Placeholder Image

字幕列表 影片播放

  • I want to tell you

    我要告訴大家,

  • how 20,000 remarkable young people

    為什麼 2 萬個傑出的年輕人,

  • from over 100 countries

    來自 100 多個國家,

  • ended up in Cuba

    當初會選擇去古巴,

  • and are transforming health in their communities.

    而現在正在改善他們的社區衛生。

  • Ninety percent of them would never

    九成的這些年輕人 本來永遠不會離開家鄉,

  • have left home at all

    要不是獲得獎學金去古巴學醫,

  • if it weren't for a scholarship to study medicine in Cuba

    而且立志回到那些

  • and a commitment to go back

    像他們生長背景的地方服務:

  • to places like the ones they'd come from

    偏遠的農村、山區和貧民區。

  • remote farmlands, mountains, ghettos

    成為醫生,

  • to become doctors for people like themselves,

    服務跟自己一樣的弱勢,

  • to walk the walk.

    用行動實踐信念。

  • Havana's Latin American Medical School:

    哈瓦那拉丁美洲醫學院

  • It's the largest medical school in the world,

    是世界上最大的醫學院,

  • graduating 23,000 young doctors

    從 2005 年第一班畢業, 至今已有 2 萬 3 千名畢業生,

  • since its first class of 2005,

    還有大約 1 萬名在學。

  • with nearly 10,000 more in the pipeline.

    學校的宗旨是:

  • Its mission, to train physicians for the people

    為最需要醫生的人培訓醫生,

  • who need them the most:

    為世界上 10 多億從沒看過醫生的人。

  • the over one billion

    這些人從出生到死亡,

  • who have never seen a doctor,

    一輩子生活在各種貧窮線水平之下。

  • the people who live and die

    這所醫學院的學生很特殊,

  • under every poverty line ever invented.

    他們是學校最大的風險,

  • Its students defy all norms.

    也是最大的勝算,

  • They're the school's biggest risk

    他們從世界上最窮的地區被招收進來。

  • and also its best bet.

    學校相信

  • They're recruited from the poorest,

    他們不單可以成為好醫生,

  • most broken places on our planet

    而且是他們社群迫切需要的卓越醫生。

  • by a school that believes they can become

    他們也願意去多數醫生不去的地方,

  • not just the good

    這些地方不但貧窮,

  • but the excellent physicians

    甚至通常很危險。

  • their communities desperately need,

    醫療包裡要帶蛇毒解毒劑,

  • that they will practice where most doctors don't,

    或是四處出診,

  • in places not only poor

    遊走在被毒品、黑幫、子彈摧殘得 千瘡百孔的地區,

  • but oftentimes dangerous,

    就是他們的家園。

  • carrying venom antidotes in their backpacks

    培訓的目的

  • or navigating neighborhoods

    是要透過這些醫生, 就近提供社區醫療照護,

  • riddled by drugs, gangs and bullets,

    提升貧窮地區的衛生水準,

  • their home ground.

    甚至顛覆醫學訓練和行醫的方式;

  • The hope is that they will help

    這些醫生會成為醫療先鋒,

  • transform access to care,

    將衛生保健推到世界每一個角落,

  • the health picture in impoverished areas,

    任務真的非常艱鉅。

  • and even the way medicine itself

    兩個大暴風, 和「用行動實踐信念」的想法,

  • is learned and practiced,

    催生了哈瓦那拉丁美洲醫學院,

  • and that they will become pioneers in our global reach

    在 1998 創校。

  • for universal health coverage,

    喬治和米奇兩個颶風

  • surely a tall order.

    重襲加勒比海和中美洲,

  • Two big storms and this notion of "walk the walk"

    造成 3 萬人死亡,

  • prompted creation of ELAM back in 1998.

