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Health Care in Hell

A recent article in The Lancet is titled "North Korea’s health system in disarray" — but that implies that it was ever actually in array in the first place.

by
Theodore Dalrymple

Bio

August 10, 2010 - 12:07 am

When I was a prison doctor, my patients — the prisoners — would often try moral blackmail. If I did not give them what they wanted, they said, they would kill someone, and then it would be on my conscience.

I never gave in to the blackmail, and eventually the prisoners abandoned the attempt. But I always had a niggling fear that they might carry out their threat. The fact that they were responsible for their own actions was never sufficient to allay it entirely.

North Korea is the international blackmailer par excellence. An article in The Lancet for July 31 titled “North Korea’s health system in disarray” is subtitled “Food shortages, international sanctions, and a lack of funding have pushed North Korea’s health system past breaking point.” A little later we read that “fears are increasing that North Korea is on the verge of another famine as a result of cuts in international aid …”

It seems, then, that those principally responsible for the situation in which 45 per cent of children are stunted because of malnutrition and 9 million people lack enough food are foreigners. This is, in effect, to accept the viewpoint of the blackmailer. Though the article cannot be said to be positively sympathetic to the regime, there is not a single word in it about what the regime might have done to bring this catastrophic situation about. There is nothing about its economic and agricultural policies, which have been shown the world over to bring about permanent shortage and acute famine wherever and whenever they are tried, to say nothing of its total concentration on military might and the production of nuclear weapons. It is perfectly obvious that if the North Korean regime were really worried about famine and the health of its population, all it would have to do is dismantle itself.

It is difficult to believe that if, say, the British or French government decided to spend less than a dollar per year per person on the health service in order to increase the army’s size to between three and four million, and to produce yet more nuclear weapons and missiles, all in conditions of food shortage and famine, this would go entirely uncriticized by The Lancet — assuming, of course, that the staff of The Lancet would not be sent immediately to the harshest possible labor camps if they did so.

For a health system to be in disarray, it must once have been in array. Given the difference in the stature — the height — of the people of the two Koreas, which has now persisted for decades, it seems unlikely that the array was ever very great, notwithstanding the propaganda. When I was in North Korea I was shown a gleaming facility that was so obviously a Potemkin hospital — a façade and nothing else — that only a regime with a great deal to hide would have resorted to such an expedient.

Every cloud has a silver lining, however. The Lancet quotes the head of World Health Organization, Dr. Margaret Chan, as saying that the health services of North Korea would be the envy of the developing world. According to the WHO, North Korea has made progress not only in the field of infant and maternal mortality, but in the reduction of deaths during surgery. Since The Lancet goes on to quote, by contrast, the testimony of a man who had his leg amputated without anesthetic for a broken ankle, while being held down by five medical assistants, it is rather alarming to think of what North Korean surgery must have been like before the improvement took place. Only four medical assistants to hold patients down, perhaps?

Theodore Dalrymple, a physician, is a contributing editor of City Journal and the Dietrich Weismann Fellow at the Manhattan Institute. His new book is Second Opinion: A Doctor's Notes from the Inner City.
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