Category Archives: economics

by | 19 February 2015 · 5:06 am

UN Occupies Cambodia, 1992

From Cambodia’s Curse: The Modern History of a Troubled Land, by Joel Brinkley (Public Affairs, 2011), Kindle Loc. 144-165, 1178-1197:

In fact, the Cambodian “war” had ended in 1979, more than a decade before the UN occupation began. An old leader had regained his strength while new ones had emerged. Prince Norodom Sihanouk, the consummate self-interested monarch who was extremely popular with most of the Cambodian people, had ruled Cambodia since 1941, until a military coup deposed him in 1970. The Khmer Rouge brought him back as their titular head of state—though he was imprisoned in his palace during their reign. Then, as the UN troops began arriving in 1992, they made him honorary king again. But he wanted nothing less than his old job back—the all-powerful monarch, just like the kings who had ruled Cambodia since the beginning of time. Now, however, he had competitors.

During the Vietnamese occupation, from 1979 to 1989, a young Khmer Rouge officer named Hun Sen was named prime minister. He was barely educated, but clever and utterly ruthless—as one might expect of a young man trained by the Khmer Rouge and then the Vietnamese military. The prime minister’s job was handed to him in 1985; he was not about to give it up.

A third competitor arose, Norodom Ranariddh, one of Sihanouk’s sons. He had led a hapless guerrilla organization, funded by the United States. Its goal was to drive the Vietnamese and their appointed government, including Hun Sen, out of the country. After Vietnam pulled out, Ranariddh coveted power too. He seemed to know or care little about governance. But as prime minister, he knew he would be able to enrich himself. Ranariddh was not as clever as Hun Sen, but he was of royal lineage, which gave him a strong advantage.

So, past examples like Germany and Japan—even South Korea—simply were not useful models for this grand experiment. In fact, the Cambodian venture was unprecedented. Even before the UN troops left, the three aspiring leaders were grappling for power, as if the UN election had never taken place. Their contest lasted many years.

The troops may have left, but the United Nations was still there, running a phalanx of charitable organizations—UNICEF, UNESCO, the World Food Program (WFP), and the rest. The United States Agency for International Development (USAID), the World Bank, and other major relief agencies from around the world worked alongside the UN. In fact, in time, 2,000 different donors and nongovernmental organizations (NGOs) set up shop in Cambodia. As the power struggles grew heated, even violent, the government grew ever more corrupt, and the donors began pushing the leaders to live up to their promises, to serve their people.

Hun Sen, Ranariddh, and the king offered little more than lip service to those demands, but that seemed to be enough. The donors kept giving money, hundreds of millions of dollars, year after year—even as the nation headed for a military showdown to settle the power struggle once and for all.

…

If anyone had doubted Hun Sen’s true intentions, he made them clear during the first Paris Peace Conference, in 1989, when he declared, “You can talk about sharing power in Paris, but not in Cambodia.” Vietnam had handed him the nation in 1985. He had ruled it uncontested for seven years. He would not step down or share his throne without a fight. And now, with wide reportage of the bamboo-pole incident [in which UN representatives were turned back at a bamboo-pole roadblock], Hun Sen and everyone else realized that the UN was not to be feared. It was nothing more than a paper force. A correspondent for the Far Eastern Economic Review, reporting from Cambodia at the time, put it this way: “The Cambodian people believed that the UN blue berets were like Jupiter threatening to unleash lightning against the Khmer Rouge. What do people see? UNTAC pulls back.”

The fact remained that the Khmer Rouge had not been defeated. The UN’s deputy military commander, Michael Loridon, a French brigadier general, urged his commander to attack and “deal with the Khmer Rouge problem once and for all.” That never happened, though the debate continued for years, until the last UN officer boarded a plane home. From the first days of the UN occupation, everyone knew that over ten years the Vietnamese army, with hundreds of thousands of troops, had never been able to defeat the Khmer Rouge. So what could the UN possibly do now?

