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

瑪格麗特·布爾多: 為什麼平民在戰爭結束後遭受更多的痛苦?

Filmed:
979,657 views

在戰爭中,事實證明暴力並不是平民最大的殺手。 什麼才是?疾病、飢餓、貧窮──因為戰爭破壞了運行社會的公共機構,像基楚建設、銀行、食品系統和醫院等。 瑪格麗特·布爾多醫生(Margaret Bourdeaux)提出了一個大膽的方案來解決衝突後之重建任務,確定什麼才是修復的優先重點。
- 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.

請問你有曾想過,
00:12
So have you ever wondered想知道
what it would be like
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生活在一個不受管制的地方
是怎樣感覺嗎?
00:16
to live生活 in a place地點 with no rules規則?
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聽來是蠻酷的。
00:19
That sounds聲音 pretty漂亮 cool.
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00:21
(Laughter笑聲)
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(笑聲)
00:22
You wake喚醒 up one morning早上, however然而,
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可是,大早醒來後,
你發現沒有管制的原因
00:23
and you discover發現 that the reason原因
there are no rules規則
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卻是因為已沒有政府了,
而且也沒有任何法律了,
00:26
is because there's no government政府,
and there are no laws法律.
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00:29
In fact事實, all social社會 institutions機構
have disappeared消失.
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甚至一切社會體制都不存在了:
00:34
So there's no schools學校,
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沒有學校,
00:36
there's no hospitals醫院,
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沒有醫院,
00:37
there's no police警察,
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沒有警察,
00:38
there's no banks銀行,
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沒有銀行,
00:40
there's no athletic競技 clubs會所,
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沒有健身會所,
00:42
there's no utilities公用事業.
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沒有水電等供應。
00:44
Well, I know a little bit
about what this is like,
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我倒是知道這是什麼的感覺。
00:48
because when I was
a medical student學生 in 1999,
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因為在 1999 年,
我為醫學院學生時,
00:50
I worked工作 in a refugee難民 camp
in the Balkans巴爾幹 during the Kosovo科索沃 War戰爭.
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在科索沃戰爭中,曾在巴爾幹的
一個難民收留中心工作。
00:57
When the war戰爭 was over,
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當戰爭結束後,
00:58
I got permission允許 -- unbelievably令人難以置信 --
from my medical school學校
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難以置信,
我居然獲得醫學院的允許,
01:01
to take some time off
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拿到假期,
01:02
and follow跟隨 some of the families家庭
that I had befriended結識 in the camp
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跟著我在營地結識的一些家庭,
01:06
back to their village in Kosovo科索沃,
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回到他們在科索沃的家鄉。
01:09
and understand理解 how they navigated導航
life in this postwar戰後 setting設置.
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去觀察他們在戰火後,
是如何作生活的安排。
01:16
Postwar戰後 Kosovo科索沃
was a very interesting有趣 place地點
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戰後的科索沃
是一個非常有趣的地方,
01:19
because NATO北約 troops軍隊 were there,
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因為有北約部隊在那裡,
01:22
mostly大多 to make sure
the war戰爭 didn't break打破 out again.
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目的是為了確保戰爭
不會再度爆發。
01:26
But other than that,
it was actually其實 a lawless不法 place地點,
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但除此之外,科索沃實際上已是
一個無法無天的地方,
01:30
and almost幾乎 every一切 social社會 institution機構,
both public上市 and private私人的,
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而且幾乎所有的社會體制,
不論是公營或私營,
01:33
had been destroyed銷毀.
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都已被毀掉了。
01:35
So I can tell you
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所以我可以告訴你,
01:39
that when you go into one
of these situations情況 and settings設置,
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當你置身在這種情況和環境中,
01:44
it is absolutely絕對 thrilling驚險 ...
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它是會令你絕對毛骨悚然......
01:47
for about 30 minutes分鐘,
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長達 30 分鐘左右,
01:49
because that's about how long it takes
before you run into a situation情況
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因為這就是發現自己
是何等的脆弱,所需要的時間。
01:53
where you realize實現
how incredibly令人難以置信 vulnerable弱勢 you are.
