David Syren

Contributed by: David Syren, Firefighter/paramedic with the Anchorage Fire Department (Ret.) and CFK technical volunteer.

We all have events in our lives that grab our attention, challenge the status quo, and change us forever.   Sometimes, it comes simply by taking a walk in someone else’s shoes, even briefly. 

In the spring of 2010, I returned home to Alaska from a visit to North Korea not feeling very well.  Having traveled there many times before with CFK to volunteer on various technical projects, I knew that in spite of being careful, it was not unusual to suffer from an upset stomach and indigestion.  This can linger a bit upon returning to the US, but usually a few days of rest and familiar food puts one back on track and running strong.  This time it was not to be.  After a couple of weeks at home, I was still not doing well, so I started on a course of antibiotics.  When, after a few more days, I was still sick, I knew I needed further tests.  I soon learned I was infected with the parasite giardia lamblia.  Alaska has a lot of this water-born parasite from beavers; many hunters, hikers and campers are exposed by drinking contaminated water during recreational activities, but even as a life-long Alaskan who is often in the wild, I had never suffered from this before and so it was a whole new miserable experience.  The doctor prescribed Flagyl, the drug of choice for this ailment, and I started feeling better after about a week of treatment.  Unfortunately, the normal dosage wasn’t strong enough, or taken long enough to cure the problem, so I relapsed (twice more, over the summer).  It wasn’t until just before I was scheduled to return on the Fall technical trip with CFK that I started to feel like myself again.

  Being sick with giardia was miserable – something I hope never to repeat.  Over 5 months, I lost 23 pounds (from my usual 135-pound frame) from a parasite that many North Koreans have to live with while struggling under far more stressful daily living conditions.  Like them, it wasn’t like I could just crawl in bed and wait to get better.  Life goes on with its work, projects, schedules, visitors and adventures – especially during our beautiful, yet short daylight-around-the-clock Alaska summers.  At least it was summer, so I didn’t have to stumble around in the cold and dark getting to the outhouse – often. 

I can’t imagine exposure to giardia without diagnosis or medicine for treatment, and many other contaminates abound in North Korea besides giardia that result in terrible suffering as well.  Yet opportunities for change in North Korea are present.  Some good water wells have been drilled, and many more are needed.  One water project CFK completed at an outlying rest home and rural village took water from a pure spring source and protected it, installing a full gravity-powered system down to the village and rest home that resulted in virtual elimination of patient and community GI disorders that year alone. 

I have seen time and time again how God multiplies the talents and resources provided through CFK so that many people there are helped and blessed in many permanent and life changing ways.  We serve a Creator who is still creating, giving, forgiving, healing, and transforming.  He loves His creation and longs to be known by each person alive today in every corner of the world, including North Korea.  It is toward this end that we labor through CFK in North Korea to show God’s love and, if possible, to share the Good News personally with those we meet along the way.  In a certain way CFK is not so much leading the way for change along an existing path on foreign soil, but rather it has been granted a unique opportunity to forge a new trail in very difficult terrain fraught with many obstacles and dangers.  It is this amazing opportunity that compels me to labor for Christ, within His care and keeping, in North Korea.

Kay Rader

Contributed by: Paul A. Rader & Kay Rader, General and Commissioner of the Salvation Army (Ret.), and missionaries to Korea for 22 years. Kay is a member of CFK’s Board of Directors.

Returning after four years our impression is that citizens of Pyongyang, at least, are somewhat better off.  They appear to be better dressed, there are more vehicles on the road, more cars and bicycles.  Though broad boulevards are sometimes eerily bereft of traffic, at other times there is considerable movement.  We had a hard time getting a left turn into the road to our hotel on several occasions. 

