PHWR Public Health Weekly Report

Tuberculosis (TB) is a disease that has existed since the advent of humankind. Over a span of two centuries, the global death toll from TB has amounted to nearly 1 billion, making it among the deadliest diseases in history [1]. In the middle ages, TB was often misunderstood as a hereditary disease. Following the Industrial Revolution, TB became more prevalent among the urban poor and workers because of the concentration of the workforce in cities and deteriorating sanitary conditions [1]. Despite the advent of anti-TB drugs in the 1950s, TB remains a serious health problem for humankind owing to the spread of human immunodeficiency virus infection and rising TB mortality in developing countries [2].

Republic of Korea (ROK) has a historical experience with TB that aligns with the global trend. After liberation in 1945, ROK was ravaged by the United States military regime, the division of the country into North and South Korea (ROK), the Korean War, and political turmoil until the 1960s, leaving the majority of the population in poverty and disease. These social and economic hardships resulted in a vicious cycle of TB infection and outbreaks, with social services being heavily reliant on foreign aid [3]. It was during this process that the need for an organization for TB treatment and management at the national level was realized.

Consequently, the Mokpo National Hospital, which has played a pivotal role in the management of TB in ROK, was established in 1962 with the cooperation of foreign aid organizations and the city of Mokpo. This study aims to analyze the history and performance of the Mokpo National Hospital, especially to reexamine its role in the national TB control system. This work is intended to draw attention to TB control in society and contribute to the promotion of the capacity of Mokpo National Hospital in the treatment and management of TB.

TB is a chronic infectious disease caused by Mycobacterium tuberculosis, and unlike other acute infectious diseases, it is strongly influenced by housing and nutritional conditions. It spreads through airborne transmission, and its development after infection is contingent upon individual immune status and living environment [1].

Following the Korean War, ROK faced a grave social crisis, with extremely poor living conditions and inadequate nutrition contributing to the rapid spread of TB. Toward the end of the 1950s, the country’s high TB prevalence and mortality rates had made the disease a serious social problem. In the absence of a national TB control system at that time, the social burden due to TB increased because of the increasing number of patients, which led to the need for organized care [3].

1. Establishment and Development of Mokpo National Hospital

During the Korean War, ROK received substantial medical aid, both human and material, from numerous countries through United Nations Peacekeeping. In particular, Norway sent 623 healthcare providers (including doctors and nurses) to serve during the war, and after the war, Norwegian healthcare providers remained in ROK to care for the wounded and war orphans.

In an attempt to help rebuild ROK after the war, the Norwegian Korean Association was founded with the aim to organize a nationwide fundraising effort to build a hospital in ROK. On June 26, 1961, a memorandum of agreement to build and operate Mokpo Children’s Tuberculosis Hospital was signed by Gotfred Rekkebo, a nurse and social worker affiliated with the Norwegian-Korean Association; Cho Ki-dong, acting chairman of the Unitarian Service Committee of Canada, who shared the same sentiments as the Norwegian-Korean Association; and Lee Jae-hong, the mayor of Mokpo, who realized the need for a TB management facility. These initiatives culminated in the construction of a 314.2-pyeong (1,038.6 m²) building comprising 68 beds, eight inpatient rooms, an X-ray room, and a laboratory, the construction of which was completed on January 4, 1962, on a 1,200-pyeong (3,966.9 m²) plot of land at 201 Daeseong-dong, Mokpo-si (the site of a former Japanese Red Cross Blood Center). On April 28 of the same year, Mokpo Children’s Tuberculosis Hospital was officially opened with the participation of officials representing ROK (Minister of Health and Social Welfare Jung Hee-sup), Canada (Ambassador William F. Bull), and Norway (Ambassador Eigil Nygaard) (Figure 1) [4,5].

Figure 1. Mokpo Children’s Tuberculosis Hospital opening ceremony (1962)
Reused from the Korean National Tuberculosis Association. (A History of Tuberculosis in Korea. Korean National Tuberculosis Association; 1998. p. 57-8.) [5].

After the ceasefire, the hospital began operations with two doctors and 13 nurses to treat the increased number of patients with TB, especially affected children in orphanages and infant care centers. During that era, TB was widely regarded as an incurable disease, and a considerable number of children could not access treatment owing to economic impoverishment. In response, the hospital played an instrumental role by initiating intensive TB treatment for pediatric patients [6]. Of the 70 patients who were hospitalized, over 40% were children between the ages of 5 months and 3 years, thereby showing the influence of the war and other social factors on the situation (Figure 2) [5].

