Jones said the professor's careful response -- "Under the guidance of our Dear Leader, we have eliminated heart disease from our country" -- didn't surprise him. "He must have been shocked to meet a Korean-speaking American out in a Pyongyang park who identified himself as a fellow professor of medicine," Jones said. "So he reacted cautiously."
Jones realized then, as he has many times since, that given the profound mistrust each side has about the other, "both are extremely cautious in early meetings. Each side is careful and wants to shape the encounter."
"When North Koreans came to our medical center at the University of Mississippi for the first time," Jones said, "we were very guarded about what we said and showed them. We wanted them to see only the best we had. When we went to Pyongyang in those early visits, we saw only their showcase projects."
"With the passage of time, the relationship has entirely changed," Jones said. "When we get together, we get right to the problems we need to deal with as physicians."
Jones recalls his earliest work in North Korea, before he began working with GRS, as "'This is what we can do for you.' We came up with a project we thought they needed, and offered it to them."
As GRS built up its medical programs, Jones began contributing as a senior adviser. The project starting place became, what kind of project are you interested in?
An early request, Jones said, was unexpected. And it caused him some unease.
"What they wanted was training in laparoscopic surgery," Jones recalled. "The Koreans told us they'd understood that procedure cut patient recovery time and improved outcomes. They said they wanted their patients to have the benefit of that."
Those benefits are real, Jones told me, but he remembers thinking to himself, "This is an advanced technique that may not be appropriate for the North. It requires a very high skill level, and even if we could train some surgeons to do it, they would have trouble replicating the training in their own country."
Through discussions with North Korea's health ministry and ministry of education, GRS established a partnership with the Pyongyang National Medical University.
In 2002, six months after the Koreans made their first request, GRS brought a team of North Korean doctors for three months of training to the University of Mississippi Medical School (where Jones served as Dean), the University of Alabama-Birmingham School of Medicine, and Beth Israel Medical Center in New York.
Two U.S. surgeons then went to Pyongyang for a month to train North Korean surgeons and nurses. That training included pre-operative preparation, joint operations on patients, and post-operative recovery.
The North Koreans then returned for a month to the University of Mississippi for advanced training. GRS surgeons and engineers made three more training trips to North Korea.
Despite Jones' initial misgivings, the impetus to scale up the training came from the North Koreans themselves.
"This project is now self-sustaining," Jones said. "Our doctors visit the North about once a year, and we see North Koreans we haven't trained doing the procedures we trained their teachers in, and they've mastered the techniques." At this point, 150 North Korean surgeons have been trained in laparoscopy, and they now perform 20,000 procedures a year.
Jones told me the North Korean physicians he's worked with have excellent skills but work in a resource-poor environment -- which pushes them to substitute ingenuity for technology. He explained training in laparoscopic surgery is quite expensive, in part because of the equipment. In the United States, medical students use a laparoscopic surgery simulator, a high-priced piece of equipment. Part of what the simulator does is impose a barrier between hands and eyes, so surgeons learn to follow their hand movements magnified on a monitor, rather than looking directly at their hands. In North Korea, students use a simple box, with high-resolution cameras inside it, in place of the simulator. "They are able to master the technique using this much cheaper solution," Jones said.
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GRS's most complex undertaking in North Korea was bringing the Sons of Jubal chorus to perform at an international arts festival in April 2012, marking the 100th anniversary of Kim Il Sung's birthday. The chorus, 150 Baptist ministers and educators from Georgia, landed in Pyongyang the day after what the North declared was an unsuccessful satellite launch, widely seen in the United States as a missile test. Given the sour political mood between the two countries, chorus members didn't know what kind of welcome they would receive.
When the chorus music director, Dr. Jon Duncan of Atlanta, returned to the United States, he was asked, "You were there to sing as a Christian group in a communist country. Were there any restrictions on what you could sing?"
The short answer was no, but the longer answer -- still no -- is more interesting.
Rob Springs and Jon Duncan had made an advance trip to Pyongyang in January 2012, to discuss the chorus' visit and scout performance locations.
The North Korean officials organizing the festival asked Duncan about the music the chorus would perform.
Duncan said his traditional program was a mix of classical music, popular Broadway tunes, and songs of faith. The chorus had also worked hard to learn songs in Korean and planned to sing those as well.
"What kinds of songs of faith?" the North Koreans asked.
Duncan explained these would be chosen for their theme of reconciliation -- "Amazing Grace," "Thou, O Lord" from Psalm 3, and "Battle Hymn of the Republic."