in Benin City, Nigeria,

我在奈及利亞的貝寧城 成為一位醫生時，

some 30-odd years ago,

那是在大約三十多年前。

I was drawn to help people live full lives.

那時我渴望協助大家好好過生活。

But often, I found myself feeling impotent.

但，我常感到自己很無能。

Here I was, a brand-new doctor with all these skills,

當時的我是個新手醫生， 身懷各種技巧，

but I couldn't cure my patients who had chronic diseases --

但我卻無法治癒慢性病的病人——

illnesses like heart disease, asthma, diabetes --

比如心臟疾病、氣喘、糖尿病——

and needed more than just handing them a prescription

他們需要的不只是 我們開處方給他們，

or providing grief counseling in the office to get the job done.

或者在辦公室裡提供 處理悲傷的諮詢服務。

Fast-forward 15 years later:

快轉十五年，

I'm in Atlanta, Georgia;

我在喬治亞州的亞特蘭大；

it's a different world,

那是個不同的世界，

but it was déjà vu all over again.

但同樣的情況又出現了。

As doctors, we see our patients who have chronic illnesses

身為醫生，我們治療 慢性病病人的方式，

in an episodic way.

是片斷式的。

In between,

在兩次就診之間，病人必須學習

the patients have to learn how to make a lot of decisions for themselves.

如何自己做許多決定。

I'll give you examples.

讓我舉例說明。

If you have medications you're supposed to take every day,

若你有每天應服用的藥物，

what do you do when you're sick?

當你生病時要怎麼辦？

Are you still supposed to take it?

你仍然要吃那些藥物嗎？

How do you recognize a complication when it happens?

併發症發生時，你如何辨識？

How do you recognize a side effect when it happens?

副作用發生時，你如何辨識並處理？

What do you do with it?

除了這些之外，

In addition to all of this,

他們還要處理無可避免的 寂寞、孤獨、焦慮，

they're dealing with the inevitable loneliness, isolation and anxiety

那些慢性病病人都得面對的。

that people who have chronic illnesses deal with.

光是在美國， 十個成人中就有六個有慢性病。

In the US alone, six in 10 adults have a chronic illness.

總數達一億兩千五百萬人。

That's 125 million people.

羅伯特伍德約翰遜基金會 最近有一篇報告指出，

A recent report from the Robert Wood Johnson Foundation

人們的健康狀態，

showed that health habits account for 50 percent

有一半是健康有關的習慣造成的，

of the health outcomes that people experience,

只有兩成是醫療照護。

while medical care only accounts for 20 percent.

事實上，疾病管制署說，

In fact, the Centers for Disease Control

如果我們能消除抽菸、

says that if we could eliminate smoking,

缺乏身體活動，以及營養不良，

physical inactivity and poor nutrition,

我們就可以預防八成的心臟疾病、

that we can prevent 80 percent of heart disease,

八成的第二型糖尿病，

80 percent of type 2 diabetes

以及四成的癌症。

and 40 percent of cancer.

但，我們也知道，

But we also know

改變健康相關習慣是很困難的事。

that changing health behaviors is very difficult.

所以，我們要問：如果，

So we asked the question:

如果我們能創造一種資源

What if we could create a resource

來激勵大家改變健康 相關習慣，會如何？

that could motivate people to change health behavior?

事實上，外面有很多這類資源

The truth is, there are a lot of these resources out there

能協助大家學習到 所謂的自我管理技能。

that help people acquire these so-called self-management skills.

但，通常，這些資源不易取得， 或很難感受到關聯性，

But many a time, they're not easily accessible or relatable,

對於少數族群及缺乏服務的 社區而言更是如此。

particularly to individuals within minority and underserved communities,

他們除了被歧視，還要面對 語言和文化的障礙，

who face bias in addition to barriers like language and culture

以及健康保險範圍的不足。

and inadequate health insurance coverage.

所以，在過去十二年間，

And so in the last 12 years,

我和我在摩爾豪斯醫學院的同事，

my colleagues and I at Morehouse School of Medicine

創造了一個以科技 為基礎的應用程式，

have created a technology-based application

來協助慢性疾病者的照護。

to assist with chronic illness care.

在網路上可以免費

It's freely available on the web

下載這個應用程式。

and as an app.

我們所做的，是讓大家追蹤變數——

And what we do is get people to track variables --

血壓、血糖——

blood pressure, blood sugar --

然後我們以不同顏色顯示的 格式回報給他們。

and then report it back to them in a color-coded format.

綠色代表的是健康的範圍，

So green would indicate a healthy range,

紅色代表有問題需要處理。

and red would indicate a problem that needs something done about it.

我們連結這些統計數字和相關課程。

We link these stats to a curriculum.

相關課程協助每個人了解 自己的健康狀況，

The curriculum helps the individual learn about their health condition,

不論他們的慢性疾病是哪一種。

whatever the chronic illness is.

他們也和健康教練合作，

They also work with a health coach

學習自我管理的技能。

to learn self-management skills,

這些技能可以協助他們 預防疾病造成的併發症。

skills that'll help them prevent complications of their illness.

教練若要能成功幫助病人，

In order for the coach to be successful,

他們必須能取得合作對象的信賴。

they have to be able to gain the trust

我們在診所裡測試這個應用程式，

of the individual that they're working with.

在那裡，健康教練是醫療助理。

We tested this application

我們也在都市裡的大型教堂中測試，

in clinics, where the health coaches were medical assistants,

在那裡，健康教練則是 來自健康署的志工。

and in a large urban church,

一年後，三分之一的參與者

where the health coaches were volunteers from the health ministry.

