"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.
* * *
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."
"Songs of faith," the North Koreans said, "could be a problem."
So when the Sons of Jubal arrived in Pyongyang in April 2012 they weren't sure what program they would actually perform.
Immediately upon the chorus' arrival, officials from the DPRK's Ministry of Culture met with Duncan. "Please do your full program," they told Duncan, "including your songs of faith."
The chorus included early in its program a song known to every North Korean, "Red Sky of Steel Refined." The group sang the lyrics both in English and in Korean, and the audience response was thunderous.
"Red Sky" tells of a father's love for his people, and for North Koreans the father in question is Kim Il Sung, North Korea's first and longest-serving leader. But for the members of the chorus, Duncan told me, the lyrics told of God's love for His children. "That's the thing about music. It's universal, because it's open to interpretation."
"We connected to the audience with that song," said Duncan, "because we had clearly worked so hard on something that had a particular meaning for our listeners. We sang it in their own language. And the audience responded in the way that touches the hearts of musicians everywhere."
The Korean audience gave the same thunderous response to the song that followed "Red Sky," "Battle Hymn of the Republic."
"When we introduced 'Battle Hymn,' our Korean announcer explained the significance of that song in American history -- that it had been written during our Civil War, that its singing during the war transcended North and South because it had been sung so widely on both sides even as the war raged on," Duncan said. "The audience connected to it in a way that Americans may have during our Civil War." (The lyrics to the "Battle Hymn of the Republic," written by Julia Ward Howe, first appeared in The Atlantic , February 1862, on the front page.)
But perhaps most surprising of all, Duncan continued, "When we sang 'Amazing Grace,' the audience, which included many North Korean musicians, hummed along."
The North Koreans unexpectedly asked the Americans to give the same program in the same hall the next evening.
The Sons of Jubal stayed in the DPRK for almost a week, and, in addition to performances at various venues around Pyongyang, traveled south to the DMZ, approaching it from the North Korean side. The chorus members were taken to a room their North Korean guide called the exchange room -- half in North Korea, half in the South, a thin black line down the middle to separate the two sides. It was called the exchange room, they were told, because officials would exchange bodies there.
"Our North Korean guide was a soldier in uniform," Duncan said. "As he took us to the DMZ line, he gave us a stern lecture about American imperialism, American aggression, that he said the United States had committed against North Korea and its people. 'We held off the American invasion,' the solider told us. He was very severe. His presentation was difficult for all of us to listen to, but especially for the oldest member of our group, who had been in the Korean War."
The Americans listened in silence.
"When the soldier finished, someone in the group asked him to take our pictures," Duncan continued. "Then, he got in the pictures. We started talking. We smiled. He smiled. And the whole mood changed. Before we left, the soldier in uniform -- the same guy -- asked us to sing the Star Spangled Banner -- on the North Korean side of the DMZ!"
* * *
Rob Springs had asked James Min, the Ohio international trade lawyer, to accompany the Sons of Jubal to North Korea.
After the group arrived in Pyongyang, the North Koreans told Springs that GRS could send one person to see the April 15, 2012, military parade in Kim Il Sung Square on the centenary of the late president's birth. Springs sent Min, who wound up standing not far from the DPRK's newly installed leader, Kim Jong Un, Kim Il Sung's grandson.
The April 15 parade is the North's showcase event of its military strength. And as Min watched the procession of soldiers and their equipment, for the first time he had some understanding of the North's focus on its military. "It wasn't just the uniforms and hardware. More, it was the pride of the crowds watching their military on parade."
That focus, Min considered, was the result of Korea's history of being on the wrong end of foreign invasions over the millennia, of being a small country surrounded by larger, more powerful countries. And Min said he understood the determination not to be invaded again.