Repetitive images of hunger in North Korea are etched like a tableau of famine in the mind of Michael J. Frank.
Malnourished people scour empty rice fields, picking up single grains one at a time, collecting them in small bags after harvest workers have done their job and left.
Elsewhere, four skinny, sickly adults and children -- coughing, suffering from dysentery -- are nervous about talking to the foreigner from Parkville, Md. They say they search for food every day, with only modest success.
The sick may be better off staying away from hospitals that have no soap, no aspirin, no other medicines, no anesthetics, no blankets and no heat in this cold country.
"We saw a population that was physically very, very weak because of malnutrition and lack of health services", said Frank, leader of a group of five U.S. aid officials who for three months monitored the North Koreans' distribution of 55,000 metric tons of American corn given that country.
His team's stay from Aug. 23 to Nov. 15 was the longest allowed Americans since the Korean War of 1950-1953, he said. Belgian and French aid workers have been there longer this year. Other visitors have been allowed one-week or 10-day visits.
Kim Jong Il, 55, has for three years led a North Korea which aid agencies and other observers fear to be on the verge of mass starvation. Kim faces a conflicting task: sustaining the secretive isolation of the Stalinist state founded by his late father, Kim Il Sung, on the one hand, and allowing in the food aid his people so desperately need on the other.
The country, the size of Mississippi, with a population of 23 million, has suffered a collapsed economy and other problems since the early 1990s when Russian aid dried up after the fall of the Soviet Union. That was followed by drought in 1992, floods in 1995 and 1996 and typhoon flooding this year.
Frank, 47, is government relations director for the Baltimore-based Catholic Relief Services. Accompanied by North Korean government officials, Frank's team visited food distribution points, hospitals, orphanages, homes, schools and government offices in 10 of 12 provinces.
The four other aid officers were from CARE, World Vision, Mercy Corps and Amigo Internationales. The United Nation's World Food Program monitored another 45,000 American tons.
The quintet said it overcame North Korean resistance to the length and scope of the inspection. The hosts wanted all five men to go in one car and leave after their visa expired in 20 days. They were persuaded to let the Americans use three cars to go to different places and to stay the originally agreed upon three months.
The team's mission seemed part of a race against time before hunger could take a greater and greater toll.
Frank agreed with Douglas Coutts, of World Food, that North Korea faces another food crisis in February or March. That's when citizens will have eaten the recent harvest of corn and rice and the U.S. corn.
Frank felt the long-term answer to North Korea's problems is internal.
"The North Koreans are very stubborn and say they don't need to reform. They say just lift the U.S. economic sanctions. There's more to it than that. We saw rusted-out empty factories that haven't been used for a decade. They need to beef up their industry. Agriculture can't carry the country."
Frank and other CRS officials had further impressions of North Koreans: their total faith in their government despite a worsening economy, their fear of foreigners, especially Americans, their isolation from the outside world, and the resilience of many.
"We saw no observable cynicism or questioning of the government," said Frank. "The people believe the government will overcome the recent difficulties."
The fear of foreigners is apparent. "For three generations or more, their government has told them the 37,000 Americans [troops] just across the border in South Korea will come and shoot them, so they are afraid of outsiders," said Kenneth Hackett, CRS executive director. He toured North Korea for five days in November in a U.S. interfaith fact-finding group.
Another visitor noticed the Koreans' lack of knowledge of the outside world. A government "minder" who accompanied the aid officials was an ardent soccer fan but unfamiliar with the most famous soccer star ever. "He didn't know who Pele was," said CRS media aide Tom Price.
"They're not talking with anyone outside their country," Hackett said of North Korean officials. Also, he said he found, "There wasn't a common ground from which to start conversations. There wasn't much room for discussion."
The people showed toughness and pride in the face of calamity. One such person introduced herself as Mrs. Han. Her family's home in the coastal province of South Pyongan was destroyed by flood and soon rebuilt with concrete and mud, a spotless hut containing only matting for sleep and kitchen utensils.
She was embarrassed she couldn't give visitors a gift, a national tradition.