Friday, 15 April 2011

Korea travels, Spring 2011

Beauty- natural or acquired?

During twelve days in Korea I experienced some amazing contrasts between the commercial strength of the beauty industry and the remoteness of the old leprosy colonies on remote peninsulas in the far South.

The World Congress of Dermatology was held in a 21st century conference building and was impeccably organised with teams of polite Korean students keen to help and every detail of the conference planned , from daily conference newspapers for the 9.000 attendees to giving us prepaid travel cards for the metro. Dermatology conferences have been completely hijacked by the beauty industry and the L’Oreal stand dominated the exhibition hall advertising attainment of beauty, there were two floors of exhibits 95% of which were stands advertising botox injections or laser treatments to magic away aging skin. Vast photos of Asian women with impossibly flawless spot free skin hung over the stands, all advertising an unattainable ideal. Delegates flocked to the sessions on cosmetic dermatology but just a few brave souls came to the 8 am leprosy and leishmania sessions where we discussed real skin problems. From the advertising and sponsorship one would have no idea that skin disease is unpleasant and that treating itch is the daily challenge of dermatologists. I also had my skin assessed by a computer programme that mapped out wrinkles, spots and blemishes. One could see a vision of one’s younger skin, so I was contrary and asked to see my older skin, so that I can prepare for those deep wrinkles The girl running the programme must have liked my approach because she then reassured me that I did not need treatment when of course she should have been emphasising how much improvement I could gain from botox. I also learnt that one cannot smile if one has had repeated botox injections and so the botox recipients have to relearn smiling. One of my colleagues Terence Ryan is fighting a rearguard action against cosmetic dermatology and is promoting the concept of community dermatology, so that the focus on skin disease or poor people is not completely lost. He shared the leprosy platform but should have been somewhere with higher visibility. The other pleasure was meeting leprosy friends from India, Brazil and Sri Lanka.

I then flew south to visit two leprosaria. The first leprosarium I visited was a former mission-run hospital located on a rocky tree-covered peninsula. It had been founded by missionaries in 1926 when Korean leprosy patients were cast out of society and stoned if they were on the roads. The missionaries were the only people who would care for them. The hospital has now evolved into a modern orthopaedic and dermatology hospital. There was also an excellent museum created around pictures of patients and missionaries. The different phases of leprosy treatment were well shown, from shelter through early drug treatments, to rehabilitation. The old missionaries were also remembered with statues and a Korean carved stone memorial. About 70 very old patients still live in the hospital and are e cared for in an old people’s home. I looked in on one old lady with severe deformities. She was lying on her tatami mat with a bowl of cherries nearby and light was flooding in through the window, a peaceful scene. The hospital was run by a very energetic surgeon who took me and some other visitors out on a walk in the evening. We walked though a huge flat reed bed and up a small mountain with an observatory atop it. Cranes and herons flew around the reeds and crabs scrabbling around in the mud. There were beautiful views and also notices telling one precisely where to take the best photos. In the evening after a Chinese meal at which all the docs had been very deferential to their boss, I was driven back to the hospital by a young doctor doing his national service who poured out his woes to me about his remote posting and how he could not travel overseas because of his service status. So he was a typical conscript in hating his posting, even though it had interesting possibilities for research. The next day Ii travelled to the government hospital on an island. As I was waiting in a car park a hospital bus pulled up and I thought this was my transfer but instead 12 staff got out to welcome me. We then went to a restaurant and sat on the floor and had a Korean feast with a least 12 different types of fish to be picked at with chopsticks. I was then driven over the hospital by a local dermatologist in his Mercedes. I had been expecting a dingy building but instead found a new modern hospital with a high airy atrium and art pieces in the lobby. They had made a large sign saying “Welcome to Dr Lockwood and her special lecture on leprosy”. I then talked about leprosy on London. The director was passionate about providing a good service to the remaining leprosy patients in Korea. There are about 20 000 patients altogether in Korea but now only 20 new patients per year. I was then taken around the island where there were villages that ex-patients had settled in. There was also a small prison for misbehaving patients. The most poignant remnant was a mortuary, preserved with an autopsy table still inside and a notice saying that here patients had autopsies without consent and married patients were sterilised. It was like seeing something from Nazi Germany and was a very forceful reminder of the human rights abuses that leprosy patients have suffered. In the mission hospital I had met some anthropology students from Seoul who were interviewing patients about their past injustices. Patients had been forcibly relocated and also had to work as forced labour. All occurred mainly during the Japanese colonization from 1920-1945. The Korean government has acknowledged the damage done to former patents and when the president came to open the new hospital he apologised to the old patients. I had known of the abuses that leprosy patients had suffered in Japan but I had not realised that this also occurred in Korea. I was very touched by seeing the mortuary and although it is historical there is still much to do to demystify and moralise leprosy.

