Giving Until It Hurts

The roads are lined with the ligaments of a sclerotic state: laborers shouldering homemade shovels and pickaxes, youth-brigade members, soldiers, students, oxen-drawn carts, swarms of bicyclists. Vehicular traffic consists of military convoys, the occasional passenger car smuggled in from China and a contraption known as a moktan cha, or "charcoal truck," which is powered by cornstalks converted into carbon monoxide by a retrofitted burner. A similar technology was employed by taxis in postwar Japan, according to Linton, who is something of a gearhead.

Despite its poverty, the North Korean countryside displays a tidy bucolic tableau: rows of squat farmhouses with whitewashed plaster walls trimmed in apricot or blue, and dried cornhusks suspended above the entryway. Children attempt to ice-skate across frozen rice paddies. Thrust among these delicate vignettes are imposing billboards and monuments, usually superimposed with portraits of Kim Il Sung, imploring citizens to struggle, to resist, to endure, to work hard, to observe clean work habits, to smile.

The site visits assume a familiar rhythm. Fresh supplies are stacked neatly in front of the administration offices with the Eugene Bell logo clearly visible. Unboxed goods, such as wheelbarrows and tractors, are lined up nearby. Aside from international inspections of Pyongyang's nuclear facilities, the Eugene Bell resupply tour could be North Korea's most thoroughly documented event. Once the Bell delegation arrives, Linton performs what he calls a "hello-how-are-you" shot, a brief videotaped exchange with the facility's director and a quick explanation of what supplies are being delivered and who donated them. Staff members are summoned to hold banners with the donor's name in front of the shipment, or attach stickers with the proper logos onto each box. When the cargo is funded by several donors, teams of staff members are rotated before the cameras with the appropriate banners. Every delivered item is accounted for on a manifest that is signed on camera by the site director. It is an exhausting archive of data and images that over the next several months will be edited and collated to create both a report for each donor and a memento book that Linton will present to the hospital or sanatorium on his next visit, complete with extra photos for the staff.

On the fourth day of the tour, Linton and his delegates stop at the Kosong People's Hospital, a whitewashed building with rounded corners and neatly painted gray windowpanes. A team of physicians in threadbare, stain-spattered scrubs escorts them into the head office and sits down at a long table that extends perpendicularly from the director's desk, which is set parallel to the wall opposite the doorway. Above the desk are framed photos of the elder and younger Kims. On the desktop are two phones from the Sputnik-era East Bloc and a day-per-page datebook made of coarse recycled paper. (During the two-week tour, the delegates are received by 12 directors, and each office is identical to the other. The telephones rarely ring, and the daybooks are blank.)

The Bell delegates are treated to helpings of sweet potatoes and whole chestnuts, peanuts in their shells, apples and tea. Like the rest of the facility, the office is unheated, so coats stay on. Linton sits closest to the director as, for about an hour, the two men discuss the hospital's future needs. The meeting could be wrapped up in less time, but Linton doesn't want to risk appearing rude. By the end of the discussion, two small pyramids of potato peels and chestnut skins have accumulated on the desk before him.

The director then escorts the delegation on a tour of the hospital and its equipment, much of which predates the Cuban missile crisis. Like most hospitals and care centers in North Korea, the facility employs a direct-fluoroscopy machine, an X-ray device that irradiates the patient from behind while the doctor examines an image projected on a fluoroscopic plate of glass between them. "The negative is the doctor's retina," says Linton, who frequently admonishes physicians for submitting themselves to the machines' potentially fatal doses of radiation. Most physicians in North Korea use them regularly, and suffer the consequences. The radiologist at Kosong, for example, has receding gums and low hemoglobin, common signs of radiation sickness. Three of his colleagues have died over the years -- one from radiation overdose, another from cancer and a third from tuberculosis.

Like their counterparts throughout a country isolated by international sanctions, the physicians at Kosong have become expert scavengers and foragers. They fashion their own surgical instruments with the help of local blacksmiths. The hospital's

tuberculosis wards -- long, narrow dormitories warmed by wood stoves -- share space with thickets of cotton plants that provide the fibers needed for gauze or bandages. A common Eugene Bell donor item is plastic sheeting for greenhouses to nurture fresh vegetables and other produce for the patients' nutritional needs. Physicians even harvest one another: Earlier, the director and three of his colleagues had lowered their trousers to reveal fresh scars on their inner thighs where patches of flesh had been sliced away to be used in skin grafts.

One thing North Korea's medical community cannot jury-rig, however, are medical textbooks. When Linton opens a carton of South Korean books, Kosong staff members set upon them hungrily. Forty minutes later, when orderlies are asked to gather the books for registration with the health ministry, a nurse holds hers tight to her chest, clearly loath to relinquish it.

Before saying goodbye, Linton inspects the hospital's emergency vehicles, bantering with the maintenance crew as he distributes fresh shock absorbers and air filters. In mock reproach, he scolds a mechanic for having dirty fingernails, then rewards him with a wristwatch for keeping detailed service records. The damaged auto parts have already been removed and sorted on a burlap sack, like freshly removed organs.

Linton will take these back with him to Seoul. "Otherwise," he says, "they'll end up in some black-market stall."

THE IMAGES THAT MELT LINTON'S DONORS' HEARTS is footage of him interviewing tuberculosis patients in their wards. With a practiced hand, he pins a microphone on the patient's clothing -- more often than not Eugene Bell-issued pajamas -- and begins a short interview. At a sanatorium in Dongdaewon on the eighth day of the tour, Linton meets a 27-year-old woman who contracted tuberculosis after her discharge from the military. She was diagnosed in a city hospital and sent to the care unit after she failed to respond to treatment, which suggests MDR.