health care, abroad
Amnesty International has [finally!] put out a report about health care in North Korea.
There's a lot of interesting content in it. The report is nominally about health care, but the first half of it is really about food. There isn't enough of it. The report has a lot of details and personal narratives about how bad things are. They're very bad. And a lot of sickness is caused by malnutrition.
But there were a number of other facts in the report that I hadn't seen before. It turns out that the North Korean command economy has mostly come unstuck. Many basic goods and services (including food and medicine) are exclusively available on the black market, either by cash or barter.
There's no fuel, so people who want medical treatment have to walk (or be carried) to the hospitals.
There was one detail, though, that really took me aback. Apparently, patients are responsible for buying all their own medicines. Including anesthetics. There are reports of people having appendectomies or amputations without any kind of anesthesia. That was so shocking to me that I did a little research. As near as I can tell, this is something that we probably haven't had in the West in well over a century.
Edit: I don't just mean patients have to pay for it. I mean the patients have to physically go to a nominally illegal market and buy their own anesthetics, because the hospitals don't have any in stock.
Even in very primitive medical conditions, anesthesia has been around for a very long time. Both sides during the American Civil War used anesthetics routinely although not universally in surgery. Even the South, under blockade, issued its field surgeons with ether and chloroform.
During World War II, it sometimes happened that pharmacist's mates -- who weren't officially doctors -- would have to perform emergency surgery. This happened several times on submarines. And they had anesthetics available. They might have been undertrained and working in very improvised conditions, but it turns out they had ether on those submarines. This is particularly striking, since the official policy was "don't do surgery on submarines." Presumably, somebody in the Navy Department had said "the rules say they shouldn't be performing surgery -- but just in case, let's make sure they have ether."
Somehow I can understand a country not having enough food, more easily than I can understand a medical system that does surgery on patients who are awake and screaming.
Something I find a bit baffling is that Amnesty wants to wrap all these hair-raising stories in legalese. Instead of just saying "conditions are monstrous and awful and people are starving" they want to say "and the fact that people have to walk to the hospital violates the convention against discrimination against women." Can it really be that "you violated a treaty" is a better slogan than "people are starving to death?"
In a way, reading about how dreadful North Korea has become reminds me just how far we've come as a civilization. My sense is that this sort of misery -- hunger, primitive medicine, hopelessness -- used to be an occasional part of the human experience even in wealthy countries, down to the early 19th century.
There's a lot of interesting content in it. The report is nominally about health care, but the first half of it is really about food. There isn't enough of it. The report has a lot of details and personal narratives about how bad things are. They're very bad. And a lot of sickness is caused by malnutrition.
But there were a number of other facts in the report that I hadn't seen before. It turns out that the North Korean command economy has mostly come unstuck. Many basic goods and services (including food and medicine) are exclusively available on the black market, either by cash or barter.
There's no fuel, so people who want medical treatment have to walk (or be carried) to the hospitals.
There was one detail, though, that really took me aback. Apparently, patients are responsible for buying all their own medicines. Including anesthetics. There are reports of people having appendectomies or amputations without any kind of anesthesia. That was so shocking to me that I did a little research. As near as I can tell, this is something that we probably haven't had in the West in well over a century.
Edit: I don't just mean patients have to pay for it. I mean the patients have to physically go to a nominally illegal market and buy their own anesthetics, because the hospitals don't have any in stock.
Even in very primitive medical conditions, anesthesia has been around for a very long time. Both sides during the American Civil War used anesthetics routinely although not universally in surgery. Even the South, under blockade, issued its field surgeons with ether and chloroform.
During World War II, it sometimes happened that pharmacist's mates -- who weren't officially doctors -- would have to perform emergency surgery. This happened several times on submarines. And they had anesthetics available. They might have been undertrained and working in very improvised conditions, but it turns out they had ether on those submarines. This is particularly striking, since the official policy was "don't do surgery on submarines." Presumably, somebody in the Navy Department had said "the rules say they shouldn't be performing surgery -- but just in case, let's make sure they have ether."
Somehow I can understand a country not having enough food, more easily than I can understand a medical system that does surgery on patients who are awake and screaming.
Something I find a bit baffling is that Amnesty wants to wrap all these hair-raising stories in legalese. Instead of just saying "conditions are monstrous and awful and people are starving" they want to say "and the fact that people have to walk to the hospital violates the convention against discrimination against women." Can it really be that "you violated a treaty" is a better slogan than "people are starving to death?"
In a way, reading about how dreadful North Korea has become reminds me just how far we've come as a civilization. My sense is that this sort of misery -- hunger, primitive medicine, hopelessness -- used to be an occasional part of the human experience even in wealthy countries, down to the early 19th century.