By December 1992, more than a year after the Paris Peace Accords, the United Nations finally had its full force of soldiers and administrators in country. They were too late. Every Cambodian already knew that Jupiter had never climbed up the mountain. Pol Pot and Hun Sen were ignoring the UN and facing no penalty. But the truth was, the UN force offered a great deal more than the prospect of military reconciliation. Most Cambodians loved having them in town.

The visitors spent money, more money, and then more money still—$3 billion in all. Every staffer was given a daily living allowance of $145 on top of his salary—a year’s income for most Cambodians. Contractors had quickly put up apartment buildings and now were taking in $2,000, $3,000 a month—ridiculously high rents for Phnom Penh. Hotels were full, and new ones were under construction. Anyone who’d ever had a fleeting thought of running a restaurant scrambled to open one. Everyone with a car hired himself out as a driver. Brothels worked overtime; UN doctors treated thousands of their men and women for sexually transmitted diseases. Liquor vendors couldn’t keep up with demand; restaurant and bar owners had to replace fixtures and furniture broken in drunken brawls almost every evening. UN vehicles and equipment routinely disappeared in the night, but no one was sure whether the thieves were Cambodian or renegade UN employees.

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Filed under Cambodia, democracy, economics, military, NGOs, U.N., U.S.

by | 14 February 2015 · 10:55 am

Nationalist, not Moralist, Conflict in Asia

From Asia’s Cauldron: The South China Sea and the End of a Stable Pacific, by Robert D. Kaplan (Random House, 2014), Kindle Loc. 322-333, 585-592:

There is nothing romantic about this new front line. Whereas World War II was a moral struggle against fascism, the Cold War a moral struggle against communism, the post-Cold War a moral struggle against genocide in the Balkans, Africa, and the Levant, as well as a moral struggle against terrorism and in support of democracy, the South China Sea shows us a twenty-first-century world void of moral struggles, with all of their attendant fascination for humanists and intellectuals. Beyond the communist tyranny of North Korea, a Cold War relic, the whole of East Asia simply offers little for humanists. For there is no philosophical enemy to confront. The fact is that East Asia is all about trade and business. Even China, its suffering dissidents notwithstanding, simply does not measure up as an object of moral fury.

The Chinese regime demonstrates a low-calorie version of authoritarianism, with a capitalist economy and little governing ideology to speak of. Moreover, China is likely to become more open rather than closed as a society in future years. China’s leaders are competent engineers and regional governors, dedicated to an improving and balanced economy, who abide by mandatory retirement ages. These are not the decadent, calcified leaders of the Arab world who have been overthrown. Rather than fascism or militarism, China, along with every state in East Asia, is increasingly defined by the persistence, the rise even, of old-fashioned nationalism: an idea, no doubt, but not one that since the mid-nineteenth century has been attractive to liberal humanists.

…

Truly, in international affairs, behind all questions of morality lie questions of power. Humanitarian intervention in the Balkans in the 1990s was possible only because the Serbian regime was not a great power armed with nuclear weapons, unlike the Russian regime, which at the same time was committing atrocities of a similar scale in Chechnya where the West did nothing; nor did the West do much against the ethnic cleansing in the Caucasus because there, too, was a Russian sphere of influence. In the Western Pacific in the coming decades, morality may mean giving up some of our most cherished ideals for the sake of stability. How else are we to make at least some room for a quasi-authoritarian China as its military expands? (And barring a social-economic collapse internally, China’s military will keep on expanding.) For it is the balance of power itself, even more than the democratic values of the West, that is often the best preserver of freedom. That also will be a lesson of the South China Sea in the twenty-first century—one more that humanists do not want to hear.

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Filed under China, democracy, economics, energy, Japan, Korea, military, nationalism, philosophy, Russia, Southeast Asia

by | 14 February 2015 · 10:52 am

Geostrategic South China Sea

From Asia’s Cauldron: The South China Sea and the End of a Stable Pacific, by Robert D. Kaplan (Random House, 2014), Kindle Loc. 222-253:

The South China Sea functions as the throat of the Western Pacific and Indian oceans—the mass of connective economic tissue where global sea routes coalesce. Here is the heart of Eurasia’s navigable rimland, punctuated by the Malacca, Sunda, Lombok, and Makassar straits. More than half of the world’s annual merchant fleet tonnage passes through these choke points, and a third of all maritime traffic worldwide. The oil transported through the Malacca Strait from the Indian Ocean, en route to East Asia through the South China Sea, is triple the amount that passes through the Suez Canal and fifteen times the amount that transits the Panama Canal. Roughly two thirds of South Korea’s energy supplies, nearly 60 percent of Japan’s and Taiwan’s energy supplies, and 80 percent of China’s crude oil imports come through the South China Sea. Whereas in the Persian Gulf only energy is transported, in the South China Sea you have energy, finished goods, and unfinished goods.

