TB testing lab built in N. Korea

March 3, 2010, 1:03 a.m.

Correction: In an earlier version of this story, The Daily incorrectly reported that all 22 team members were from Stanford and the Bay Area. In fact, the team included members from outside the area.

A team of Stanford medical professors and researchers are now shedding light on a nearly unprecedented month-long trip to North Korea in November to help develop the first drug-resistant tuberculosis diagnostic lab in Pyongyang, the nation’s capital.

The team, consisting of 22 members chosen from Stanford, the Bay Area and beyond, traveled to the Communist state for a month last November in an attempt to help combat the critical health problem and improve United States-North Korea relations. Both the size of the group and the length of the visit make the trip an extremely rare occurrence for the closed nation.

“This project was an important organizational achievement for the Stanford international health community. A project like this doesn’t happen without magnificent synchronization,” said Dr. Sharon Perry, a science fellow at the Stanford Center for International Security and Cooperation (CISAC) and epidemiologist in the School of Medicine, who led the team to North Korea.

“There were no guideposts when we started, and we had to invent every step of the way,” she added.

John Lewis, a professor who directs CISAC’s Project on Peace and Cooperation in the Asian-Pacific Region, generated the idea of a tuberculosis lab in 2007 when searching for a project that could ease relations between the two countries. He partnered with Perry, who organized a team of Bay Area experts to support the cause.

Considered incurable throughout most of history, tuberculosis currently affects one in three people worldwide, with North Korea possessing one of the highest rates in the world outside of sub-Saharan Africa. Some of the same factors that caused 19th-century Americans to romanticize the disease, which causes its victims to become thin and pale, greatly heighten the risk of death in countries that have faced food shortages, such as North Korea.

The nation’s lack of inclusion in international medical dialogue exacerbates the problem. Conventional medical methods of diagnosis by microscope — the only method for which North Korea currently has the capability — only diagnoses 50 percent of cases, and cannot tell whether or not the TB strain is drug-resistant. By developing a tuberculosis culture-testing lab in Pyongyang, Stanford researchers hope to help North Korean scientists combat the killer disease on the same level as the Western world.

“There’s a huge need in that part of the world to develop international collaborative TB laboratory networks, and North Korea needs to become a part of this group,” Perry said. “I think this lab is a big step.”

In 2008, after navigating difficult legal challenges, the team successfully hosted a delegation of North Korean Ministry of Public Health officials. Perry said that while the group was highly qualified and highly trained, they were well aware of the technological disadvantages they faced while fighting the disease in North Korea.

“They knew what they didn’t know,” she said. “When we took them around to Stanford labs, they’d say, ‘Oh, this is great, but it’s so far out of our reach.’”

The first advanced team of Americans traveled to the Pyongyang site in spring of 2009 with permission from the U.S. government and the North Korean Office of Foreign Affairs. American policy places extreme restrictions on trade with North Korea, but by cooperating with the World Health Organization (WHO) and Christian Friends of Korea (CFK), a humanitarian organization, the team was able to gain authorization.

In November, the full Stanford team traveled to the site to deliver equipment, help train physicians and develop the laboratory. While the team delivered 95 percent of the lab’s equipment on their November trip, a lack of adequate electricity prevented them from completing set-up.

“They’re very good technologists; it’s just that the infrastructure is not there for basic microbiology,” said Dr. Niaz Banaei, director of the Stanford Medical Center Clinical Microbiology Laboratory.

The team will return to finish completion of the lab as soon as the municipal center provides the lab with adequate electricity.

Fourth-year medical student Eugene Yim, who traveled with the team to provide cultural support, also helped the team achieve another groundbreaking feat. North Korea has different government agencies to deal with white Americans and ethnically Korean Americans separately, and previously rarely allowed teams with members of each of those ethnicities.

“Every time I travel to North Korea, it’s definitely a learning experience because their culture is so different than ours — their way of life is so different, even sharing an ethnic heritage,” Yim said.

But these differences did not create discord between the two groups of scientists.

“They treated us all very warmly,” Yim said.

Several North Korean attendants remained with the Stanford team throughout their trip, but their movements were not greatly restricted. The team provided North Korean physicians with training for the new equipment, and Niaz believes that soon they will be highly self-sufficient. As long as food and medicine donations to North Korea continue uninterrupted, the lab could soon succeed in greatly reducing the tuberculosis rate in the region.

“Reducing the rate of an infections disease such as tuberculosis is not just dependent on a lab,” Banaei said. “You also need appropriate medicines to treat people, nutritious meals to give the patients to fight the disease as they’re getting treated. You need all the components to get an effective health care system.”

Based on the success thus far, the team is highly optimistic about the future of the lab and of reduced tuberculosis rates in North Korea based on qualified physicians operating with higher technological standards.

“North Koreans are extremely likeable people — they’re funny, they’re intelligent, so it just baffles [me] how there can be such a gulf between us. You get the feeling of a culture that can make significant contributions in the world,” Perry said.

“This lab is a good-feeling project,” she said. “Tuberculosis is an enemy without borders.”

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