<P>Dr. England has worked with many partners in an e?ort to bring about continuous and lasting progress. The good will and trust established between the MoPH of the DPRK toward the CFK en- abled this project to begin and continue on a good footing. Dr. England and Stanford University (Dr. Schoolnik) also work closely with WHO, UNICEF, and Global Fund partners who continue their work in DPRK inde?nitely to ensure a lasting impact. Cultural di?erences in the structure of organizations and systems of quality management have presented a challenge. Dr. England and others have found that the desire of the NTRL sta? to seek international accreditation has helped them to accept interna- tional standards for quality assurance and to incorporate those standards into their daily practices. The Global Laboratory Ini- tiative (GLI) Stepwise Process Towards Laboratory Accreditation (http://gliquality.org/) has also proven to be a very useful tool in promoting the acceptance and introduction of quality testing. organizations and individuals for humanitarian aid to the DPRK. Loss of external support for the national TB program could halt progress and allow the TB situation to expand further out of control and beyond the borders of the DPRK. Even with all the external challenges and politics, the Ministry of Public Health continues to regularly allow U.S. partners into the country to work closely and pro- ductively with their citizens for extended periods of time. This clearly shows that they recognize the gravity of their situation and are working diligently to control TB in their country. Furthermore, through our collaboration, we have witnessed many individuals, local physicians, health care workers, laboratorians, and members of the nations public health system, who dedicate their lives to serving and caring for those a?icted with this debilitating and life-threatening disease, even at great risk to their own health and safety. The work and commitment by the Min- istry and all those involved is truly commendable. 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