4.4 Findings
4.4.6 First, do no harm
She had Bo Kyoung leave first while she stayed and made money to pay off her debts from defecting. Instead of defecting to South Korea, however, Bo Kyoung’s mother instructed her to defect to the United States so she could receive a better education. Thus, in the North Korean context, access to education can play a considerable role for those who choose to defect - particularly those who choose not to stay in China.
citizens don’t have access to such a department. They go to an ordinary medical depart- ment [which] is a problem because, well, there simply is no medication available. So the vast majority of regular citizens have to buy medication prescribed by the doctor at a mar- ketplace.”
The lack of treatment and medicine available to ordinary North Koreans was a com- mon frustration amongst those who mentioned medical hardships. Min Seok, a 22-year-old man from Hwanghae Province, states that North Korea’s medical system was probably the
“second biggest reason” as to why he became disillusioned with North Korea. Min Seok explains, “It is often advertised in North Korea that its citizens do not get sick, and even if they do, they have access to free healthcare. They say this but my father faced a reality that was totally different from what was said, and without knowing what disease he had, he passed away.” His father was ill for several years and because his family was poor, was never able to receive treatment in a hospital or even receive a proper diagnosis. Min Seok says that due to his family’s poor financial situation, his father was only ever able to see a
“novice doctor” who was unable to identify what ailed him.
When asked why his family did not try to go to a different hospital, Min Seok explains that there no other hospitals in the area. The lack of adequate medical facilities is a common experience for North Koreans living outside of major cities such as Pyongyang. A lack of money and hospitals are the reasons Min Seok gives for his father not being able to receive the medical care he needed. Jun Ho reflects this assessment, adding that rural areas typically only have a clinic but the lack of regular transportation makes it so that people cannot even visit a clinic when they are ill.
Eun Mi, a 39-year-old woman from Onsong, North Korea, experienced similar limita- tions in accessing health care. Her assessment of North Korea’s free health care is that it is “meaningless.” She discusses having to buy medication from the black market, as men- tioned above by Dong Hyu. Both she and Bo Kyoung describe having to give themselves injections due to the inaccessibility of medical professionals for ordinary North Koreans.
Even if North Koreans outside of the core class manage to receive a proper diagnosis along with a prescription from a doctor, there is no guarantee that the medicine they need will be available in the markets. This was the case for Kyu Ri, a 41-year-old woman from Nampo, North Korea who suffers from a peculiar heart disease that causes the vessels in her heart to narrow. Kyu Ri describes hersongbunas “below the middle class” and though Pyongyang is just north of Nampo and accessible by train, imports of the medicine she needed were blocked by the state. Fortunately for Kyu Ri, she is half Chinese and had family in China who could secure proper treatment for her. She is now living in South Korea and uses a medicine imported from Germany to treat her condition. For Kyu Ri, it was the lack of access to medical care for her condition that ultimately prompted her to flee.
The inaccessibility of health care for the North Korean masses has downstream effects regarding food as well. As briefly mentioned above, monthly rations, when distributed, are determined by the number of days a person is present at work. Su Kyoung, whose family were farmers in Hoery˘ong, says that food would still be withheld even if a person was visibly ill. “If you were hurt then you needed documentation from the hospital like a written diagnosis,” she explains. She goes on to tell me of a time her father was unable to work because he was injured but because he was unable to pay for a diagnosis, his rations were withheld. This can be crippling for individuals already facing extreme food insecurity as chronic hunger weakens the body’s ability to fight off infections and diseases related to malnutrition such as typhoid and tuberculosis (Demick, 2010). Hunger-related illnesses are well documented in North Korea and unequal access to food and medicine work to reinforce the impoverishing effects of the other in North Korea. Food shortages mean people are more susceptible to disease. A lack of quality medical care can keep people out of work which only exacerbates issues related to malnutrition as food is distributed through the work place.
Deprivation of either can force people to leave for the sake of survival. When asked what the biggest difference between her life in North Korea versus her life in South Korea, Kyu
Ri’s answer is succinct but solemn: “The fact that I can survive.”