the missile launching.

However, the shift in policy may have started much earlier. Back in April 2004, the Chinese suspended provision of oil and food to North Korea. At the time, 60-70% of such supplies came from mainland China, so the decision had a dramatic effect on the North. Regardless of the timing of this shift, the important point is that the Chinese government is providing less support for the regime in North Korea. Since China has such a crucial role in the economic stability of North Korea, the notable shift in support will have important consequences for stability in Pyongyang.

STABILITY OF NORTH KOREA

Officials in South Korea are concerned about the stability of North Korea. Over the last few years, the South Korean government has encouraged North Korea to build up its economy. By providing some financial support and by placing a few economic investments in the North, the South Koreans hoped to strengthen the economy of the North.

Some South Korean officials believe that North Korea, as a whole, is in a volatile state both economically and politically. The question to ask is then, “Does the South want the regime in North Korea to fail?� One would think so, but many South Korean officials are afraid of the prospect.

In the case of a complete collapse of the North Korean government, analysts project that millions of refugees would flood the North-South border into South Korea. Officials are thus concerned that the South is not prepared for the immediate unification of the North and South.

PREPARATION FOR UNIFICATION

The prospect of imminent reunification has contributed to the formation of the Ministry of Unification of the South Korean government. The purpose of the ministry is to help North and South Korean to improve its relationship through a series of dialogues regarding economy, culture, and politics. The goal is to enhance the homogeneity of the two divergent groups in preparation for future reunification.

Despite the efforts of the government, officials believe that the peninsula is not prepared for immediate reunification. To explain why the Korean peninsula is not prepared, the situation has often been compared to that of Germany before its unification. Compared to that situation, the present situation suggests that Korea is not prepared for unification on several fronts:

1) Economy- In Germany, both sides were in good shape prior to reunification. However, in the present situation, the North is lacking in stability and even the South is not prepared for the increased burden following unification.

2) Swing system- In Germany, the West helped the East through a Swing system in which payments were composed of 1/3 cash and 2/3 credit. Although South Korea has begun efforts for a financial support system, the system is far too underdeveloped to support a full union.

3) Homogeneity- East and West Germany were relatively similar in terms of culture, philosophy, and systems. In contrast, North and South Korea have strikingly different qualities on many axes: cultural, political, economic, educational, health, etc.

Although unification is a desired goal, it is apparent that the peninsula is not presently prepared for it. The goal of unification has helped build a collaborative relationship between sides that will hopefully benefit all parties involved.

Eugene: The first four months of resettlement for North Koreans

Daesung Gongsa and Hanawon

I had the rare opportunity to travel to the satellite Hanawon site today. After driving a couple hours away from the city of Seoul, I finally arrived at the heavily-fortified site. Access to the complex is highly restricted, but the NGO I work for was able to arrange a visit for me.

The satellite clinic has two patient exam rooms, one for a Western approach and one for a Eastern approach to care. Every day except on Wednesdays, there is a doctor on staff at the clinic. As can be seen, the rooms (and the facility as a whole) are clean and new. The problem seems to be with a lack of staffing for the 500 North Koreans in the two sites.

While visiting the clinic, I also spoke with Chae Byung Soon, the head nurse of the satellite site. She showed me the medical facilities and spoke to me more about the health system for the North Koreans.

Since the onsite facility has limited capabilities, most specialized cases are referred out to hospitals in the region. The care of the North Koreans is fully covered by the government, but the referral process is an arduous one. The nurse is responsible for taking all the patients to their referrals.

Each trip out of the complex requires supervision of several patients that require care at different hospitals and different specialists within the hospitals. The nurse thus commented at the system is quite generous in its access to care, but the staff at Hanawon could use some more manpower.

Shown above is the head nurse of the satellite clinic speaking with the vice president of the NGO. She has been overwhelmed by the amount of work required to manage the cases at the clinic and suggests that increasing staffing would help the clinic most at this point. On a positive note, access to care and the quality of facilities is quite high.

When North Koreans first enter South Korea, they spend their first month with Daesung Gongsa, a government agency responsible for national security in South Korea. During that first month, North Koreans are interviewed by the agency to find out more about their motivation for seeking residency in the South.