    250 萬人無家可歸。

  • The Hurricanes Georges and Mitch

    數以百計的古巴醫生自願去救災,

  • had ripped through the Caribbean

    不過他們一到那裡,

  • and Central America,

    卻發現更大的災難:

  • leaving 30,000 dead

    很多社區完全沒有醫療服務,

  • and two and a half million homeless.

    偏鄉的醫院都關閉了。

  • Hundreds of Cuban doctors volunteered for disaster response,

    因為人手短缺。

  • but when they got there,

    有太多太多的嬰兒不到周歲就夭折。

  • they found a bigger disaster:

    這群古巴醫生離開以後, 又會變成什麼樣呢?

  • whole communities with no healthcare,

    必須有醫生接手,繼續提供醫療,

  • doors bolted shut on rural hospitals

    但要去哪裡找醫生?怎麼訓練?

  • for lack of staff,

    後來,一所哈瓦那海事學院的舊校園,

  • and just too many babies dying

    由古巴衛生部接管,

  • before their first birthday.

    改建成了拉丁美洲醫學院,

  • What would happen when these Cuban doctors left?

    也就是 ELAM。

  • New doctors were needed to make care sustainable,

    它提供學費、食宿,和小額生活津貼,

  • but where would they come from?

    給數百名來自受災最重國家的學生。

  • Where would they train?

    我在哈瓦那當記者,

  • In Havana, the campus of a former naval academy

    看著首批 97 位尼加拉瓜學生

  • was turned over to the Cuban Health Ministry

    在 1999 年 3 月來報到,

  • to become the Latin American Medical School,

    搬進了幾乎未整修的學校宿舍,

  • ELAM.

    幫教授們一下清空教室、

  • Tuition, room and board, and a small stipend

    一下又搬進課桌椅和顯微鏡。

  • were offered to hundreds of students

    接下來的幾年,

  • from the countries hardest hit by the storms.

    美洲各國的政府

  • As a journalist in Havana,

    都來幫自己的學生申請獎學金。

  • I watched the first 97 Nicaraguans arrive

    美國國會黑人同盟

  • in March 1999,

    也申請並且獲得數百個獎學金名額,

  • settling into dorms barely refurbished

    提供給美國的年輕人。

  • and helping their professors not only sweep out the classrooms

    至今 2 萬 3 千名校友,

  • but move in the desks and the chairs and the microscopes.

    總共來自 83 個國家,

  • Over the next few years,

    遍佈美洲、非洲和亞洲,

  • governments throughout the Americas

    新生的國籍也增加到 123 個國家,

  • requested scholarships for their own students,

    半數以上是年輕的女性,

  • and the Congressional Black Caucus

    來自 100 個不同種族,

  • asked for and received hundreds of scholarships

    說 50 種不同的語言,

  • for young people from the USA.

    WHO 總幹事陳馮富珍說過:

  • Today, among the 23,000

    「終於,如果你是窮人、

  • are graduates from 83 countries

    女性、

  • in the Americas, Africa and Asia,

    或是原住民,

  • and enrollment has grown to 123 nations.

    這些條件反而變成獨特的優勢,

  • More than half the students are young women.

    這種價值觀使 ELAM 與眾不同。」

  • They come from 100 ethnic groups,

    魯瑟.卡斯第羅來自 托卡馬喬市的聖佩德羅,

  • speak 50 different languages.

    位在洪都拉斯的大西洋岸。

  • WHO Director Margaret Chan said,

    這個村落沒有自來水、

  • "For once, if you are poor, female,

    沒有電力,

  • or from an indigenous population,

    從鎮上到那裡還得走好幾個鐘頭,

  • you have a distinct advantage,

    或跟我一樣,碰運氣搭小貨車,

  • an ethic that makes this medical school unique."

    沿大西洋岸,趁著退潮行駛。

  • Luther Castillo comes from San Pedro de Tocamacho

    魯瑟

  • on the Atlantic coast of Honduras.

