Counting the days

In March 2017, a multidisciplinary team returned to the Democratic Peoples’ Republic of Korea (DPRK) to evaluate and expand the hepatitis program, HOPE (Hepatitis B Overview and Program to trEat). Patients started on treatment last September returned for their bi-annual checkups, and new patients were started on the program. Despite tensions in the current external climate, we are continuing to strengthen the HOPE program and the relationships with patients and healthcare workers, as reported by Hepatitis B Free Co-Director Dr Alice Lee.

This article was originally published in the April 2016 Newsletter (English)


Clinics in the DPRK are busy, with foreign and local physicians working side by side to consult patients. Each patient attends a six monthly appointment and blood tests to ensure careful monitoring during their treatment with antiviral therapy.



This marked my tenth visit to the DPRK. Now more than ever, I realise how little I know about the lives of those we hope to help. This was the third visit for the hepatitis treatment (HOPE) program; we now have close to 500 patients on hepatitis B antiviral therapy. The focus of this trip was skills transfer and building on the relationships with the partners with whom we work. The other goal was to visit a new potential site to expand our hepatitis program. I spent the longest time in country of any trip that I had done to date, but it was still under 10 days. It was extremely long and yet, as I sit on the plane to reflect, I am not sure what happened to the time. I am sure it was the time thief at work again.

The first cohort of patients started on treatment last September were, by sheer need, the most severely sick. As we expected, there was a mixture of responses to treatment. Sadly this included patients who could not be saved from the end of long term hepatitis B complications, despite praying for otherwise. Even so, a sense of hope had returned. For many, a sense of well-being could be felt in their spirits; we witnessed a transformation in laboratory parameters and physical signs. For this, I was so grateful. We continue to work tirelessly both in country and outside with many partners and friends to ensure the growth of this program.


Dr Hillmers and Dr Lee provided health care worker training


Word spread that we are doing something quite remarkable. People clung to this and came from distant places. Some travelled over half a day to attend our clinics, negotiating transport and time off work. One patient was so unwell that I was concerned that we were too late to help. It was not an uncommon story to hear of medication bringing someone back from the brink of a dire situation. There was the heartache of having to tell patients that they likely have liver cancer for which treatment is all but impossible. There were also many joys, and seeing familiar faces has always been extraordinary.

“We count the days till your team returns,” they told us. The waiting is not only for the medicines, it is for us.


Dr Lee with a local physician



Being able to provide training in the DPRK is always such a privilege for us, but opportunities are limited for the local staff. Despite the language barrier, the local health professionals patiently put up with my basic Korean interspersed with some English phrases. At Kaesong, we continued training well into the dark at the end of a long day of clinics. I worry about the health care workers leaving late at night with little to light their way, some travelling far distances to reach home. In Pyongyang, an entire day of training still didn’t seem like enough. Despite fatigue from the full day, when we offered, they were eager to continue the training. Everyone went home well after dark. We felt content that the minds of the local doctors were filled with new and exciting information.


Training from Dr Lee and Dr Hillmers continued into the night


We achieved much, despite many challenges. There is a real sense of partnership and deepening trust with our counterparts. Above else, we must continue striving to nurture these relationships. There are images imprinted in me that I cannot describe in words. Much of what I thought I knew about the DPRK remains true, but life is more complex than I can imagine. Despite having been in country, talking to people, seeing it and feeling it, there is so much that I do not know. Perhaps as I witness a little more each time, what I see most is the complexity. Nevertheless, there is some absolute clarity – we are loved, wanted, and perhaps even needed. I am counting the days until our next trip.

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