ABOUT THE SPEAKER
Margaret Bourdeaux - Physician, global health policy analyst
Margaret Bourdeaux investigates the best ways to protect, recover and reconstruct health systems and institutions disrupted by war or disaster.

Why you should listen

Margaret Ellis Bourdeaux, MD, MPH spearheads the Threatened Health Systems Project at Harvard Medical School -- an initiative that brings together public sector leaders, health care providers, academics, military strategists and private sector stakeholders to generate creative approaches to protecting valuable health system resources in countries affected by armed conflict and acute political crisis.

Bourdeaux's journey in global health began when she took a year of leave from Yale Medical School to work in refugee camps during the Kosovo War in 1999. She returned on her own after the war to trace families she had befriended in the camps and find out what had happened to them. Living in villages of Kosovo's countryside, she documented how these families struggled to care for their children, find health services and make a living in a society decimated by genocide and ethnic conflict. This experience impressed upon her the stark truth that war kills people by stripping them of their personal, community and national resources and institutions. Far more people died in Kosovo from the depleted health systems and institutions than from wounds sustained during the armed conflict.

Later experiences in Haiti, Afghanistan, Libya, Sierra Leon, Madagascar and Liberia revealed a similar pattern: armed conflict would decimate indigenous health institutions that never recovered, leaving people helpless when later crises -- earthquakes, epidemics, renewed conflict -- invariably struck. Strong, resilient health systems are the key to making war, disasters and epidemics less deadly.

After completing a joint residency in Internal Medicine and Pediatrics at the Harvard Combined Med/Peds Program, Bourdeaux was among the first graduates of Brigham and Women's Global Women's Health Fellowship. She has worked with the Office of the Secretary of Defense Policy to analyze the US Department of Defense’s global health projects and programs. She led a joint Harvard-NATO team of analysts to evaluate the impacts, challenges and opportunities international security forces have in protecting and rebuilding health systems in conflict affected states. She joined the faculty of the Division of Global Health Equity at Brigham and Women’s Hospital and Harvard Medical School in 2011.

This year she was awarded the prestigious Harvard Global Health Institute's Burke Fellowship in Global Health to investigate the responsiveness of foreign aid to health system distress and disruption. She is co-developing the first executive education course between Harvard Medical School and Harvard Kennedy School of Government for senior security policy makers on health system threat detection and response. In addition, she is launching Harvard Global Health Institute's first Summit on Threatened Health Systems in June 2017.

More profile about the speaker
Margaret Bourdeaux | Speaker | TED.com
TEDxBeaconStreet

Margaret Bourdeaux: Why civilians suffer more once a war is over

Margaret Bourdeaux: Por que os civís sofren máis cando xa rematou a guerra

Filmed:
979,657 views

Nunha guerra, resulta que a violencia non é a principal asasina de civís. Quen o é, entón? Pois as enfermidades, a fame e a pobreza, porque a guerra destrúe as institucións que fan que a sociedade funcione, como os servizos, os bancos, o sistema alimentario e os hospitais. A doutora Margaret Bourdeaux propón un enfoque valente para garantir a recuperación unha vez rematado o conflito no que establece prioridades en canto ao que se debería arranxar en primeiro lugar.
- Physician, global health policy analyst
Margaret Bourdeaux investigates the best ways to protect, recover and reconstruct health systems and institutions disrupted by war or disaster. Full bio

Double-click the English transcript below to play the video.