In addition to centrality of location, the South China Sea has proven oil reserves of seven billion barrels, and an estimated 900 trillion cubic feet of natural gas. If Chinese calculations are correct that the South China Sea will ultimately yield 130 billion barrels of oil (and there is some serious doubt about these estimates), then the South China Sea contains more oil than any area of the globe except Saudi Arabia. Some Chinese observers have called the South China Sea “the second Persian Gulf.” If there really is so much oil in the South China Sea, then China will have partially alleviated its “Malacca dilemma”—its reliance on the narrow and vulnerable Strait of Malacca for so much of its energy needs coming from the Middle East. And the China National Offshore Oil Corporation has invested $20 billion in the belief that such amounts of oil really do exist in the South China Sea. China is desperate for new energy. Chinese oil reserves account for only 1.1 percent of the world total, while it consumes over 10 percent of world oil production and over 20 percent of all the energy consumed on the planet.

It is not only location and energy reserves that promise to give the South China Sea critical geostrategic importance, it is the territorial disputes surrounding these waters, home to more than two hundred small islands, rocks, and coral reefs, only about three dozen of which are permanently above water. Yet these specks of land, buffeted by typhoons, are valuable mainly because of the oil and natural gas that might lie nearby in the intricate, folded layers of rock beneath the sea. Brunei claims a southern reef of the Spratly Islands. Malaysia claims three islands in the Spratlys. The Philippines claims eight islands in the Spratlys and significant portions of the South China Sea. Vietnam, Taiwan, and China each claims much of the South China Sea, as well as all of the Spratly and Paracel island groups. In the middle of 2010 there was quite a stir when China was said to have called the South China Sea a “core interest.” It turns out that Chinese officials never quite said that: no matter. Chinese maps have been consistent. Beijing claims to own what it calls its “historic line”: that is, the heart of the entire South China Sea in a grand loop—the “cow’s tongue” as the loop is called—surrounding these island groups from China’s Hainan Island south 1,200 miles to near Singapore and Malaysia. The result is that all of these littoral states are more or less arrayed against China, and dependent upon the United States for diplomatic and military backing. For example, Vietnam and Malaysia are seeking to divide all of the seabed and subsoil resources of the southern part of the South China Sea between mainland Southeast Asia and the Malaysian part of the island of Borneo: this has elicited a furious diplomatic response from China. These conflicting claims are likely to become more acute as energy consumption in developing Asian countries is expected to double by 2030, with China accounting for half of that growth.

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Filed under China, economics, energy, industry, Japan, Korea, nationalism, Southeast Asia, Taiwan

by | 8 February 2015 · 2:56 pm

Deng Xiaoping in Singapore

From Asia’s Cauldron: The South China Sea and the End of a Stable Pacific, by Robert D. Kaplan (Random House, 2014), Kindle Loc. 1569-1586:

In the heart of Singapore, along the Singapore River, near to the perfectly engineered design statement that is the Asian Civilizations Museum, stands a diminutive and elegant monument to the late Chinese leader Deng Xiaoping. Deng was arguably among the greatest men of the twentieth century, because he dramatically lifted the living standards of close to a billion people throughout East Asia by introducing a version of capitalism to the Chinese economy. No man in history improved the quality of life for more people in a shorter time than Deng. But Deng elicits mixed feelings in the West. He was a ruthless authoritarian, who was the driving force behind the massacre of perhaps thousands of protesting students at Tiananmen Square in Beijing in 1989. Only in Singapore would he be so openly honored—at so appropriate a measured level, and for the right reasons. “Singapore has raised pragmatism to the level of a philosophy,” explained retired local diplomat Tommy Koh, whose idea it was to erect the monument to Deng. Singapore, he told me, stands against the beauty of ideas in favor of what works.