Having said that, our initial impression as we drove to the hotel from the airport, and  the image still in our minds and hearts even now, is the darkness.  Still no street lamps.  Still no lights in the windows of high rise apartments, no store windows aglow with displays, no lights on bicycles, no flashlights.  We couldn’t help noticing how the wide-range beams of the head lights on the new CFK van were providing a path of light for pedestrians ofPyongyangas they stumbled along the footpaths or competed with traffic, trudging forward in the darkness. 

Darkness is one of the stark realities of life inNorth Korea.  One Director told us they get electricity two hours a day.  In this regard, four years have made little difference.  Solar panels were among the most frequent requests from the directors.  MOPH officer, Mr. Ri ChilNam’s demonstration of the wind-up ‘flash-light’ included in the doctors’ bags seemed a favorite attraction to doctors, nurses and other staff members at the institutions we visited. They gathered round him like eager children to watch as he turned the lever, creating a bright light.  With every turn of the handle they leaned in more closely not to miss it when it happened.  These dear people are deprived of this basic commodity.   Nevertheless, the statues of the Great Leader are bathed in it.   

Façade is everywhere evident. Pyongyangitself is a façade.  Even in the city, reasonably attractive properties that may line the main streets are rarely representative of the crumbling and shabby reality that lies behind them – inPyongyang, or elsewhere.  

Outside of Pyongyang the situation is grimmer.  True, there are more bicycles on the road, more machinery in the fields – though plowing with oxen seems to be the norm.  We noticed more color in the clothing but this, too, seems only a façade for the crowds on the roads still carry heavy burdens, push bicycles up steep inclines, and always they are overloaded to the breaking point. 

In our travels across over 2,000 miles of North Korean countryside far from the capital city’s perimeters we had opportunity to observe the daily realities of life.  While food is scarce, at least in the provinces we visited (North andSouth Hwanghae) we saw little evidence of severe starvation levels of need.  Even so, the sight of people (often women and/or children) foraging for food in harvested fields or on the denuded hillsides tells its own story.  Some food is distributed by the government to the citizenry, though it is not clear how consistently or how equitably.  Generally speaking, when asked how much of the protein patients receive comes from CFK, the directors of the homes and hospitals said, “About 60-70%.”    The vinyl houses are among the most appreciated contributions of CFK and may themselves provide 30% or more of the food for the institutions.  Heavy rains in the spring and early summer of this year washed out seed and harmed the harvest so that production was apparently down in the flood affected areas. 

One director was so appreciative of the emollients given to aid in the quality of crop production, he suddenly reached behind his desk and brought forth from a drawer a “bouquet” of soy bean shoots, complete with pods, providing a moment of levity for our confirmation team.

Four years ago we thought that the proliferation of political banners glorifying the Great Leader and the ‘Marshall’ or ‘Great Military Leader,’ Kim Jong Il, could not be more ubiquitous.  How silly of us!  There seems to be almost a desperate effort to force their messages on the attention of the people.  We counted fourteen such banners or monuments within the grounds of the National TB Hospital alone, many of which seem to have materialized since the opening of the TB Reference Lab.  They are probably counterproductive, quietly resented by some and ignored by most.  For the first time we saw three stone markers erected in many prominent places representing Kim Il-sung, Kim Jong-il and Kim Jong-un.  We wondered if this were not perhaps preliminary to the April celebrations of the 100^th anniversary of the birth of the great leader, an opportunity to celebrate the Kim family and further consolidate Kim Jong-un as the successor to his father.

In the face of this seemingly stepped up political activity, we were given more freedom to move about than in the past – in particular the freedom to venture unaccompanied down to the Potong River walkway near the hotel, never challenged about taking photos, although from past experience we tried to act with discretion in this regard.  We met an Egyptian man on the elevator in the hotel who told us they have now put 700,000 cell phones into the hands of North Koreans, no international communication, of course.  Intranet is available, albeit with serious limitations, but still no Internet and still no letters may be posted toSouth Korea. 