00:12
So have you ever wondered
what it would be like
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Algunha vez vos preguntastes como sería
00:16
to live in a place with no rules?
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vivir nun lugar sen normas?
00:19
That sounds pretty cool.
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Soa ben, non si?
00:21
(Laughter)
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(Risas)
Mais unha mañá espertas
00:22
You wake up one morning, however,
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e descobres que a razón
pola que non hai normas
00:23
and you discover that the reason
there are no rules
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é que non hai goberno e tampouco hai leis.
00:26
is because there's no government,
and there are no laws.
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00:29
In fact, all social institutions
have disappeared.
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De feito, todas as institucións sociais
desapareceron,
00:34
So there's no schools,
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polo que non hai escolas,
00:36
there's no hospitals,
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non hai hospitais,
00:37
there's no police,
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non hai policía,
00:38
there's no banks,
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non hai bancos,
00:40
there's no athletic clubs,
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non hai clubs deportivos,
00:42
there's no utilities.
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non hai servizos.
00:44
Well, I know a little bit
about what this is like,
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Pois ben, eu teño unha idea do que é iso
00:48
because when I was
a medical student in 1999,
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porque, cando era
estudante de medicina no 1999,
00:50
I worked in a refugee camp
in the Balkans during the Kosovo War.
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traballei nun campo de refuxiados
nos Balcáns durante a guerra de Kosovo.
00:57
When the war was over,
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Cando rematou a guerra,
00:58
I got permission -- unbelievably --
from my medical school
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incriblemente obtiven
un permiso da facultade
01:01
to take some time off
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para coller uns días
01:02
and follow some of the families
that I had befriended in the camp
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e acompañar a algunhas das familias
coas que trabara amizade no campo
01:06
back to their village in Kosovo,
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na viaxe de volta ás súas vilas en Kosovo,
01:09
and understand how they navigated
life in this postwar setting.
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para comprender como afrontaban a vida
nun contexto de posguerra.
O Kosovo da posguerra
era un lugar moi interesante
01:16
Postwar Kosovo
was a very interesting place
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01:19
because NATO troops were there,
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porque alí estaban as tropas da OTAN,
01:22
mostly to make sure
the war didn't break out again.
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máis que nada para garantir
que non volvese estalar a guerra,
01:26
But other than that,
it was actually a lawless place,
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mais, á parte diso,
o certo é que era unha zona sen lei
01:30
and almost every social institution,
both public and private,
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e case todas as institucións sociais,
tanto públicas coma privadas,
01:33
had been destroyed.
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foran destruídas.
01:35
So I can tell you
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Teño que dicir
01:39
that when you go into one
of these situations and settings,
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que cando te atopas nun escenario
ou nunha situación coma esa
01:44
it is absolutely thrilling ...
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é a cousa máis emocionante do mundo...
01:47
for about 30 minutes,
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durante uns 30 minutos,
01:49
because that's about how long it takes
before you run into a situation
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porque iso é, máis ou menos,
o que tardas en bater cunha situación
01:53
where you realize
how incredibly vulnerable you are.
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na que te decatas
do incriblemente vulnerábel que es.
01:59
For me, that moment came
when I had to cross the first checkpoint,
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No meu caso, ese momento chegou
ao ter que cruzar o primeiro control
02:03
and I realized as I drove up
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e reparar, mentres me achegaba,
02:05
that I would be negotiating passage
through this checkpoint
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en que ía ter que negociar
o paso por este control
02:09
with a heavily armed individual
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cun individuo armado ata as orellas que,
02:11
who, if he decided to shoot me
right then and there,
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se decidía pegarme un tiro alí mesmo,
02:15
actually wouldn't be doing
anything illegal.
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en realidade
non estaría a facer nada ilegal.
02:18
But the sense of vulnerability that I had
was absolutely nothing
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Porén, a sensación de vulnerabilidade
que eu sentín non era absolutamente nada
02:23
in comparison to the vulnerability
of the families that I got to know
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comparada coa vulnerabilidade
das familias que coñecín
02:27
over that year.
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ao longo daquel ano.
02:29
You see, life in a society
where there are no social institutions
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A vida nunha sociedade
sen institucións sociais