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01:59
For me, that moment時刻 came來了
when I had to cross交叉 the first checkpoint檢查站,
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個人來說,那一刻發生在當我要
通過第一個檢查站時,
02:03
and I realized實現 as I drove開車 up
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當車子開近時,我就意識到
02:05
that I would be negotiating談判 passage通道
through通過 this checkpoint檢查站
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我必須跟一名全副武裝的人討價還價
02:09
with a heavily嚴重 armed武裝 individual個人
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才能通過這個檢查點;
02:11
who, if he decided決定 to shoot射擊 me
right then and there,
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如他想在此時此地把我射殺的話,
02:15
actually其實 wouldn't不會 be doing
anything illegal非法.
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也是完全合法之事。
02:18
But the sense of vulnerability漏洞 that I had
was absolutely絕對 nothing
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但當時我體會到的脆弱感,
是絲毫比不上
02:23
in comparison對照 to the vulnerability漏洞
of the families家庭 that I got to know
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我將在未來一年認識的家庭
02:27
over that year.
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所體會的脆弱感。
02:29
You see, life in a society社會
where there are no social社會 institutions機構
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你要明白,生活在一個沒有
任何社會體制的社會裡,
02:34
is riddled百病 with danger危險 and uncertainty不確定,
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是充滿危險和不確定性的。
02:38
and simple簡單 questions問題 like,
"What are we going to eat tonight今晚?"
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甚至一個簡單的問題,
像「今晚我們要吃什麼呢?」
02:42
are very complicated複雜 to answer回答.
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要回答也很複雜了。
02:46
Questions問題 about security安全,
when you don't have any security安全 systems系統,
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至於安全問題,
當你沒有任何保安系統時,
02:51
are terrifying可怕的.
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是非常可怕的。
02:52
Is that altercation爭吵 I had
with the neighbor鄰居 down the block
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我與街頭那邊的鄰居吵得面紅耳赤,
02:55
going to turn into a violent暴力 episode插曲
that will end結束 my life
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會不會演變成暴力事件,
終結我的生命
02:58
or my family's家庭的 life?
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或我家人的生命呢?
03:00
Health健康 concerns關注
when there is no health健康 system系統
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沒有衛生系統時,健康問題
03:02
are also terrifying可怕的.
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也是非常可怕的。
03:05
I listened聽了 as many許多 families家庭
had to sort分類 through通過 questions問題 like,
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我聽到很多家庭必須解決這類問題:
03:08
"My infant嬰兒 has a fever發熱.
What am I going to do?"
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「我的嬰兒在發燒。我該怎麼辦?」
03:12
"My sister妹妹, who is pregnant,
is bleeding流血的. What should I do?
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「我懷孕的姐姐正在出血,
我該怎麼辦?
03:16
Who should I turn to?"
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我該去找誰呢?」
03:17
"Where are the doctors醫生,
where are the nurses護士?
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「醫生在哪裡?護士在哪裡?」
03:19
If I could find one, are they trustworthy可靠?
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如果我能找到一位,會可靠嗎?
03:22
How will I pay工資 them?
In what currency貨幣 will I pay工資 them?"
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我該怎麼付錢?
我要用哪國貨幣支付?」
03:25
"If I need medications藥物治療,
where will I find them?
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「如果我需要藥物,
我在哪裡可以找到?
03:28
If I take those medications藥物治療,
are they actually其實 counterfeits假冒?"
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如果我服用了這些藥物,
它會是假冒的嗎?」
03:31
And on and on.
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連綿不斷的問題。
03:34
So for life in these settings設置,
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所以在這環境之下生活,
03:37
the dominant優勢 theme主題,
the dominant優勢 feature特徵 of life,
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生活的主要特徵,
03:41
is the incredible難以置信 vulnerability漏洞
that people have to manage管理
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就是人民日以繼夜要懂得掌控
03:45
day in and day out,
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這難以置信的脆弱感,
03:47
because of the lack缺乏 of social社會 systems系統.
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起因就是缺乏社會制度。
03:50
And it actually其實 turns out
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原來,
03:51
that this feature特徵 of life
is incredibly令人難以置信 difficult to explain說明
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這生活特徵是很難解釋的,
03:55
and be understood了解 by people
who are living活的 outside of it.
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難以得到身置其外的人理解的。
03:59
I discovered發現 this when I left Kosovo科索沃.
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當我離開科索沃時,
我才發現這一點。
04:03
I came來了 back to Boston波士頓,
I became成為 a physician醫師,
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我回到了波士頓,我成了一名醫生,
04:07
I became成為 a global全球 public上市
health健康 policy政策 researcher研究員.
