A recent survey of 370 North Koreans reported by Radio Free Asia (and picked up by MBC News in South Korea) found that 90% of those surveyed had given gifts (of money, food, cigarettes, or alcohol) to a doctor in exchange for treatment. Though medical care in the North is supposed to be free, the country can no longer afford to provide enough medicine and pay salaries, leaving many doctors and nurses to demand bribes/gifts/payments in exchange for treatment.
The cost to patients can be quite severe, worth 140% of a month’s income for farmers, 80% of a month’s income for office workers, and 60% for factory workers. A heavy burden given that the average monthly income for a worker in their 40s is $45, which leaves little to spare for emergencies.
A side effect of the high costs has been tuberculosis (TB) patients not completing their full cycle of medication, instead selling some of their medicine on the black market once the disease appears to have passed. With TB medicine one of the most common items donated to the North by groups from the World Health Organization to the Eugene Bell Foundation, patients sometimes receive this medicine for free or at very low cost. Unfortunately, they often sell some on the black market rather than take the full course of treatment – giving a boost to much harder to treat drug-resistant forms of the disease. Drug-resistant TB is much more dangerous than earlier forms of the disease and, unfortunately, spells even worse trouble looming in North Korea’s already bleak future.