Nevertheless, our counterparts from MOPH seemed quite willing to be identified with CFK.  One North Korean official with us donned the outfit given him by CFK with visible  logo.  He even stepped outside the van to confer with the checkpoint guards, wearing the outfit, a Christian cross, not to mention the word, ‘Christian’ displayed on the shirt. 

We were encouraged with the bold witness at theChilGolChurchworship service of a professor at PUST who had come fromHong Kongto the faculty.  He informed us there are 40 professors who have come from abroad.  Obviously some (all?) of these are committed Christians.  What will the future of PUST be?  How far will the regime allow freedom for Christian presence and witness among the faculty? 

The two Protestant churches are an anomaly.  Chilgol tends to feel more authentic than Pongsu where the church has been rebuilt into an impressive facility with a ‘seminary’ attached.  The number of congregants, however, does not seem to have increased with the enlargement of the auditorium.  There are no children, or young people.  One wonders if there are ever any baptisms, weddings or funerals in which the church participates, how congregations are permitted or chosen to attend is uncertain.  Active evangelism is out of the question.  Still, the Bible is read, hymns are sung and earnest prayers are offered, evoking hearty ‘amens’ at the appropriate points.  One can only be grateful that this witness, such as it is, is permitted, while praying for the day when there will be freedom of worship once more, the Gospel freely and fully proclaimed.

We had numbers of opportunities to converse with our counterparts.  Paul was asked to bring greetings at both Chilgol and Ponsu.   His comments about the work of CFK were most warmly received by the congregants, the pastor reiterating what he had said and asking them to support CFK with their prayers.

The introduction of the donor lists afforded opportunity to present the motivation for CFK’s ministries, the presentation ending with words from Scripture, “We love because He first loved us.”  Our entourage seemed quite willing to accept prayer before meals in the Korean language.  There was also an opportunity to dedicate the new van purchased in honor of Dr. Dwight Linton, his son, Sam, with us paying tribute to his father.  Again there was prayer in the presence, not only of our counterparts, but nurses, doctors, lab technicians from the National Lab and National TB Hospital, and MoPH colleagues. 

 We were given much greater access to patients who responded with enthusiasm and appreciation, sometimes reaching out to us with their hands, leaning their heads onto our shoulders as we took photos, thanking us effusively for sending medicine and nodding approval and appreciation when told we will be thinking of them and praying for them.

 We had a remarkable team in Drs. Ed Desmond and Jim McLaughlin, Sam Linton, Chris Rice, Ron Ward, Dr. Eugene Oh, Dr. Sam So and Heidi.  The devotional times were greatly enriched by interaction and the fellowship of prayer.  

There were some tensions growing out of misunderstandings and misinformation toward the end of the visit, but all seemed to be somewhat resolved in answer to prayer.  In the wrap-up meeting on the last day, several of the NK counterparts seemed on edge.  Dr. Sam So relieved the tension with what seemed to them a compliment.  Speaking diplomatically, he said, “I have never visited a country that has twelve hospitals and about 200 rest homes dedicated to hepatitis care alone.”  They were so pleased.  We were made to understand by their immediate response that this was the idea of the Great Leader.  All’s well that ends well!  

One is impressed that there are many good and well-intentioned people in the DPRK, genuinely concerned for the welfare of those they serve and genuinely grateful for CFK help.  One Director took our hands as we were leaving and said, “You have suffered much to come here,” meaning that he realized the difficulty for someone our age to travel so far.  He knew the effort involved.  They live and function in an environment of uncertainty, suspicion, fear and vulnerability into which it is impossible for us to enter fully.  We pray for them. 

We cannot afford to be naïve about the reality that prevails in what is an oppressive and often brutal regime.  The DPRK ranks at the top of nations persecuting and seeking to suppress the Christian witness.  Thousands of believers have been imprisoned and many martyred for their faith.    Still, can we not assume that there are Obadias (I Kings 18), Esthers, Daniels, Josephs and Nehemiahs even within the government and the system of the DPRK who are believers or ‘God fearers’ struggling to act with conscientiousness and character and who may be prepared when the time comes to lay down their lives for their faith?