02:34
is riddled with danger and uncertainty,
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está chea de perigo e incerteza.
02:38
and simple questions like,
"What are we going to eat tonight?"
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Preguntas tan sinxelas como
“que imos cear hoxe?”
02:42
are very complicated to answer.
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vólvense moi difíciles de responder.
02:46
Questions about security,
when you don't have any security systems,
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As cuestións sobre seguridade
cando non hai sistema de seguridade ningún
02:51
are terrifying.
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son terroríficas.
02:52
Is that altercation I had
with the neighbor down the block
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Tornará aquel altercado
que tiven co veciño de abaixo
02:55
going to turn into a violent episode
that will end my life
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nun episodio violento
que acabe coa miña vida
02:58
or my family's life?
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ou coa da miña familia?
03:00
Health concerns
when there is no health system
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Os problemas de saúde
cando non hai sistema de saúde
03:02
are also terrifying.
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tamén son terroríficos.
03:05
I listened as many families
had to sort through questions like,
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Escoitei a moitas familias
facerse preguntas como
03:08
"My infant has a fever.
What am I going to do?"
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“O meu neno ten febre.
Que podo facer?”
03:12
"My sister, who is pregnant,
is bleeding. What should I do?
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“A miña irmá, que está preñada,
está a sangrar. Que fago?
03:16
Who should I turn to?"
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A quen acudo?”
03:17
"Where are the doctors,
where are the nurses?
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“Onde andan os doutores?
U-los enfermeiros?
03:19
If I could find one, are they trustworthy?
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Se atopo algún, será de fiar?
03:22
How will I pay them?
In what currency will I pay them?"
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Como lles hei pagar?
En que moeda lles pago?”
03:25
"If I need medications,
where will I find them?
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“Se preciso medicamentos, onde os atopo?
03:28
If I take those medications,
are they actually counterfeits?"
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E se tomo eses medicamentos,
non serán falsificacións?”
03:31
And on and on.
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E así unha detrás da outra.
03:34
So for life in these settings,
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Nestas circunstancias vitais,
03:37
the dominant theme,
the dominant feature of life,
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o tema predominante,
o aspecto dominante da vida,
03:41
is the incredible vulnerability
that people have to manage
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é a incrible vulnerabilidade
coa que teñen que lidar as persoas
03:45
day in and day out,
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un día si e outro tamén
03:47
because of the lack of social systems.
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por mor da falta de sistemas sociais.
03:50
And it actually turns out
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E resulta
03:51
that this feature of life
is incredibly difficult to explain
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que este aspecto da vida é
incriblemente difícil de explicar
03:55
and be understood by people
who are living outside of it.
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e facérllelo entender ás persoas
que viven alleas a el.
03:59
I discovered this when I left Kosovo.
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Isto descubrino cando marchei de Kosovo.
04:03
I came back to Boston,
I became a physician,
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Volvín a Boston, fíxenme doutora,
04:07
I became a global public
health policy researcher.
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logo investigadora
de políticas de saúde pública mundiais.
Uninme á Escola de Medicina de Harvard
04:11
I joined the Harvard Medical School
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04:12
and Brigham and Women's Hospital
Division of Global Health.
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e á División de Saúde Mundial
do hospital Birgham and Women.
04:15
And I, as a researcher,
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Eu, como investigadora,
04:17
really wanted to get started
on this problem right away.
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devecía por pórme a traballar
neste problema de contado.
Eu dicía: “Como diminuímos
a vulnerabilidade devastadora
04:19
I was like, "How do we reduce
the crushing vulnerability
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04:23
of people living in these types
of fragile settings?
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á que se enfrontan as persoas que viven
neste tipo de situacións tan fráxiles?
04:27
Is there any way
we can start to think about
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Hai algún xeito no que podamos
comezar a pensar
04:29
how to protect and quickly recover
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en como protexer e recuperar axiña
04:32
the institutions
that are critical to survival,
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as institucións fundamentais
para a supervivencia,
04:35
like the health system?"
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como o sistema de saúde?”
04:36
And I have to say,
I had amazing colleagues.
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Debo dicir que tiña
uns colegas marabillosos e,
04:40
But one interesting thing about it was,
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no entanto, un detalle interesante
04:42
this was sort of an unusual
question for them.
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era que, para eles,