    是托市 40 個上過小學的孩子之一,

  • There's no running water,

    加利福納黑人原住民兒童,

  • no electricity there,

    這些原住民佔宏都拉斯兩成人口。

  • and to reach the village, you have to walk for hours

    離他們最近的醫院

  • or take your chances in a pickup truck like I did

    在好幾哩外,緊急時根本救命不及。

  • skirting the waves of the Atlantic.

    魯瑟每天得要走上 3 個小時,

  • Luther was one of 40 Tocamacho children

    才能到中學上課,

  • who started grammar school,

    只有 17 個小孩能上中學,

  • the sons and daughters of a black indigenous people

    只有 5 個繼續唸高中,

  • known as the Garífuna,

    只有 1 個最後上了大學:

  • 20 percent of the Honduran population.

    魯瑟來到了 ELAM 醫學院!

  • The nearest healthcare was fatal miles away.

    成為第一批加利福納畢業生。

  • Luther had to walk three hours every day

    整個宏都拉斯歷史, 之前只曾有過 2 個加利福納族醫生,

  • to middle school.

    現在有 69 個!

  • Only 17 made that trip.

    多虧有 ELAM 醫學院。

  • Only five went on to high school,

    非常問題需要非常手段,

  • and only one to university:

    靠偉大的理想、想像力和膽識激發,

  • Luther, to ELAM,

    但手段也必須行得通。

  • among the first crop of Garífuna graduates.

    ELAM 沒有實證可行的現成課程,

  • Just two Garífuna doctors had preceded them

    所以大家必須辛苦地摸索學習,

  • in all of Honduran history.

    邊學邊做,邊調整。

  • Now there are 69, thanks to ELAM.

    這些貧窮地區,就算是最聰明的學生,

  • Big problems need big solutions,

    也沒能力立刻開始 6 年醫學訓練。

  • sparked by big ideas, imagination and audacity,

    所以學校設計了科學銜接課程,

  • but also solutions that work.

    再上語言課。

  • ELAM's faculty had no handy evidence base

    學生來自馬普切族、克丘亞族、 瓜拉尼族、加里福納族

  • to guide them, so they learned the hard way,

    多為原住民,

  • by doing and correcting course as they went.

    學過西班牙語,成為第二語言;

  • Even the brightest students

    也有說克里奧爾語的海地學生。

  • from these poor communities

    所以西班牙文成為

  • weren't academically prepared

    上醫學先修課程之前的先修課程。

  • for six years of medical training,

    即使如此,

  • so a bridging course was set up in sciences.

    在古巴,

  • Then came language:

    音樂、食物、氣味等等,

  • these were Mapuche, Quechuas, Guaraní, Garífuna,

    一切風情民俗都截然不同,

  • indigenous peoples

    所以全校師生都變成一家人: 「ELAM 之家」

  • who learned Spanish as a second language,

    宗教信仰多元:跨原住民信仰、

  • or Haitians who spoke Creole.

    約魯巴信仰、穆斯林信仰、 基督教福音教派,

  • So Spanish became part

    擁抱多元成為生活的方式。

  • of the pre-pre-med curriculum.

    為什麼會有這麼多國家的人

  • Even so, in Cuba,

    爭取這些獎學金呢?

  • the music, the food, the smells,

    第一:他們的國家沒有足夠的醫生,

  • just about everything was different,

    就算夠醫生,

  • so faculty became family, ELAM home.

    也分佈不均,漠視窮鄉僻壤。

  • Religions ranged from indigenous beliefs

    因為全球的衛生醫療危機,

  • to Yoruba, Muslim and Christian evangelical.

    是受人力資源短缺危機所致,

  • Embracing diversity became a way of life.

    光是基本醫療需求, 就缺少 4 到 7 百萬名醫療人員,

  • Why have so many countries

    世界各地都有這個問題。

  • asked for these scholarships?

    醫生都集中在都市,

  • First, they just don't have enough doctors,

    而都市只占全球人口的半數。

  • and where they do, their distribution

    而且醫生都集中在市內,

  • is skewed against the poor,

    不在週邊的貧民區或南洛杉磯。

  • because our global health crisis

    在美國,

  • is fed by a crisis in human resources.