 In many ways the situation is as opaque to us and to the world as ever.  We cannot know what the future will hold.  We can know that God is not indifferent to the fervent prayers of intercessors for this land all around the world.  We come away grateful for the privilege of expressing the love of Christ in the service ministries of Christian Friends of Korea, always with the prayer in our hearts that somehow the seeds of love sown will one day bear fruit in causing those we serve to look to the God who moves us to respond to their need with compassion and practical action.

 The uniqueness of the approach of Christian Friends lies not only in the quality of the assistance provided, the accountability and integrity, the professional and technical expertise leveraged, and the immediate and practical value of the food and meds and equipment, but in our presence to those we serve in the name and spirit of Christ.  We are there for Jesus’ sake.  Simply being physically present to those we serve has important value and conveys what the gifts and expertise alone cannot and bears its own witness. 

 We watched as an official from the local government office peeled an apple and offered it to Heidi.  An incredible cookout on the beach below one of the rest homes appeared out of nowhere, providing an atmosphere of unprecedented camaraderie and friendship.

 In a meeting with the World Health Organization (WHO) representative to the DPRK, Ethiopian, Dr. Yonai Tegegn, said, “Visiting in the country on road trips, I have seen the marks of CFK work and have been greatly impressed.  You are always there and making a difference.  We are sincerely thankful for what you do.  Keep it up!  We do it for the men and women to whom we give hope for a better life.  There are ups and downs but we are committed to this country’s welfare like a marriage, for ‘better or for worse,’ but what it comes down to is the faces of the little children, and their mothers.”

 We long to be able to share the truth of the Gospel in words, knowing that faith comes by hearing and hearing by the Word.  But until that day we are there in love and hope.

The Psalmist tells us “Blessed are those who consider the helpless.  The Eternal will stay near them, leading them to safety, in times of bitter struggle.”  (The Voice)  Who more helpless than the people ofNorth Korea?  We trust Him to stay near those with whom we work, our counterparts, to lead them to safety, to spare them bitter struggle.  We continue to hold to our belief in the Cross.  One of my favorite authors, Oswald Chambers writes, “We get back to the bedrock of the Cross of Christ. . .from the Bible point of view an infinitesimal thing – yet of more importance than all the empires of the world.”

 The particular petitions of the Lord’s Prayer never seemed so relevant and powerful as they did to me as we shared them together in our devotional times on the 9th floor of Potong Kang Hotel: ‘Hallowed be thy Name!’  ‘Thy Kingdom come on earth [this place of poverty and oppression] as it is in heaven.’  ‘Give us [give them their] daily bread!’  ‘Forgive us our sins [our indifference, our self-centeredness, our greed] as we forgive everyone who sins against us.’  ‘Lead us not into temptation and deliver us [and deliver them] from the evil one.’  For in the face of all that would seem to deny it, ‘Yours is the Kingdom, the Power and the Glory’ now and forever. So be it, Father! Amen.

Contributed by: Dr. Choong Hyun Park, Director of Microbiology (Retired), Inova Fairfax Hospital, July 2011

This was one of the most rewarding and exciting experiences in my life since I felt deeply and surely that it was our Lord who allowed me to go.  The trip was beyond my expectation; accommodation was quite comfortable and our environment was always amiable, probably attributed to our colleagues friendliness.  This trip was very meaningful for me since my parents were born in Pyongyang and educated by the American missionaries who planted Christian faith in the Park family.  Because our team was mostly serious Christians, the relationship among us was very congenial, joyful, and easy to carry on our daily tasks with a heart of thanksgiving instead of complaints.  I felt we all belonged to one family in spite of diversities.  There is no doubt that the pivotal element that united us was the love for our Lord.  What surprised me was the extent of CFK’s involvement for TB mission in NK. I had heard about its activities before but did not realize its vast range of assistance by such a small organization.  Here I learned that it doesn’t have to be a big organization to produce a big outcome.  If the task is for God’s glory, there is nothing to worry about!

