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  • I want to share with you something my father taught me:

    譯者: Lilian Chiu 審譯者: Wendy Chen

  • no condition is permanent.

    我想與大家分享的 是我父親教我的一個道理:

  • It's a lesson he shared with me again and again,

    沒有什麼狀況是永恆不變的。

  • and I learned it to be true the hard way.

    他一再地告訴我這個道理,

  • Here I am in my fourth-grade class.

    我也花費了一番功夫才學會。

  • This is my yearbook picture taken in my class in school

    照片是我與小學四年級的班級,

  • in Monrovia, Liberia.

    來自學校的畢業紀念冊,

  • My parents migrated from India to West Africa in the 1970s,

    學校位在賴比瑞亞的蒙羅維亞市。

  • and I had the privilege of growing up there.

    我父母在 70 年代 從印度移居到西非,

  • I was nine years old,

    我有幸在那兒成長。

  • I loved kicking around a soccer ball,

    我當時九歲,

  • and I was a total math and science geek.

    熱愛踢足球,

  • I was living the kind of life that, really, any child would dream of.

    更是個熱愛數學和科學的怪胎。

  • But no condition is permanent.

    我過著所有孩子們所憧憬的生活,

  • On Christmas Eve in 1989,

    但沒有什麼狀況是永恆不變的。

  • civil war erupted in Liberia.

    1989 年的聖誕夜,

  • The war started in the rural countryside,

    賴比瑞亞內戰爆發。

  • and within months, rebel armies had marched towards our hometown.

    戰事從偏鄉引爆,

  • My school shut down,

    幾個月內,反叛軍進軍我們的家鄉。

  • and when the rebel armies captured the only international airport,

    我的學校關閉,

  • people started panicking and fleeing.

    當反叛軍佔領唯一的國際機場時,

  • My mom came knocking one morning and said, "Raj, pack your things --

    人們開始驚慌逃難。

  • we have to go."

    某個早晨,我母親邊敲門邊說:

  • We were rushed to the center of town,

    「拉吉,快打包,我們得離開了。」

  • and there on a tarmac, we were split into two lines.

    我們趕往鎮中心,

  • I stood with my family in one line,

    在飛機跑道上, 人們被分成兩排隊伍。

  • and we were stuffed into the cargo hatch

    我和我家人置身其中一排,

  • of a rescue plane.

    然後從貨艙口

  • And there on a bench, I was sitting with my heart racing.

    擠進救援飛機裡。

  • As I looked out the open hatch,

    坐在長凳上,我的心跳加速,

  • I saw hundreds of Liberians in another line,

    我從打開的貨艙口看出去,

  • children strapped to their backs.

    看到數以百計的賴比瑞亞人 在另一排隊伍中,

  • When they tried to jump in with us,

    有人背著孩子。

  • I watched soldiers restrain them.

    當他們試圖跳上我們的飛機,

  • They were not allowed to flee.

    我眼見士兵制止他們,

  • We were the lucky ones.

    他們不被允許逃離。

  • We lost what we had,

    我們是幸運兒。

  • but we resettled in America,

    我們失去曾擁有的一切,

  • and as immigrants, we benefitted from the community of supporters

    但我們重新在美國落腳。

  • that rallied around us.

    在新社區中,許多的支持者

  • They took my family into their home,

    對我們這些移民都非常的照顧。

  • they mentored me.

    他們讓我們一家人住進他們家,

  • And they helped my dad start a clothing shop.

    他們教導我,

  • I'd visit my father on weekends as a teenager

    他們也協助我父親開了一間服飾店。

  • to help him sell sneakers and jeans.

    我青少年時,週末都會拜訪父親,

  • And every time business would get bad,

    幫他賣運動鞋和牛仔褲。

  • he'd remind me of that mantra:

    每當生意不好時,

  • no condition is permanent.

    他總會提醒我那句真言,

  • That mantra and my parents' persistence and that community of supporters

    沒有什麼狀況是永恆不變的。

  • made it possible for me to go through college

    因為那句真言、我雙親的堅持毅力、 和社區人們的支持下,

  • and eventually to medical school.

    我才得以上大學,

  • I'd once had my hopes crushed in a war,

    最終進入醫學院就讀。

  • but because of them,

    我的希望曾被戰爭毀滅,

  • I had a chance to pursue my dream to become a doctor.