Standing next to the monument to Deng, I looked out at downtown Singapore: a dull grayish and blue-slate corporate park built on the scale of a megacity, the product of a meticulous mind, with sharp puzzle pieces of skyscrapers all neatly fitting together, maddening in their mathematical logic. At work was the abstract genius of the Chinese, who understand the conceptual utility of empty spaces; as opposed to the Indianized Malay mind, which is more at home in the world of thickly colored and deliciously cluttered textiles, with their floral and cartouche patterns (as evidenced by the displays in the nearby museum). But to call Singapore cold and impersonal is too easy a judgment. For everywhere there is civilizing greenery, starting with the dazzling bougainvillea bushes that line the road from the airport. Singapore is the only place in the Indo-Pacific, other than Japan, where traffic stops voluntarily for pedestrians.

At the end of history there is somnolence: that is the lesson of Singapore. Pragmatism carried to the furthest degree may not inspire the Western humanist mind, but it has been the only way for Singapore to survive as a physical speck of a city-state at the southern tip of the Malay Peninsula, whose location is coveted by the great powers. Singapore’s inner logic follows from its geographical vulnerability.

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by | 3 December 2014 · 7:36 am

Burmese Junta’s Policies toward Minorities

From Where China Meets India: Burma and the New Crossroads of Asia, by Thant Myint-U (Farrar, Straus and Giroux, 2011), Kindle Loc. 1569-1581:

In a way, the Burmese army’s policies towards their opponents were the direct opposite of the policy of Western governments towards the ruling junta. Western governments had employed economic embargoes and diplomatic isolation, hoping that by shunning the Burmese generals, the generals would eventually come around. They didn’t. The Burmese army employed very different tactics. They fêted their erstwhile foes, calling them ‘leaders of the national races’. They took them to the big cities, created new desires and allowed them to enrich themselves. Business links, even illicit ones, were actively promoted. They did this knowing that it would sap the insurgents’ strength as fighting organizations. By 2010 the Burmese army was in a far stronger position than when the ceasefires were first agreed.

Under the new constitution, some power would be devolved to local governments, each with their own semi-elected legislatures. It would be far from a federal system and the real authority of the local governments would be heavily circumscribed. But it was a small concession to ethnic minority leaders who had been fighting for genuine self-determination.

The Burmese military leadership also offered the ex-insurgent armies a deal on their future armed status: reorganize your men into a ‘Border Guard Force’, that will partly be officered by us and that will ultimately come under our authority. It meant a partial but not complete integration with the Burmese army. Acceptance would mean sweet business deals and a place for former rebel leaders in the new order. Some of the smaller militias accepted. The rest have not, so far.

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by | 28 November 2014 · 4:34 am

North Korea’s Economic Collapse

From Nothing to Envy: Ordinary Lives in North Korea, by Barbara Demick (Spiegel & Grau, 2009), Kindle Loc. 1810-1832:

KIM IL-SUNG’S DEATH had, in fact, not changed much in the country. Kim Jong-il had gradually been assuming power over the decade preceding his father’s death. The economy’s inevitable collapse had been set in motion years before under the weight of its own inefficiencies. But North Korea’s Great Leader picked a convenient time to die, one that would prevent his legacy from being tarnished by the catastrophic events of the coming years. Had he lived a moment longer, North Koreans today would not be able to look back with nostalgia at the relative plenty they had enjoyed during his lifetime. His passing coincided with the last gasps of his Communist dream.

By 1995, North Korea’s economy was as stone-cold dead as the Great Leader’s body. Per capita income was plummeting, from $2,460 in 1991 to $719 in 1995. North Korea’s merchandise exports dropped from $2 billion to about $800 million. The collapse of the economy had an organic quality to it, as though a living being were slowly shutting down and dying.