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我成了一名
環球公共衞生政策研究員。
04:11
I joined加盟 the Harvard哈佛 Medical School學校
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我加入了哈佛醫學院
04:12
and Brigham布里格姆 and Women's女士的 Hospital醫院
Division of Global全球 Health健康.
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和布萊根婦女醫院的全球衞生部門。
04:15
And I, as a researcher研究員,
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我作為研究員,
真的很想立即就研究這問題。
04:17
really wanted to get started開始
on this problem問題 right away.
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我在想:
「對生活在這種匱乏環境的人,
04:19
I was like, "How do we reduce減少
the crushing破碎 vulnerability漏洞
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04:23
of people living活的 in these types類型
of fragile脆弱 settings設置?
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我們如何能減少
這令人窒息的脆弱感?
04:27
Is there any way
we can start開始 to think about
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我們可以開始思考用什麼方法
04:29
how to protect保護 and quickly很快 recover恢復
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去保護和迅速恢復
04:32
the institutions機構
that are critical危急 to survival生存,
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這些對生存至關重要的體制,
04:35
like the health健康 system系統?"
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像醫療衞生系統?」
04:36
And I have to say,
I had amazing驚人 colleagues同事.
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我不得不說,我有了不起的同事,
04:40
But one interesting有趣 thing about it was,
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但有一件有趣的事情是:
04:42
this was sort分類 of an unusual異常
question for them.
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對他們來說,
這是一種不尋常的問題。
04:45
They were kind of like,
"Oh, if you work in war戰爭,
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他們的反應是:
「哦,你在戰場中工作,
04:47
doesn't that mean
you work on refugee難民 camps營地,
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那是不是你是在難民營工作?
04:49
and you work on documenting文檔化
mass atrocities暴行?" --
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在記錄戰爭暴行?」
04:52
which哪一個 is, by the way, very,
very, very important重要.
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順帶一提,這些工作都是非常重要。
04:55
So it took me a while to explain說明
why I was so passionate多情 about this issue問題,
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所以我必得花上一段時間來解釋
我為什麼對這個問題那麼熱衷,
05:00
until直到 about six years年份 ago.
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直至大約六年前。
05:02
That's when this landmark里程碑 study研究
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當時這份重點研究被發表,
05:04
that looked看著 at and described描述
the public上市 health健康 consequences後果 of war戰爭
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內容是探討和描述戰爭對公共衞生
05:08
was published發表.
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所帶來的後果。
05:09
They came來了 to an incredible難以置信,
provocative挑釁 conclusion結論.
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研究人員作出一個
意想不到的驚世結論:
05:15
These researchers研究人員 concluded總結
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這些研究人員的結論
05:18
that the vast廣大 majority多數 of death死亡
and disability失能 from war戰爭
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就是絕大多數因戰爭
死亡和殘疾的事情
05:22
happens發生 after the cessation戒菸 of conflict衝突.
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是發生在衝突停止之後。
05:24
So the most dangerous危險 time to be a person
living活的 in a conflict-affected受衝突影響 state
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所以活在受衝突影響的國家中
最危險的時候,
05:29
is after the cessation戒菸 of hostilities敵對行動;
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是在敵對行動停止之後;
05:31
it's after the peace和平 deal合同 has been signed.
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是在和平協議簽署之後;
05:33
It's when that political政治 solution
has been achieved實現.
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是在政治解決方案已經實現之後。
05:36
That seems似乎 so puzzling令人費解,
but of course課程 it's not,
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這表面看來令人費解,但當然不是,
05:39
because war戰爭 kills殺死 people
by robbing劫財 them of their clinics診所,
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因為戰爭之所以殺人,
是因為它摧毀了診所,
05:45
of their hospitals醫院,
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摧毀了醫院,
05:47
of their supply供應 chains.
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摧毀了供應鏈。
05:48
Their doctors醫生 are targeted針對, are killed殺害;
they're on the run.
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醫生們被狙擊、殺害,以至逃命。
05:52
And more invisible無形
and yet然而 more deadly致命 is the destruction毀壞
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而且雖無形但更致命的,
就是衞生管治體制及其財政崩潰。
05:56
of the health健康 governance治理 institutions機構
and their finances財政.
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06:01
So this is really not
surprising奇怪 at all to me.
