Farai,

八月，在哈拉雷，一個溫暖的早晨，

a 24-year-old mother of two,

法拉艾，

walks towards a park bench.

二十四歲，兩個孩子的母親，

She looks miserable and dejected.

走向公園的長椅。

Now, on the park bench sits an 82-year-old woman,

她看起來很悲慘、很沮喪。

better known to the community as Grandmother Jack.

公園長椅上坐著一位 八十二歲的老女人，

Farai hands Grandmother Jack an envelope from the clinic nurse.

社區的人都叫她傑克阿嬤。

Grandmother Jack invites Farai to sit down

法拉艾交給傑克阿嬤 一個診所護士給她的信封。

as she opens the envelope and reads.

傑克阿嬤邀請法拉艾坐下，

There's silence for three minutes or so as she reads.

她打開信封，閱讀內容。

And after a long pause, Grandmother Jack takes a deep breath,

阿嬤讀信時，沉默持續了大約三分鐘。

looks at Farai and says,

停頓了很長的一段時間之後， 傑克祖母深深吸了一口氣，

"I'm here for you.

看著法拉艾，說：

Would you like to share your story with me?"

「我在這裡陪你。

Farai begins,

你願意和我分享你的故事嗎？」

her eyes swelling with tears.

法拉艾開始說，

She says, "Grandmother Jack,

她的眼睛泛著淚光。

I'm HIV-positive.

她說：「傑克阿嬤，

I've been living with HIV for the past four years.

我的愛滋病毒檢測是陽性。

My husband left me a year ago.

我有愛滋病毒已經四年了。

I have two kids

我丈夫一年前離開了我。

under the age of five.

我有兩個孩子，

I'm unemployed.

都不到五歲。

I can hardly take care of my children."

我沒有工作。

Tears are now flowing down her face.

我幾乎無法照顧我的孩子。」

And in response, Grandmother Jack moves closer,

眼淚沿著她的臉頰落下。

puts her hand on Farai,

傑克阿嬤的回應是 先向她靠近了一些，

and says, "Farai, it's OK to cry.

把她的手放在法拉艾身上，

You've been through a lot.

說：「法拉艾，哭吧，沒有關係。

Would you like to share more with me?"

你吃了很多苦。

And Farai continues.

你願意和我多講一點嗎？」

"In the last three weeks,

法拉艾繼續說：

I have had recurrent thoughts of killing myself,

「在過去三週，

taking my two children with me.

我一直有想要自殺的念頭，

I can't take it anymore.

帶兩個孩子一起走。

The clinic nurse sent me to see you."

我無法再承受了。

There's an exchange between the two, which lasts about 30 minutes.

診所護士要我來找你。」

And finally, Grandmother Jack says,

兩人之間交流了大約三十分鐘。

"Farai,

最後，傑克阿嬤說：

it seems to me that you have all the symptoms of kufungisisa."

「法拉艾，

The word "kufungisisa" opens up a floodgate of tears.

在我看來，你似乎有 kufungisisa 的症狀。」

So, kufungisisa is the local equivalent of depression

「kufungisisa」這個詞 打開了眼淚的防洪閘門。

in my country.

在我國家，「kufungisisa」一詞

It literally means

等同於憂鬱。

"thinking too much."

字面上的意思是

The World Health Organization estimates

「想太多」。

that more than 300 million people globally, today, suffer from depression,

世界衛生組織估計，

or what in my country we call kufungisisa.

現今全球有超過三億人 受到憂鬱症的折磨，

And the World Health Organization also tells us

或是在我的國家，稱為 kufungisisa。

that every 40 seconds,

世界衛生組織也告訴我們，

someone somewhere in the world commits suicide

每四十秒，

because they are unhappy,

世界上某處就有人自殺，

largely due to depression or kufungisisa.

因為不快樂，

And most of these deaths are occurring in low- and middle-income countries.

主要是出於憂鬱症或 kufungisisa。

In fact,

這些死亡案例多半發生 在中低收入的國家。

the World Health Organization goes as far as to say

事實上，

that when you look at the age group between 15 to 29,

世界衛生組織甚至還說，

a leading cause of death now is actually suicide.

對於 15~29 歲的年齡層而言，

But there are wider events that lead to depression

自殺是這個年齡層的主要死因之一。

and in some cases, suicide,

但有更多、更廣的事件會導致憂鬱，

such as abuse,

有些情況會導致自殺，

conflict, violence,

這些事件包括虐待、

isolation, loneliness --

衝突、暴力、

the list is endless.

孤立、寂寞──

But one thing that we do know

還有許多其他的。

is that depression can be treated and suicides averted.

但我們的確知道一件事，

But the problem is

憂鬱是可以治療的， 自殺是可以避免的。

we just don't have enough psychiatrists or psychologists in the world

但，問題是，

to do the job.