Choong helping to train clinical lab doctors at the National Tuberculosis Reference Lab

Contributed by: Professor Don Clark, Trinity University, San Antonio, June 2010

In late March and early April 2010 I had the privilege of accompanying Director Heidi Linton and a delegation of Christian Friends of Korea (CFK) on a “confirming trip” to North Korea, traveling in and around Pyongyang and out into the provinces of North and South Hwanghae.

     Until recently I had no idea what a “National TB Reference Laboratory” is or how serious the lack of such a lab is in the DPRK when it comes to finding and treating Multiple Drug Resistant (MDR) cases of TB. Last winter’s edition of the CFK newsletter presented the importance of this project for the people of Korea and for CFK.  In traveling with CFK and visiting lab in March, I could see why the project was so essential.  MDR tuberculosis is a serious problem in North Korea requiring complicated and expensive treatment that can’t start until patients are properly diagnosed.  This diagnosis cannot be made in North Korea, nor can an individualized patient treatment plan be designed without a functioning National TB Reference Laboratory.  Lives that could be saved by earlier diagnosis are being lost.    

     In our suffering world there are many things that should not be.  In the 21^st century, people with MDR tuberculosis should not be condemned to miserable illnesses and deaths for lack of a lab to provide timely diagnoses.  This is why I believe in the National Lab project and why I am so thankful that CFK, working with world experts from Stanford, the Bay Area TB Consortium, and the DPRK Ministry of Public Health, have managed to build and equip a National TB Reference Laboratory for the DPRK in just over a year.  I am glad to contribute towards the final needed item: the special electrical cable needed to bring continuous power from the power supply station across the Potong River, to the facility itself.

     I support CFK because I understand how important relationships are in Korea and why after fifteen years CFK is known and trusted by the North Korean authorities.  This track record of experience, promise-keeping, genuine Christian concern, and “Confucian sincerity” matters in North Korea, and it has created striking possibilities for extensive and important engagement such as through the National Lab project.

     In March and April as I traveled with our CFK group through rarely-seen areas of the DPRK, witnessing the situation with agriculture, small-scale marketing, electric power, and transportation, I was struck by how much North Korea needs basic infrastructure.  Though I thought I detected signs of better agriculture and potential food supply for the current year, I saw little improvement in electric power, safe water supply, fuel, or public transportation, even in Pyongyang.  In other words, North Korea is always just barely making it, mobilizing the fierce loyalty of the people through relentless slogans, references to external threats, and visions of a better future to which there seems to be no clear path. 

     Having lived in the south off and on since the 1950s in places that used to look a lot like North Korea does today, I know what it took to bring South Korea out of poverty, intermittent electricity, scarce fuel, rampant diseases, and the grossest injustices.  North Korea has tremendous human potential.  The people are well educated, disciplined, know how to work hard and sacrifice, and are willing to be mobilized for higher purposes.  They deserve better than they get, and my hope and prayer would be that somehow, in the next decade or two, a way can be found for them to move from the present to a brighter future.

     CFK has always been a leading humanitarian organization in support of the people of the DPRK.  In tuberculosis work it found a niche, and in the creation of the National TB Reference Laboratory it played a unique and leading role.  In some ways we have to regard North Korea—for example in food sufficiency—as an ongoing “emergency” requiring continuing shipments of food and medicine.  CFK is also branching out into hepatitis treatment, meeting another medical need.  But I think the long term for CFK also lies in infrastructural investments—things like the largest type of vinyl greenhouses, clean water, technical training, and installations like the National Lab. 