In Chongjin, the hulking factories along the waterfront looked like a wall of rust, their smokestacks lined up like the bars of a prison. The smokestacks were the most reliable indicators. On most days, only a few spat out smoke from their furnaces. You could count the distinct puffs of smoke—one, two, at most three—and see that the heartbeat of the city was fading. The main gates of the factories were now coiled shut with chains and padlocks—that is, if the locks hadn’t been spirited away by the thieves who had already dismantled and removed the machinery.

Just north of the industrial district the waves lapped quietly against the empty piers of the port. The Japanese and Soviet freighters that used to make regular calls to pick up steel plates from the mills were gone. Now there was only North Korea’s fleet of rusting fishing vessels. Perched on a cliff above the port, giant letters proclaimed KIM JONG-IL, SUN OF THE 21ST CENTURY, but even they appeared to be crumbling into the landscape. The red lettering on the propaganda signs along the road hadn’t been repainted for years and had faded to a dull pink.

One of the most polluted cities in North Korea, Chongjin now took on a new beauty, stark and quiet. In autumn and winter, the dry seasons in northeast Asia, the sky was crisp and blue. The sharp odor of sulfur from the steelworks had lifted, allowing people once more to smell the sea. In summer, hollyhocks crept up the sides of concrete walls. Even the garbage was gone. Not that North Korea ever had much litter—there was never enough of anything to go to waste—but with economic life at a standstill, the detritus of civilization was disappearing. There were no plastic bags or candy wrappers wafting in the breeze, no soda cans floating in the harbor. If somebody stamped out a cigarette on the pavement, somebody else would pick it up to extract a few flecks of tobacco to roll again with newspaper.

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by | 27 November 2014 · 7:38 am

Kitachosenjin in North Korea

From Nothing to Envy: Ordinary Lives in North Korea, by Barbara Demick (Spiegel & Grau, 2009), Kindle Loc. 534-548:

In fact, Japanese Koreans, who were known as kitachosenjin, after the Japanese term for North Korea, Kita Chosen, lived in a world apart. They had distinctive accents and tended to marry one another. Although they were far from rich by Japanese standards, they were wealthy compared with ordinary North Koreans. They had arrived in the new country with leather shoes and nice woolen sweaters, while North Koreans wore canvas on their feet and shiny polyester. Their relatives regularly sent them Japanese yen, which could be used in special hard-currency shops to buy appliances. Some had even brought over automobiles, although soon enough they would break down for lack of spare parts and have to be donated to the North Korean government. Years after they arrived, Japanese Koreans received regular visits from their relatives who would travel over on the Mangyongbong-92 ferry with money and gifts. The ferry was operated by the pro-regime Chosen Soren and its visits to North Korea were encouraged as a way of bringing currency into the country. The regime skimmed off a portion of the money sent by relatives. Yet for all their wealth, the Japanese Koreans occupied a lowly position in the North Korean hierarchy. No matter that they were avowed Communists who gave up comfortable lives in Japan, they were lumped in with the hostile class. The regime couldn’t trust anyone with money who wasn’t a member of the Workers’ Party. They were among the few North Koreans permitted to have contact with the outside, and that in itself made them unreliable; the strength of the regime came from its ability to isolate its own citizens completely.

The new immigrants from Japan quickly shed their idealism. Some of the early immigrants who arrived in North Korea wrote letters home warning others not to come, but those letters were intercepted and destroyed. Many of the Japanese Koreans, including some prominent in Chosen Soren, ended up being purged in the early 1970s, the leaders executed, their families sent to the gulag.

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Filed under economics, Japan, Korea, migration

by | 26 November 2014 · 3:24 pm

Women and Markets in North Korea

From Nothing to Envy: Ordinary Lives in North Korea, by Barbara Demick (Spiegel & Grau, 2009), Kindle Loc. 2445-2482:

For the first time, the markets stocked household goods so cheap even North Koreans could buy them. The results of Deng Xiaoping’s economic reforms of the 1970s and 1980s were seeping into North Korea. From China came writing paper, pens and pencils, fragrant shampoos, hairbrushes, nail clippers, razor blades, batteries, cigarette lighters, umbrellas, toy cars, socks. It had been so long since North Korea could manufacture anything that the ordinary had become extraordinary.

