SEOUL - In 1993, French neurosurgeon Francois-Xavier Roux received a phone call in Paris from an unidentified North Korean official. The then leader-in-waiting, Kim Jong Il, had suffered a head injury from horse-riding accident and they wanted his advice.
Fifteen years later the North Koreans contacted him again. This time, it was more urgent.
They flew Roux out to Pyongyang in an operation so secret Roux himself was unaware who his patient would be until he met a frail Kim Jong Il lying in a modern intensive care bed flanked by his doctors.
"They were visibly anxious about the situation - maybe that's why they asked for a foreign doctor, since I had no problem asking Kim Jong Il questions, or telling him what to do," said Roux, who also met a young Kim Jong Un, whom he said appeared moved by his father's deteriorating health.
State media acknowledged for the first time last month that Kim Jong Un, who assumed power in North Korea when his father died in 2011, was suffering from "discomfort" due to unspecified health reasons, prompting speculation over what ails him.
North Korea, founded by the young Kim's grandfather when a post-Japanese colonised Korean peninsula was divided into North and South in 1945, is a hereditary dictatorship - making the health of its leaders an especially sensitive subject.
Kim, who is 31 and frequently the centrepiece of the state propaganda machine, has not been photographed by official media since appearing at a concert alongside his wife on Sept. 3. Footage from an event with key officials in July showed him walking with a limp.
The time Roux spent in Pyongyang treating Kim Jong Il gives him a near-unparalleled insight for a Westerner into the medical facilities enjoyed by the isolated country's ruling family. "The local doctors were quite competent, and during the discussions I had with them, it was exactly as if I was talking to European doctors. They were at the same medical level as I was," he told Reuters by phone from Paris. "They had almost everything. They had very good facilities."
Beer bottles for drips
Healthcare is technically free for ordinary North Koreans, but years of failed economic policy and a lack of basic supplies means it is often only those with enough hard cash to buy medicine on the black market who get the care they need.
"Conditions were everywhere pretty simple, even primitive. There were staff but little equipment - we saw beer bottles recycled as drips," said James Hoare, a British diplomat who visited rural North Korean hospitals in the early 2000s.
Recent reports from the country suggest the situation has improved, albeit not by much.
For the leadership, however, no expense is spared.
Kim Jong Il in his later years underwent frequent check-ups at the secretive Ponghwa Clinic in central Pyongyang.
A large modern structure surrounded by thick foliage and equipped with its own helipad, the Ponghwa Clinic underwent massive renovations in the years following Kim Jong Il's stroke, historical satellite imagery shows.
"If Kim Jong Un has been advised that medical necessity prevents him from participating in public events, then he's probably under the care of staff by the Ponghwa Clinic," said Michael Madden, an expert on the North Korean leadership.