Peony Point

     On our trip I was struck not only by the intelligence and dedication of the people we met and by the strong potential for the North Koreans to build their own better life, but also by the physical beauty of the countryside—the increasing number of trees, the lakes and streams, and by the setting of the city of Pyongyang on the majestic Taedong River.  My parents used to tell me about visiting “Peony Point” for Pyeng Yang Foreign School picnics, looking out at the river from the topmost pavilion, called Ulmildae.  One morning in April, a few of us went up to Ulmildae on “Peony Point” (Moranbong, in Korean) on a brilliant spring day when the cherry blossoms were just starting to show.  The city shimmered in the distance—the stadiums where they have the Mass Games, the apartments that often don’t have electricity for elevators, the great monuments.  All of it was new—not there when my family called Pyongyang home.  My mind was full of tumbled thoughts but even so, the beauty of the place took my breath away.  I realized that I was seeing something of an illusion; but still I harbor faith that in God’s own time the illusion can give way to reality.  

Contributed by:  Rick Armstrong, Electrical Engineer, Consultant, and CFK Volunteer, November 2011

As I reflect on our time, I’m once again amazed at how great our God is to provide for all our needs and beyond our expectations.  From all of us, thank you for your prayers and support!  Miracle after miracle occurred.  Although much was accomplished by hands, more importantly, relationships grew and hearts were touched.

Week 1

We arrive in Pyongyang on Tuesday evening and begin work on Wednesday.  Before leaving the warehouse in Pyongyang where we have retrieved our supplies for the work ahead, we learn that over 2000’ of poly water pipe along with a few other items shipped from the US cannot be found.  Perhaps the rolls of pipe are still in customs or have been delivered to the work sites?  Only time will tell.

Thursday we divide and travel to job sites where well drilling begins at Hwangju TB Rest Home along with work to insulate the greenhouse.  Meanwhile, at Unpa TB Rest Home (an hour’s drive from Hwangju) unearthing the Unpa spring begins for the gravity system we hope to install here.  There are few workers to dig the 1200’ long pipe trench there.  No poly pipe is found at either site.  We return to the hotel that night to learn that Pyongyang will essentially be shut down Friday through Sunday due to the national holiday celebrations for the 65th anniversary of the founding of the Workers Party of Korea (WPK).  We’re told we can’t travel out of the city during that time.  Heidi and the Ministry of Public Health (MoPH) team scramble to find the US pipes that were supposedly shipped, or an in country alternative.  The MoPH team understands our resource and time dilemma.  The thought hits us that we’ll likely not be able to finish.  We’re not happy about it but all we can do is pray and do what we can.

To our surprise on Friday, MoPH gives us permission to travel to Hwangju only, but we must return early to Pyongyang.  Well drilling continues there but progress is slow.  The Water4 team decides before we leave that the well location will be adequate, so trenching for pipes can be started by local volunteers over the weekend.  We’ll return Monday.

Saturday we can’t leave the city but are allowed to work at the National TB Reference Lab for a few hours.  That turned out to be an important visit, finding and fixing a few problems and discovering one that required parts from the US that the next team could bring a few days later.  We learn that the pipe from the US never shipped due to a supplier error, however the MoPH staff find similar pipe through a local source that will work with our US pipe fittings.  Praise God!

Saturday night and Sunday we’re given the rare privilege of witnessing the truly remarkable WPK anniversary celebrations, including the impressive military parade, all the while we’re thinking about the tasks ahead.  There will only be 3 days to complete the work; it seems an impossible task.

Week 2

We discover on Monday that work has continued slowly at Unpa.  The workers have completed less than 1/2 of the trenching for the 1200’ pipeline to an insufficient depth to prevent freezing.  It’s not for lack of effort, however; the terrain is rocky and workers are few.  We push ahead with what we can do.  Meanwhile at Hwangju, a decision by the director is made to move the solar panel frame (already installed and concreted in) closer to the facility for fear of theft or vandalism, and now 100’ further from the pump.  Pipe trenches have only been started.  The good news is that the greenhouse team has nearly completed insulating the greenhouse.