The clothing was also a revelation, an invasion of alien colors from another world. Pink, yellow, tangerine, and turquoise—colors as luscious as the tropical fruits now on the market, in fabrics much softer and shinier than anything made in North Korea. Occasionally you’d see some better-quality clothes at the market with the labels ripped out. The vendors would whisper that these came from areh dongae, “the village below,” a euphemism for South Korea. People would pay more for clothing from the enemy state.

Every time Mrs. Song went to the market it seemed bigger and bigger. It was no longer just the old ladies squatting over tarpaulins in the dirt; there were hundreds of people laying out merchandise on wooden crates or carts. Vendors brought in tables and display cases and umbrellas to protect their wares from the sun.

The biggest market in Chongjin sprang up in an industrial wasteland near the Sunam River, which cut inland from the port through the center of the city. Behind the pitiful wreckage of the Chemical Textile factory, the Sunam Market would eventually become the largest market in North Korea. It was organized much like markets elsewhere in Asia—several aisles devoted to food, others to hardware, pots and pans, cosmetics, shoes, and clothing. It wasn’t until 2002 that Kim Jong-il belatedly legalized the markets. The Chongjin authorities, however, had recognized their de facto reality years earlier and begun to regulate them. The market authorities charged the vendors 70 won a day rent—about the price of a kilo of rice. The vendors who couldn’t afford the rent set up outside the gates, and so the market expanded further, spilling onto the sloping banks of the river. Mrs. Song’s cookie business never rose to the level where she would get her own booth. She didn’t want to pay the rent. But she did become part of a community of vendors who worked around the edges of a market in Songpyeon, a district west of the port where she moved once she made a little money.

The markets were magnets for all sorts of other businesses. Outside Sunam, along a whitewashed wall crawling with hollyhocks, was a line of crude wooden carts. Their owners usually slept on top, waiting for customers who needed merchandise transported. Chongjin had no taxis, not even the rickshaws or pedicabs of China (the North Korean government thought them demeaning), but people had decided to fill a void by setting themselves up as porters. Hairdressers and barbers trained by the government’s Convenience Bureau, the agency that was supposed to provide all services, set up mobile haircutting services. All they needed was a pair of scissors and a mirror. They worked near the food market, often getting into quarrels with the other vendors, who didn’t want hair wafting into their food. The hairdressers clipped quickly, one eye making sure a razor didn’t nick an ear, the other looking out for the police, who would confiscate their equipment if they were caught engaging in private business. Still, it was lucrative. Women with stomachs growling from hunger would shell out their last won for a perm.

By a market at the train tracks, people set up makeshift restaurants with planks of wood laid across bricks for tables, overturned buckets for chairs. The customers ate quickly, their spoons scraping small metal bowls of steaming soup or noodles. The cooks sweated over cylindrical metal stoves no bigger than paint cans, cranking old-fashioned bellows to fan the fires. It was not unusual to see a woman squatting over the fire with a baby strapped onto her back.

The vast majority of the vendors were women. Koreans accorded a low status to markets, so traditionally they were frequented only by women. This remained the case in the 1990s even as the markets expanded. Men had to stay with their work units, around which all life in North Korea revolved, but women were sufficiently expendable that they could wriggle out of their day jobs. Joo Sung-ha, a North Korean defector from Chongjin who became a journalist in Seoul, told me he believed that Kim Jong-il had tacitly agreed to let women work privately to relieve the pressure on families. “If the ajummas [married women] hadn’t been allowed to work, there would have been a revolution,” he said. The result was that the face of the new economy was increasingly female. The men were stuck in the unpaying state jobs; women were making the money. “Men aren’t worth as much as the dog that guards the house,” some of the ajummas would whisper among themselves. Women’s superior earnings couldn’t trump thousands of years of patriarchal culture, but they did confer a certain independence.