Figure 2. Mokpo Children’s Tuberculosis Hospital 1st anniversary ceremony (1963)
Reused from the Korean National Tuberculosis Association. (A History of Tuberculosis in Korea. Korean National Tuberculosis Association; 1998. p. 57-8.) [5].

After the enactment of the Public Health Center Act in 1956 and the dissemination of Bacillus Calmette–Guérin (BCG) vaccination campaigns, the Mokpo Children’s Tuberculosis Hospital emerged as a pivotal institution for the treatment of pediatric TB. In 1963, the basic policy was to administer the BCG vaccine to children with a negative tuberculin skin test (TST) through periodic mass screening for the early detection and treatment of active TB. In 1964, the hospital established a healthcare social work unit within the hospital and established the Mokpo Social Welfare Center with the support of Mokpo-si, with the objective of providing assistance to families of patients with TB in financial hardship [5].

According to the First National Tuberculosis Survey in 1965, the situation remained critical, with a TST positivity rate of 59.9% among those aged 5 years and older, and 60–80% of children with latent TB infection under the age of 6 years developing pulmonary TB [7]. Thus, since the implementation of the Tuberculosis Prevention Act in 1967, Mokpo Children’s Tuberculosis Hospital has played a vital role at the forefront of pediatric TB treatment.

In 1965, the Mokpo Tuberculosis Control Center was established as a response to the hospital’s inadequate outpatient capacity to prevent and treat TB among visiting patients in their homes. On April 1, 1970, the operation of the Mokpo Children’s Tuberculosis Hospital was transferred to the local government of Mokpo-si. Then, on February 1, 1973, the operation of the Mokpo Tuberculosis Control Center was transferred to the local government of Mokpo-si. The hospital and the control center were integrated and renamed Mokpo City Tuberculosis Hospital.

On January 1, 1983, the operation of the Mokpo City Tuberculosis Hospital was transferred to the Ministry of Health and Social Affairs and promoted and reorganized into a national hospital under the name Mokpo National Tuberculosis Hospital. At the time, the hospital was located at 201 Daeseong-dong, Mokpo-si, on 38,800 m² of land and included 70 beds and six medical departments. Later, as part of the Presidential Pledge Project in 1986, the National Mokpo Tuberculosis Hospital was modernized, and the construction of the new hospital began in its current location in Seokhyeon-dong, Mokpo-si, on 66,116 m² of land. The new hospital had 360 beds, two medical departments (Department of Thoracic Medicine and Department of Thoracic Surgery) and four support departments (Department of Pathology, Department of Pharmacy, Department of Nursing, and Department of General Affairs). On December 20, 1990, the construction of the new hospital was completed, with 89 staff members providing inpatient and outpatient care [8].

2. Mokpo National Hospital Becoming a Specialized National TB Hospital

The International Monetary Fund’s foreign exchange crisis that occurred in late 1997 precipitated a national government reorganization aimed at addressing the crisis. This restructuring process involved the introduction of the “executive agency” system as a pivotal component of the government management system. Since January 1, 2001, Mokpo National Tuberculosis Hospital has also been designated as an executive agency to promote efficient hospital operations. To safeguard the rights of patients with TB, the hospital was formally designated as Mokpo National Hospital on May 6, 2002. This nomenclature was selected to circumvent the direct disclosure of the disease and has since been retained.

ROK has witnessed an overall enhancement of TB treatment indicators after the implementation of a health insurance system, as the role of private healthcare organizations in TB management has expanded. However, the country continues to have the highest TB incidence and mortality rates among Organization for Economic Co-operation and Development countries, particularly among individuals aged 65 years and older, who account for 60% of all TB cases. Furthermore, individuals belonging to vulnerable populations, such as foreign nationals and the homeless, are susceptible to the contraction of communicable diseases, including TB, because of socioeconomic challenges and frequently encounter difficulties in adhering to treatment regimens, even after the onset of TB, leading to suboptimal TB control [9]. In response, Mokpo National Hospital has focused on managing difficult-to-manage non-compliant patients and multidrug-resistant TB and has consistently undertaken systematic TB treatment and management projects for the elderly, foreign nationals, and vulnerable groups.

With an aging population and increasing prevalence of chronic diseases, TB control in the elderly and the management of people with latent TB infection have become increasingly important national health challenges. Therefore, the Mokpo National Hospital is implementing two new initiatives as it seeks long-term development directions and innovation in national health services.

1) Enhancement of infectious disease control capacity to respond to national public health crises

On August 14, 2008, the Mokpo National Hospital initiated the operation of a designated inpatient treatment unit, comprising 10 beds designated for negative pressure isolation and 40 beds for general isolation, to address the need for inpatient treatment of patients with emerging infectious diseases during a period of national public health emergency. On August 3, 2016, the hospital was designated as the first “infectious disease control organization” in Jeollanam-do, and has become an important player in the field of infectious disease control.

