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Stanford health experts help develop North Korea’s first drug-resistant tuberculosis diagnostic lab
PALO ALTO, Calif.—In an unprecedented move to collaborate with a foreign power and jointly fight the spread of a life-threatening disease, Stanford University professors have broken new ground by trekking through North Korea to initiate the installation of a diagnostic lab to test drug-resistant tuberculosis.
This is no easy feat, since hospitals in the rural areas lack modern equipment and supplies and must ration electricity and heat. Doctors and technicians use 50-year-old antiquated X-ray machines that cause them radiation burns, while patients lay on cots in coats waiting for surgery that must wrap up before the sun goes down.
Making the situation worse is the weakened health of the North Korean people. After famines plagued North Korea in the 1990s, the country witnessed a resurgence of tuberculosis—but this time, the disease has been resistant to antibiotics. Stanford's TB project seeks to strengthen the country's ability to detect all forms of the disease and support its treatment and control.
A U.S. team, led by Stanford epidemiologist Sharon Perry, recently returned from North Korea. The project is headed by the Bay Area TB Consortium, which Perry directs, and the Nuclear Threat Initiative (NTI), a Washington, D.C.-based nonprofit group working to strengthen global security.
Ironically, it was a North Korean contingent of doctors who visited California in 2008, thus making the first move toward launching the TB Diagnostics Project. The doctors met with Stanford and Bay Area tuberculosis experts and together came up with a plan.
"This effort represents an unprecedented level of cooperation between the U.S. partners and the North Korean Ministry of Public Health," says John Lewis, professor emeritus at CISAC.
Perry, who is also a senior research scientist for Stanford's Center for International Security and Cooperation (CISAC), which helps policymakers address North Korea's nuclear program and denuclearization of the peninsula, agrees that "the new laboratory will fill a critical gap in North Korea's TB control program."
Gary Schoolnik, Stanford professor of medicine and senior physician on the team, adds, "Without these services, considered the standard of care in the West, only about 50 percent of TB is detected, and the types of drugs needed to effectively treat the disease cannot be determined."
Former U.S. Sen. Sam Nunn (D-Ga.), co-chairman of the NTI's Global Health and Security Initiative, says, "With the emergence of drug-resistant forms of TB, international cooperation is essential, and this work is vital to reduce biological risks and advance health security. The impact in economic and security terms is very costly, particularly for countries with limited resources. The burden could be catastrophic in the event of a major epidemic or global pandemic causing widespread disruption and human suffering."
The Stanford-led team also includes Niaz Banaei, assistant professor and director of the School of Medicine's Microbiology Laboratory, medical student Eugene Yim and two senior microbiologists from a California public health laboratory. The group worked with Louise Gresham, director of NTI's Global Health and Security Initiative, to deliver and install equipment and supplies to the Pyongyang TB Hospital laboratory.
U.S. participants also include a technical lab team and Christian Friends of Korea, a humanitarian group operating in North Korea for 15 years. The volunteers conducted orientation workshops with scientists and doctors from the Ministry of Public Health. Donated equipment and supplies will be used at the Central Tuberculosis Institute for culture and drug susceptibility testing services for TB patients.
Longtime missionary Stephen Linton, director of the Eugene Bell Foundation, visited several sites in North Korea in 2007 to drop off medical equipment. Linton delivers his supplies personally, lest they be diverted or end up on the black market.
As the son and grandson of Christian ministers, Linton spent most of his youth in South Korea, he says. Linton speaks flawless Korean, gaining his entry into "one of the world's most forbidding and totalitarian regimes with strategic gifts: tuberculosis drugs for the elites (in Pyongyang, the disease carries a social stigma that can ruin a career)."
South Korean sources suggest that tuberculosis has affected as much as 5 percent of North Korea's population of 23 million. Linton's foundation has treated up to 250,000 patients, 70 percent of whom might have otherwise died.
The Stanford team hopes its efforts can rival Linton's and do even better with the help of North Korea's new diagnostic lab.