It’s now Tuesday with only two working days left. We’re discussing compromised plans at both sites as we travel to begin work.  The team nearing Unpa rest home passes a regiment of army soldiers carrying picks and shovels.  To our surprise, minutes later they come marching up the single lane dirt road to the rest home.  Everyone is excited.  By the end of a long day the 1200’ trench is done, pipe is laid, water tank and most outlets installed, and final connections are made.  The water begins to charge the 1200’ of distribution lines and begins to fill the tank from the spring.  We hope (estimate) that the output of the spring will bring the tank to about 2/3 full by the time we expect to return at mid-day tomorrow.  Meanwhile at Hwangju the greenhouse classroom training begins while the well drilling stops.  The 12 foot deep well through stony terrain yields nearly 3 gal/min which should be adequate for solar pumping to provide over 1000 gallons/day.  Progress on trenches at Hwangju is slow, but steady.  The solar panel frame is moved and reinstalled and electrical work begins.

Wednesday is our last work day at both sites.  Arriving at Hwangju we find more workers with shovels already making good progress.  Before lunch, the pump is lowered into the well and water begins to flow as we test the solar system.  The greenhouse crew successfully completes training in the afternoon.  Meanwhile, on the way to Unpa, our MoPH colleague receives a phone call on his cell phone from the director of Unpa who tells him that the 2200 gallon tank was filled to overflowing at 1AM, and the local residents are “mad with joy” at the volume and pressure of the water in their new system.  Upon arrival at Unpa, the water team is greeted by excited rest home attendants and local residents.  The Unpa team completes the work, enjoys a quick celebratory lunch hosted by Unpa Rest Home, and heads for Sariwon TB Rest Home to complete an assessment for a possible future water project there.  Then it’s on to Hwangju to assist.  It’s all hands on deck as everyone participates in the completion of the Hwangju water project.  By 7 PM (and in the gathering darkness) the job is done except for back-filling the trenches.  As we return to the hotel in Pyongyang and prepare to leave for home, we each have a story to tell of how God worked out the details of our day to a successful ending.  Simply amazing.  How great is our God!

Contributed by: Dr. Sharon Perry, December 2009

Timely diagnosis of active tuberculosis is a critical component of TB control, because treatment stops transmission as well as disease.  Worldwide, the most common method of diagnosis is observation of acid-fast bacilli in a stained sample of patient sputum, a technique developed by Robert Koch near the end of the 19^thcentury.  While this method is quick and cheap, it misses up to 50% of cases.  Growing organism from a patient sample takes more time, but improves

Pediatric TB patients

diagnosis by 30-50%.  In addition, a culture is needed before tests for drug resistance can be carried out.  In the Western World, routine culture and drug susceptibility tests are the standard of care.  With the emergence of multi-drug resistant TB as a global epidemic, world health authorities have recognized the critical importance of developing these resources in every country.  The DPRK National TB laboratory project, a collaborative effort undertaken by Christian Friends, Stanford University, and Mercy Corps in cooperation with the Ministry of Public Health, seeks to address this critical gap in the DPRK national TB program.

Since the famines of the mid 1990’s DPRK has experienced a serious resurgence of tuberculosis, a disease that thrives on malnutrition and other immune-compromising illnesses.  In 2008, the rate of tuberculosis in DPRK was estimated to be 344 per 100,000 population, ranking it among the highest burden countries in the world.  DPRK is also one of the only high burden countries in the world to lack at least one culture laboratory.  Plagued by chronic shortages of drugs and laboratory supplies, in recent years, the proportion of patients who have failed an initial regimen of TB drugs, a high-risk group for drug resistance, has been steadily increasing.  In the absence of capacity to culture TB and test for drug resistance, the true extent of their need and the drugs needed to control their epidemic cannot be determined.

