As I prepare to be reunited with my confiscated mobile phone at the airport, returning to the UK and media frenzy about Swine Flu, I reflect on what I have seen and learned here. TB is one of the oldest health problems in the world, a potentially deadly lung disease – extremely painful. The drugs which cure the disease are powerful and themselves make the patients feel very sick. The disease is transmitted by people coughing, spitting and sneezing; those with weakened immune systems are particularly susceptible. It is even gaining a foothold in the UK again after many years of absence.
Here in North Korea where food is often in short supply and people sleep in crowded accommodation with poor ventilation in winter, there is a serious epidemic with an incidence rate of nearly 350 new cases every year per 100,000 population compared to a global average of 38 per 100,000. TB epidemics incubate slowly and may remain undetected as disease quietly spreads through a population. Once an epidemic starts it can take years to get under control as the TB bacteria often remain undetected even as the disease continues to spread amongst the population.
As well as undertaking the major project at the National TB reference lab, CFK is already supplying up to 40% of all supplies – TB medicine and food, (more cans of chicken!) for many of the hospitals and rest homes, as well as new operating theatres like the one we saw in Sariwon. Of course there remain many challenges.
Overall, I have seen myself what a wonderful job CFK is doing, really on a shoestring. They are one of just a handful of NGOs working in the country and they are very respected as an organisation in North Korea. It is clear that they have a good co-operative working relationship with the right people and government departments, which is enabling them to get things done. But they are also realistic; they don’t make promises they can’t keep. This is all leading to them being involved in new opportunities and new work; hepatitis is the next big challenge and that could be exciting.
CFK make 3 or 4 trips a year like the one I’ve just been on, delivering supplies and checking their projects. It is not easy to go; it is certainly not a holiday and it takes planning, willingness and flexibility, but for anyone like me who has lived in and visited South Korea, life above the impermeable 38th parallel remains a subject of much curiosity. So, to go there is always fascinating – to me it now feels like South Korea did in the ‘60s.
To have the purpose of visiting CFK’s work and seeing where my donations have been spent is very special; I’ve seen some amazing things and gained a real insight into the working conditions and therefore the value and hard-earned success of this excellent charity.

On our last day, we visit the National TB Reference Laboratory in Pyongyang.
The main challenge now facing the TB system in North Korea is that they are unable to qualify to receive medicines needed to treat patients suffering from drug resistant TB strains. This is in part because they are not able to do the complex culture and sensitivity testing needed to accurately diagnose and treat drug resistant TB. Also, because they cannot provide accurate statistics on the incidence rate, they are not receiving the level of attention needed to attract stable pools of funding for medicines.
The National TB Reference Laboratory project will mean that North Korea will be able to understand the pattern of TB transmission and prevalence much better as well as to access the necessary supplies of medicine from international funding pools. This will be an important step in substantially reducing the incidence of TB in North Korea.
Another excursion to South Hwang Hae Province. Yesterday’s heavy rain has resulted in flooding. Today we pass through a number of places where the road is under a foot of water and the North Koreans are wading stoically through with their bicycles. At one point the road had collapsed completely and we had to cancel our visit to Umpah.
CFK has renovated and re-equipped a number of old fashioned operating theatres with a resulting increase in successful operations and a reduction in infections post-surgery.
Local officials have prioritised the construction and it has been completely rebuilt and fitted out with window frames and roofing material imported from China by CFK. A fine team effort.
CFK is working with the Ministry of Public Health which oversees the civilian population, so they are our hosts. That night we had what can only be described as a banquet – 10 courses included grilled trout, barbequed beef, and beer, soju (rice wine) and even a bottle of warm Muscadet – very friendly and convivial.