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我對這些並不驚訝,
06:05
But what is surprising奇怪
and somewhat有些 dismaying令人沮喪,
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但令我驚訝和有一點沮喪的是:
06:08
is how little impact碰撞 this insight眼光 has had,
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從這份研究得出的見解,
只能稍微改變
我們對人類苦難和戰爭的看法。
06:12
in terms條款 of how we think
about human人的 suffering痛苦 and war戰爭.
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06:16
Let me give you a couple一對 examples例子.
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讓我給你幾個例子。
06:19
Last year, you may可能 remember記得,
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你可能會記得去年
06:21
Ebola埃博拉病毒 hit擊中 the West西 African非洲人
country國家 of Liberia利比里亞.
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伊波拉病毒侵襲西非國家賴比瑞亞。
06:26
There was a lot of reporting報告
about this group, Doctors醫生 Without沒有 Borders國界,
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當時有很多關於
無國界醫生這個組織的報導,
06:30
sounding聽起來 the alarm報警
and calling調用 for aid援助 and assistance幫助.
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叫人提高警覺並呼籲作出援助。
06:33
But not a lot of that reporting報告
answered回答 the question:
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但沒有很多報導解答到這個問題:
06:37
Why is Doctors醫生 Without沒有 Borders國界
even in Liberia利比里亞?
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為什麼無國界醫生會在賴比瑞亞呢?
06:39
Doctors醫生 Without沒有 Borders國界
is an amazing驚人 organization組織,
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無國界醫生是一個令人敬佩的組織,
06:42
dedicated專用 and designed設計 to provide提供
emergency care關心 in war戰爭 zones.
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盡心盡力在戰區提供緊急護理。
06:47
Liberia's利比里亞 civil國內 war戰爭 had ended結束 in 2003 --
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賴比瑞亞的內戰在 2003 年已結束,
06:50
that was 11 years年份
before Ebola埃博拉病毒 even struck來襲.
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亦是伊波拉病毒爆發的 11 年前。
06:54
When Ebola埃博拉病毒 struck來襲 Liberia利比里亞,
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當伊波拉病毒衝擊賴比瑞亞時,
06:56
there were less than 50 doctors醫生
in the entire整個 country國家
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在全國 450 萬人口之中,
醫生不到 50 名。
07:00
of 4.5 million百萬 people.
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07:02
Doctors醫生 Without沒有 Borders國界 is in Liberia利比里亞
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無國界醫生駐守在賴比瑞亞,
07:04
because Liberia利比里亞 still doesn't really have
a functioning功能 health健康 system系統,
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是因為賴比瑞亞依然沒有
一個能運作的醫療系統,
在 11 年後仍沒有。
07:08
11 years年份 later後來.
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07:10
When the earthquake地震 hit擊中 Haiti海地 in 2010,
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在 2010 年,地震衝擊海地後,
07:13
the outpouring流露 of international國際
aid援助 was phenomenal非凡的.
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來自國際社會的援助排山倒海。
07:16
But did you know that only
two percent百分 of that funding資金
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但你知不知道國際社會
捐款中只有 2%
07:20
went to rebuild重建
Haitian海地 public上市 institutions機構,
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用去重建海地的公共體制,
07:23
including包含 its health健康 sector扇形?
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包括衞生部門?
07:25
From that perspective透視,
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從這個角度看,
07:27
Haitians海地人 continue繼續 to die
from the earthquake地震 even today今天.
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海地人民可謂到了今天
還因地震而繼續死亡。
07:31
I recently最近 met會見 this gentleman紳士.
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我最近認識了這位先生,
07:33
This is Dr博士. NezarNezar Ismet伊斯梅特.
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他是尼薩‧伊斯密特醫生。
07:36
He's the Minister部長 of Health健康
in the northern北方 autonomous自主性 region地區 of Iraq伊拉克,
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他是伊拉克北部自治區庫爾德斯坦的
07:39
in Kurdistan庫爾德斯坦.
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衞生部長。
07:41
Here he is announcing宣布
that in the last nine months個月,
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他正在宣佈在過去九個月中,
07:45
his country國家, his region地區, has increased增加
from four million百萬 people
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他所屬地區的人口從 400 萬
07:49
to five million百萬 people.
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增加到 500 萬。
07:50
That's a 25 percent百分 increase增加.
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這是增加 25% 之多。
這些數以千計的新移民
經歷了難言的創傷。
07:52
Thousands成千上萬 of these new arrivals到達
have experienced有經驗的 incredible難以置信 trauma外傷.
