Exporting Fakes?

North Korean Clinics Hawk Questionable Medical Care to Tanzania

Part 2

At a clinic in the Kariakoo ward of Dar es Salaam’s Ilala district, a North Korean doctor in his mid-50s speaks with his patient in Swahili, the official language of Tanzania, while checking the man’s blood pressure and blood sugar levels inside of a poorly lit examination room. A female nurse joins the doctor and records other vital signs before the patient is led to the reception area, where he pays in cash and receives his medical records. Credit cards are not accepted. The patient exits the clinic onto a street strewn with trash amid small factories operating clanging machinery—hardly an ideal environment for providing medical treatment. The clinic is just one of four operated by medical staff sent by authorities in North Korea to Tanzania’s commercial capital to earn foreign currency for the regime in Pyongyang.

In late 2015, a reporter from RFA’s Korean Service traveled to Tanzania and obtained video footage secretly filmed earlier in the year by a local resident, showing the conditions inside the clinic and others like it. In another clip, the resident visits the longest-serving North Korean clinic in Tanzania, located in the Magomeni ward of Dar es Salaam’s Kinondoni district. On the wall outside of the clinic is a sign that reads, “My Country is the Best” in large Korean characters.

A female receptionist introduces the clinic’s doctor as her husband, who greets the resident in Swahili, while patriotic North Korean songs blare forth from a television in the corner. An investigation of the restroom attached to the clinic’s reception area reveals extremely unsanitary conditions. After proceeding down the hall for treatment, the resident enters a room where a filthy mop leans against the wall near an examination table. The room appears to lack an air conditioner or fans and registers a temperature of 37C (98.6F), forcing an attending female nurse in her 50s to continuously wipe the sweat from her brow. Once the resident receives a diagnosis, the nurse retrieves medicine from a closet and a desk drawer, and fills several small paper packets with the powders. Spilled medicine is picked up and placed back into the packets by hand, without regard to hygiene.

The Temeke Clinic

A visit to Tanzania’s largest North Korean clinic, located in the Temeke ward of Dar es Salaam’s Temeke district, reveals slightly better conditions. The reception area boasts several sofas for waiting patients and the restroom is relatively clean. However, the room lacks air conditioners or fans, so patients are forced to wait outside where the air is only marginally cooler. A female doctor at the clinic who appears to be in her late 20s or early 30s prescribes Chinese medication used to treat erectile dysfunction to patients who are suffering from heart disease, saying it will help treat their symptoms.

Close Relations

Despite maintaining a national health care system, Tanzania lacks a sufficient number of hospitals, pharmacies, and medical staff. North Korea, which has longstanding ties with Tanzania, has capitalized on that need by building 12 clinics throughout the African nation since 1991 and dispatching around 100 doctors and nurses each year to staff them. A retired local official told RFA that the Tanzanian government fully endorsed the North Korean clinic program in 1994.

“A North Korean organization called Juche carried the project forward after establishing a relationship with Tanzania’s ruling Revolutionary State Party,” or Chama Cha Mapinduzi (CCM), he said, speaking on condition of anonymity. “That is how North Korean clinics started to occupy spaces in the Dar es Salaam region.”

But according to local media, unsanitary conditions in the clinics, as well as incorrect diagnoses and prescriptions by medical staff, have done more harm than good for residents. Tanzania’s Nipashe daily newspaper, which has been investigating North Korean clinics in the country since the beginning of last year, reported that staff routinely prescribe medications containing high percentages of lethal heavy metals to patients, in addition to committing other forms of malpractice. Nipashe quoted Danny Kauka, a specialist in Tanzania, as saying that North Korean clinics often incorrectly use herbal remedies to treat kidney disease and other serious illnesses that require specific medical treatment. Local media also report that when doctors and nurses at North Korean clinics determine a patient is wealthy, they regularly pressure them to purchase costly nutrient supplements and other items that are unnecessary for their health.

Additionally, North Korean clinics fail to include labels for the ingredients, side effects, expiration dates, and methods of treatment on the drugs they prescribe, despite laws requiring that the information be present on all medication sold or distributed in Tanzania—including herbal medicines. Tanzania’s Swahili-language Mwanachi daily newspaper reported last year that because the herbs used in medicines prescribed by North Korean clinics do not grow naturally in the country and lack either English or Swahili names, they should be required to undergo toxicological tests before they can be imported.