I was also a regular tourist and was bussed out to the Demilitarised Zone about 50 km from Seoul. It was a murky day so I barely saw over the barbed wire to an N Korean exhibition village that is close to the border but no inhabitants. . We were also taken deep underground to one of three tunnels that the South Koreans found were being burrowed towards the border. These were discovered in the 1970s and 80s and the S Koreans claimed that 60.00 soldiers could pass through the tunnel in 6 hours. I’m not sure that the North Koreans have the ability or the energy to attack the south now. Being in Korea I could feel how far apart the two countries are and how suspicious the South Koreans are. An N. Korean collapse like the collapse of E Germany in 1989 seems very unlikely. It is a very surreal place to be, especially as the DMZ is now a haven for wild life because it has had 40 years of complete wilderness.

Koreans work insanely hard, one sees school students on the street at 10pm, having just finished their post-school academy work and heading home for home work. Their fathers will also have worked 10pm and will be eating with their work colleagues before returning home to sleep and then starting again. I spent a day with Heyjon, a Korean scientist who had done a PhD at LSHTM and she confirmed that she only eats with her husband at the weekend. Suicide is the biggest medical problem facing Korea ; this happens at all ages, school kids, young people, middle aged people because they are all under huge pressure to achieve good grades or earn good salaries. When a celebrity commits suicide then people agree that something should be done but then nothing happens. I guess it requires such a deep change that it is too difficult to contemplate. Most families have one child only by choice and I can understand the huge pressures that are then put on these children and how resentments can develop.

Seoul feels like a huge American city with endless blocks of high rises and four lane highways criss-crossing the city, but when one explores it the individual districts are interesting and have their own flavour. I stayed in the Yonsei university guest house and that district was very lively at night with cafes and bars. Yonsei university was founded in the 1980’s and has an Ivy league feel with ivy clad 19th century buildings, but has continued building since then and has a beautiful outdoor Greek style auditorium to seat 3000 spectators. The women’s’ university was also as old and had an amazing piece of modern architecture that looked like a deep canyon cut out of the hill with glass sides. As I explored it I found that classrooms had been set into hill behind the glass. New graduates in miniskirts and high heels were posing with their friends for graduation photos. The straplines of the two made an interesting comparison, Yonsei was “First and Best”, the women’s, “Where Change begins” In the Bukkon area old Korean house built around courtyards with blue tiled roofs had been preserved and are now used by artists. There is also a very vibrant modern art and photography scene in Seoul and I wandered around small studios with interesting installations and maxed out on contemporary art. This was such a contrast to the public sector and corporate scene that I wonder whether Korea’s artists are doing a collective dissent for the nation. Certainly in other spheres dissent is not encouraged.

I also met a young English architect who has worked on the renovation plans for my house in Islington and is now doing a project in Seoul designing student accommodation. We spent a day biking around central Seoul and then an evening walking around the downtown area. She was both excited by being there and to be doing a project that she would not have done at home, but she also found the working conditions difficult. The long hours were killing her and she was surprised to find that there is little team work in Korean offices so people do not share information about the projects they are working on or help people with ways of improving computer programmes.

So my trip to Korea was full of contrasts, first the contrast between beauty and real world dermatology, then being in the leprosy hospital and feeling that I was touching a very recent past which involved exiling leprosy patients and abusing them. Then meeting Korean people and getting a glimpse into their work –oriented and dissent-averse society. But also being able to enjoy the sculpture and art in public spaces.

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