A nearly completed Lab room

In 2006, a joint WHO/MOPH team designated a 2500 square foot space at the #3 TB Hospital in Pyongyang for development of DPRK’s first national TB culture laboratory.  However, the space was never finished due to lack of funding.  Following visits in 2008 by MOPH officials to Stanford and by CFK to the laboratory site in Pyongyang, our organizations raised funds to purchase TB diagnostic equipment and supplies and complete needed infrastructure renovations.  During an unprecedented month-long visit this past November, CFK construction and installation teams, Stanford laboratory scientists, and their MOPH counterparts remodeled 13 rooms and installed nearly $300,000 in furnishings and diagnostic equipment.  By the end of the visit, MOPH physicians successfully tested two culture systems, the first cultures to be processed at the laboratory site.  While completion of this project should be envisioned as a 1-2 year scale up operation, and will likely require more fundraising, the November trip signifies a major milestone in a 2-year planning effort.  As we return to families and friends for the holidays, there is much for which to be thankful.  For we at Stanford, this includes the opportunity to work with CFK, and the many friendships we have formed along the way.

Lab demonstration by BATC scientist

Developing this laboratory is not unlike building a suspension bridge.  A good suspension bridge stands as a testament not only to the harmony of structure and function, but also to sheer human organization.  Geologists, mathematicians, civil engineers, divers, carpenters, cablers, cooks, and metallurgists—an entire microcosm of human society– assemble from all corners of the globe to camp out in special dormitories where they share colds as well as bathrooms, and learn that problem-solving is not an accident, but a routine.  In the end, what builds a bridge is a common vision, and the human organization that unites behind it.  Similarly, the legacy of a bridge is realized selflessly in the new connections it makes possible.

In the annals of civil engineering, what is affectionately known as “The Bridge” in San Francisco claims several distinctions that could also be applied to the DPRK national laboratory project: a lot of people said it couldn’t be done; it was funded entirely by voluntary contributions; it stuck to a schedule; and—something that certainly has not happened in bridge building since– it stayed on budget.  When the Golden Gate was completed in 1937, its chief engineer, Joseph Strauss, wrote the following stanzas that I would like to dedicate to some very special bridge-builders.  To Heidi Linton and the family at CFK, without whose vision, support, faith, and abiding love of the Korean people, the human community needed to build this laboratory, this new bridge of hope for TB patients in DPRK, would not be possible.  Like the Golden Gate, may your efforts endure as a breath-taking symbol of the human spirit.

Ask of the steel, each strut and wire,
Ask of the searching, purging fire,
That marked their natal hour;
Ask of the mind, the hand, the heart,
Ask of each single, stalwart part,
What gave it force and power.

High overhead its lights shall gleam,
Far, far below life’s restless stream,
Unceasingly shall flow;
For this was spun its lithe fine form,
To fear not war, nor time, nor storm,
For Fate had meant it so.

From The Mighty Task is Done, by Joseph P. Strauss, Chief Engineer

Golden Gate Bridge and Highway District, May 1937

The Stanford/BATC orientation workshop team

The First LIS Graduating Class!

Contributed by: Heidi Linton, Director of CFK, December 2009.

While the technical team was fully engaged in the last installation at the Kaesong TB Hospital, Dr. Marcia Kilsby and Dr. Ri (one of our North Korean guides) were conducting a week-long workshop on the use of the Lab-in-a-Suitcase (LIS) for a dozen lab professionals who work at four of our supported hospitals. Each day they participated in lectures and hands-on use of all the equipment in the Lab-in-a-Suitcase, learning how each component could help in the diagnosis and treatment of patients served by their hospitals. The lab equipment comes with a solar panel and battery that can be recharged from a variety of sources. With power unavailable at the training site for much of the training time, it was a very realistic test of the capability of the LIS under usual local conditions.  Those who participated in the training were delighted to receive a Lab-in-a-Suitcase for their hospital, and a full starter set of supplies.  Central authorities are very interested in this practical and useful project and they hope very much that we can find the necessary funding to expand this important project to many other hospitals in the future.  Each LIS costs $5,000 and we have been asked to send 200 or more of them if possible.