Our reporters met with the family of the victim who was featured in an article published on May 17th edition of Tanzania’s daily, Nipashe. An athletic 19 year-old, Gabriel Shayo who used to be called a soccer prodigy, went to a North Korean clinic with a hacking cough and chest pain. The problem was the fact that his family had been taken in by their neighbor, who told them the “Korean Clinic” would take good care of Gabriel’s illness. At first there seemed to be a bit of an improvement in his condition, but even after more than a month of taking the medication that the clinic gave him, the symptoms didn’t go away. Gabriel’s parents not only had to give the drugs that the clinic prescribed to their son but were coerced to buy expensive herbal medicine they had never even heard of.

Patients say that North Korean doctors also frequently administer minor electroshock treatments to various parts of their bodies using “low frequency therapeutic devices,” regardless of what symptoms they are experiencing and without any prior medical examination or testing. But few patients are well-informed about their medical problems and agree to pay hefty sums, assuming that the clinics will provide better treatment than those run by Tanzanian medical practitioners. One woman, whose son nearly died from tuberculosis after being misdiagnosed and receiving a lengthy treatment at a North Korean clinic, told RFA that the facility should be shut down by authorities.

“It was really painful to take my son to the North Korean clinic every day for six months [and not see any improvement], but there was nothing I could do because he was on a course of medication,” said the woman, who also declined to be named.

“Had I taken him to a good hospital sooner, the symptoms would not have become so serious. The North Korean clinic must be closed immediately and its administrators taken to court.”

Substantial earnings

Treatment at North Korean clinics generally costs between U.S. $10 and $100—a substantial amount of money in Tanzania, which has a gross national income per capita of U.S. $920, according to the most recent statistics from the World Bank. But for those who appear to be wealthy, doctors at North Korean clinics generally prescribe dried ginseng and other herbal medicines which they say are necessary for a quick recovery at a cost of more than U.S. $200 and pressure patients to purchase the items. Additionally, North Korean clinics admit patients even after consultation hours are over in a bid to earn more foreign currency and sell costly medicines. Through these methods, the clinics earn around U.S. $1.3 million each year in Tanzania—90 percent of which is sent home to authorities in North Korea. While authorities in Tanzania do not consider the clinics to be operating illegally, nongovernmental organizations in other countries in Africa are taking action against doctors sent by North Korea’s regime for similar practices.

Infographic by Vincent Meadows

In Mozambique, where Pyongyang has dispatched more than 150 medical workers, international healthcare watchdog Forum of Angolan Non-Governmental Organizations (FONGA) last year lodged a complaint with minister of health Nazira Abdula over what it called “wrongful medical practices” by North Korean doctors in the country and demanded their expulsion. According to the complaint, North Korean doctors in Mozambique have solicited bribes from and blackmailed patients and their families, provided treatment in their own homes against government regulations, and authorized unlicensed employees to administer care to reduce the working hours of their medical staff. One doctor in particular—Chang-ho Jeon—was even found to have collected an “express charge” in exchange for moving patients up on a list of surgeries he was to perform.

Oversight

According to Tanzania’s tax law, all foreign clinics “must issue receipts after treating patients and when this is violated, it will be considered illegal and the concerned party will be punished.” North Korean clinics do not issue receipts after receiving payment from patients, but authorities have failed to conduct a proper investigation into whether they are involved in tax evasion. One local journalist, who spoke on condition of anonymity, told RFA that North Korean clinics avoid scrutiny because they are partially owned by members of the ruling CCM.

“The health authorities say that they are aware of the complaints residents make about North Korean clinics and even promised the people that they would investigate the situation through local officials, but the probe never took place,” he said.

“That is why we have no choice but to conclude that there is a close relationship between North Korean clinics and local officials.”

The journalist said that North Korean clinics leverage their relationship with members of the CCM to avoid cooperating with investigations by the authorities and local media. A local resident of Dar es Salaam with knowledge of the situation confirmed that the clinics had the backing of Tanzania’s powerful ruling party.

“The North Korean Embassy in Dar es Salaam is located close to the CCM headquarters,” said the resident, who declined to be named.

“North Korea and the ruling party of Tanzania are operating these clinics together.”

While the public has called on the government to take action against North Korean clinics for malpractice, irregular operations, and illegal activities, residents say a new clinic was established last month near the North Korean Embassy advertising treatment for “various kinds of diseases using conventional medical treatments.”

Reported by Albert Hong for RFA’s Korean Service. Translated by Min Kyung Kang. Written in English by Joshua Lipes.