能夠學到三項新的自我管理技能，

A year later, a third of the participants

並持續維持這些技能到足以改善

were able to acquire three new self-management skills

他們的血壓、血糖，

and maintain them to the extent that it was able to improve

以及他們的運動。

their blood pressures, their blood sugar

有一點讓我們 很驚訝的簡單事實是，

and their exercise.

比起在純粹醫療照護底下的群體，

Now, what was simple yet fascinating to us

教堂群體的表現一樣好或甚至更好。

was that the group from the church did just as well or even better

我們想要知道為什麼會這樣。

than the group that were under purely medical care.

所以我們做了進一步的研究——

And we wanted to learn why that was.

從四百小時的對話錄音——

So we looked a little further into the research --

我們的發現是，教堂的教練

400 hours of recorded conversation --

的確有比較多時間 可以花在病人身上，

and what we learned was that the coaches from the church

他們能接觸到病人的家人，

did have more time to spend with the patients,

所以他們能得知大家需要什麼，

they had access to the patients' families,

並提供他們所需要的資源。

and so they could figure out what people needed

我和我的團隊將之稱為 「契合文化的輔導」。

and provide those resources for them.

為了說明「契合文化的輔導」 這個概念，

My team and I call this "culturally congruent coaching."

我要跟各位談談 我們的病人柏薩女士。

To illustrate this concept of culturally congruent coaching,

柏薩女士八十三歲， 有糖尿病及高血壓。

I want to tell you about one of our patients.

她被指派給安，也就是 她的教會的健康教練。

I'll call her Ms. Bertha.

安剛好是她家多年的朋友，

So Ms. Bertha is an 83-year-old lady with diabetes and hypertension.

他們是同教會的會友。

She was assigned to Anne, her health coach in the church.

在前幾次造訪之後，安觀察到

Anne also happened to be a family friend to Ms. Bertha for many years,

雖然柏薩女士有如實 記錄她的統計數字，

and they were fellow congregants.

數字仍然都呈現紅色。

Anne observed after the first few visits

所以她更深入探究，

that even though Ms. Bertha faithfully recorded her stats,

試圖了解柏薩女士的 狀況是怎麼回事，

they were all showing up as red.

而柏薩女士告訴她最真的真相。

So she probed a little deeper

（笑聲）

to try to understand what was going on with Ms. Bertha,

她告訴她，有些時候，

and Ms. Bertha gave her the real-real.

她的藥物會讓她感覺怪怪的，

(Laughter)

她就不會照處方吃藥， 因為她認為是藥物造成的，

She told her that there were times

但她沒有告訴醫生這件事。

when her medications made her feel weird,

有時她也因為各種理由 而沒有去預約的門診，

and she wouldn't take them the way they were prescribed,

其中一個理由是她並沒有變好，

because she thought it was due to the medicines

而她不想讓她的醫生生氣， 所以她乾脆不去了。

but she didn't tell her doctor that.

於是，安和柏薩女士談，

She also skipped out on some doctor appointments

並請她在下次造訪時 帶她女兒一起來，她也照做了。

for a variety of reasons,

在那次造訪時，

but one of them was she wasn't doing better

安把柏薩女士所收集的統計數字

and she didn't want to make her doctor mad,

通通都印出來，

so she just didn't go.

交給她，並鼓勵她們一起 去看醫生，她們也照做了。

So Anne talked to Ms. Bertha

有了那些資訊，醫生便能針對 柏薩女士的治療方式做調整。

and asked her to bring her daughter in for the next visit, which she did.

不到三個月，柏薩女士的 數字就變成綠色了。

And at that visit,

沒有人比柏薩女士 還要更興奮或驚訝。

Anne was able to print out a log of all these stats

安扮演的健康教練十分成功，

that Ms. Bertha had been collecting,

因為她的關心夠深入，穿越表層，

gave them to her and encouraged them to go see the doctor together,

去深究柏薩女士深藏的文化，

which they did.

並在那個層級上和她交流。

With that information,

她知道如何傾聽， 她知道如何問對的問題，

the doctor was able to make changes to Ms. Bertha's treatment.

以取得需要的資訊。

Within three months, Ms. Bertha's numbers were all in the green.

我們都有在潛意識深處的規則，

No one was more excited or surprised than Ms. Bertha herself.

影響我們做出健康相關的決定。

Now, Anne was successful as a health coach

那是我們的文化。

because she cared enough to go below the surface

安和柏薩女士之間的關係和對話

and probe Ms. Bertha's deep culture

說明了有不同的可能性，

and was able to reach her at that level.

只要我們能和病人、我們的朋友，

She knew how to listen,

和我們的鄰居，在深層的 文化層級進行對話。

and she knew how to ask the right questions

我個人非常興奮，

to get to what was needed.

因為只要用這個簡單的 「契合文化的輔導」概念，

We all have deep unconscious rules

我們就可以協助美國 一億兩千五百萬

that drive the way we make our health decisions.

及世界各地更多的慢性疾病 病人改善他們的生活。

That's our culture.

謝謝。

The relationship and the conversation between Anne and Ms. Bertha

（掌聲）

illustrates what's possible

when we have conversations with our patients,

our friends and our neighbors

on a deep cultural level.

And personally, I'm beyond excited

to think that with this simple concept of culturally congruent coaching,

we could change the lives of 125 million Americans

and many others across the world

that are living with chronic diseases.

Thank you.

(Applause)