    但因為他們,

  • My condition had changed.

    我有機會去追逐成為醫生的夢想,

  • It had been 15 years since I escaped that airfield,

    我的狀況改變了,

  • but the memory of those two lines had not escaped my mind.

    我逃離那機場已是 15 年前的事,

  • I was a medical student in my mid-20s,

    但那兩排隊伍的記憶, 仍在我腦海裡揮之不去。

  • and I wanted to go back

    在我 25 歲左右, 還是醫學生的時候,

  • to see if I could serve the people we'd left behind.

    我想要回去,

  • But when I got back,

    看能否幫助被我們丟下的人們。

  • what I found was utter destruction.

    但在我回去後,

  • The war had left us with just 51 doctors

    只看見滿目瘡痍,

  • to serve a country of four million people.

    一個四百萬人口的國家

  • It would be like the city of San Francisco having just 10 doctors.

    在戰後只剩下 51 名醫生在服務,

  • So if you got sick in the city where those few doctors remain,

    這就像整個舊金山 只有 10 個醫生一樣。

  • you might stand a chance.

    若你在城市中生病, 有少數幾個醫生還留在那裡,

  • But if you got sick in the remote, rural rainforest communities,

    你可能還有機會看病。

  • where you could be days from the nearest clinic --

    但若你在偏僻的雨林社區裡生病,

  • I was seeing my patients die from conditions no one should die from,

    離最近的診所是好幾天的路程──

  • all because they were getting to me too late.

    我曾目睹我的病患, 死於不該命絕的病症,

  • Imagine you have a two-year-old who wakes up one morning with a fever,

    只因為他們太晚才來到我這裡。

  • and you realize she could have malaria,

    想像你的兩歲小孩 某天早上起床就發起高燒,

  • and you know the only way to get her the medicine she needs

    你驚覺她可能染上瘧疾。

  • would be to take her to the riverbed,

    你知道只有一個方法 可以取得她需要的藥物,

  • get in a canoe, paddle to the other side

    就是帶著她到河邊,

  • and then walk for up to two days through the forest

    划著獨木舟到對岸,

  • just to reach the nearest clinic.

    然後走上兩天的路,穿過森林,

  • One billion people live in the world's most remote communities,

    只為了到達最近的診所。

  • and despite the advances we've made in modern medicine and technology,

    十億人口住在世界最偏遠的社區,

  • our innovations are not reaching the last mile.

    儘管現代醫學與科技如此進步,

  • These communities have been left behind,

    我們的創新卻無法觸及 那些最後一英里的人們。

  • because they've been thought too hard to reach

    這些社區遭到遺忘,

  • and too difficult to serve.

    因為它們被認為太遠、難以抵達,

  • Illness is universal;

    且太難給以協助。

  • access to care is not.

    疾病是全球性的;

  • And realizing this lit a fire in my soul.

    但醫療照護的資源卻不是。

  • No one should die because they live too far from a doctor or clinic.

    了解到這點,點燃了我靈魂中的火。

  • No condition should be permanent.

    沒有人應該因為住處 離醫生、診所太遠而喪命。

  • And help in this case didn't come from the outside,

    這樣的狀況不應該是永恆不變的。

  • it actually came from within.

    在這個案例中,他們沒有外援,

  • It came from the communities themselves.

    得到的協助是來自社區內部。

  • Meet Musu.

    來自於這個社區本身。

  • Way out in rural Liberia,

    她是姆索。

  • where most girls have not had a chance to finish primary school,

    在賴比瑞亞偏僻的鄉下,

  • Musu had been persistent.

    當地大多數女孩都沒機會讀完小學。

  • At the age of 18, she completed high school,

    但姆索堅毅不拔,

  • and she came back to her community.

    她 18 歲讀完了高中,

  • She saw that none of the children were getting treatment

    然後返回自己的社區,

  • for the diseases they needed treatment for --

    眼見社區裡孩子

  • deadly diseases, like malaria and pneumonia.

    生病時無法能得到應有的治療──

  • So she signed up to be a volunteer.

