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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,