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07:57
His doctors醫生 are working加工
16-hour-小時 days without pay工資.
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他轄下的醫生們
每天無薪的工作 16 小時。
08:03
His budget預算 has not increased增加
by 25 percent百分;
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可是他的財政預算
並沒有增加 25 %,
08:05
it has decreased下降 by 20 percent百分,
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而是減少了 20%。
08:08
as funding資金 has flowed流入 to security安全 concerns關注
and to short-term短期 relief浮雕 efforts努力.
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因為撥款已調去應付保安問題
和短期救援工作。
08:13
When his health健康 sector扇形 fails失敗 --
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所以當他的衞生部門崩潰時—
08:15
and if history歷史 is any guide指南, it will --
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如果歷史有任何預告能力,
它是一定會的——
08:17
how do you think that's going to influence影響
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你覺得這會怎樣影響
當地 500 萬居民的決定呢?
08:19
the decision決定 making製造
of the five million百萬 people in his region地區
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他們正在考量是否應該逃跑,
08:23
as they think about
whether是否 they should flee逃跑
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08:25
that type類型 of vulnerable弱勢 living活的 situation情況?
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離開這危機重重的生活環境。
08:29
So as you can see,
this is a frustrating洩氣 topic話題 for me,
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所以你可以看到,
這是個令我沮喪的議題。
08:32
and I really try to understand理解:
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我很用心去嘗試理解:
08:34
Why the reluctance不情願 to protect保護 and support支持
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大家為什麼不願意維護和支持
08:37
indigenous土著 health健康 systems系統
and security安全 systems系統?
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本土的衞生和保安系統呢?
08:41
I usually平時 tier一線 two concerns關注,
two arguments參數.
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我常聽到兩個關注點或論點。
08:44
The first concern關心 is about corruption腐敗,
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第一個關注點是貪污:
08:47
and the concern關心 that people
in these settings設置 are corrupt腐敗
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在這些系統工作的人都是腐敗的,
08:49
and they are untrustworthy靠不住.
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都是不可信的。
08:52
And I will admit承認 that I have met會見
unsavory難吃的 characters人物
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我承認我是有見過品德不良的人物,
08:55
working加工 in health健康 sectors行業
in these situations情況.
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在這種情況下之衞生部門工作。
08:57
But I will tell you that the opposite對面
is absolutely絕對 true真正
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但我也可告訴你,
相反的也是絕對有的,
09:01
in every一切 case案件 I have worked工作 on,
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在我有參與的每一個案件中都有——
從阿富汗到利比亞、到科索沃、
到海地、到賴比瑞亞——
09:03
from Afghanistan阿富汗 to Libya利比亞, to Kosovo科索沃,
to Haiti海地, to Liberia利比里亞 --
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09:07
I have met會見 inspiring鼓舞人心 people,
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我都遇到鼓舞人心的人,
09:09
who, when the chips芯片 were down
for their country國家,
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他們都在國家存亡的一刻,
09:11
they risked冒險 everything
to save保存 their health健康 institutions機構.
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冒著一切風險來
挽救他們的衞生體制。
09:15
The trick for the outsider局外人
who wants to help
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所以,對真心想幫忙的局外人來說,
09:18
is identifying識別 who those individuals個人 are,
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難題是如何識別這些人,
09:21
and building建造 a pathway for them to lead.
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並建立渠道讓他們走上領導位置。
09:23
That is exactly究竟 what happened發生
in Afghanistan阿富汗.
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這也正是在阿富汗能做到的。
09:27
One of the unsung幕後 and untold數不清
success成功 stories故事
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我們在阿富汗國家建設上付出的努力
其中一個無聲無聞的成功故事,
09:31
of our nation-building國家建築 effort功夫
in Afghanistan阿富汗
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09:34
involved參與 the World世界 Bank銀行 in 2002
investing投資 heavily嚴重
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就是世界銀行在 2002 年
投放大量資金
去發掘、培訓和提拔
阿富汗的衞生部門領袖。
09:37
in identifying識別, training訓練 and promoting促進
Afghani阿富汗 health健康 sector扇形 leaders領導者.
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09:44
These health健康 sector扇形 leaders領導者
have pulled off an incredible難以置信 feat功績
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這些衞生部門領袖在阿富汗
排除萬難完成壯舉。
09:47
in Afghanistan阿富汗.