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by | 26 November 2014 · 5:01 am

Homelessness in North Korea

From Nothing to Envy: Ordinary Lives in North Korea, by Barbara Demick (Spiegel & Grau, 2009), Kindle Loc. 2613-2626:

It is worth noting here how extraordinary it was for anyone to be homeless in North Korea. This was, after all, the country that had developed the most painstaking systems to keep track of its citizens. Everybody had a fixed address and a work unit and both were tied to food rations—if you left home, you couldn’t get fed. People didn’t dare visit a relative in the next town without a travel permit. Even overnight visitors were supposed to be registered with the inminban, which in turn had to report to the police the name, gender, registration number, travel permit number, and the purpose of the visit. Police conducted regular spot checks around midnight to make sure nobody had unauthorized visitors. One had to carry at all times a “citizen’s certificate,” a twelve-page passport-size booklet that contained a wealth of information about the bearer. It was modeled on the old Soviet ID.

All that changed with the famine. Without food distribution, there was no reason to stay at your fixed address. If sitting still meant you starved to death, no threat the regime levied could keep people home. For the first time, North Koreans were wandering around their own country with impunity. Among the homeless population, a disproportionate number were children or teenagers. In some cases, their parents had gone off in search of jobs or food. But there was another, even stranger, explanation. Facing a food shortage, many North Korean families conducted a brutal triage of their own households—they denied themselves and often elderly grandparents food in order to keep the younger generation alive. That strategy produced an unusual number of orphans, as the children were often the last ones left of entire families that had perished.

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Filed under economics, family, food, Korea, labor, migration

by | 25 November 2014 · 9:08 am

Doctors and Patients in North Korea

From Nothing to Envy: Ordinary Lives in North Korea, by Barbara Demick (Spiegel & Grau, 2009), Kindle Loc. 1672-1694:

Making one’s own medicine is an integral part of being a doctor in North Korea. Those living in warmer climates often grow cotton as well to make their own bandages. Doctors are all required to collect the herbs themselves; Dr. Kim’s work unit took off as much as a month in spring and autumn to gather herbs, during which time the doctors slept out in the open and washed only every few days. Each had a quota to fill. They had to bring their haul back to the hospital pharmacy, where it would be weighed, and if the amount was insufficient, they would be sent out again. Often, the doctors had to hike far into the mountains because the more accessible areas had already been scoured by ordinary citizens who sought to sell the herbs or use them for themselves. The most coveted was peony root, which was used as a muscle relaxant and to treat nervous disorders. Wild yam was thought to regulate menstrual cycles. Dandelion was used to stimulate digestion and ginger to prevent nausea. Atractylodes, which is also popular in Chinese medicine to strengthen immunity, was used when it was impossible to get antibiotics.

For years, North Korean hospitals had been using herbal remedies in combination with Western medicine. Instead of painkillers, the doctors used cupping, a technique in which a suction cup is applied to stimulate circulation to parts of the body. Another technique borrowed from the Chinese involved lighting sticks of mug-wort next to the afflicted area. With anesthesia in short supply, acupuncture would be used for simpler surgeries, such as appendectomies.

“When it works, it works very well,” Dr. Kim told me years later. And when it didn’t? Patients would be strapped to the operating table to prevent them from flailing about. For the most part, North Koreans were stoical about enduring pain during medical treatment. “They weren’t like South Koreans, who scream and holler about the slightest little thing,” Dr. Kim said.

For all its shortcomings, North Korea’s public health system provided the public with better care than they’d had in pre-Communist times. The right to “universal free medical service … to improve working people’s health” was in fact written into the North Korean constitution. Dr. Kim was proud to be a part of the health-care system and gratified by the service she provided her patients. But by the early 1990s, the deficiencies in the system became more pronounced. Much of the medical equipment was obsolete and broken down, with spare parts impossible to obtain since the factories in the Communist-bloc countries where they were manufactured were by now privatized. The pharmaceutical factory in Chongjin curtailed its production due to a lack of supplies and electricity. There was little money to import pharmaceuticals from abroad. The bag that Dr. Kim carried on her rounds had gotten progressively lighter until she had nothing inside but her stethoscope. All she could do for patients was write prescriptions and hope that they had a connection in China or Japan, or a stash of money to buy the drugs on the black market.

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