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,