In addition, the North Koreans are offered a complete physical exam that covers the following: vitals, urinalysis, CBC, blood typing, hepatitis titers, venereal disease, malaria, biochemical assays, kidney function, X-ray, EKG, and cervical cancer. Following this screening and also in the case of medical emergencies, the north Koreans are given free medical care covered fully by the government.

After passing through the screening by Daesung Gongsa, North Koreans are taken to Hanawon, a resettlement facility sponsored by the government. For three months, the migrants are given intensive training aimed at easing resettlement in South Korean society, a new environment that is starkly different from their home in the North.

To facilitate this transition, training at Hanawon incorporate a wide range of educational courses, ranging from the most mundane of topics to more abstract concepts. The facility and its programs thus help the North Korean migrants navigate and better understand a foreign environment and mindset.

The comprehensive medical coverage provided at Daesung Gongsa is extended through the three months the North Koreans spend at Hanawon. Hanawon houses two medical clinics, one at their headquarters and one at a satellite site designated for single males.

Between these two clinics, the staff includes five physicians and two nurses. One nurse is responsible for each clinic, and the physicians travel between the two sites during the week. Since the on-site clinics have limited technological capabilities, the clinics mainly provide first-aid and referrals to outside hospitals.

Eugene: North Koreans in the South Korean Healthcare system

From a conversation this morning with one of the vice presidents of the NGO, I gained some insight into the healthcare of North Koreans in South Korea.

Fortunately, South Korean policies regarding national healthcare extend to all people in the peninsula, including all North Koreans. North Koreans entering South Korea are thus eligible for coverage by the national health system.

Analogous to the Medicaid/Medicare system in the United States, the healthcare system in South Korea provides fiduciary support for the healthcare of the elderly and the poor. Virtually all the arriving North Koreans are thus eligible for this program, which covers the cost of most basic medical services and part of the cost of more advanced services.

The system works well for routine care but is often insufficient for more advanced needs. For example, the cost of an MRI in South Korea is about 500 US dollars. Since the MRI is considered an advanced service, the national health insurance program is only able to cover half the cost. This leaves about 250 US dollars to be paid out-of-pocket.

The South Korean government is generous enough to provide a 400 dollar/month allowance to support the North Korean migrants, but after elective use of advanced care, such an allowance is quickly depleted. As a result, many North Koreans opt out of advanced care even when it is medically necessary.

Having identified this issue, the NGO I am working for has begun efforts to address this concern. In May of 2006, the NGO opened up the Clinic for North Koreans, located at the National Medical Center in Seoul.

To learn more, I spoke with Dr. Jong Heung Kim, who is the chief of the department of surgery at the National Medical Center and is one of the medical directors of the free clinic. According to Dr. Kim, the clinic has two main goals:

1) to defray the cost of medical services not covered by the national health care system,
2) to help North Koreans navigate the South Korean healthcare system.

The North Korean clinic provides free medical consultation and basic medical treatment. In addition, the clinic provides more advanced services at a lower cost than outside hospitals. The medical center receives subsidies from the Ministry of Health and Welfare, and a portion of these funds are earmarked to support the care of the North Koreans. As a result, MRIs, X-rays, and endoscopic examinations are more affordable for the refugees and become a realistic option when the procedures are medically necessary.

The clinic is open every Tuesday afternoon and has already helped nearly one hundred patients since it opened a couple months ago. Patients schedule appointments at the clinic by calling into the NGO office. Dr. Lee, a former North Korean, takes an initial history over the phone and schedules the patients for appointments on the next clinic day.

Upon arriving to the clinic, the physician on duty meets briefly with the patient to record a more detailed history. The patients are then referred to appropriate specialists within the larger medical center for appropriate physical exams and treatment.

Although I came on an off-day at the clinic, there were three North Koreans who came in with urgent needs. Dr. Kim, who was technically off-duty, was happy to see the patients and address their needs. After seeing these patients, I reflected with Dr. Kim on the care of the North Koreans. I was concerned about how such a system would hold up as an increasing number of North Koreans enter South Korea.

Dr. Kim gracefully acknowledged my concerns and reminded me that the efforts of the NGO and the clinic are just a beginning.

The free clinic is located within the National Medical Center in Seoul