esa pregunta era algo estraña.
04:45
They were kind of like,
"Oh, if you work in war,
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Dicíanme cousas como:
“Iso de traballar na guerra
04:47
doesn't that mean
you work on refugee camps,
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non significa traballar
en campos de refuxiados
04:49
and you work on documenting
mass atrocities?" --
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e documentar atrocidades masivas?”,
04:52
which is, by the way, very,
very, very important.
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cousa que é moi moi importante, por certo.
04:55
So it took me a while to explain
why I was so passionate about this issue,
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Levoume un anaco explicarlles
por que me apaixonaba tanto este asunto,
05:00
until about six years ago.
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ata haberá uns seis anos.
05:02
That's when this landmark study
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Daquela publicouse
un estudo sen precedentes
que analizaba e describía
as consecuencias da guerra
05:04
that looked at and described
the public health consequences of war
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05:08
was published.
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na saúde pública.
05:09
They came to an incredible,
provocative conclusion.
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Chegaron a unha conclusión
incrible e provocadora:
05:15
These researchers concluded
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os investigadores concluíron
05:18
that the vast majority of death
and disability from war
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que a maior parte das mortes
e discapacidades provocadas pola guerra
05:22
happens after the cessation of conflict.
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ocorren cando xa rematou o conflito.
05:24
So the most dangerous time to be a person
living in a conflict-affected state
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O período máis perigoso para as persoas
que viven nun estado en conflito
05:29
is after the cessation of hostilities;
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é tras a fin das hostilidades,
05:31
it's after the peace deal has been signed.
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despois de asinar o acordo de paz,
05:33
It's when that political solution
has been achieved.
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cando xa se acadou unha solución política.
05:36
That seems so puzzling,
but of course it's not,
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Semella desconcertante,
mais abofé que non o é,
05:39
because war kills people
by robbing them of their clinics,
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porque as guerras matan as persoas
roubándolles as súas clínicas,
05:45
of their hospitals,
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os seus hospitais,
05:47
of their supply chains.
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as súas cadeas de subministración.
05:48
Their doctors are targeted, are killed;
they're on the run.
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Os médicos tórnanse en obxectivos
e asasínanos. Teñen que fuxir.
05:52
And more invisible
and yet more deadly is the destruction
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E máis invisíbel e, con todo,
aínda máis letal é a destrución
05:56
of the health governance institutions
and their finances.
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das institucións de goberno sanitarias
e os seus medios financeiros.
06:01
So this is really not
surprising at all to me.
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Así que a min isto
non me resulta nada sorprendente
06:05
But what is surprising
and somewhat dismaying,
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O que si é sorprendente e,
dalgún xeito, desalentador
06:08
is how little impact this insight has had,
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é o escaso impacto
que esta percepción tivo
06:12
in terms of how we think
about human suffering and war.
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na nosa maneira de pensar
no sufrimento humano e a guerra.
06:16
Let me give you a couple examples.
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Vouvos poñer un par de exemplos.
06:19
Last year, you may remember,
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Se cadra lembrades que o ano pasado
06:21
Ebola hit the West African
country of Liberia.
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o ébola azoutou Liberia,
o país de África occidental.
06:26
There was a lot of reporting
about this group, Doctors Without Borders,
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Daquela déuselle moita cobertura
a un grupo, Médicos Sen Fronteiras,
06:30
sounding the alarm
and calling for aid and assistance.
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que estaba a dar a alarma
e a pedir axuda e medios.
06:33
But not a lot of that reporting
answered the question:
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Non obstante, poucas desas reportaxes
respondían á seguinte cuestión:
06:37
Why is Doctors Without Borders
even in Liberia?
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Que fan en Liberia
os de Médicos Sen Fronteiras?
06:39
Doctors Without Borders
is an amazing organization,
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Médicos Sen Fronteiras
é unha organización magnífica
06:42
dedicated and designed to provide
emergency care in war zones.
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que se dedica a prestar coidados
de emerxencia en zonas de guerra.
06:47
Liberia's civil war had ended in 2003 --
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A guerra civil de Liberia rematou no 2003,
06:50
that was 11 years
before Ebola even struck.
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11 anos antes de que
chegase sequera o ébola.
06:54
When Ebola struck Liberia,
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Cando o ébola atacou Liberia,
06:56
there were less than 50 doctors
in the entire country
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había menos de 50 médicos
para todo un país
07:00
