Aid group engages N. Korea in fight against TB

Stephen Linton, left, chairman of the Eugene Bell Foundation, stands with a group of North Korean patients during a ceremony to “graduate” them from a program to treat multidrug resistant tuberculosis in this 2010 photo.

/ Courtesy of Eugene Bell Foundation

By Kim Young-jin

Amid ongoing tensions between the two Koreas, a U.S.-based aid organization is taking major steps in fighting a highly-resistant strain of tuberculosis spreading in the North ― and in doing so is quietly fostering cooperation on the peninsula.

Dr. Stephen Linton, founder of the Eugene Bell Foundation, says his group’s program to combat multidrug resistant TB (MDRTB) has cured its first patients after four years of working to establish adequate care in the North.

“We’re making progress,” Linton, 60, said in a phone interview. “It has been a tremendous learning curve for the North Koreans on a very short time frame. It takes most nations decades to put together a good MDRTB program because the treatment is so intensive.”

A growing health concern worldwide, MDRTB emerges when regular TB is inadequately treated, creating bacteria resistant to first- and sometimes second-line drugs. Half of those who do not get treatment, which can take up to two years to complete, die.

The problem is compounded in poor countries not properly equipped to diagnose the disease and where malnutrition makes the body more susceptible to TB.

The organization’s hopeful outlook follows its most recent trip to the North in November last year, when it found a steadily-increasing rate of patients testing negative for the strain ― meaning they are no longer infective.

It also comes as the international community wrestles with how to help the impoverished country ― which has called in recent weeks for humanitarian assistance ― without supporting its provocative behavior.

In the case of treating MDRTB, the doctor says the breakthrough would be impossible without meaningful contributions on both sides of the tense border that divides the Koreas.

Powerful medicine

By 2007, Linton had been travelling to the North to treat TB for more than a decade, so he was braced for the news when caregivers complained that first-line drugs were not helping some patients.

“I knew it was going to be a real headache,” he said of the undertaking. “But the commitment of our donors and the desire to treat the people in most need ― that was a powerful incentive.”

Later that year, Linton and his team took sputum from 19 patients, brought the samples to a South Korean hospital for analysis, and returned six months later with medicine. On subsequent trips, the number of patients wanting the test grew.

By 2009, as an indication of the worsening health situation but also the growing trust in the program, Eugene Bell was overwhelmed by crowds of people at its testing centers.

The program now accommodates upwards of six hundred patients at six specialized centers across the country’s northwest.
Linton, who spent his childhood in South Korea, says the process requires significant “buy-in” from North Koreans, beginning with the health authorities.

In their biggest show of cooperation, the government agreed to Eugene Bell’s recommendation that treatment take place in centrally-located MDRTB centers, despite reluctance over the logistics.

It also needs the dedication of health care providers, who must vigilantly keep patients on their programs. If not, they can become resistant to MDRTB medications, opening the door for the emergence of XDRTB, which Linton calls “virtually incurable.”

But the biggest commitment comes from patients, who are prescribed with a harsh cocktail of drugs. Some need to learn to trust outside help, not always an easy task in the isolated country.

“This is a very rigorous and rough treatment program. It takes a lot of very strong, toxic medicines to treat MDRTB. Patients suffer a good bit,” said Linton, who counted nausea, vomiting, temporary deafness and psychosis as side effects.

If after eighteen months, a patient’s sputum tests negative for MDRTB, they are effectively cured. But if after a year they still test positive, the treatment is considered a failure.

“Most of those people know, because they are still coughing up phlegm,” the doctor said. “But failing people is terrible. This work can be very dramatic at times.”

Channel for engagement

Linton said his “constant prayer” is to continue to receive permission from both Koreas to continue their efforts.

While it doesn’t need permission from Seoul to visit the North, because the delegations travel as members of the U.S.-based organization, medications are purchased and shipped under South Korean law.

The fact that the sputum is tested in the South greatly eases the complex and costly process, Linton said.

South Korean humanitarian aid groups to the North have been sidelined since the North sank a South Korean warship in March and shelled Yeonpyeong Island in November, killing a total of fifty people.

Many in the international community, including Washington and Seoul, are concerned that humanitarian aid to the North, such as food and medical aid, is diverted for military purposes.

Though Eugene Bell counts itself as fortunate, it operates under the constant cloud that tensions on the peninsula could spike to the extent that the group can’t deliver the medicines.

Such a scenario poses a grave threat to both North and South Koreans, Linton said, as TB is serious on both sides, and changes in the North could eventually reach the South.

For now though, the program continues to act as a channel for engagement and Linton called for power holders to rethink the humanitarian aid paradigm for the North.

“The tragedy for me is that everybody assumes that government engagement must precede civilian engagement,” he said. “I think that is exactly backwards. In a democratic society, it is the civilian sector that guarantees continuity, because government programs and administrations come and go.”

In the end, the doctor believes, the biggest benefactors are the sick people that deserve a leg up in an ongoing struggle with the disease.

“These patients put up with more pain and suffering than most of us are willing to do. They are good candidates for a strong MDRTB program and we are trying very hard to put that kind of program in place,” he said.

What is the Eugene Bell Foundation?

In 1995, Stephen Linton founded the Eugene Bell Foundation to commemorate the 100th year of the arrival of Rev. Eugene Bell, a Southern Presbyterian missionary, in South Korea. The late reverend is the great-grandfather of Linton, a doctor and founder of the foundation.

Since its establishment, the foundation has been providing humanitarian assistance to North Korea. Its tuberculosis treatment and the general medical program reach into the entire portion of the communist North’s northwest area, or approximately onethird of the country. The foundation has the support of donors worldwide that have enabled it to supply over 43 medical facilities in the North and provide tens of millions of dollars worth of medicine and medical equipment.