Despite the relaxation, the sanctions against the tuberculosis epidemic in North Korea

PYONGYANG, North Korea (AP) – Dr. O Yong He opens a glbad door with a bright orange biohazard sign and gestures to the machine that he hoped would revolutionize the work of his life. That's what the GeneXpert is called and it's about the size of a domestic microwave oven. As head of the National Reference Laboratory for Tuberculosis in North Korea, Dr. O saw it as a boon.

Tuberculosis is the biggest public health problem in North Korea. With this machine manufactured in the United States, his laboratory could perform a tuberculosis test in two hours instead of two months.

It took years, but Dr. O discovered that GeneXpert needed cartridges. can not replace. It is not entirely clear that the cartridges would violate international sanctions. For a long time, the producer refused to disclose which agents were inside because it was a patented information. But that does not really matter. It seems like no one wants to help get it from abroad and risk angering Washington.

Despite a relaxing atmosphere in the Korean peninsula since the summit between President Donald Trump and North Korean leader Kim Jong Un Last month in Singapore, the sanctions being defended by the United States and the policy of " Trump's 'maximum pressure' continue to generate an atmosphere of hesitation and fear of even unintentional violations. And this allows thousands of North Korean TB patients to keep vital medicines and supplies.

The O Laboratory, built with the help of Stanford University and Christian Friends of Korea 's self – help group, basically runs idle since the beginning of the month. April.

But the inactive GeneXperts may soon be the least of his troubles.

kills more than 1.6 million people a year. When she is not treated, she will be fatal in half of the cases that she infects. It is the world's most deadly infectious disease and it is so contagious that we can expect that each case will result in 10 to 20 others.

In developed countries, it has been largely controlled. There is a vaccine that prevents it and a badtail of drugs that can be used to treat, and often cure, in a few months. This is a major scourge in less affluent countries, including North Korea and sub-Saharan Africa.

To help North Korea control its TB problem, an international aid organization called the Global Fund to Fight AIDS, Tuberculosis and Malaria. Since 2010, it has funded more than $ 100 million in grants. It has funded the treatment of some 190,000 North Korean patients.

Two weeks ago, the Global Fund ended all of its grants. accept the "unique operating conditions" of the North. Spokesman Seth Faison said the fund had informed Pyongyang in February so he has time to look for other sources of funding. He said the Global Fund provides regulatory stocks of medicines and health products to support the treatment of TB patients until next June.

Faison said the Global Fund welcomes "positive diplomatic efforts" between Pyongyang and its neighbors.

The decision shocked the doctors of the Pyongyang Tuberculosis Laboratory, who commended the Global Fund for the work done but accused it of sinking in front of US political pressure and vow Trump to keep the pressure on and not relax sanctions before the North takes significant steps towards denuclearization. The US government, which pledged $ 1.4 billion this year, is one of the largest donors to the Global Fund.

The withdrawal of the fund also provoked outrage outside North Korea. In an open letter published in the Lancet medical journal, Harvard's doctor, Kee Park, director of North Korean programs for the Korean American Association, warned that the withdrawal of the fund could create a "humanitarian and social crisis". public health".

Whatever the reason, leaving is a valid cause for concern.

When TB patients prematurely reduce or stop their medications, or start taking substandard medications, the bacteria responsible for their disease may develop resistance to the two most potent anti-TB drugs, making the disease more difficult and much more expensive to treat. This type of multidrug-resistant tuberculosis is most often encountered in China, India and Russia

and it is a big problem in North Korea.

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North Korea's health system is fragile and short of resources. But according to Kim's guidelines for raising the standard of living of the nation, officials are looking for ways to improve.

"We are conducting a vigorous struggle with a very ambitious plan to increase the average life expectancy of the population," says Ri Jong Chang, director of the Central Institute for Tuberculosis Prevention and who has worked with patients with tuberculosis over the last 25 years

.Basic level, the country maintains a network of about 7000 clinics and a system initiated decades ago that places the emphasis on "family doctors." Each physician is responsible for the care of 150 households in their administrative area.With primary care, they keep their patients informed and educated about health problems and carry out activities to prevent diseases.

If a suspected case of tuberculosis is discovered, the patient is sent to a district hospital for testing.

Conscious of its needs and vulnerabilities, North Korea, general ally secret and deeply suspicious of anything that resembles foreign interference, has shown a surprising willingness to accept help, to allow access and to share information with UN agencies. and foreign aid organizations.

With the Global Fund, the most established group treating TB patients in the North is the Eugene Bell Foundation, which supports the treatment of more than 1,000 patients in 12 centers across the country. Unlike the Global Fund, the Eugene Bell Foundation has focused since 2008 solely on the fight against multidrug-resistant TB, which lasts an average of 18 months and costs nearly $ 5,000 per patient.

Stephen Linton, Founder of the Group in 1995, "

" We probably only cover one-tenth of the MDR-TB patients in the country, "he told the Associated Press.

He said that almost half of his patients were sick. are in Pyongyang, a city of 3 million residents and the place where most of the northern elites reside. The reason is simple: MDR-TB develops after exposure to drugs that have failed. In rural areas, fewer people have access to these drugs to begin with.

"If you live in the countryside in North Korea, you are far less likely to get MDR-TB than if you live in Pyongyang. "He said." We can not get to the bottom of things, even though we are concentrating a lot of resources there. "

What really worries him, and the North Korean government, is that it's not going to get to the bottom of it. what will happen if patients rely on Global Fund support for drugs, stop getting help or turn to less effective and less expensive treatments.

Many will die. But not before infecting many others.

"It's an airborne infection," he said. "Whenever you're in a closed space with a tuberculous patient, you are at risk, so for all those who travel to North Korea, all tourists, all diplomats, they pose a risk to all who approach them.

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C & Was supposed to be the year when Eugene Bell really began to improve his game in North Korea, tripling to 3,000 the number of patients

Many sanatoriums where TB patients are treated in the North was built 30 or 40 years ago. They have poor insulation, are overcrowded and often pose fire hazards. To address these issues and the transparency issues of concern to the Global Fund, Eugene Bell developed tailored prefabricated protections to meet northern conditions.

These are single-storey duplexes. Everyone can be set up quickly by three or four people, which means that the whole process can be monitored while Linton and other Eugene Bell people are in the country when their semi-annual medical team visits. The barriers are already paid when they are shipped from China, so the money does not go into the pockets of government officials or does not fund Kim Jong Un's missile programs.

The idea was to start setting up 80-100 neighborhoods to create large centers in each of North Korea's nine provinces. A pilot project of ten neighborhoods is currently underway on the outskirts of Pyongyang, not far from the airport

Linton said everything was going well until last December.

"We then encountered this problem of sanctions". "It's officially approved, the design is approved and it's not that we can not send anything. But these buildings have a metal roof – a panel that contains metal, aluminum – and that's the problem. "

Linton says Eugene Bell has a quarter of a million dollars worth of money. between them "rot in the monsoon weather" in a shipyard outside Seoul. He believes that as long as Washington does not oppose humanitarian aid, other countries and humanitarian organizations will hesitate to act – or even approve sending items like GeneXpert cartridges to Dr. O or the Eugene Bell patient rooms that are clearly intended for As an American, he is concerned that the United States will be held accountable for everything that happens with the Tuberculosis in North Korea, because no country is considered "proprietary" sanctions as much as America.

"Unless something is done and quickly done, this medical emergency will become known in Korea as the TB Epidemic Sanctions," he said. "And he will haunt the peninsula for generations.

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Talmadge is the head of the PA office in Pyongyang Follow him on Instagram and Twitter: @EricTalmadge