    例如像可能致命的瘧疾和肺炎,

  • There are millions of volunteers like Musu in rural parts around our world,

    她因此自願成為義工。

  • and we got to thinking --

    全世界偏遠區域 有數百萬名像姆索這樣的義工,

  • community members like Musu could actually help us solve a puzzle.

    這讓我們思考──

  • Our health care system is structured in such a way

    像姆索這樣的社區成員 能幫我們解決難題。

  • that the work of diagnosing disease and prescribing medicines

    我們的醫療保健制度的 結構是這樣的:

  • is limited to a team of nurses and doctors like me.

    診斷疾病和開藥的工作

  • But nurses and doctors are concentrated in cities,

    只能由像我這種醫師 及護士的團隊來做。

  • so rural communities like Musu's have been left behind.

    但醫生和護士都集中在城市,

  • So we started asking some questions:

    因此像姆索所居住的 偏鄉社區就被遺忘了。

  • What if we could reorganize the medical care system?

    這讓我們提出幾個問題:

  • What if we could have community members like Musu

    若我們能重整 醫療照護制度,會如何?

  • be a part or even be the center of our medical team?

    假如能讓像姆索這樣的社區成員,

  • What if Musu could help us bring health care from clinics in cities

    加入甚至成為 醫療團隊中的主要角色呢?

  • to the doorsteps of her neighbors?

    若姆索能幫我們 將城市診所提供的醫療

  • Musu was 48 when I met her.

    帶到她鄰居的門口呢?

  • And despite her amazing talent and grit,

    我認識姆索時,她 48 歲。

  • she hadn't had a paying job in 30 years.

    儘管她擁有驚人的天賦與膽量,

  • So what if technology could support her?

    她 30 年來都沒有領過任何薪水。

  • What if we could invest in her with real training,

    所以如果科技能支助她呢?

  • equip her with real medicines,

    若我們能投資讓她受真正的訓練,

  • and have her have a real job?

    讓她帶著真正的藥品,

  • Well, in 2007, I was trying to answer these questions,

    擁有一份真正的工作呢?

  • and my wife and I were getting married that year.

    2007 年,我試著去回答這些問題。

  • We asked our relatives to forgo the wedding registry gifts

    我和我太太在那年結婚,

  • and instead donate some money

    我們讓親友不要送新婚禮物,

  • so we could have some start-up money to launch a nonprofit.

    而以捐款取代,

  • I promise you, I'm a lot more romantic than that.

    好讓我們有一些基金 去成立一個非營利機構。

  • (Laughter)

    我保證,我其實比那更浪漫很多的。

  • We ended up raising $6,000,

    (笑聲)

  • teamed up with some Liberians and Americans

    我們最後籌到了六千元,

  • and launched a nonprofit called Last Mile Health.

    與一些賴比瑞亞人和美國人合作,

  • Our goal is to bring a health worker within reach of everyone, everywhere.

    共同成立一個非營利組織 叫做「最後一英哩醫療」。

  • We designed a three-step process --

    我們的目標是要讓每個地方每個人 都能接觸得到這些醫療工作者。

  • train, equip and pay --

    我們設計了一個三步驟的流程──

  • to invest more deeply in volunteers like Musu

    訓練、裝備、付款──

  • to become paraprofessionals,

    更扎實地資助像姆索這樣的義工,

  • to become community health workers.

    成為協助提供醫療的專業人員,

  • First we trained Musu to prevent, diagnose and treat

    成為社區健康工作者。

  • the top 10 diseases afflicting families in her village.

    我們先訓練姆索, 針對影響她村落族人的前十大疾病,

  • A nurse supervisor visited her every month to coach her.

    做預防、診斷、與治療。

  • We equipped her with modern medical technology,

    每月有護士訪視並指導姆索,

  • like this $1 malaria rapid test,

    我們提供她現代醫療技術,

  • and put it in a backpack full of medicines like this

    像這個一塊錢的瘧疾快速檢測,

  • to treat infections like pneumonia,

    放在裝滿這類配備的背包中,

  • and crucially,

    來治療像肺炎這類的感染。

  • a smartphone, to help her track and report on epidemics.

    重要的是,

  • Last, we recognized the dignity in Musu's work.