世界上沒有足夠的 精神病醫生或心理醫生

In most low- and middle-income countries, for instance,

來做這件事。

the ratio of psychiatrists to the population

比如，在大部分中低入的國家，

is something like one for every one and a half million people,

精神病醫生佔總人口的比例

which literally means that 90 percent of the people

大約是一百五十萬比一，

needing mental health services

那表示，需要心理健康服務的人

will not get it.

當中就有九成

In my country,

無法取得服務。

there are 12 psychiatrists,

在我的國家，

and I'm one of them,

有十二名精神病醫生，

for a population of approximately 14 million.

我是其中之一，

Now, let me just put that into context.

全國人口有近一千四百萬人。

One evening while I was at home,

讓我用一個情境來說明。

I get a call from the ER,

有一晚，我在家的時候，

or the emergency room,

我接到 ER 打來的電話，

from a city which is some 200 kilometers away

也就是急診室，

from where I live.

它在我家兩百公里外的

And the ER doctor says,

一個城市。

"One of your patients,

急診室醫生說：

someone you treated four months ago,

「我們有一位病人

has just taken an overdose,

是你在四個月前治療過的，

and they are in the ER department.

剛剛用藥過量，

Hemodynamically, they seem to be OK,

他們現在在急診室。

but they will need neuropsychiatric evaluation."

血液的流動似乎沒問題，

Now, I obviously can't get into my car in the middle of the night

但會需要神經精神評估。」

and drive 200 kilometers.

很顯然，我不可能大半夜跳進車裡，

So as best as we could,

開兩百公里過去。

over the phone with the ER doctor,

所以我們最好的做法，

we come up with an assessment.

就是和急診室醫生透過電話，

We ensure that suicidal observations are in place.

做出一項評估。

We ensure that we start reviewing the antidepressants

我們確保有做好自殺觀察。

that this patient has been taking,

我們確保我們會開始檢視這個病人

and we finally conclude

服用的抗抑鬱劑，

that as soon as Erica -- that was her name, 26-year-old --

我們最後的結論是，

as soon as Erica is ready to be released from the ER,

等艾瑞卡──

she should come directly to me with her mother,

這是她的名字，二十六歲──

and I will evaluate

等艾瑞卡準備好可以離開急診室了，

and establish what can be done.

她應該要和母親立刻直接來找我，

And we assumed that that would take about a week.

我就會做評估

A week passes.

與確認哪些事是可以做的。

Three weeks pass.

我們假設這大概會需要一週的時間。

No Erica.

一週過去了。

And one day I get a call from Erica's mother,

三週過去了。

and she says,

沒有艾瑞卡。

"Erica committed suicide three days ago.

有一天，艾瑞卡的媽媽打電話給我，

She hanged herself from the mango tree

她說：

in the family garden."

「艾瑞卡在三天前自殺了。

Now, almost like a knee-jerk reaction,

她在芒果樹上上吊，

I couldn't help but ask,

在我們家的院子裡。」

"But why didn't you come to Harare, where I live?

幾乎就像膝反射一樣，

We had agreed that as soon as you're released from the ER,

我忍不住問：

you will come to me."

「為什麼你們不來哈拉雷， 來我住的地方？

Her response was brief.

我們先前就達成同意， 一旦你們離開了急診室，

"We didn't have the 15 dollars bus fare

就要來找我。」

to come to Harare."

她的回應很簡短。

Now, suicide is not an unusual event

「我們沒有十五元的公車錢

in the world of mental health.

可以去哈拉雷。」

But there was something about Erica's death

在心理健康的世界裡，

that struck me at the core of my very being.

自殺並非不尋常的事件。

That statement from Erica's mother:

不知為什麼，艾瑞卡的死

"We didn't have 15 dollars bus fare to come to you,"

卻一直在我腦中揮之不去。

made me realize

艾瑞卡母親的那句話：

that it just wasn't going to work,

「我們沒有十五元的 公車錢去找你。」

me expecting people to come to me.

讓我了解到，

And I got into this state of soul-searching,

這樣不行的。

trying to really discover my role

我不能期望人們來找我。

as a psychiatrist in Africa.

我開始沈思與反省，

And after considerable consultation and soul-searching,

試圖找到，在非洲， 身為精神科醫生的自己，

talking to colleagues, friends and family,

我的角色到底是什麼，

it suddenly dawned on me

經過大量的諮詢和深思探索，

that actually, one the most reliable resources we have in Africa

和同事、朋友、家人的交談，

are grandmothers.

我突然開始理解，

Yes, grandmothers.

其實，非洲最可靠的資源之一，

And I thought,

就是阿嬤們。

grandmothers are in every community.

是的，阿嬤們。

There are hundreds of them.

我心想，

And --

每個社區都有阿嬤。

(Laughter)

有成百上千個阿嬤。

And they don't leave their communities in search of greener pastures.

且──

(Laughter)

（笑聲）

See, the only time they leave

她們不會離開她們的社區 去找更好的生存環境。

is when they go to a greener pasture called heaven.