    我們雖然有健保改革,

  • We are short four to seven million health workers

    卻短缺醫療專業人員。

  • just to meet basic needs,

    到 2020 年,

  • and the problem is everywhere.

    會少 4 萬 5 千名基層醫療醫師。

  • Doctors are concentrated in the cities,

    我們也是造成問題的元凶之一:

  • where only half the world's people live,

    美國是吸引全世界最多 發展中國家醫師的國家,

  • and within cities,

    第二個學生們搶進古巴的理由,

  • not in the shantytowns or South L.A.

    是這個小島本身的衛生水準,

  • Here in the United States,

    基層醫療做得很好。

  • where we have healthcare reform,

    醫學權威《The Lancet》期刊的委員會

  • we don't have the professionals we need.

    把古巴列為全球醫療衛生 最佳的中收入國家之一。

  • By 2020, we will be short

    「救助兒童會」評選古巴為

  • 45,000 primary care physicians.

    最適合生小孩的拉丁美洲國家。

  • And we're also part of the problem.

    古巴人的平均壽命跟美國人一樣長,

  • The United States is the number one importer

    嬰兒死亡率比美國低,

  • of doctors from developing countries.

    且差距較少;

  • The second reasons students flock to Cuba

    但是古巴花在醫療衛生的人均消費,

  • is the island's own health report card,

    卻只有美國人的 1 / 20。

  • relying on strong primary care.

    ELAM 對課業要求很嚴格,

  • A commission from The Lancet

    但學生畢業率達 80%。

  • rates Cuba among the best performing

    主修科目跟一般醫學院一樣:

  • middle-income countries in health.

    基礎科學與臨床科學。

  • Save the Children ranks Cuba

    但是也有很大的不同:

  • the best country in Latin America to become a mother.

    首先,訓練走出了象牙塔,

  • Cuba has similar life expectancy

    進入診間教室和社區,

  • and lower infant mortality than the United States,

    就是多數畢業生將來執業的地方,

  • with fewer disparities,

    當然他們也有講座和醫院輪班,

  • while spending per person

    但是社區實習從新生入學就開始了。

  • one 20th of what we do on health

    其次,學生注重全人治療,

  • here in the USA.

    兼顧病人的生理和心理,

  • Academically, ELAM is tough,

    並且考量病人的家庭、社群,

  • but 80 percent of its students graduate.

    和文化背景。

  • The subjects are familiar

    第三,他們學習公共衛生,

  • basic and clinical sciences

    評估病人的飲水、家居環境,

  • but there are major differences.

    和社經條件。

  • First, training has moved out of the ivory tower

    第四,他們學習到

  • and into clinic classrooms and neighborhoods,

    仔細地問診

  • the kinds of places most of these grads will practice.

    加上周全的臨床檢測,

  • Sure, they have lectures and hospital rotations too,

    可以深入了解病情,幫助診斷,

  • but community-based learning starts on day one.

    省下確診技術的昂貴費用。

  • Second, students treat the whole patient,

    最後,他們不斷被教育

  • mind and body,

    預防的重要性,

  • in the context of their families, their communities

    尤其是現在慢性疾病

  • and their culture.

    拖垮世界各國的衛生醫療。

  • Third, they learn public health:

    這種實作學習

  • to assess their patients' drinking water, housing,

    也注重團隊精神,

  • social and economic conditions.

    學生們學習彼此合作,

  • Fourth, they are taught

    也學習領導團隊,

  • that a good patient interview

    並且保持謙遜的態度。

  • and a thorough clinical exam

    一畢業,這些新科醫生就開始

  • provide most of the clues for diagnosis,

    把知識分享給助理護士、助產士、

  • saving costly technology for confirmation.