2) Introduction of integrated nursing and caregiving services

The proportion of hospitalized patients with TB requiring nursing care has increased substantially owing to two factors, namely aging and the rise in comorbidities. However, the inherent nature of respiratory infectious diseases makes the care of patients with TB a formidable challenge, because it poses a significant risk of family members or personal caregivers becoming infected. Furthermore, patients who are unable to access care because of financial burdens are increasingly discontinuing or abandoning treatment, creating a vicious cycle of hard-to-treat drug-resistant TB (DR-TB).

Consequently, the Mokpo National Hospital was the first among the nine national hospitals to fully introduce “integrated nursing and care services.” It started with one ward and 25 beds in 2018 and added another ward and 30 beds in 2019, resulting in a total of two wards and 55 beds. The introduction of this service enabled patients with TB in need of care to receive more stable treatment by providing nursing care free of charge by specialized staff. This service has been shown to facilitate the delivery of essential nursing and care services to patients without the need for a guardian or private caregiver, thereby mitigating the risk of nosocomial infections and reducing the burden-of-care costs, which has been documented to reach KRW 150,000 per day. It also serves to improve access to care for patients with severe TB and those requiring intensive care and are difficult to manage in private-sector institutions.

Over the past 63 years, since its opening in 1962, Mokpo National Hospital has consistently evolved in response to prevailing national health policies and shifts in the national and international environments. It has assumed a pivotal role in the treatment of TB and the control of infectious diseases within the country (Table 1).

Table 1 The establishment and history of Mokpo National Hospital

Timeline	History
1962. 04. 28.	Establishment and opening of 「Mokpo Children’s Tuberculosis Hospital」 (jointly with foreign aid organizations and Mokpo City) - 70 Beds, 2 doctors, 13 nurses
1965. 02. 01.	Opening of the 「Mokpo Tuberculosis Management Center」, affiliated with 「Mokpo Children’s Tuberculosis Hospital」
1970. 04. 01.	Mokpo City takes over and operates the 「Mokpo Children’s Tuberculosis Hospital」
1973. 02. 01.	Renamed to 「Mokpo City Tuberculosis Hospital」
1983. 01. 01.	「National Mokpo Tuberculosis Hospital」 renamed and promoted to national status (transferred to the Ministry of Health and Social Affairs) - 6 Division (pulmonology, thoracic surgery, pathology, pharmacy, nursing, general affair), number of public servant 49
1990. 12. 20.	Completion and relocation of new hospital as part of hospital modernization project (expansion from 70 beds to 360 beds) - 6 Division, number of public servant 89
2001. 01. 01.	Implementation of the 「Executive Agency system」
2002. 05. 06.	Renamed to 「Mokpo National Hospital」
2008. 08. 14.	Installation and operation of nationally designated hospitalization treatment beds (10 negative pressure isolation beds, 40 general isolation beds)
2016. 08. 03.	Designation and operation of 「infectious disease management agency」 (Jeollanam-do No. 1)
2018–2019	Comprehensive Nursing Care Service (2 wards, 55 beds) first implemented in a national hospital
2020. 09. 12.	Transfer of central administrative agency to the Korea Disease Control and Prevention Agency

Mokpo National Hospital is a nationally operated specialty care facility for TB and commemorates the anniversary of the establishment of Mokpo Children’s Tuberculosis Hospital on April 28, 1962. This event recognizes the contributions of distinguished individuals and organizations to the development of TB control initiatives and provides an opportunity to call attention to TB and infectious disease control.

Mokpo National Hospital was founded in 1962 with the support of international aid organizations. It operated as Mokpo City Tuberculosis Hospital in 1973 and took its current form in 1983 when it was upgraded to a national hospital. Here are some of the highlights of the hospital’s accomplishments so far:

First, Mokpo National Hospital has assumed a pivotal role as a specialized TB hospital for children since the Korean War, emerging as a leading TB treatment center that has contributed to the global fight against pediatric TB. It occupies an important place in the history of TB control in ROK.

Second, the hospital specializes in treating patients with TB who are difficult to manage in private healthcare organizations, including patients with hard-to-treat DR-TB, foreign patients diagnosed while working in ROK, vulnerable and elderly patients with TB, and patients who experience serious adverse events during TB treatment. In 2018, the hospital became the first national hospital to introduce integrated nursing and care services, providing nursing and care services to approximately 20,000 inpatients annually.

Third, Mokpo National Hospital participates in the “Tuberculosis Relief Belt” project, a collaboration between national TB hospitals and local public hospitals to improve access to treatment for vulnerable patients with TB. TB is a disease that is closely related to socio-structural issues such as aging, poor environment, low income, and an increasing number of foreign workers. The Tuberculosis Relief Belt project is a program designed to provide vulnerable populations with services that are oriented toward protection. These services include support for treatment and referral fees, nutritional snacks, and patient transportation. The objective of these services is to prevent individuals from discontinuing TB treatment.

Fourth, as an “infectious disease control organization” with a “nationally designated negative-pressure isolation facility” for the prevention and treatment of emerging infectious diseases, the hospital responds quickly to public health crises. It has played a role as a specialized organization for public infectious disease response, including in the treatment of suspected Middle East respiratory syndrome cases in 2015, 46 suspected and confirmed cases of novel influenza in 2019, and four suspected cases of mpox in 2022–2023. In addition, the construction of a “Specialized DR-TB Treatment Center” is underway with a target completion date of 2027, which is expected to enable specialized treatment of patients with DR-TB and rapid transition to isolation hospitals in the event of a national epidemic crisis (Figure 3).

Figure 3. Mokpo National Hospital specialized in multi-resistant tuberculosis (bird’s eye view)

Fifth, to reduce the socio-economic burden of elderly patients with TB and improve treatment success rates, the National Tuberculosis Hospital Treatment and Care Integration Support Project has been in place since May 2024. Inpatients at long-term care facilities cannot be treated at home after being diagnosed with TB and need to be transferred to other institutions. However, the difficulty of finding a healthcare facility for transfer and the burden-of-care costs for isolation treatment are increasing. In response, Mokpo National Hospital has been promptly receiving patients with TB from long-term care facilities and hospitals for treatment and providing specialized healthcare services free of charge, including nursing care, hospitalization, and food. From May to December 2024, 16 patients with TB from 11 long-term care hospitals and five long-term care facilities received inpatient treatment at Mokpo National Hospital, and from 2025, the project will be expanded to the whole country. Furthermore, in January–February 2025, seven elderly patients with TB were hospitalized for nursing care and TB treatment. These initiatives have contributed to the prevention of secondary infections in the elderly and the publicization of healthcare services.

As such, Mokpo National Hospital started as a pioneer in the treatment of pediatric TB in ROK and has become a key institution in the country’s TB treatment and infectious disease response. In accordance with national health policies, Mokpo National Hospital will persist in addressing deficiencies in TB and infectious disease treatments and will further expand public healthcare services for the medically vulnerable.

The establishment of Mokpo National Hospital was driven by a commitment to improve public health by eradicating TB. As a leading organization in the management of TB and other infectious diseases, the hospital has treated a significant number of patients and continues to engage in comprehensive prevention strategies, including educational initiatives and community outreach activities, aimed at mitigating TB outbreaks.

TB, once regarded as an invariably terminal ailment, has evolved from a universally feared scourge into a manageable condition. Concurrently, public awareness and interest in this health issue have been progressively waning, mirroring the declining prevalence of the disease. However, patients with hard-to-treat DR-TB, vulnerable and elderly patients with TB, and patients with limited mobility and care needs continue to pose a substantial societal challenge.

Mokpo National Hospital has played an instrumental role in the national health system, providing a wide range of public health services, including building a healthcare safety net for the low-income population, treating vulnerable populations, and responding to infectious diseases. Moreover, the establishment of a specialized DR-TB treatment center is expected to improve the treatment success rate of difficult-to-treat DR-TB cases. This, in turn, is expected to lead to an improvement in the quality of healthcare, thereby elevating the level of healthcare to ensure a safer environment for people to live free from TB and emerging infectious diseases [10]. In addition, to fulfill its social responsibility as a public healthcare institution, Mokpo National Hospital will actively participate in the fight against TB through free TB screenings for vulnerable populations, including those in remote or island regions, which are considered blind spots for healthcare. It will also actively conduct TB education for long-term care facilities and hospitals to increase TB awareness.

Ethics Statement: Not applicable.

Funding Source: None.

Acknowledgments: None.

Conflict of Interest: The authors have no conflicts of interest to declare.

Author Contributions: Conceptualization: JSJ, SKP. Data curation: JSJ. Methodology: JSJ, CNB. Investigation: JSJ, HHP. Project administration: JSJ, SKP, CNB. Validation: JSJ. Visualization: JSJ, HSJ, SNK. Writing – original draft: JSJ. Writing – review & editing: CNB, HHP, HSJ, SNK, SKP.