    給她一隻智慧手機協助她 追縱和回報傳染病。

  • With the Liberian government, we created a contract,

    最後,我們表彰姆索的努力,

  • paid her

    和賴比瑞亞政府合作 我們立了一張合約,

  • and gave her the chance to have a real job.

    來支付她薪水,

  • And she's amazing.

    給她一個機會擁有一份真正的工作。

  • Musu has learned over 30 medical skills,

    她真的很棒,

  • from screening children for malnutrition,

    姆索學習了超過 30 種醫療技能,

  • to assessing the cause of a child's cough with a smartphone,

    從篩檢營養不良兒童,

  • to supporting people with HIV

    到用智慧手機來 評估孩童咳嗽的原因,

  • and providing follow-up care to patients who've lost their limbs.

    到協助愛滋病患者,

  • Working as part of our team,

    並提供後續照護給失去肢體的病人。

  • working as paraprofessionals,

    以我們團隊隊員的身份工作,

  • community health workers can help ensure

    以協助性醫療人員的身份工作,

  • that a lot of what your family doctor would do

    讓社區健康工作者能確保

  • reaches the places that most family doctors could never go.

    你家庭醫生能提供的那些服務,

  • One of my favorite things to do is to care for patients

    大部份也能被提供到 多數家庭醫師不會去的地方。

  • with community health workers.

    我最喜歡做的事情之一, 就是與這些社區健康工作者

  • So last year I was visiting A.B.,

    一同照顧病人。

  • and like Musu, A.B. had had a chance to go to school.

    所以去年我去拜訪了艾畢,

  • He was in middle school, in the eighth grade,

    艾畢和姆索一樣有機會去上學。

  • when his parents died.

    他父母過世時,他讀中學,

  • He became an orphan and had to drop out.

    才八年級,

  • Last year, we hired and trained A.B. as a community health worker.

    他因此成為孤兒,而必須輟學。

  • And while he was making door to door house calls,

    去年,我們僱用並訓練艾畢 成為社區健康工作者。

  • he met this young boy named Prince,

    當他出診挨家挨戶拜訪時,

  • whose mother had had trouble breastfeeding him,

    他見到一個男孩,名叫普林斯,

  • and by the age of six months, Prince had started to waste away.

    他的母親無法餵母奶。

  • A.B. had just been taught how to use this color-coded measuring tape

    六個月大時,普林斯開始消瘦。

  • that wraps around the upper arm of a child to diagnose malnutrition.

    艾畢才剛學會如何用 有顏色編碼的檢測帶,

  • A.B. noticed that Prince was in the red zone,

    繞著孩童的手臂來診斷營養不良。

  • which meant he had to be hospitalized.

    艾畢注意到普林斯 是落在紅色區域,

  • So A.B. took Prince and his mother to the river,

    意味著他必須要住院。

  • got in a canoe

    所以艾畢帶著普林斯 和他的母親到河邊,

  • and paddled for four hours to get to the hospital.

    上了獨木舟,

  • Later, after Prince was discharged,

    划船划了四小時到醫院。

  • A.B. taught mom how to feed baby a food supplement.

    之後,普林斯出院後,

  • A few months ago,

    艾畢教母親如何 餵寶寶吃營養補給品。

  • A.B. took me to visit Prince, and he's a chubby little guy.

    幾個月前,

  • (Laughter)

    艾畢帶我去造訪普林斯, 他是個圓胖的小傢伙。

  • He's meeting his milestones, he's pulled himself up to a stand,

    (笑聲)

  • and is even starting to say a few words.

    他走到了人生的幾個哩程碑, 他開始讓自己站立,

  • I'm so inspired by these community health workers.

    他甚至開始說了幾個字。

  • I often ask them why they do what they do,

    這些社區健康工作者非常鼓舞我,

  • and when I asked A.B.,

    我常問他們為什麼要做這些,

  • he said, "Doc, since I dropped out of school, this is the first time

    當我問艾畢時,

  • I'm having a chance to hold a pen to write.

    他說:「醫生,從我輟學之後,

  • My brain is getting fresh."

    這是我第一次有機會拿著筆寫字,

  • The stories of A.B. and Musu have taught me something fundamental

    我的頭腦變得精力充沛。」

  • about being human.