of 4.5 million people.
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de 4,5 millóns de persoas.
07:02
Doctors Without Borders is in Liberia
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Médicos Sen Fronteiras está en Liberia
07:04
because Liberia still doesn't really have
a functioning health system,
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porque Liberia aínda non conta
cun sistema de saúde operativo
07:08
11 years later.
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11 anos despois.
07:10
When the earthquake hit Haiti in 2010,
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Cando o terremoto sacudiu Haití no 2010,
07:13
the outpouring of international
aid was phenomenal.
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o fluxo de axuda internacional
foi fantástico,
07:16
But did you know that only
two percent of that funding
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mais sabiades que
só un 2 por cento deses fondos
07:20
went to rebuild
Haitian public institutions,
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se usaron para restaurar
as institucións públicas haitianas,
07:23
including its health sector?
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incluído o sector sanitario?
07:25
From that perspective,
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Dende esa perspectiva,
07:27
Haitians continue to die
from the earthquake even today.
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mesmo hoxe os haitianos
seguen a morrer a causa do terremoto.
07:31
I recently met this gentleman.
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Hai pouco coñecín a este cabaleiro.
07:33
This is Dr. Nezar Ismet.
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É o doutor Nezar Ismet.
07:36
He's the Minister of Health
in the northern autonomous region of Iraq,
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É o ministro de Saúde
da rexión autónoma do norte de Iraq,
07:39
in Kurdistan.
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Kurdistán.
07:41
Here he is announcing
that in the last nine months,
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Aquí está a anunciar
que nos últimos nove meses
07:45
his country, his region, has increased
from four million people
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a poboación do seu país,
da súa rexión, aumentou de catro
07:49
to five million people.
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a cinco millóns de persoas,
07:50
That's a 25 percent increase.
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un aumento do 25 por cento.
07:52
Thousands of these new arrivals
have experienced incredible trauma.
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Milleiros destas persoas que chegaron
experimentaron traumas incribles.
07:57
His doctors are working
16-hour days without pay.
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Os seus médicos traballan
xornadas de 16 horas sen cobrar.
08:03
His budget has not increased
by 25 percent;
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Os seu presuposto
non aumentou un 25 por cento,
08:05
it has decreased by 20 percent,
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senón que diminuíu un 20 por cento,
08:08
as funding has flowed to security concerns
and to short-term relief efforts.
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xa que os fondos destináronse a seguridade
e medidas de auxilio a curto prazo.
08:13
When his health sector fails --
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Cando o seu sector sanitario caia
08:15
and if history is any guide, it will --
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—e se algo nos di a historia é que caerá—
08:17
how do you think that's going to influence
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como pensades que vai afectar iso
08:19
the decision making
of the five million people in his region
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ás decisións dos cinco millóns de persoas
da súa rexión
08:23
as they think about
whether they should flee
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2819
cando consideren se deberían fuxir
dese tipo de situación vital vulnerable?
08:25
that type of vulnerable living situation?
159
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2491
08:29
So as you can see,
this is a frustrating topic for me,
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Como vedes, este é
un tema frustrante para min.
08:32
and I really try to understand:
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500688
1502
e xuro que intento comprender
08:34
Why the reluctance to protect and support
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502214
3524
por que somos tan remisos
a protexer e apoiar
08:37
indigenous health systems
and security systems?
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505762
3636
os sistemas de saúde
e de seguridade autóctonos.
08:41
I usually tier two concerns,
two arguments.
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509422
2619
Normalmente escoito
dúas preocupacións, dous argumentos.
08:44
The first concern is about corruption,
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2187
O primeiro ten que ver coa corrupción.
08:47
and the concern that people
in these settings are corrupt
166
515138
2719
coa preocupación de que a xente
que está nestas situacións
08:49
and they are untrustworthy.
167
517881
1745
é corrupta e pouco de fiar.
08:52
And I will admit that I have met
unsavory characters
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3061
Hei de admitir que teño batido
con varios personaxes indesexables
08:55
working in health sectors
in these situations.
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traballando no sector sanitario
nestas situacións,
08:57
But I will tell you that the opposite
is absolutely true
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3700
pero podo dicirvos que o contrario
tamén é completamente certo
09:01
in every case I have worked on,
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529445
2030
en todos os casos nos que traballei.
09:03
from Afghanistan to Libya, to Kosovo,
to Haiti, to Liberia --
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531499
3813
Dende Afganistán até Libia,
pasando por Kosovo, Haití, Liberia...
09:07
I have met inspiring people,
