Giving Until It Hurts

THE MEETING CONVENES PROMPTLY AT 2 p.m. in the Kobangsan's imposing conference room. Surveying the proceedings from just below the 16-foot ceiling are five-foot-tall portraits of North Korea's late founder, Kim Il Sung, and his son and current strongman, Kim Jong Il. On another wall is a vast mural of a snarling tiger set against a range of snow-swept mountains.

Linton, in coat and tie, unveils his schedule revisions. He produces a Eugene Bell "memento book" -- a binder with profiles of each center and the donor or donor group that supports it -- and slashes through five separate pages with a pink highlighter. (Mary Lyso, his able assistant, was unable to find the requested red marker, but the point is made.) He asks that the directors of care centers that the health ministry struck from the original schedule be gathered in Pyongyang so they can obtain their MDR kits from him.

Linton's three Korean counterparts are seated beside him in midnight-blue tukinyubus -- closed-collared tunics and matching trousers that resemble Mao suits. They take notes feverishly, and the meeting concludes with awkward handshakes and forced smiles. Linton later explains that the North Koreans agreed to restore only one care unit to the list. They said they'd consider his request about the MDR kits but couldn't make a decision yet. Thin gruel, but Linton claims a tactical victory. "Fewer visits means we'll be able to spend more time with the care centers and their staff," he says. And things may still change. "It's only a matter of time before the ministry starts getting angry calls from physicians demanding to know what happened to their shipments. Hopefully that will persuade the ministry that we must have access to those sites next year."

After dinner that evening, Linton brings the Bell delegates to his room to show them the MDR formulas. Drug resistance among tuberculosis patients is a problem anywhere treatment regimens are either improperly administered or simply not completed. Often a patient will ask to be discharged, thinking himself cured, only to return home and spread the disease to his family. Even in Pyongyang, where tuberculosis is not nearly the prolific killer it is in the countryside, the disease is frequently misdiagnosed as a persistent cold.

When patients show obvious symptoms but do not respond to medicine taken orally, doctors inject isoniazid and ethambutol, part of a common four-drug tuberculosis regimen, directly into their lungs. It is a painful process: In North Korea, the needles required are often so dulled by repeated use that they can only be inserted with pliers. And the more of the regimen the patient receives, the stronger his or her resistance becomes.

The MDR kits are stacked in a corner of Linton's room, which is cluttered with everything from stethoscopes to auto parts. There are 20 kits in all, sealed in boxes about a foot square, each costing about $1,000 and bearing the name of the patient whom, based on sputum samples Linton collected during his previous visit, it was designed to treat. If distributed, the kits will supply patients with the first third of an 18-month treatment.

Snaking out from the Kobangsan grounds the next morning, the Eugene Bell convoy -- two Mitsubishi Pajeros, a Kia sedan and a cargo truck -- prompts curious looks from ordinary North Koreans and salutes from soldiers. First stop is a warehouse district on the outskirts of Pyongyang, where international aid agencies store their goods. The road there leads past a coal mine district, where laborers draped in mantles of black dust squat not far from the roadside, scooping rice out of a bucket with cupped fingers. Nearer to the city, farmhouses give way to residential complexes -- warrens for the proletariat, many with ground-floor windows protected by security bars.

The warehouse district is located near a bus terminal and surrounded by housing blocks with corrugated steel roofs. Clustered together are Quonset huts identified by the logos of the NGOs that use them. Linton is encouraged to see Eugene Bell goods stacked neatly with the foundation's logo facing outward. He takes inventory and then distributes gifts of spare auto parts and a bicycle to the warehouse staff.

The Eugene Bell logo, a schematic image of two people in a rowboat, is a reference to a Korean folk tale about two brothers who feud with each other over an ingot of gold. When the dispute threatens to destroy their family, the siblings row out to sea and toss the gold overboard. It is a metaphor for Korea's geopolitical divide, but it could also stand for the Linton family's own breach.

In the late 1990s, as Linton was making the transition from academia to full-time aid work, two of his siblings and a close friend quit Eugene Bell in a dispute over donor solicitations. Linton was left with $10,000 and a Rolodex of donors. For a while he lived off his savings. Then his wife of 20 years left him for someone else. "All of this took place on a stage," he says, "where everyone is watching in horror and fascination and you can't just disappear."

Today, Linton lives in a Victorian-era house in the Howard County town of Clarksville spending most of his free time renovating a guesthouse on the small estate. He has since remarried.

EUGENE BELL'S FALL RESUPPLY CIRCUIT covers hospitals and care centers from the west-central part of the country north to the border with China. The group averages two resupply visits a day, and much of the time is spent on the road. The convoy passes collectives of farmers busy wrapping cornstalks into enormous hourglass-shaped bundles and storing them for fuel, and army units gathering the remains of the cabbage crop.