Medical & Health Related Experiences

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: 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

Lena: Dispensary

Every morning we learn about a particular topic: the vocabulary, the grammar, and the culture surrounding it. Then in the afternoons we visit a place that exemplies that component of society.

Monday: We learned about "children from difficult backgrounds" and then we visited a home for street children.
Tuesday: We learned about weather and farming and then we visited a place for mixed farming.
Today: We learned about health and then visited a dispensary.

Just to clarify what a dispensary is: it's a clinic provided by public or charitable funds according to the Compact Oxford English Dictionary. I would say that it was sort of the equivalent of a walk-in outpatient clinic, where they also supply medications and fill prescriptions.

We were told to go into a random room to find the doctor we would be talking with. Upon knocking and entering, I was surprised to find he was with a patient and all my cultural knowledge of the importance of greetings in Swahili culture went out the window and I began apologizing and attempting to explain who we were.

The doctor would have none of this and interrupted me with the traditional greetings. As he asked to sit and we all introduced ourselves, I began to wonder if perhaps the woman in his office was not a patient at all.

Just when we all began to feel a bit more comfortable, he proceeded with his consultation, pausing occasionally to explain various aspects to us. Eventually it became clear that this women was having problems with her menses and he was going to give her some fertility drugs.

At that point, the three other students in the room became extremely uncomfortable. I felt the sames light unease that I usually feel when a large group of student is privy to the intimate details of a patient's personal life. After the patient left, he said you just observed aibu, or shame.

Afterwards, all the students could talk about was how awkward and uncomfortable they had felt and what a violation of patient privacy it had been. It seemed odd that if the doctor knew the patient was feeling embarrassed and ashamed, he should have done something to ameliorate that feeling, but proceeded with no compunction. In additon, he hadn't asked the patient if it was okay for us to observe beforehand, but then I began to think that even if he had asked her, she would have agreed despite her personal discomfort.

Unlike the rest of the students, I was struck by a number of other things. Firstly, the similarity in the way one takes a history and gathers information from the patient was remarkable. Despite all the differences in health status and disease profiles as well as all the cultural differences, this doctor was modeling the same kind of clinical thinking that I had learned in the past year. He used open-ended and close-ended questions, and things like how long as it hurt and can you point to the exact location with your finger.

He also talked a good deal to us about what the most common illnesses were and had a handwritten chart on the wall of the disease burden from 2003. Interestingly, malaria, acute respiratory infections, and minor surgeries (i.e. tonsilectomies) were the most common diseases seen in Usa River. I noticed that HIV was not on their chart, nor was tuberculosis, two diseases that I thought would be relatively prevalent.

He seemed to think nothing of it, opened a book and said that they have documented 84 cases of HIV. I asked what kinds of services they provide, he again seemed to think it was obvious that they provide treatment with ARVs (antiretrovirals) and home-based care including nutritional support as well voluntary counseling and testing (VCT).

All in all, I found it to be an enlightening experience, with several surprises.

The dispensary from the outside:

The doctor's office inside:

HIV/AIDS related posters in the waiting room: