Dermatological emergencies are uncommon, but can cause devastating complications and death if not recognised and treated early. Some skin conditions require treatment in an intensive care unit. Here are some of the most serious skin conditions and what you should know about recognising them.
1. Necrotising fasciitis
Necrotising fasciitis is a severe infection of the skin, the tissue below the skin, and the fascia (fibrous tissue that separates muscles and organs), resulting in tissue death, or necrosis. The infection is rapid, fast-spreading and fatal if not detected and treated early. If not treated with antibiotics and surgery early, toxic shock and organ failure are common.
Necrotising fasciitis may occur in anyone. Previously healthy young people are often affected.
The cause may be one or more bacteria entering the body via an external injury or punctured internal organ. Group A streptococci bacteria, which are the organisms implicated in “strep throat”, are among the most common causes.
Early necrotising fasciitis is easily missed, as similar symptoms are commonly seen in less severe infection. The initial area is painful, red and swollen. This progresses to a dark, blistered, malodorous and blackened area, which is a sign of tissue death. Other symptoms include fever, intense pain, low blood pressure and shock.
The most important risk factors for necrotising fasciitis include diabetes, peripheral vascular disease, trauma, alcohol and intravenous drug use, and use of non-steroidal anti-inflammatory drugs.
Treatment of necrotising fasciitis is immediate hospitalisation, surgical removal of all dead tissue, and intravenous antibiotics. Patients often require intensive care. Management of shock and other complications reduces the risk of death. Use of a hyperbaric chamber (to increase oxygen delivery to the tissue) and immune therapy may also be required.
Around a quarter of people diagnosed with necrotising fasciitis will die, and sepsis occurs in up to 70% of cases.
2. Scalded skin syndrome
Staphylococcal scalded skin syndrome is an uncommon major skin infection. It typically affects newborn babies, young children and adults with reduced immune systems or kidney failure. This syndrome is caused by toxins produced by the bacterium Staphylococcus aureus, which is common in throat, ear and eye infections.
Around 15-40% of adults carry Staphylococcus aureus on the skin surface and have no problems. But these adults may inadvertently introduce the bacteria into nurseries or daycare centres. Because young children have weak immunity to specific toxins, they’re at increased risk of scalded skin syndrome.
Scalded skin syndrome is characterised by a red, blistering rash resembling burns. Early symptoms include fever, skin redness and skin tenderness. Other symptoms may include sore throat or conjunctivitis.
Within 24-48 hours, fluid-filled blisters form on the entire body. The blisters may rupture, leaving areas resembling burns. Large areas of the skin peel off and fall away with only minor touch.
Common skin rashes and what to do about them
Scalded skin syndrome requires hospitalisation for intravenous antibiotics and treatment of the wounds. Ruptured blisters require wound dressings, and the skin surface requires intense care to avoid further damage.
Other treatment includes intravenous fluid and electrolyte maintenance to prevent shock and other complications, paracetamol for pain and fever, and avoidance of severe sepsis. Sepsis is when chemicals released into the bloodstream to fight an infection trigger inflammatory responses throughout the body, which can be life-threatening.
Complications of scalded skin syndrome include severe infection, pneumonia, cellulitis (a bacterial skin infection) and dehydration. Most children treated appropriately recover well and healing is complete within a week.
3. DRESS syndrome
Standing for “drug reaction with eosinophilia and systemic symptoms,” DRESS syndrome is a severe reaction that affects the skin and internal organs. The patient may have an extensive rash, fever, enlarged lymph nodes and damage to the liver, kidneys, lungs, heart, blood components or pancreas. Symptoms usually start two to eight weeks after the responsible drug has been taken.
The death rate is estimated between 10 and 20%, most often due to liver failure.
The most common drugs responsible include anticonvulsants, antidepressants, non-steroidal anti-inflammatory drugs, antibiotics and sulfa drugs (a type of synthetic antibiotic). The severe reaction is thought to occur due to a pre-existing genetic change in the immune system, a triggering illness (most often a viral infection) and defective breakdown of the drug by the body.
Early diagnosis is essential. The responsible drug must be stopped immediately and patients may require intensive care or burn unit management. More intensive treatment is needed if organs are involved.
4. Life-threatening drug reactions
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are variants of a life-threatening reaction that affects the skin and mucous membranes (mouth, eyes, genitals, respiratory or gastrointestinal tracts).
These are unpredictable reactions that leave sufferers critically unwell, with widespread death of the outer skin layer (epidermis), which peels off. The rash generally begins on the trunk and extends to the limbs and face, and there is intense skin pain. Before the rash appears, symptoms include fever, sore throat, runny nose, conjunctivitis and general aches.
It’s almost always caused by medications. The most common medications causing this reaction are anticonvulsants, antibiotics, allopurinol (gout medication), non-steroidal anti-inflammatory drugs and an HIV drug. The reaction usually occurs in the first eight weeks after taking the drug. It’s more likely to happen if the patient has cancer, HIV or specific genes that may play a role.
This reaction can be fatal by causing dehydration and malnutrition, severe infection, respiratory failure, gastrointestinal complications and multi-organ failure.
The responsible drug has to be stopped, and treatment (in a burns unit and intensive care unit) includes wound care, fluid management, pain management and prevention of infection. Long-term complications, including scarring, eye, oral, genital, lung disease and mental health disorders, are common. Around a quarter of people with this reaction will die.
Everyone has had the unpleasant experience of a rash on the skin – pink, red or purple, flat or bumpy, itchy, scaly, pus-filled, or just plain unsightly. This variety isn’t surprising, because the skin is a complicated organ.
Infections, allergic reactions, immune system problems and even bad reactions to medication can all manifest as a rash.
Here are a few of the most common types.
Almost every prescription medication available can cause a rash as a side effect, and more than 80% of those are “exanthematous drug eruptions”, meaning a widespread rash accompanied by other symptoms such as headache, fever and feeling generally unwell.
This rash usually appears within two weeks of starting a new medication, as a widespread, symmetrical rash with pink-to-red spots that are flat or elevated and firm, and that might join together in patches.
This type of rash is a hypersensitivity reaction, in which the attacking soldiers of the immune system (called “T-cells”) detect the drug and try to clear it from the body by releasing inflammatory proteins.
Very rarely, a drug can cause a severe and life-threatening rash called “toxic epidermal necrolysis” where the skin begins to peel off in sheets. It’s more common in Han Chinese people with a specific genetic variant, and requires intensive care or burn unit treatment.
Most drug eruptions go away within a week once the patient stops taking the problem medication, or within several weeks in protracted cases. In the meantime, or if the drug is essential, steroid creams (which reduce inflammation) and emollient (softening) moisturisers can bring some relief.
Allergic contact dermatitis
Allergic contact dermatitis is caused by direct skin contact with a substance to which the person is allergic. The immune system’s T-cells overreact to the allergen and release proteins that call more immune cells to the area, making it red and swollen.
It’s often itchy and can be blistered or dry but bumpy. The reaction is often delayed by 48-72 hours, so it can be difficult to determine exactly what caused the reaction. It should also die down by itself over a few days, as long as the allergen is no longer on the skin.
Contact allergies can develop suddenly after years of exposure to an allergen. Jewellery containing nickel, fragrances in lotions, household cleaners, preservatives in hair products, and latex in gloves or condoms are common sources. A dermatologist can carry out a patch test to determine whether a substance is the allergen, by applying it to a small patch of skin.
Active dermatitis is treated with emollient moisturisers and steroid creams, or with oral steroids or drugs to suppress the immune system if very severe. Further episodes can be prevented by becoming aware of the sources of the allergen, reading labels carefully, and using gloves to handle allergen-containing products.
Atopic dermatitis or atopic eczema (often just called eczema) is very common in children from three months old onwards, but appears in adults too, often with hay fever and asthma.
Atopic dermatitis features patches of intensely itchy red skin, sometimes with blisters and weeping patches. Children often have open sores and scabs, because it’s so itchy that it’s hard to refrain from scratching.
Over time the skin becomes thickened and rough from frequent scratching and rubbing. Childhood atopic dermatitis tends to improve as the child grows up, but may continue. Far less commonly, atopic dermatitis can also appear first in adulthood.
Atopic dermatitis is a disease of the immune system, in which
structural defects in the skin barrier make it easier for irritants to penetrate into the skin. This throws the delicate balance of the microbial community on our skin out of whack, causing the immune system to go into overdrive. Triggers include stress, sweating, coarse fibres in clothing, inhalation of allergens such as pollen, irritants such as soap or perfumes, and eating food we’re allergic to.
Steroid creams can help treat a bad flare of atopic dermatitis, but shouldn’t be used constantly. In very severe cases, immunosuppressant drugs are prescribed. Ongoing control of atopic dermatitis often includes using emollient moisturisers to combat dry skin, keeping cool, avoiding hot water or irritants, and reducing allergens such as dust mites in the home.
For severe cases that don’t respond to these methods, the drug dupilumab has just been approved for use in Australia. This drug blocks a specific cell receptor to prevent immune cells from detecting two overactive inflammatory proteins.
Atopic dermatitis can have a big impact on quality of life, due to insomnia from the constant itchiness, and restrictions on clothing, body products, pets or activities. Its presence on prominent parts of the body like the face and hands can also reduce self-esteem. Evening sedatives to improve sleep and psychotherapy can help reduce the impact on everyday life.
Psoriasis is another chronic immune disorder. It can start at any age and can be lifelong, and is usually present as red plaques (raised or thickened skin) with well-defined edges and silvery-white scales, ranging from a few millimetres to several centimetres across. The overactive inflammation can also damage the joints and lead to psoriatic arthritis.
Psoriasis is caused by too many new skin cells being produced and moving up to the surface of the skin too quickly. It’s not known exactly why, but there’s usually an overabundance of inflammatory messenger proteins in the skin.
It can be triggered or aggravated by a streptococcal infection such as tonsillitis, smoking, hormonal changes such as menopause, and some medications. Genetics play an important role in susceptibility to psoriasis and also in what treatments are effective.
Chronic plaque psoriasis, the most common form, can be very resistant to treatment. Small areas can be treated with creams containing steroids, coal tar, or vitamin D. If a lot of the body is covered by plaques, oral immunosuppressant drugs are used, or phototherapy, which uses targeted UV light to destroy over-active immune cells. Moderate sun exposure sometimes improves psoriasis, but sunburn can worsen it – a tricky balance in Australia’s high-UV environment.
These treatments can usually improve the plaques, but it can be very difficult to clear it completely. There are several new drugs coming onto the market for severe psoriasis that hasn’t responded to other treatment.
Tinea, or ringworm, is not caused by worms at all but a fungal infection. Tinea is usually named according to the body site it’s on, but the same few kinds of fungus can cause tinea in many parts of the body and it can be spread from one part of the body to another, such as by scratching or using a contaminated towel.
Tinea pedis, on the foot, is an important type because spores can live for weeks in communal showers and changing rooms, making it a common source of infection that can then spread to the trunk, arms and legs (tinea corporis) or groin (tinea cruris, or jock itch). Cats, dogs and other animals are a common source of ringworm fungus, but many types can be spread between people too.
Typically, tinea spreads in a circular or oval patch, often healing in the middle so that it appears to be a red scaly ring of infection. Sometimes it can also become a fungal abscess that looks like a boil, feels boggy, and has pustules.
On the feet it can look like ringworm circles, patchy fine dry scales on the sole, blisters on the instep or a moist, red peeling area between the toes (athlete’s foot).
In the groin, it can have a scaly, red raised border and be extremely itchy.
Tinea is diagnosed by microscopic examination and laboratory culture of skin scrapings. It’s usually treated with antifungal creams, or oral antifungal drugs if it persists. It can become chronic in the warm, moist folds of the body.
Shingles is a famously painful, blistering rash caused by the reactivation of chicken pox virus, varicella-zoster virus, usually years or decades after the original infection.
The virus lies dormant in nerves near the spine and migrates down the sensory nerve to the skin when it is reactivated, but it’s not known why the virus is reactivated. Some possible triggers are radiotherapy, spinal surgery, other infections, or cancers.
Shingles starts with pain in the skin that is often described as burning or stabbing, followed in one to three days by a rash of raised red bumps that become blisters and then crust over. The rash is usually confined to a narrow arc of skin, along the sensory nerve that was harbouring the virus.
Patients often have a fever, headache and swollen lymph nodes. Recovery takes two to four weeks but the pain can persist after the rash has healed, called post-herpetic neuralgia.
If it’s caught within three days of onset, antiviral medication can reduce the severity of symptoms and length of the infection. Otherwise, treatment consists of powders or solutions to dry out the rash, as well as pain relief and rest.
Australians aged over 70 are eligible for a free zoster vaccine, which reduces the risk of shingles by half.
This article is part of our series about skin: why we have it, what it does, and what can go wrong.
Our skin is a big deal – literally. It’s the largest organ in the body and one of the most complicated. It has many roles in the maintenance of life and health, but also has many potential problems, with more than 3,000 possible skin disorders.
Not only does the skin hold everything in, it also plays a crucial role in providing an airtight, watertight and flexible barrier between the outside world and the highly regulated systems within the body. It also helps with temperature regulation, immune defence, vitamin production, and sensation.
The skin is unique in many ways, but no other organ demands so much attention and concern in both states of disease and health. There is a huge focus on skin health, with fierce competition to have glowing, clearer, healthier, younger and fresher skin. And this focus can cause secondary problems with self-esteem and mental health.
So, what exactly is our skin meant to do and how does it impact our life?
The structure of the skin
The skin is divided into three layers known as the epidermis, dermis and subcutis. These layers are well defined but together they allow the skin to function effectively.
The epidermis is the outermost, cellular layer of the skin which varies in thickness depending on the body site. On average it’s less than half a millimetre thick. The epidermis resembles a “brick wall” of cells known as keratinocytes, which are bound tightly together and act to prevent free movement of moisture, pathogens and chemicals into or out of the body.
Keratinocytes replicate from the basal layer and work their way up to the outer surface (known as the stratum corneum) over a period of about 28 days. Once they reach the surface the tight bonds between them break apart and they are shed.
Other than keratinocytes, pigment-producing cells known as melanocytes and immune cells known as Langerhans cells also exist within the epidermis. Melanocytes inhabit the basement membrane, at the base of the epidermis and produce a pigment known as melanin both innately (giving the skin its natural colour), and in response to ultraviolet light (UV) exposure (giving the skin a sun tan).
The melanin is a brown pigment that is taken up into the overlying keratinocytes. This pigment will then absorb UV light (from the sun) when it hits the skin, thereby protecting the basal calls underneath from UV damage.
The epidermal cells also develop hair follicles, sweat glands and sebaceous (oil) glands which extend down into the layer below known as the dermis. The small ducts from each of these glands open onto the skin surface. Sweat and sebum (oil) provide an antibacterial and protective barrier on the skin.
The dermis lies beneath the epidermis and is 20-30 times thicker. It’s made up of a dense layer of fibrous (collagen) and elastic (elastin) tissue. The dermis gives the skin its integrity, strength and elasticity; and houses blood vessels, glands and hair follicles, as well as nerves and their receptors.
Beneath the dermis lies the subcutis (also known as the hypodermis), a specialised layer of adipose (fat) and fibrous tissue. The thickness of this layer varies dramatically depending on the site and a person’s body shape and weight. It cushions the body from external trauma, insulates from the cold and stores energy (fat).
The function of the skin
The extraordinary array of functions performed by healthy skin is still coming to light. The basic day-to-day functions include:
Working as a barrier – protecting against water loss as well as physical and chemical injury, and bugs
Helping us fight off bugs, allergens, toxins and carcinogens via the parts of our immune system that exist in our skin
Regulating our temperature by dilating and constricting our blood vessels near the skin surface, controlling the transfer of heat out of the body. Temperature is also regulated by evaporative cooling due to sweat production and by the insulating effect of erect hairs on the skin surface. Heat loss is also affected by the insulating layer of subcutaneous fat
Protecting us from UV radiation by producing melanin
Giving us the sense of touch _ providing interaction with physical surroundings, allowing all fine and gross motor activities and allowing pleasurable and sexual stimulation
Beauty and physical attraction – the quality and condition of the skin greatly contributes to the perception of health, wellness, youth and beauty.
What is normal skin and how can you optimise it?
Normal healthy skin has many important roles and thus should be treated with care and respect. Many people only start focusing on the skin once there is an abnormality or at least a perceived problem.
Common concerns include dryness, sensitivity, oiliness, congestion, wrinkles, sun damage and signs of ageing. Although these states are all within the spectrum of normal functional skin, they may be considered problematic if severe or undesirable.
Normal, healthy skin that is not exposed to excessive physical or environmental insults may not require any specific care or protection, but for those who want to optimise or improve their skin, some basic steps can make a big difference.
The key to skin care is consistency and routine, and it can take time to appreciate the changes. A basic regime of daily protection from excessive UV radiation, protection from excessive irritation and drying (by avoiding drying soaps, excess water or irritating chemicals) and aiding of the skin’s barrier properties (using a moisturising protective layer) will result in noticeable improvement in almost all skin.
Switching and changing products and routines is usually counterproductive and will prevent you from seeing expected improvement in time. It’s worth looking after your skin, as you’ll wear it every day for the rest of your life.
Katin chief says previously expelled Christians will be shot if they return.
DUBLIN, November 9 (CDN) — Officials in Katin village, southern Laos have ordered six more Christian families to renounce their faith or face expulsion in early January, advocacy group Human Rights Watch for Lao Religious Freedom (HRWLRF) reported today (Nov. 9).
The Katin chief and the village religious affairs officer, along with local security forces, recently approached the six families with the threat after having expelled 11 Christian families, totaling 48 people, at gunpoint last January. The six families now under threat had become Christians since the January expulsion.
The eviction last January followed months of threats and harassment, including the confiscation of livestock and other property, the detention of 80 men, women and children in a school compound and the death by asphyxiation of a Christian villager. (See http://www.compassdirect.org, “Lao officials Force Christians from Worship at Gunpoint,” Feb. 8.)
Immediately after the expulsion, two more families in Katin village became Christians despite the obvious risk to their personal safety, according to HRWLRF. The village chief allowed them to remain in Katin but warned all villagers that their own homes would be “torn down” if they made contact with the expelled Christians.
In the following months, the expelled villagers suffered from a lack of adequate shelter, food and water, leading to eye and skin infections, diarrhea, dehydration and even the death of one villager. Katin authorities also denied Christian children access to the village school. (See http://www.compassdirect.org, “Christians Expelled from Village Suffer Critical Illnesses,” May 14.)
District officials in early May gave the Christians permission to return to Katin and take rice from their family barns to prevent starvation, said another source on condition of anonymity. Some families then tried to cultivate their rice fields to avoid losing them completely, but the work was extremely difficult as authorities had confiscated their buffaloes, essential to agriculture in Laos.
Threat to Shoot
In July, officials from the Saravan provincial headquarters and the Ta-oyl district religious affairs office met with the evicted families in their shelters at the edge of the jungle and encouraged them to return to Katin, HRWLRF said.
The Christians agreed to return under five conditions: that authorities designate a Christian “zone” within Katin to avoid conflict with non-believers; that all forms of persecution end; that their children return to school; that Christians must be granted the right of burial in the village cemetery; and that the village award compensation for six homes destroyed in the January eviction.
When higher-level officials approached Katin leaders with these terms, village officials and local residents rejected them, insisting that they would only allow the Christians to return if they gave up their faith. The higher officials invoked Decree 92, a law guaranteeing the rights of religious minorities, but village heads said they would shoot every Christian who returned to Katin.
Shortly after this discussion took place, a further four families in Katin became Christians, according to HRWLRF.
A communist country, Laos is 1.5 percent Christian and 67 percent Buddhist, with the remainder unspecified. Article 6 and Article 30 of the Lao Constitution guarantee the right of Christians and other religious minorities to practice the religion of their choice without discrimination or penalty.
Report from Compass Direct News
Muslims said to use mistaken identity to stop activities of Christian who refused to recant.
DHAKA, Bangladesh, August 27 (CDN) — A Christian convert from Islam was falsely arrested for cattle theft last weekend in a bid by influential Muslims to stop his Christian activities, area villagers said.
Day laborer Abul Hossen, 41, was arrested on Saturday (Aug. 21) for alleged cattle theft in Dubachari village in Nilphamari district, some 300 kilometers (180 miles) northwest of the capital, Dhaka.
Christian villagers told Compass that Hossen was the victim of “dirty tricks” by influential Muslims.
“There is another Abul Hossen in the village who might be the thief, but his father-in-law is very powerful,” said Gonesh Roy. “To save his son-in-law, he imputed all the blame to a different Abul Hossen who is a completely good man.”
Hossen, who converted to Christianity from Islam in 2007, has been very active in the community, and Muslims are harassing him with the charge so his ministry will be discredited and villagers will denounce his faith, Roy said.
“If he can be accused in the cattle theft case, he will be put in jail,” Roy said. “He will be a convicted man, and local people and the believers will treat him as a cattle thief. So people will not listen to a thief whatsoever.”
Some 150 villagers, about 20 percent of them Christian, went to the police station to plea for his freedom, he and other villagers said.
Sanjoy Roy, a lay pastor with Christian Life Bangladesh, told Compass that Hossen was a fervent Christian and that some Muslims have been trying to harass him since his conversion.
“They are hoping that if he is embarrassed by this kind of humiliation, he might not witness to Christ anymore, and it will be easy to take other converted Christians back to Islam,” Sanjoy Roy said. “He is a victim of dirty tricks by some local people.”
Hossen was baptized on June, 12, 2007 along with 40 other people who were raised as Muslims. Of the 41 people baptized, only seven remained Christian, with villagers and Muslim missionaries called Tabligh Jamat forcing the remaining 34 people to return to Islam within six months, sources said.
Local police chief Mohammad Nurul Islam told Compass that officers had arrested a cattle thief who confessed to police that his accomplice was named Abul Hossen.
“Based on the thief’s confessional statement, we arrested Abul Hossen,” said Islam. “There are several people named Abul Hossen in the village, but the thief told exactly of this Abul Hossen whom we arrested.”
Hossen denied the allegation that he was involved in cattle theft, Islam said.
“Hossen is vehemently denying the allegation, but the thief was firm and adamantly said that Hossen was with him during the theft,” he said. “Then we took Hossen on remand for three days for further inquiry.”
A former union council chairman who is Muslim, Aminur Rahman, also told Compass that Hossen was a scapegoat.
“He is 100 percent good man,” said Rahman, who also went to the police station to plea for Hossen’s freedom the day after his arrest. “There are two or three people named Abul Hossen in the village. Anyone of them might have stolen the cattle, but I can vouch for the arrested Abul Hossen that he did not do this crime.”
Whether Hossen is a Christian, Muslim or Hindu should not matter in the eyes of the law, Rahman said.
“He is an innocent man,” he said. “So he should not be punished or harassed. That is why I went to police station to request police to free him.”
Local government Union Council Chairman Shamcharan Roy, a Hindu from Lakmichap Union, told Compass that Hossen was not engaged in any kind of criminal activities.
“In my eight years of tenure as a union council chairman, I did not find him engaged in any kind of criminal activities,” said Shamcharan Roy. “Even before my tenure as a chairman, I did not see him troublesome in the social matrix.”
Immediately after Hossen’s arrest, Shamcharan Roy went to the police station and requested that he be freed, he added.
“I was under pressure from local people to free him from custody – more than 100 villagers went to the police camp, getting drenched to the skin in the heavy downpour, and requested police to free him,” Shamcharan Roy said. “Police are listening to a thief but are deaf to our factual accounts about Abul Hossen.”
In July 2007, local Muslims and Tabligh Jamat missionaries gathered in a schoolyard near the homes of some of the Christians who had been baptized on June 12, a source said. Using a microphone, the Muslims threatened violence if the converts did not come out.
Fearing for their lives, the Christians emerged and gathered. The source said the Muslims asked them why they had become Christians and, furious, told them that Bangladesh was a Muslim country “where you cannot change your faith by your own will.”
At that time, Hossen told Compass that Muslims in the mosque threatened to hang him in a tree upside down and lacerate his body with a blade. Hossen said the Muslims “do not allow us to net fish in the river” and offered him 5,000 taka (US$75) and a mobile phone handset if he returned to Islam.
“But I did not give up my faith, because I found Christ in my heart,” Hossen told Compass in 2007. “They threatened me with severe consequences if I do not go back to Islam. I said I am ready to offer up my life to Christ, but I won’t renounce my faith in Him.”
Report from Compass Direct News
One dead, two hospitalized; village chief threatens other residents.
DUBLIN, May 14 (CDN) — In spite of assurances of religious rights by officials in March, Lao Christians expelled from a village in Saravan Province in January are suffering from a prolonged lack of adequate food and clean water.
The lack of basic resources has led to diarrhea, dehydration, eye and skin infections, fainting and general weakness for the Christians expelled from Katin village, and one person has died, Human Rights Watch for Lao Religious Freedom (HRWLRF) reported.
A Christian who went by the single name of Ampheng died suddenly in April while praying for one of two other Christians who were hospitalized with illnesses caused by their living conditions, an HRWLRF spokesman told Compass. The exact cause and date of Ampheng’s death were not immediately known.
Expelled from their village at gunpoint on Jan. 18 for failing to renounce their faith, the 48 Christians were forced to build temporary shelters at the edge of the jungle, about six kilometers (nearly four miles) away from the village.
They have since survived on food found in the jungle and water from a hand-dug well that is unfit for cooking or drinking, sources told HRWLRF.
District officials in early May gave the Christians permission to return to Katin village and take rice from their family rice barns to prevent starvation, said another source on condition of anonymity.
In addition, some of the Christians have returned to tend their family rice fields, fearing that if the fields are completely abandoned they may lose the right to cultivate them next year. Water buffaloes essential for farm work, however, were confiscated in January along with the Christians’ homes and registration papers, according to HRWLRF.
When the Christians interred Ampheng at the local burial ground, district officials fined them for failing to produce the required proof of house registration, according to HRWLRF.
Katin’s village chief recently warned other residents that their personal possessions would be confiscated if they had any contact with the expelled Christians. If any family continued to maintain contact despite repeated warnings, their own homes would be torn down, the chief reportedly said.
Official reactions to the plight of the Christians have been mixed. In March, a delegation of provincial and district officials led by Gov. Khamboon Duangpanya visited the Christians at their jungle site and assured them of their legal right to embrace the faith of their choice and to live anywhere in the district.
Just days earlier, however, the district head, identified only as Bounma, summoned seven of the Christians to his office and said that he would not tolerate the existence of Christianity in areas under his control. (See “Lao Officials Visit Expelled Christians, Give Assurances,” March 19.)
High level officials failed to intervene last July when villagers seized a Christian identified only as Pew and poured rice wine down his throat, killing him by asphyxiation. Village officials later fined Pew’s family for erecting a cross on his grave, and then detained 80 Christians in a school compound, denying them food and pressuring them to renounce their faith.
The heads of 13 families then signed documents renouncing Christianity in order to protect their children, but most resumed attendance at worship meetings within a few months.
Provincial officials did call a meeting in September 2008 asking Katin authorities to respect Lao religious laws and allow the Christians freedom to worship, but their request was ignored.
A communist country, Laos is 1.5 percent Christian and 67 percent Buddhist, with the remainder unspecified. Article 6 and Article 30 of the Lao Constitution guarantees the right of Christians and other religious minorities to practice the religion of their choice without discrimination or penalty.
Report from Compass Direct News
A Chinese pastor, currently serving a sentence for ‘illegal activities’ while leading his church, has been transferred to a labor camp in Henan Province, China, reports Michael Ireland, chief correspondent, ASSIST News Service.
ChinaAid says that on June 29, about 3 p.m., Pastor Dou Shaowen was secretly transferred to Shifo Re-education Through Labor Center in Zhengzhou city, Henan province.
The Christian human rights group says authorities still have not informed his family of his transfer. Pastor Dou is currently serving a one-year sentence of re-education through labor for ‘engaging in illegal activities’ because of his leadership of Rock (Panshi) Church.
ChinaAid says: “Pastor Dou was first arrested on June 14 when government officials raided and forcibly abolished and sealed Rock Church’s building, a house church in Zhengzhou city, Henan. Police arrested him, his wife Feng Lu and five other believers. Pastor Dou and Feng Lu received one-year re-education through labor sentences, while the five other believers were each sentenced to 15 days detention and a 500 yuan ($74USD) fine.”
ChinaAid goes on to say that Pastor Dou was held in Jinshui Branch Detention Center of Zhengzhou City until June 25, when at about 6:30 p.m., he was transferred to Baimiao Re-education Through Labor Center located on Wenhua Road, Zhengzhou city.
ChinaAid contacts reported: “He was given inhuman treatment in the re-education through labor center. When he wanted to talk to the police officers, he was forced to squat. He worked 18 hours a day from 6 a.m. to 12 a.m. midnight. Over 70 people sleep in a room. Due to the hot weather and the poor sanitary conditions…some prisoners have eczema, herpes and other skin diseases. They have to work 18 hours a day without enough to eat.”
At about 3 p.m. on June 29, Pastor Dou was transferred to Shifo Re-education through Labor Center where conditions are reported to be worse.
According to a ChinaAid media update, authorities have permitted Pastor Dou’s wife, Feng Lu, to serve her one-year sentence at home, in order to care for their 12-year-old daughter.
The news release says: “When Feng Lu went to see her husband at the Baimiao Re-education Through Labor Center, she was told she was not allowed to visit him for a month, and was not informed he would be transferred to another labor camp. Feng Lu is required to report to the Public Security Bureau regularly, and could be sent to labor camp again if she is found ‘engaging in illegal religious activities’ again.”
ChinaAid explains that Rock Church’s gathering site is still sealed at this time, and authorities have refused to release the computer and other materials that were confiscated in the raid on June 14.
Rock Church recently released a ‘Declaration on June 14 Incident by Rock Church of Zhengzhou’ to the international community and a petition to the Chinese government.
In the declaration, the Christians of Rock Church state, “We hope the government can give us justice, give back our innocence, cancel the penalties of one year of re-education through labor for Dou Shaowen and Feng Lu immediately, protect the normal religious life of the believers, severely punish those people who committed crimes when they are supposed to enforce the law and apologize to all the believers.”
Report from the Christian Telegraph
Defectors’ descriptions add to evidence of strong but severely persecuted church.
DUBLIN, April 24 (Compass Direct News) – Eom Myong-Heui of North Korea was a loyal communist in the Workers’ Party of Korea before she became a Christian under the influence of her business partner – a missionary who was later arrested and tortured into revealing that Eom was a believer.
Authorities placed Eom into a detention center in her hometown of Moosan and tortured her into denying her faith – but her incarceration continued under appalling conditions. Officials eventually released her due to her previous national loyalty. Now an assistant pastor at a church in Seoul, South Korea after a harrowing escape from her home country, Eom relates a journey that is part of a growing body of evidence of a strong – and severely persecuted – church in North Korea.
“A lot of people ask me if there really are people in North Korea who believe in Christ,” she said. “Do you really think that the missionaries who were there and all the believers who meet underground are all dead?”
Even as the North Korean government this month allowed two high-profile, U.S. Christian bands to perform at a music festival in Pyongyang, the fear of punishment authorities have instilled in North Korean Christians keeps most of them from publicly revealing their faith. As many as 400,000 Christians are estimated to worship secretly in the country, and Suzanne Scholte, head of an association of some 60 groups campaigning for change in the country called the North Korean Freedom Coalition (NKFC), estimates that more than 200,000 North Koreans are held in political prison camps for various perceived “disloyalties” to the regime, including adherence to Christianity.
Christian support group Open Doors estimates that of the 200,000 people incarcerated in political prison camps, at least 40,000 are Christians. Under North Korea’s policy of juche, or self-reliance, citizens may worship only President Kim Jong Il and his late father, former ruler Kim Il Sung.
Jung Eun Hye, one of several North Korean refugees expected to speak about conditions in the country at events in Washington, D.C. next week, said that freedom of religion is stipulated in North Korea’s constitution, but that “Christians have to risk their lives to have a secret service away from the oppression of the government.”
Jung, who faced severe persecution after authorities caught his father and aunt with Bibles in their possession, said he did not know that any churches existed in Pyongyang until he escaped from North Korea. While a handful of government churches do exist in the capital, Jung is one of many refugees who believe that these churches exist only to “deceive the outside world.”
“Here is my question,” said Jung. “If North Korea has freedom of religion, why does the government arrest, kill or imprison Christians in camps from which they never return?”
Testimony from various sources confirms that the government actively seeks out Christian groups and meeting points and imprisons Christians solely because of their faith. The U.S. Commission on International Religious Freedom (USCIRF) last year reported refugees saying that Christianity remained a key factor in the interrogation of people repatriated from China to North Korea. Border guards reserved the harshest punishment for those who admitted having any contact with Chinese or South Korean Christians.
“There is no freedom of belief or religion,” one refugee stated. “[We are taught] that if one is involved in religion, one cannot survive.”
Former police and security officers interviewed for USCIRF’s report admitted that their superiors had instructed them to play the role of Christians and infiltrate “underground” prayer meetings in order to incriminate, arrest, imprison and sometimes execute believers in North Korea.
‘Abyss of Death’
A delegation of North Korean refugees recently described their experiences ahead of events on Capitol Hill from Sunday (April 26) through Saturday (May 2) as part of North Korea Freedom Week.
Kim Young Soon, a refugee who spent nine years in a prison camp, said North Korean ruler Kim “is pushing the people into the abyss of death. In such a society, no one can trust anyone.”
Authorities sent Kim Young Soon and her family to prison camp No. 15, otherwise known as Yodok, after she made a seemingly innocent comment about the regime.
“Every mountain and field in Yodok was covered with dead bodies because of malnutrition and hunger,” Kim said. She described waking at 3:30 a.m. to run six kilometers (nearly four miles) to her assigned workplace and surviving on a diet of unripe, salted corn. Her parents and two of her sons died during their incarceration; border guards shot her third son when she fled with him to China shortly after their release.
Former prisoner Jung Gwangil said prison guards sadistically controlled inmates through collective punishment.
“If I did something wrong, all the members of the group I belonged to were punished,” he said. “When guards withheld food or switched off heaters in the middle of winter, fellow prisoners would sometimes beat the responsible inmate to death.”
Another former prisoner, Kim Tae Jin, described being left naked in a freezing cell and forced to sit on quicklime in the rain, resulting in severe burns to her skin.
“Even now, there are people who cut their own fingers off to avoid hard labor, who disguise themselves as madmen, or who lose their arms from beatings because they believe in a God who supposedly doesn’t exist,” she added.
While she was in prison, she said, a fellow inmate known only as Park formed a small “fellowship” of seven Christians. Prison guards eventually caught Park, beat him severely and asked him, “Who told you about the existence of God?”
“Do we have to be told about the existence of the sun to know that it’s there?” Park replied. “We learn its existence by feeling its warmth.”
In such conditions, the journey to faith is perilous for North Koreans – or nothing short of miraculous in the case of Eom, an assistant pastor at Seoul’s New Pyongyang Full Gospel Church (a fellowship for North Korean Defectors associated with Yoido Full Gospel Church).
She was extremely loyal to the regime until she made contact with a South Korean-Chinese Christian businessman.
“It’s very hard to live in North Korea, so if you don’t secretly do business, you can’t survive,” Eom said in sharing her story with members of another large church in Seoul, South Korea. “So for a few days I just kept being polite and agreeing with whatever he said about God, even though I knew he was wrong … but then God started to change my heart.”
Eventually the missionary gave her a small New Testament.
“I enjoyed it,” she said. “The teaching to love your enemy, give him food if he’s hungry, give him water if he’s thirsty. I also took to heart the words about loving each other.”
Eom asked a superior why North Korea didn’t have a religion other than worship of the Kim family.
“His eyes got big and he told me that religion was poison,” she said, “and that if I tried to learn about Christianity I would automatically become a traitor.”
As a teacher, Eom knew what happened to children of traitors and immediately began to worry about her two daughters. When police arrested the missionary and someone warned her that she could be next, Eom packed a small bag and assured her youngest daughter that she would return in three days.
“At the time,” she told the Seoul congregation, “I didn’t realize that this trip would bar me from ever entering the country again.”
Detained by police, she said, she could not understand why the authorities were so concerned about whether she was a Christian instead of asking about her business activities. After her release and unable to rescue her daughters, she escaped to China, where she was arrested twice and told, “If we arrest you again, we will kill you.”
From China Eom made a dangerous journey via Myanmar to Thailand, where she spent six months in a detention center before being granted asylum in South Korea in 2002.
“This is a most critical time for the North Korea human rights movement,” said Scholte, head of the NKFC and president of the Defense Forum Foundation. “We either advance these issues now with the opportunity that comes from a new administration and a new Congress, or we see another decade of death and despair for those whose great misfortune was to be born under the Kim Jong Il dictatorship.”
Report from Compass Direct News
What is it about people that can really gain your interest? I don’t mean people who you just sort of know or a person that you chat to once in a while, yet find something interesting about them – I mean people who really catch your interest and make an impact on your life?
There are some people whom you admire because they have done something great – such as a renowned doctor or someone who has battled the odds and won. There are those that are perceived as great even though they have done little that can be truly regarded as meaningful – perhaps an actor or an actress, a football player or a well known pop singer. But it is not these people that I have in mind, as legitimately admired as they may be.
I am thinking about those people that are personally known to you, those people that have perhaps had a special impact on your life or who have a special place in your heart or life. What is it about these people?
These are the people whom you care so much about and that no matter what happens, what might be said or even might be seen, they have a place in your heart and in your life that cannot be dislodged. They have really gained your interest and you are perhaps intrigued by them to the extent that you just don’t feel you can perhaps be ‘normal’ again if they were no longer in your life.
We all have such people in our lives, even though we may not admit it to ourselves or try to give the impression to onlookers that it is not so. Yet it is so. Sometimes these people become our wife or husband, someone we admire or look up to from afar, or perhaps someone we might try to pursue, just feeling that we need them to be part of our life’s experience, no matter how small a part that might pan out to be.
Sometimes it can be just a smile and we are hooked. There we are talking away, as perhaps we have a dozen times before and then there it is – the smile. There may have been other smiles, but now there is this one. It is a smile you cannot forget.
You look and mark the characteristics of the smile. You see the dimples that form when her joy overcomes her and her delight can no longer be hidden away from view. There is the radiance that beams from her face and the eyes that seem to be able to see into your heart and mind, yet does so with a softness, with a compassion and with a knowledge that everything is going to be OK. Even her hair seems to join in with smile and her skin glows, forming part of this treasured portrait that you now will carry with you wherever you go. She may be physically removed, yet there she is, right there with you in the memory of her smile and in the smile that comes when your thoughts turn to that memory.
Sometimes these treasured ones, they leave this life before it seems time for them to do so. Sometimes they are gone well before the time that perhaps you think they should be gone. Yet this smile still remains and they are always there, with you along the way, as you remember the moment you first became aware of the smile and the place you made for her in your heart and in all that you are – because she is there and she cannot be moved from the place that you have made for her in your heart and in all of your being.
It can be a smile – that which begins it all. Something perhaps so small, so insignificant overall, but yet overwhelming for the impact and the pathway on which it sets your feet to tread. It is a pathway you walk, drawn on from such a simple beginning to an adventure of revelation and discovery as even more cherished scenes and experiences are charted along the way and the memories of a person are chronicled in the annals of this one not to be forgotten but always remembered.
There are always hooks on which you can hang the canvas of an experience you shared and of which you always wish to recall. A smell or a scene will draw from the mind a precious time or even a feature of the one you hold dear. There will be a smile, a simple smile that will form on your face that none other knows why – yet you know that your dear one is still there, even in the memories of times you held dear.
There will be times and happenings, all special for sure, yet just knowing her will be enough. What a joy it can be, just to have known and to feel the smile of that you held dear. It can be even a smile, though there be even so much more than that too.
It can be a smile.