Is North Korea shooting COVID-19 patients?

Choi Jung-hun, right, at the Teach North Korean Refugees Global Education Center. Courtesy of Casey Lartigue Jr.

As COVID-19 spread around the world causing people to isolate themselves, some wondered if the most self-isolating country had been infected by the deadly virus. There have been a range of reports, with North Korea denying it had any infections and some charging that North Korea was shooting anyone suspected of having the virus. On April 4, Dr. Choi Jung-hun, a research professor at Korea University, talked with Apple Daily reporter Yuen Chi Man from Hong Kong and with Teach North Korean Refugees Global Education Center (TNKR) co-founders Casey Lartigue and Eunkoo Lee at the organization's office in Seoul. Dr. Choi studied clinical medicine at the Chongjin Medical University in North Korea, then worked in North Korea as a doctor of neurology for three years and for seven years at the Chongjin Railway Bureau containing contagious diseases. His extended interview has been edited for publication, with his permission.

By Casey Lartigue Jr.

Dr. Choi: There are three key points I hope your readers will remember when they read about North Korea's medical system and infectious diseases. One, North Korea's medical system is not equipped to treat or even detect infectious diseases. Two, North Korea's medical system is neither free nor a paradise for patients as it claims to be. Three, even doctors and nurses must rely on the market.

One: North Korea is not equipped to diagnose or treat infectious diseases.

Yes, I have seen the reports about North Koreans getting executed when they allegedly have been infected by COVID-19. I don't believe this is true. North Korean doctors aren't equipped to detect who is infected, the medical system is still too primitive to distinguish among the flu, colds, SARS, Ebola, COVID-19 and other serious infections.

How can they start shooting people if they can't even determine who is infected?

This is not the first infection that North Koreans have been exposed to, but the regime didn't start shooting people for having it. If they started shooting people for having a virus, then people would riot.

There have been news stories and speculation about the spread of COVID-19 to North Korea, but I assume that the North Korean government won't talk about it honestly. It would undermine propaganda about North Korea being a paradise. North Korea doesn't announce such infections or problems to the general population, although it does try to treat the elite. Using common sense, it makes no sense to trust any information coming out of North Korea.

The North Korean medical system hasn't developed much over the past few decades; some hospitals are still using medical equipment from the Kim Il-sung era.

The government responded to COVID-19 as it responds to outbreaks: shutting the border to China, controlling travel within North Korea, and protecting Pyongyang. The top three hospitals are only for the Kim family, the best doctors serve there. The rest of the hospitals are for the majority of the population, but the best of those hospitals are reserved for government officials who are also wealthy enough to also bribe doctors to get better treatment.

I was in North Korea during the SARS outbreak. North Korea announced that it didn't have any SARS infections. It denied there was Ebola in North Korea. Now it is denying there is COVID-19 there. North Korea denies what it doesn't understand. It might then directly ask the World Health Organization for some support while still denying there is a problem.

During 2006-07, I was part of the medical team trying to identify people who had scarlet fever. I was going on trains trying to identify people with symptoms. We were wrong. It turned out to be a measles outbreak, not scarlet fever.

North Koreans are kept in the dark about infections and must fend for themselves. COVID-19 is just another virus for North Koreans. North Koreans don't know about the virus, so they wouldn't go see a doctor about it. Even if they did, North Korea's medical system couldn't help most of them.

Two: North Korea is not a medical paradise.

I sometimes hear some people talk about the North Korean medical system being good because it is free, but I was a doctor there, I know the reality. Saying North Korea's medical system is free is like saying you have a gun with no bullets.

As background, I worked as a doctor in North Korea for three years, I was promoted to work in the disease control center preventing infections. I worked there for seven years before I escaped North Korea in 2011 and arrived in South Korea in January 2012. When I came to South Korea, I was surprised by the range and quality of medical care. In comparison, I could see how primitive North Korea's medical system is, there are so many things that doctors in North Korea don't know and even if they did know, they don't have access to proper medical equipment. North Korea says it is a paradise providing for everyone's needs, but it doesn't. People can get more adequate medical treatment in a capitalist country like South Korea. In that way, South Korea is doing a better job at living up to North Korea's communist pledge of providing health care to the general population.

Doctors lack medical equipment and squeeze their income from patients in the form of bribes.

Rich people and those connected with the elite can get adequate health care because they can bribe doctors or they already have exclusive medical facilities set aside for them.

On the other hand, poor people don't get actual treatment at a hospital. At the most, they can get a prescription from a hospital, then go into the market to get medicine they need. Most North Koreans can't expect treatment at a hospital, and that doesn't change when there is a virus outbreak. So why would North Korea announce to the general population an outbreak that it can't diagnose or treat with its primitive medical tools and infrastructure?

Three: Even doctors in North Korea must rely on the market.

Even if doctors wanted to treat everyone, they couldn't, so they prioritize those patients who can pay. Patients pay for the room, the heating system, medical equipment or a particular medical procedure.

Patients pay with money, cigarettes, alcohol or other items doctors and nurses want or can sell. Doctors and nurses provide their skills; everything else needs to be paid for by the patient.

Patients even need to pay for the meals of doctors and nurses.

As far as I know, North Korea has the only medical system in the world where patients must even pay for the meals of the doctors and nurses.

My monthly salary as a doctor in North Korea would be enough to buy two cups of coffee here in Seoul. I made most of my money in the form of bribes from patients. When I helped 30 patients, then I could collect 30 boxes of cigarettes. Then I could sell those cigarettes in the market to make more money than I could make from my government salary.

In conclusion, it should be clear that the North Korean medical system isn't equipped to handle an infectious outbreak. Doctors are working with primitive medical tools, working in out-of-date hospitals and health centers that lack reliable water supply facilities or electricity, patients bribing doctors to get help and getting their medicine in the market and people dying from infections they aren't informed about. North Korea's medical system is not prepared to diagnose or treat an infectious virus outbreak. It is easier for North Korea to deny what is happening and to just let people die.

Casey Lartigue is co-founder of the Teach North Korean Refugees Global Education Center. He conducted this interview along with Yuen Chi Man, a reporter for Apple Daily. TNKR co-founder Eunkoo Lee translated Dr. Choi's words from Korean to English.