Correction to This Article
This article about hospitals in North Korea incorrectly referres to "the late evangelist Billy Graham." Graham, 89, lives near Asheville, N.C.

Giving Until It Hurts

By Stephen Glain
Sunday, March 9, 2008

STEPHEN LINTON IS BEING HUSTLED THROUGH THE DARKENING CORRIDORS of Hadan Tuberculosis Hospital in western North Korea. It took him three hours to get here from Pyongyang, the capital, which is linked tenuously to Hadan by 50 miles of deeply rutted and washed-out roads. A diminutive man with a craggy face and patrician silhouette, Linton has just finished unloading a cache of medical supplies, and now the hospital director, who wears a white lab coat and a head covering that could double for a baker's hat, wants him to observe a surgery. But they'll have to hurry: It's already late in the November day and, in a country where electricity is tightly rationed, a surgery's outcome can hinge on how much sunlight is pouring through operating room windows.

With orderlies and aides struggling to keep up, the two men canter through the hospital's drafty administrative building, with its faux-Palladian facade and faded, royal-blue window shutters, and across the dry empty fields that envelop the compound. The operating room is a two-story concrete blockhouse; to get to its main entrance, visitors must pick their way through spent oxygen tanks strewn along the pathway.

The patient is a young woman whose lower spine has been corroded by tuberculosis. She is lying on her side on the operating table, and an orderly is coating her lumbar region with disinfectant iodine. The surgeons will try to repair the damaged vertebra by grafting onto it a slice of bone taken from the patient's pelvis. There is no heat. Barring complications, the operation should take two hours, which would be plenty of time during the summer months, but could be a close call this late in the year.

Linton, 57, stops to peer through a window from the operating room's antechamber.

"I've seen doctors who tried to capture sunlight by reflecting it from a mirror," he says.

By North Korean standards, the patient is fortunate. She's been given a local anesthetic, which is rare in a country where surgeons routinely etherize patients, strap them down and try to finish the operation before they come to. The operating table is less than a year old, as are the surgeon's instruments and the handcarts on which they're arrayed. Also new are the hospital's X-ray machines, electrocardiogram, oxygen tanks and wheelchairs. All this is courtesy of Linton's Eugene Bell Foundation, a Maryland-based nongovernmental organization that has spent the past decade battling a raging tuberculosis epidemic in areas of North Korea where few foreigners have been allowed to travel.

It's not easy work. Of the 36 NGOs that began operations in North Korea as famine gutted the rural population in the mid-1990s, all but a handful have left in frustration. And Linton is particularly demanding: He insists on delivering his supplies personally, lest they be diverted to another facility or end up on the black market. When government officials balk, Linton refuses to resupply the site. So each of his two resupply visits annually is preceded by lengthy and sometimes rancorous negotiations. "Our donors feel very passionate about where their money goes," Linton says. "A lot of them are part of the Korean diaspora, and some are even from North Korea, and they know exactly what kind of facilities they want to help."

It has taken Linton years of resupply missions to build a redeemable store of trust with the North Korean government. On this visit, he has brought with him the first cycle of medicine for tuberculosis victims who have become resistant to the drugs most commonly prescribed for the disease -- a condition known as multidrug resistance, or MDR. Success hinges on Linton's direct access to the patients -- including ones at care centers near remote military bases and other sensitive areas. Without that, he'll take the MDR kits back with him to Seoul.

"What strikes me about Steve is his ability to persevere in a system that does not work well and maintain the integrity to say, 'No,'" says Charles "Jack" Pritchard, who, as a former special envoy for negotiations with North Korea and a member of the National Security Council, has known Linton for years. "He's had problems from Day One, but he's overcome."

The progeny of several generations of Christian missionaries, Linton spent most of his youth in South Korea. He speaks flawless Korean, marshaling it to shame obstructive bureaucrats in Pyongyang, charm hospital staffs in Kosong and bring assemblies of donors in Seoul to tears. He has insinuated himself 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) and, say, rebuilt carburetors for parts-starved truck drivers.

South Korean sources suggest that tuberculosis has affected as much as 5 percent of North Korea's population of 23 million. Linton estimates the Eugene Bell Foundation has treated up to 250,000 patients, 70 percent of whom might have otherwise died. The foundation has a staff of seven full-time and three part-time employees, and it raises $2 million to $3 million annually. But for him, personally, the work has come with some costs: estrangement from his family, a divorce.

Health risks are ever-present. At each site, Linton interviews tuberculosis victims for a videotaped log that will be featured in his next presentation to potential donors. He's frequently warned by his North Korean minders, physicians who accompany him from site to site, to wear a mask, but he refuses.

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