DATE=5/3/99 TYPE=BACKGROUND REPORT NUMBER=5-43295 TITLE=NORTH KOREA- TUBERCULOSIS BYLINE=STEPHANIE MANN DATELINE=WASHINGTON CONTENT= VOICED AT: INTRO: WITH NORTH KOREA EXPERIENCING ITS FOURTH-YEAR OF FAMINE, OBSERVERS SAY DISEASE IS A PROBLEM THAT IS GROWING WITH MALNUTRITION. V-O-A'S STEPHANIE MANN REPORTS ONE ILLNESS THAT IS NOT OBVIOUSLY LINKED TO FAMINE, BUT IS A DIRECT OUTCOME OF IT, IS TUBERCULOSIS. TEXT: TUBERCULOSIS IS AN INFECTIOUS DISEASE CAUSED BY BACTERIA BREATHED INTO THE LUNGS. IN MANY PEOPLE, THE IMMUNE SYSTEM CAN STOP THE INFECTION AND THE PATIENTS RECOVER. BUT, FOR PEOPLE WHOSE IMMUNE SYSTEMS ARE WEAKENED BY MALNUTRITION, THE INFECTION CAN SPREAD THROUGH THE BODY'S LYMPHATIC SYSTEM AND THE BLOODSTREAM AND CAN BE FATAL. IN MOST DEVELOPED COUNTRIES, VACCINATIONS HAVE PREVENTED THE SPREAD OF TUBERCULOSIS -- ALSO CALLED T-B. BUT IN POORER COUNTRIES, T-B STILL REMAINS A SERIOUS PROBLEM. IN NORTH KOREA, THE EXTENT OF TUBERCULOSIS IS NOT KNOWN, BECAUSE THE GOVERNMENT DOES NOT PROVIDE SUCH STATISTICS. STEPHEN LINTON, THE HEAD OF AN AMERICAN ORGANIZATION THAT PROVIDES MEDICINE AND MEDICAL EQUIPMENT TO NORTH KOREA, SAYS HE EXPECTS THE NUMBERS OF NORTH KOREANS DYING FROM T-B TO INCREASE. // LINTON ACT ONE // THEY CAN ONLY GROW AS LONG AS THERE IS A FOOD SHORTAGE, BECAUSE TUBERCULOSIS IS A DISEASE THAT IS DIRECTLY LINKED TO MALNUTRITION. IT IS THE COMPROMISED IMMUNE SYSTEM THAT MAKES PEOPLE PARTICULARLY SUSCEPTIBLE TO TUBERCULOSIS. AND SO, THE NUMBERS CAN BE EXPECTED TO GROW UNTIL THE FOOD SITUATION IS IMPROVED. // END ACT // MR. LINTON SAYS ABOUT HALF THE PEOPLE WITH TUBERCULOSIS GET WELL ON THEIR OWN. OF THE REST, HE SAYS, HALF DO NOT GET PROPER TREATMENT AND DIE AND THE OTHERS DEVELOP CHRONIC T-B. IF THOSE WITH CHRONIC T-B ARE NOT TREATED OR ISOLATED FROM THE GENERAL PUBLIC, HE SAYS THEY INFECT OTHER PEOPLE. // LINTON ACT TWO // WHAT WE ARE SEEING IN NORTH KOREA IS AN INABILITY TO TREAT THE DISEASE -- WHICH MAKES PEOPLE VERY RELUCTANT TO COME IN FOR TREATMENT, WHICH MEANS THAT THEY ARE MUCH MORE LIKELY TO INFECT THEIR FAMILY MEMBERS -- AND WHEN PEOPLE DO COME IN FOR TREATMENT, A LACK OF RESOURCES IN HOW TO TREAT THEM. // END ACT // THE EUGENE BELL FOUNDATION IS A SMALL NOT-FOR-PROFIT U-S ORGANIZATION THAT PROVIDES MEDICINE AND DIAGNOSTIC EQUIPMENT TO 13 HOSPITALS AND 60 TUBERCULOSIS SANITARIUMS IN NORTH KOREA. FOUNDATION CHAIRMAN STEPHEN LINTON TRAVELS TO THE COUNTRY REGULARLY TO OVERSEE DELIVERIES, AND SAYS HIS GROUP GETS A GOOD ACCOUNTING OF ITS DONATIONS AND THE RESULTS THEY ACHIEVE. // OPT // LINTON ACT THREE // WE HAVE BEEN ABLE TO SEND ENOUGH TUBERCULOSIS MEDICATION TO TREAT ALMOST 10-THOUSAND PATIENTS. AND WHILE THAT DOES NOT SOUND LIKE A LOT, AT ABOUT 65 (TO) 70-DOLLARS A PATIENT, IT IS A GOOD BIT OF INVESTMENT, ESPECIALLY BECAUSE YOU DO NOT GET DONATIONS OF TUBERCULOSIS MEDICATION. YOU REALLY HAVE TO GO OUT AND PURCHASE IT. // END ACT // END OPT // THE EUGENE BELL FOUNDATION HAS ALSO GIVEN NORTH KOREA MOBILE X-RAY CLINICS TO TEST PEOPLE FOR T-B, AND GREENHOUSES SO T-B SANITARIUMS CAN GROW VEGETABLES FOR THEIR PATIENTS IN THE WINTER. MR. LINTON SAYS BECAUSE OF ITS SEVERE ECONOMIC SITUATION, NORTH KOREA LACKS ENOUGH MEDICINE TO TREAT TUBERCULOSIS PATIENTS AND LACKS X-RAY FILM USED IN DETECTING THE DISEASE. THEREFORE, HE SAYS, NORTH KOREA RELIES ON METHODS THAT HE DESCRIBES AS TRAGIC WHEN VIEWED FROM THE OUTSIDE. // LINTON ACT FOUR // NORTH KOREANS ARE DIAGNOSED WITH TUBERCULOSIS WITH A PROCESS CALLED DIRECT FLUOROSCOPY, WHICH MEANS THAT THE PATIENT IS PLACED BETWEEN THE DOCTOR AND A RADIATION SOURCE AND IN A DIM ROOM. AND THE RADIATION IS THEN SHOT THROUGH THE PATIENT INTO A FLUOROSCOPY SCREEN IN FRONT OF THE DOCTOR'S FACE. // END ACT // THIS METHOD EXPOSES DOCTORS TO MASSIVE DOSES OF RADIATION, BUT MR. LINTON SAYS THEY HAVE NO CHOICE BECAUSE THEY HAVE NO X-RAY FILM AND MUST SEE THEIR PATIENTS' LUNGS IN REAL TIME. HE SAYS NORTH KOREA ALSO TRIES TO CUT COSTS BY STRETCHING THE USE OF MEDICINES, BECAUSE WHEN TAKEN BY MOUTH ONLY 80-PERCENT OF THE MEDICINE IS DIGESTED. // LINTON ACT FIVE // ONE WAY TO EXTEND OR TO USE MEDICINE TO TREAT MORE THAN THE USUAL NUMBER OF PATIENTS WHO COULD BE TREATED IS TO TRY DIRECT INJECTIONS. AND THE NORTH KOREANS HAVE BEEN INJECTING TUBERCULOSIS MEDICINE INTO PEOPLE'S LUNGS WITH VERY LONG HYPODERMIC NEEDLES WHICH IS AN EXTREMELY PAINFUL PROCESS. // OPT // THEY HAVE ALSO EXPERIMENTED WITH INSERTING OR FIXING A TUBE DOWN THE TRACHEA INTO THE LUNGS AND DRIPPING MEDICINE INTO THE LUNGS ON A DAILY BASIS, WHICH IS A LITTLE BIT EASIER ON THE PATIENT, BUT THE POTENTIAL FOR SECONDARY INFECTIONS AND PNEUMONIA ... IS JUST AMAZING. // END OPT // // END ACT // MR. LINTON SAYS HIS IS ONE OF THE FEW GROUPS HELPING TO BATTLE TUBERCULOSIS IN NORTH KOREA. MOST LARGE ORGANIZATIONS, SUCH AS THE WORLD HEALTH ORGANIZATION, REQUIRE SURVEYS AND ASSESSMENTS BEFORE THEY COMMIT AN INVESTMENT. THE EUGENE BELL FOUNDATION DOES NOT DEMAND THAT KIND OF INFORMATION, WHICH HE SAYS NORTH KOREA WOULD NOT BE WILLING TO GIVE. MR. LINTON SAYS ANOTHER REASON MORE ORGANIZATIONS ARE NOT INVOLVED IS THAT THE DISEASE IS NOT -- IN HIS WORDS -- TELEGENIC. TUBERCULOSIS IS A SLOW-DEVELOPING DISEASE, IT DOES NOT DISFIGURE ITS VICTIMS AND IT DOES NOT USUALLY AFFECT CHILDREN, MAKING IT HARD TO RAISE MONEY FOR T-B PROGRAMS BECAUSE IT DOES NOT USUALLY ATTRACT MUCH ATTENTION FROM NEWS MEDIA. IF PATIENTS GET THE STANDARD TREATMENT OF FOUR DRUGS TAKEN IN A CERTAIN SEQUENCE OVER A SIX-MONTH PERIOD OF TIME, MR. LINTON SAYS THERE IS AN 85 TO 90-PERCENT CHANCE OF COMPLETE RECOVERY. BUT HE SAYS AS LONG AS NORTH KOREA'S FOOD SHORTAGE CONTINUES AND AS LONG AS THE COUNTRY IS DEPENDENT ON MEDICINE FROM THE OUTSIDE, THE T-B PROBLEM WILL GROW. (SIGNED) NEB/SMN/RAE 03-May-99 11:23 AM EDT (1523 UTC) NNNN Source: Voice of America .