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535336
2099
teño coñecido xente inspiradora,
09:09
who, when the chips were down
for their country,
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537459
2495
que, cando o seu país
se viu nunha encrucillada,
09:11
they risked everything
to save their health institutions.
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539978
3309
o arriscaron todo para salvar
as súas institucións sanitarias.
09:15
The trick for the outsider
who wants to help
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3348
O truco para as persoas alleas
que queiran axudar
09:18
is identifying who those individuals are,
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2904
está en identificar eses individuos
09:21
and building a pathway for them to lead.
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2308
e marcarlles o camiño
no que farán de guías.
09:23
That is exactly what happened
in Afghanistan.
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551943
3184
Iso mesmo foi
o que aconteceu en Afganistán.
09:27
One of the unsung and untold
success stories
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555714
3329
Un dos casos de éxito
esquecidos e descoñecidos
09:31
of our nation-building effort
in Afghanistan
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2918
das nosas iniciativas
de consolidación nacional en Afganistán
09:34
involved the World Bank in 2002
investing heavily
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562009
3496
foi o grande investimento que realizou
o Banco Mundial no 2002
09:37
in identifying, training and promoting
Afghani health sector leaders.
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565529
5135
para identificar, instruír e ascender
os líderes do sector sanitario afgáns.
09:44
These health sector leaders
have pulled off an incredible feat
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572049
3853
Estes líderes do sector sanitario
conseguiron toda unha fazaña
09:47
in Afghanistan.
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575926
1372
en Afganistán.
09:49
They have aggressively increased
access to health care
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577322
3947
Aumentaron de xeito impresionante
o acceso aos servizos sanitarios
09:53
for the majority of the population.
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581293
2016
para a maior parte da poboación.
09:55
They are rapidly improving
the health status
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583333
2204
Están a mellorar rápido
a situación sanitaria
09:57
of the Afghan population,
189
585561
1271
da poboación afgá,
09:58
which used to be the worst in the world.
190
586856
1986
que antes era a peor do mundo.
10:01
In fact, the Afghan Ministry
of Health does things
191
589945
2822
De feito, o Ministerio de Saúde
afgán fai cousas
10:04
that I wish we would do in America.
192
592791
1696
que oxalá fixeramos nos EE.UU.
10:06
They use things like data to make policy.
193
594511
2372
Usan datos para deseñar medidas políticas.
10:08
It's incredible.
194
596907
1185
Abraiante.
10:10
(Laughter)
195
598116
2392
(Risas)
10:12
The other concern I hear a lot about is:
196
600532
1929
A outra preocupación que oio moito é:
10:14
"We just can't afford it,
we just don't have the money.
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602485
2602
“Non nolo podemos permitir,
non hai cartos para iso.
10:17
It's just unsustainable."
198
605111
1355
É insostíbel.”
10:19
I would submit to you
that the current situation
199
607419
2733
Gustaríame apuntar que a situación actual,
10:22
and the current system we have
200
610176
1735
o sistema que temos actualmente,
10:23
is the most expensive, inefficient system
we could possibly conceive of.
201
611935
4038
é o sistema máis caro e ineficiente
que poderiamos concibir.
10:27
The current situation
is that when governments like the US --
202
615997
3378
Na actualidade, os gobernos,
como o dos EE.UU.,
10:31
or, let's say, the collection
of governments
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619399
2064
ou, por exemplo, o conxunto de gobernos
10:33
that make up the European Commission --
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621487
1874
que forman a Comisión Europea,
10:35
every year, they spend 15 billion dollars
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623385
2649
gastan 15 mil millóns
de dólares todos os anos
10:38
on just humanitarian and emergency
and disaster relief worldwide.
206
626058
4006
só en axuda humanitaria, de emerxencia
e para catástrofes en todo o mundo.
10:42
That's nothing about foreign aid,
that's just disaster relief.
207
630088
3321
Iso non inclúe a axuda exterior,
só a axuda para catástrofes.
10:46
Ninety-five percent of it
goes to international relief agencies,
208
634075
5045
O 95 por cento deses cartos
van ás axencias de axuda internacional,
10:51
that then have to import resources
into these areas,
209
639144
4337
que logo teñen que importar
recursos a esas zonas
10:55
and knit together some type
of temporary health system, let's say,
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643505
4389
e montar unha especie
de sistema sanitario temporal
10:59
which they then dismantle and send away
when they run out of money.
211
647918
3569
que logo desmantelan e mandan fóra
cando se esgotan os cartos.
11:04
So our job, it turns out, is very clear.
212
652181
3930
A nosa misión, polo tanto, é moi clara.
11:09
We, as the global health
community policy experts,
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657181
4775
Como expertos en políticas
da comunidade sanitaria mundial,
11:13
our first job is to become experts
in how to monitor
214
661980
5545
a nosa primeira misión
é facernos expertos en observar
11:19
the strengths and vulnerabilities
of health systems
215
667549
2447
os puntos fortes e débiles
dos sistemas sanitarios
11:22
in threatened situations.
216
670020
2567
en situacións de ameaza.
11:24
And that's when we see doctors fleeing,
217
672611
2010
E esta dáse cando os médicos foxen,
11:26
when we see health resources drying up,
218
674645
1937
cando se esgotan os recursos sanitarios,
11:28
when we see institutions crumbling --
219
676606
2435
cando se veñen abaixo as institucións.
11:31
that's the emergency.
220
679065
1613
Esa é a emerxencia.
11:32
