Building Capacity of Hearing Care Services in North Korea

By Timothy Cooke

Over 600 million people in the world suffer from hearing loss. Approximately 80% of those with hearing loss live in low or middle income countries where access to hearing care is limited.

In 2002, Glyn Vaughan left his audiology practice in London to start one of the first hearing clinics in Cambodia. Glyn is now the director of All Ears Cambodia (AEC), a medical aid organization providing ear and hearing health services to in-need populations throughout Cambodia.

Starting in 2011, AEC partnered with All Ears International (AEI) to develop the capacity of hearing health care services in North Korea.

We recently had the chance to catch up with Glyn Vaughan and learn more about his efforts.

Can you tell us about your efforts in North Korea?

AEC hosted a delegation from North Korea in 2011 at the Institute of Audiology and Primary Ear Health Care in Phnom Penh. The delegation was led by the Korean Federation for the Protection of the Disabled (KFPD) which subsequently invited AEC and AEI to visit North Korea to conduct a needs-assessment the following year. The aim was to establish what service development was required and how collaboration might be established between AEI/AEC and local partners. The end result would be a self-sustaining service improvement that could be carried forward by North Korea.

AEC/AEI returned to North Korea in 2013 to deliver ENT OPD instruments and oto-surgical equipment as well as to sign a formal Memorandum of Understanding with the Korean Federation for the Protection of the Disabled (KFPD). The development of existing services is needed and the KFPD has secured a site for a new Audiology and Primary Ear Health Care center in Pyongyang.

The aim of the All Ears North Korea Project will be (1) to develop audiology as a specialty in its own right and, in time, to establish a degree-level university course; (2) to train ENT doctors (as well as graduates) to a higher level of skill in diagnostic and rehabilitative audiology through study at home and in Cambodia while audiology is developed; and (3) concomitant development of otolaryngology facilitated through further visits and workshops and study visits to the UK and Cambodia.

AEC/AEI will return in April 2014 to launch the first set of audiology training courses. An exchange visit to the AEC Institute of Audiology and PEHC by KFPD staff is anticipated in either March or May of 2014.

Can you describe the level of hearing health care offered in North Korea?

The need is great. There is a desperate shortage of surgical instruments for standard ENT procedures not least equipment and medicine in the outpatient departments. There is no hearing aid service in North Korea. Diagnostic audiology is archaic. As well as the need for new technology there is a prerequisite for developing human resources. ENT physicians currently provide the audiology services although with only minimal resources at a handful of hospitals.

Have there been any challenges with your initiative in North Korea?

It's often asked how challenging it is it when operating in areas that are maybe seen as hostile. Oddly though, wherever it might be, North Korea, the Middle East, sub-Saharan Africa, when you sit down with your counterparts and discuss work, you could be anywhere else in the world doing much the same. There is something reassuringly universal about the process and hostility has no place in it. Getting into that room of counterparts is, however, another matter.

How does your work in North Korea compare to your efforts in Cambodia?

After thirty years of civil war, Cambodia remains one of the poorest, most disease-racked nations on Earth. The genocidal regime of the Khmer Rouge all but destroyed the health service. Over 90% of Cambodian doctors were executed, died or left the country. Government infrastructure today is deficient, unable to provide high quality, high volume health care. Auditory rehabilitation in Cambodia receives little or no attention within Government departments. Lack of political support, together with a scarcity of resources has resulted in those with ear disease and hearing loss being neglected.

In North Korea, the doctor-patient ratios are favorable. Under Kim Il Sung, the state health service underwent a restructuring and enlargement in the late 1940s after the fall of Japanese rule. It was modernized to reflect the Soviet section-doctor system. With the expansion of doctor numbers, North Korea set up an army of household doctors, each responsible for overseeing basic health within their communities. Tens of thousands of these physicians still exist today with one family doctor responsible for ~250 households. All hospitals are staffed by ENT medics of some type.

Despite the comprehensive network, however, the healthcare system in North Korea has been in steep decline since the 1990s - owing to natural disasters, economic upheaval and food and energy shortages. There is a desperate shortage of equipment and they rely on antiquated machines that arrived decades ago when the flow of supplies from the former Soviet Union was steady.


All Ears Cambodia (AEC) is a local medical aid organization registered with the Cambodian Ministry of Interior. It provides specialist ear and hearing health services for anyone in need of help, focusing on the most marginalized members of society.

All Ears International (AEI) is a UK-registered charity. It promotes activities for the prevention, mitigation or relief of ear disease and hearing loss in less privileged parts of the world. AEC is federated with AEI, and AEI is currently investigating scope for creating similar initiatives to AEC in other countries.