Greetings, one and all, and welcome back to Ask a North Korean: the NK News feature where readers can ask our defector writers about what life is really like on the ground in North Korea.

Today’s question is about the North Korean healthcare system. The official line boasts that healthcare is free for all citizens, but is this really true?

Today, Tae-il Shim answers just that question, and even tells of his own personal experience getting surgery when he was still living in the country.

Got a question for Tae-il? Email it to [email protected] with your name and city. We’ll be publishing the best ones.

North Koreans received better medical care under Kim Il Sung than they do these days.

Back then, a certain degree of medical treatment and preventative medicine was provided at no cost. For example, in the 1970s and 1980s, you could receive free medical treatment at the hospital if you hurt yourself while working at a factory or fell ill for whatever reason.

These days, the medical system only caters only to the upper classes. They have access to the number 11 general hospital (11호종합병원), the Red Cross general hospital (적십자종합병원), and the Kim Man-yu hospital (김만유병원), among others.

Namsan hospital and Bonghwa medical office (봉화진료소), in particular, exclusively serve the most privileged of this elite.

Despite the healthcare disparity between rich and poor, lofty slogans can still be found in North Korean hospitals: “devotion is the best medicine,” “socialist medicine is preventive medicine.” But such words ring hollow these days because average North Koreans see their lives as left to fate. They no longer expect anything from the government in terms of health care.

North Korea’s largely empty hospitals have no electricity or heating, so doctors performed surgeries using battery-powered flashlights (of course, such operations only take place when the patients can afford them).

Wealthier patients pay for firewood or use a self-made heater (by burning wood inside steel plates or a drum) to keep their rooms warm.

The hospital beds are the only things that still remain from the so-called medical privileges of our socialist nation.

Many doctors in their thirties or younger are unqualified, and these days no doctor works honorably or takes pride in saving lives.

Once assigned to their hospitals, they work hard to earn money so they can repay the huge bribe they gave to get their good and stable jobs.

Since there’s a lack of medical equipment and medicine in North Korean hospitals, patients must get together everything required to treat them themselves.

How much money a patient has determines whether they live or die.

When my wife and I had surgery to remove tumors, we brought everything from cotton and dressing to anesthetic (novocaine) and antibiotics (penicillin).

We also had to pay the surgeon 50~100 RMB and treat the rest of the ten members of staff to a meal at a privately-run restaurant, which serves better and more diverse dishes than those run by the state. This costs around 100 RMB, bringing the total for minor surgery to 200 RMB.

This is a huge sum of money when you consider that you only receive 10 RMB after a hard day of labor in North Korea — and that’s only when you’re lucky enough to even find a privately paying job like this.

Working at a factory, your assigned government job, wouldn’t even get you 1 won at the end of the month. The only people who are paid are those who work in the munitions industry and jointly-run Chinese companies.

But even their monthly wages only amount to 2000~3000 won — less than 5 RMB, the price for 1kg of rice. They can’t even buy one day’s worth of food with their monthly income.

Many in the lower classes habitually skip a meal or two on a daily basis — they can’t afford expensive medicine. It’s impossible for ordinary people to save up for treatment.

Only the top 1 percent actually enjoys free healthcare. Maybe 20% can afford to pay a doctor. The rest wouldn’t even dare to think of going to visit a doctor.

North Koreans see their lives as left to fate. They no longer expect anything from the government in terms of health care

It’s not unusual for people to undergo painful surgery without anesthetics to save money.

I had surgery five times when I was in North Korea. I was awake for one of those times.

One day, I was stabbed by some robbers at 3 in the morning. The machete penetrated my left lung, almost reaching my heart.

It took me an hour to struggle to the hospital. I lost so much blood that by then no more was spurting out. Much of it had gushed down and filled my shoes.

Unfortunately, only a drunken male urologist and a female nurse were staffing the emergency room. He finally woke up thirty minutes after I had arrived and told me he didn’t know how to perform the operation.

A surgeon finally arrived at 8 in the morning. Thankfully, I knew him. Seeing how dire my condition was, he quickly made a makeshift operating table by putting four chairs together and began treating my wound.

Using anesthetics and antibiotics required approval, but it was so early that neither the head of the hospital nor the pharmacy staff had arrived yet.

He cleansed the stab injury and began stitching me up. My left lung had been torn apart so I could hardly breathe, and I was unable to cough or speak. I was crying out of pain but I was barely heard by those next to me. On the sixth stitch, I blacked out.

Though the experience was a great ordeal, I was still lucky in that I did actually receive treatment.

Only after coming to South Korea did I learn that they and many international organizations have been supplying medical aid to North Korea.

However, all kinds of medicine and medical equipment end up in the hands of merchants and are sold at high prices, as opposed to being offered at the hospitals for free.

For the majority of North Koreans, who live in a world where they are forced to work for nothing in return, free medical care is something that they can’t even imagine. Most are merely concerned about what to boil the next morning if they have already corn porridge for dinner.

Translated by Jihye Park

Edited by James Fretwell