That's when we need to sound the alarm
and wave our arms.
221
680702
3110
É aí cando temos que dar a alarma
e sacudir os brazos.
11:35
OK?
222
683836
1394
Estamos?
Non agora.
11:37
Not now.
223
685254
1151
11:38
Everyone can see that's an emergency,
they don't need us to tell them that.
224
686429
3912
Calquera ve que iso é unha emerxencia,
non precisan que llelo digamos nós.
11:43
Number two:
225
691122
1939
Segundo:
11:45
places like where I work at Harvard
need to take their cue
226
693085
3337
os lugares como no que eu traballo
en Harvard deben seguir o exemplo
11:48
from the World Bank experience
in Afghanistan,
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696446
2198
da experiencia do Banco Mundial
en Afganistán,
11:50
and we need to -- and we will --
228
698668
1657
e precisamos —e farémolo—
11:52
build robust platforms to support
health sector leaders like these.
229
700349
5263
establecer plataformas sólidas para apoiar
estes líderes do sector sanitario.
11:58
These people risk their lives.
230
706471
1702
Esta xente xoga a súa vida.
12:00
I think we can match their courage
with some support.
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708197
3712
Coido que podemos corresponder
ao seu valor con algo de apoio.
12:04
Number three:
232
712425
1154
Terceiro:
12:05
we need to reach out
and make new partnerships.
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713603
2578
temos que comunicarnos e
formar novas alianzas.
12:08
At our global health center,
234
716205
1874
No noso centro sobre saúde mundial,
12:10
we have launched a new initiative
with NATO and other security policy makers
235
718103
4012
sacamos unha nova iniciativa coa OTAN
e máis creadores de política de seguridade
12:14
to explore with them what they can do
to protect health system institutions
236
722139
5366
para estudar con eles o que poden facer
para protexer as institucións sanitarias
12:19
during deployments.
237
727529
1715
durante os despregamentos.
12:21
We want them to see
238
729268
1540
Queremos que se decaten
12:22
that protecting health systems
and other critical social institutions
239
730832
4700
de que protexer os sistemas sanitarios
e outras institucións sociais fundamentais
12:27
is an integral part of their mission.
240
735556
2443
é unha parte indispensábel da súa misión.
12:30
It's not just about avoiding
collateral damage;
241
738023
3137
Non todo é evitar danos colaterais;
12:33
it's about winning the peace.
242
741184
1805
hai que gañar a paz.
12:36
But the most important partner
we need to engage is you,
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744725
3583
Agora ben, o socio máis importante
ao que cómpre que impliquemos sodes vós,
12:40
the American public,
and indeed, the world public.
244
748332
3432
os cidadáns estadounidenses e,
por suposto, os de todo o mundo,
12:43
Because unless you understand
the value of social institutions,
245
751788
5696
porque, a non ser que entendades
o valor das institucións sociais,
12:49
like health systems
in these fragile settings,
246
757508
2511
como o sistema sanitario,
nestas situacións fráxiles,
12:53
you won't support efforts to save them.
247
761066
2248
non apoiaredes
as iniciativas para salvalos.
12:55
You won't click on that article
248
763338
2398
Non ides picar nese artigo
12:57
that talks about "Hey, all those
doctors are on the run in country X.
249
765760
4966
que di “Ei, todos os médicos
do país X están fuxindo.
13:02
I wonder what that means.
250
770750
2417
Que significará?
13:05
I wonder what that means
251
773191
1852
Pregúntome como vai afectar iso
13:07
for that health system's ability
to, let's say, detect influenza."
252
775067
3952
á capacidade dese sistema sanitario para,
por exemplo, detectar a influenza”.
13:11
"Hmm, it's probably not good."
That's what I'd tell you.
253
779853
3377
“Mmm, non ha de ser boa cousa”.
Iso é o que vos diría eu.
13:15
Up on the screen,
254
783770
1164
Na pantalla,
13:16
I've put up my three favorite American
institution defenders and builders.
255
784958
6280
están tres dos meus defensores e creadores
de institucións estadounidenses favoritos.
13:23
Over here is George C. Marshall,
256
791846
2885
Por aquí está George C. Marshall,
13:26
he was the guy that proposed
the Marshall Plan
257
794755
2829
o tipo que propuxo o Plan Marshall,
13:29
to save all of Europe's economic
institutions after World War II.
258
797608
4191
que salvou as institucións económicas
de Europa tras a Segunda Guerra Mundial.
13:34
And this Eleanor Roosevelt.
259
802299
2353
Logo temos a Eleanor Roosevelt.
13:36
Her work on human rights
really serves as the foundation
260
804676
3146
O seu traballo a prol
dos dereitos humanos é a base
13:39
for all of our international
human rights organizations.
261
807846
3028
das nosas organizacións internacionais
de dereitos humanos.
13:43
Then my big favorite is Ben Franklin,
262
811330
2040
E logo está o meu favorito, Ben Franklin,
13:45
who did many things
in terms of creating institutions,
263
813394
3208
que fixo moitas cousas
no que se refire a crear institucións,
13:48
but was the midwife of our constitution.
264
816626
2767
mais foi o pai da nosa constitución.
13:52
And I would say to you
265
820582
1724
E vouvos dicir
13:54
that these are folks who, when our
country was threatened,
266
822330
3753
que estes foron os tipos que,
cando o noso país estaba ameazado,
13:58
or our world was threatened,
267
826107
2007
cando o noso mundo estaba ameazado,
14:00
they didn't retreat.
268
828138
1303
non se renderon.
14:01
They didn't talk about building walls.
269
829465
2341
Non falaron de construír muros;
14:03
They talked about building institutions
to protect human security,
270
831830
5381
falaron de construír institucións
para garantir a seguridade humana,
14:10
for their generation and also for ours.
271
838008
2614
para a súa xeración e tamén para a nosa,
14:13
And I think our generation
should do the same.
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2798
e eu coido que a nosa xeración
debería facer o mesmo.
14:16
Thank you.
273
844683
1160
Grazas.
(Aplausos)
14:17
(Applause)
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ABOUT THE SPEAKER
Margaret Bourdeaux - Physician, global health policy analyst
Margaret Bourdeaux investigates the best ways to protect, recover and reconstruct health systems and institutions disrupted by war or disaster.

Why you should listen

Margaret Ellis Bourdeaux, MD, MPH spearheads the Threatened Health Systems Project at Harvard Medical School -- an initiative that brings together public sector leaders, health care providers, academics, military strategists and private sector stakeholders to generate creative approaches to protecting valuable health system resources in countries affected by armed conflict and acute political crisis.

Bourdeaux's journey in global health began when she took a year of leave from Yale Medical School to work in refugee camps during the Kosovo War in 1999. She returned on her own after the war to trace families she had befriended in the camps and find out what had happened to them. Living in villages of Kosovo's countryside, she documented how these families struggled to care for their children, find health services and make a living in a society decimated by genocide and ethnic conflict. This experience impressed upon her the stark truth that war kills people by stripping them of their personal, community and national resources and institutions. Far more people died in Kosovo from the depleted health systems and institutions than from wounds sustained during the armed conflict.

Later experiences in Haiti, Afghanistan, Libya, Sierra Leon, Madagascar and Liberia revealed a similar pattern: armed conflict would decimate indigenous health institutions that never recovered, leaving people helpless when later crises -- earthquakes, epidemics, renewed conflict -- invariably struck. Strong, resilient health systems are the key to making war, disasters and epidemics less deadly.

After completing a joint residency in Internal Medicine and Pediatrics at the Harvard Combined Med/Peds Program, Bourdeaux was among the first graduates of Brigham and Women's Global Women's Health Fellowship. She has worked with the Office of the Secretary of Defense Policy to analyze the US Department of Defense’s global health projects and programs. She led a joint Harvard-NATO team of analysts to evaluate the impacts, challenges and opportunities international security forces have in protecting and rebuilding health systems in conflict affected states. She joined the faculty of the Division of Global Health Equity at Brigham and Women’s Hospital and Harvard Medical School in 2011.

This year she was awarded the prestigious Harvard Global Health Institute's Burke Fellowship in Global Health to investigate the responsiveness of foreign aid to health system distress and disruption. She is co-developing the first executive education course between Harvard Medical School and Harvard Kennedy School of Government for senior security policy makers on health system threat detection and response. In addition, she is launching Harvard Global Health Institute's first Summit on Threatened Health Systems in June 2017.

More profile about the speaker
Margaret Bourdeaux | Speaker | TED.com

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