    艾畢和姆索的故事教導了我關於

  • Our will to serve others

    身為人的根本道理。

  • can actually help us transform our own conditions.

    我們願意去服務他人的意願,

  • I was so moved by how powerful the will to serve our neighbors can be

    其實能協助我們轉變 我們自身的現狀。

  • a few years ago,

    幾年前,這樣服務鄰居的意願強大到

  • when we faced a global catastrophe.

    讓我好感動。

  • In December 2013,

    當時我們在面對全球性災難,

  • something happened in the rainforests across the border from us in Guinea.

    2013 年 12 月,

  • A toddler named Emile fell sick with vomiting, fever and diarrhea.

    在幾內亞的雨林發生了些狀況。

  • He lived in an area where the roads were sparse

    一個才在學步的孩童艾米爾 感到噁心想吐、發燒、和痢疾。

  • and there had been massive shortages of health workers.

    他所住的地方,道路很稀少,

  • Emile died,

    且健康工作者嚴重短缺。

  • and a few weeks later his sister died,

    後來艾米爾死了,

  • and a few weeks later his mother died.

    幾週後,他的姐妹也死了,

  • And this disease would spread from one community to another.

    再幾週後,他的母親也死了。

  • And it wasn't until three months later

    而這個疾病 從一個社區傳到另一個,

  • that the world recognized this as Ebola.

    一直到三個月後,

  • When every minute counted, we had already lost months,

    世界才發現那是伊波拉病毒。

  • and by then the virus had spread like wildfire all across West Africa,

    當每一分鐘都是關鍵時, 我們卻已失去了幾個月的先機。

  • and eventually to other parts of the world.

    那時,病毒已經像野火 散佈到整個西非,

  • Businesses shut down, airlines started canceling routes.

    後來也傳到世界的其他區域。

  • At the height of the crisis,

    商業停止,航空公司開始取消航線。

  • when we were told that 1.4 million people could be infected,

    在危機的最高峰,

  • when we were told that most of them would die,

    我們得知有 140 萬人可能受感染,

  • when we had nearly lost all hope,

    我們得知他們大多難逃一死,

  • I remember standing with a group of health workers

    我們幾乎失去所有希望。

  • in the rainforest where an outbreak had just happened.

    我還記得我與一群醫療工作者

  • We were helping train and equip them to put on the masks,

    站在剛暴發過病情的雨林。

  • the gloves and the gowns that they needed

    我們協助訓練他們, 讓他們戴上面罩、

  • to keep themselves safe from the virus

    手套、手術衣等等,

  • while they were serving their patients.

    他們需要這些裝備, 以防止在服務他們的病人時

  • I remember the fear in their eyes.

    被病毒感染。

  • And I remember staying up at night, terrified if I'd made the right call

    我記得他們眼中的恐懼,

  • to keep them in the field.

    我記得晚上無法入睡, 因為深怕我做錯決定,

  • When Ebola threatened to bring humanity to its knees,

    讓他們留在現場。

  • Liberia's community health workers didn't surrender to fear.

    當伊波拉病毒威脅要讓人類屈服,

  • They did what they had always done:

    賴比瑞亞社區健康工作者 並沒有向恐懼投降,

  • they answered the call to serve their neighbors.

    他們做的是他們一直在做的,

  • Community members across Liberia learned the symptoms of Ebola,

    他們回應了鄰居的求助。

  • teamed up with nurses and doctors to go door-to-door to find the sick

    整個賴比瑞亞的社區成員 學到了伊波拉病毒的症狀,

  • and get them into care.

    與護士及醫生合作 挨家挨戶去找出病人,

  • They tracked thousands of people who had been exposed to the virus

    讓他們受到照護。

  • and helped break the chain of transmission.

    他們追縱了數千名 曝露在病毒中的人,

  • Some ten thousand community health workers risked their own lives

    協助破壞了傳染鏈。

  • to help hunt down this virus and stop it in its tracks.

    數萬名社區健康工作者 冒著生命危險,

  • (Applause)

    協助這些防止病毒傳播的工作。

  • Today, Ebola has come under control in West Africa,

    (鼓掌)

  • and we've learned a few things.

    現今在西非,伊波拉病毒已受控制。

  • We've learned that blind spots in rural health care

    我們學到了幾件事,