    社區衛生工作者,

  • And finally, they're taught over and over again

    幫助他們更能勝任工作,

  • the importance of prevention,

    而不是取代他們,

  • especially as chronic diseases

    也會跟巫醫和傳統治療工作者合作。

  • cripple health systems worldwide.

    ELAM 的畢業生

  • Such an in-service learning

    是否證明了這麼大膽的嘗試奏效?

  • also comes with a team approach,

    從數十個計畫

  • as much how to work in teams

    可以窺知他們的能力。

  • as how to lead them,

    像是加利福納的畢業生,

  • with a dose of humility.

    不但回到家鄉工作,

  • Upon graduation, these doctors share

    還集結社區力量,

  • their knowledge with nurse's aids, midwives,

    蓋了宏都拉斯第一間原住民醫院。

  • community health workers,

    在一位建築師的幫助下,

  • to help them become better at what they do,

    居民們胼手胝足, 憑空打造出一座醫院。

  • not to replace them,

    2007 年 12 月,收了首批病患

  • to work with shamans and traditional healers.

    到現在,這間醫院收容過

  • ELAM's graduates:

    將近 100 萬的求診人次,

  • Are they proving this audacious experiment right?

    而政府也很關注,

  • Dozens of projects give us an inkling

    以這所醫院做為宏都拉斯

  • of what they're capable of doing.

    農村公共醫療的模範,

  • Take the Garífuna grads.

    ELAM 的畢業生聰明、

  • They not only went to work back home,

    堅強能幹,

  • but they organized their communities to build

    而且全心奉獻。

  • Honduras' first indigenous hospital.

    2010 年 1 月海地地震,

  • With an architect's help,

    傷慟的悲劇:

  • residents literally raised it from the ground up.

    人們被埋在 3 千萬噸的瓦礫碎片下,

  • The first patients walked through the doors

    悲痛難當!

  • in December 2007,

    340 個古巴醫生

  • and since then, the hospital has received

    已經長期駐地救治傷患。

  • nearly one million patient visits.

    還有很多醫生正在趕過來, 但仍需要更多的醫生。

  • And government is paying attention,

    在 ELAM,學生們晝夜不停地

  • upholding the hospital as a model

    聯繫 2 千位畢業醫生。

  • of rural public health for Honduras.

    結果,好幾百位醫生趕來海地,

  • ELAM's graduates are smart,

    總共來自 27 個國家,

  • strong and also dedicated.

    包括撒哈拉的馬利、

  • Haiti, January 2010.

    聖露西亞、玻利維亞、 智利、美國等國家,

  • The pain.

    彼此用流利的西班牙語溝通,

  • People buried under 30 million tons of rubble.

    也能了解病人用克里奧爾語描述病情,

  • Overwhelming.

    幸好有這些海地學生,

  • Three hundred forty Cuban doctors

    從古巴 ELAM 醫學院及時飛過來。

  • were already on the ground long term.

    很多人待了好幾個月,

  • More were on their way. Many more were needed.

    甚至爆發霍亂疫情,仍堅守不離。

  • At ELAM, students worked round the clock

    數百位海地的 ELAM 畢業生,

  • to contact 2,000 graduates.

    必須收拾殘局重建家園,

  • As a result, hundreds arrived in Haiti,

    忍住自己的傷慟,

  • 27 countries' worth, from Mali in the Sahara

    然後一肩扛起重擔,

  • to St. Lucia, Bolivia, Chile and the USA.

    為海地建立全新的公共衛生系統。

  • They spoke easily to each other in Spanish

    現在,有了世界組織和各國政府資助

  • and listened to their patients in Creole

    包括挪威、古巴、巴西等國家,

  • thanks to Haitian medical students

    已經蓋好數十所新衛生中心,

  • flown in from ELAM in Cuba.

    找好人手,

  • Many stayed for months,

    其中 35 所,院長是 ELAM 畢業生。

  • even through the cholera epidemic.

    不過,海地事件

  • Hundreds of Haitian graduates

    也暴露了很多國家面臨的更大問題。