（笑聲）

(Laughter)

只有一種情況下，她們會離開，

So I thought, how about training grandmothers

去更好的地方，那就是去天堂。

in evidence-based talk therapy,

（笑聲）

which they can deliver on a bench?

所以，我心想， 來訓練這些阿嬤，會如何？

Empower them with the skills to listen,

教她們以證據為基礎的談話治療，

to show empathy,

她們在長椅上就能進行。

all of that rooted in cognitive behavioral therapy;

教導她們傾聽的技巧、

empower them with the skills to provide behavior activation,

展現同理心，

activity scheduling;

這些都是來自認知行為治療；

and support them using digital technology.

讓她們運用這些技巧， 提供行為活化治療、

You know, mobile phone technology.

計畫活動、

Pretty much everyone in Africa has a mobile phone today.

並用數字科技協助她們。

So in 2006,

你們知道的，行動電話科技。

I started my first group

現在非洲幾乎人人都有手機了。

of grandmothers.

在 2006 年，

(Applause)

我開始了我的第一個

Thank you.

阿嬤團隊。

(Applause)

（掌聲）

Today, there are hundreds of grandmothers

謝謝。

who are working in more than 70 communities.

（掌聲）

And in the last year alone,

現在，有數百名阿嬤，

more than 30,000 people received treatment

在超過七十個社區工作。

on the Friendship Bench

單單在去年，

from a grandmother in a community in Zimbabwe.

就有超過三萬人接受治療，

(Applause)

在「友誼長椅」上，

And recently, we published this work that is done by these grandmothers

由在辛巴威社區的阿嬤所提供。

in the Journal of the American Medical Association.

（掌聲）

And --

最近，我們發表了 這項由阿嬤完成的工作，

(Applause)

在美國醫學會雜誌上。

And our results show that six months after receiving treatment

且──

from a grandmother,

（掌聲）

people were still symptom-free:

且我們的結果顯示，

no depression,

接受阿媽治療後的六個月

suicidal ideation completely reduced.

病人的症狀沒有復發，

In fact, our results -- this was a clinical trial --

沒有憂鬱，

in fact, this clinical trial showed

自殺傾向完全減少。

that grandmothers were more effective at treating depression

事實上，我們的結果 ──這是一項臨床試驗──

than doctors and --

事實上，這項臨床試驗顯示，

(Laughter)

在治療憂鬱上，阿嬤的成效

(Applause)

比醫生還好──

And so,

（笑聲）

we're now working towards expanding this program.

（掌聲）

There are more than 600 million people currently aged above 65 in the world.

所以，

And by the year 2050,

我們現在在努力擴展這個計畫。

there will be 1.5 billion people aged 65 and above.

在全世界，有超過六億人的 年齡在六十五歲以上。

Imagine if we could create a global network of grandmothers

到 2050 年，

in every major city in the world,

將會有十五億人的年齡 在六十五歲以上。

who are trained in evidence-based talk therapy,

想像一下，如果我們能

supported through digital platforms,

在世界上每個主要都市

networked.

創造一個全球的阿嬤網，

And they will make a difference in communities.

這些阿嬤受過實證支持療法的訓練，

They will reduce the treatment gap

由數位平台協助，

for mental, neurological and substance-use disorders.

聯成網路。

Finally,

她們將會為社區帶來改變。

this is a file photograph of Grandmother Jack.

她們會縮小治療的空缺，

So, Farai had six sessions on the bench with Grandmother Jack.

心理、神經或藥物濫用造成的空缺。

Today, Farai is employed.

最後，

She has her two children at school.

這是傑克阿嬤的照片。

And as for Grandmother Jack,

所以，法拉艾在長椅上接受了 傑克阿嬤的六次治療。

one morning in February, we expected her to see her 257th client on the bench.

現在，法拉艾有工作了。

She didn't show up.

她的兩個孩子都在上學。

She had gone to a greener pasture called heaven.

至於傑克阿嬤，

But I believe that Grandmother Jack,

二月的一個早晨，她應該要在 長椅上看她的第 257 個病人。

from up there,

她沒有出席。

she's cheering on all the other grandmothers --

她去了更好的地方，天堂。

the increasing number of grandmothers who are making a difference

但我相信，傑克阿嬤

in the lives of thousands of people.

就在上頭

And I'm sure she's in awe

為所有其他阿嬤加油──

when she realizes that something that she helped to pioneer

有越來越多的阿嬤，

is now spreading to other countries,

正改變數以千計的人的生命。

like Malawi,

我確信她會心存敬畏，

the island of Zanzibar

如果她能知道她協助開創的這個計畫

and coming closer to home here in the Unites States

現在正在向其他國家拓展，

in the city of New York.

比如馬拉威、

May her soul rest in peace.

溫古賈島，

Thank you.

以及美國這裡更靠近家的地方，

(Applause)

紐約市。

(Cheering)

願她的靈魂安息。

(Applause)

謝謝。