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09:49
They have aggressively積極 increased增加
access訪問 to health健康 care關心
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他們積極增加醫療服務
讓大部分人口可以使用。
09:53
for the majority多數 of the population人口.
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09:55
They are rapidly急速 improving提高
the health健康 status狀態
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他們正在迅速改善
阿富汗人口的健康狀況,
09:57
of the Afghan阿富汗 population人口,
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09:58
which哪一個 used to be the worst最差 in the world世界.
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而它曾經是世界上最糟糕的。
10:01
In fact事實, the Afghan阿富汗 Ministry
of Health健康 does things
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事實上,阿富汗衞生部所做的事
是我希望我們也能在美國做到的。
10:04
that I wish希望 we would do in America美國.
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10:06
They use things like data數據 to make policy政策.
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他們用數據資料來製定政策。
簡直不可思議。
10:08
It's incredible難以置信.
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10:10
(Laughter笑聲)
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(笑聲)
10:12
The other concern關心 I hear a lot about is:
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我經常聽到的另外一個關注點是:
10:14
"We just can't afford給予 it,
we just don't have the money.
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「我們負擔不起,我們真的沒錢。
這是不可能持續的。」
10:17
It's just unsustainable不可持續的."
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10:19
I would submit提交 to you
that the current當前 situation情況
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但讓我告訴你:我們現有的情況
10:22
and the current當前 system系統 we have
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和我們現有的制度
10:23
is the most expensive昂貴, inefficient低效 system系統
we could possibly或者 conceive構想 of.
201
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是我們可以想像
最昂貴、效率最低的制度。
10:27
The current當前 situation情況
is that when governments政府 like the US --
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目前的情況是美國等多國政府——
10:31
or, let's say, the collection採集
of governments政府
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或者說組成歐盟委員會的
一眾成員國政府——
10:33
that make up the European歐洲的 Commission佣金 --
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10:35
every一切 year, they spend 15 billion十億 dollars美元
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每年就要花費 150 億美元
10:38
on just humanitarian人道主義 and emergency
and disaster災害 relief浮雕 worldwide全世界.
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在全球的人道、緊急和災難救援上。
10:42
That's nothing about foreign國外 aid援助,
that's just disaster災害 relief浮雕.
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這數字不包括外援,只是賑災而已。
10:46
Ninety-five九十五 percent百分 of it
goes to international國際 relief浮雕 agencies機構,
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這費用 95% 給了國際救援機構,
10:51
that then have to import進口 resources資源
into these areas,
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然後他們必須把資源引進這些地區,
10:55
and knit針織 together一起 some type類型
of temporary臨時 health健康 system系統, let's say,
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並且拼湊一個臨時衞生系統,
10:59
which哪一個 they then dismantle拆除 and send發送 away
when they run out of money.
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錢用光後就要把它瓦解,
把人員遣散。
11:04
So our job工作, it turns out, is very clear明確.
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所以我們的工作原來是非常清楚的。
11:09
We, as the global全球 health健康
community社區 policy政策 experts專家,
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我們作為全球衞生政策專家,
11:13
our first job工作 is to become成為 experts專家
in how to monitor監控
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首要工作就是要專注監控
在政局不定環境下,衞生部門的
11:19
the strengths優勢 and vulnerabilities漏洞
of health健康 systems系統
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各個強項和弱項。
11:22
in threatened受威脅 situations情況.
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11:24
And that's when we see doctors醫生 fleeing逃離,
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當我們看到醫生逃跑時,
11:26
when we see health健康 resources資源 drying烘乾 up,
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當我們看到衞生資源枯竭時,
11:28
when we see institutions機構 crumbling搖搖欲墜 --
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當我們看到體制崩潰時,
11:31
that's the emergency.
220
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這就是緊急情況。
11:32
That's when we need to sound聲音 the alarm報警
and wave our arms武器.
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這就是我們需要發出警報
並揮手求救之時。
11:35
OK?
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行嗎?
11:37
Not now.
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還等什麼?
11:38
Everyone大家 can see that's an emergency,
they don't need us to tell them that.
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大家都可以看到這是緊急情況,
他們不需要我們告訴他們吧。
11:43
Number two:
225
691122
1939
第二點:
11:45
places地方 like where I work at Harvard哈佛
need to take their cue球桿
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我在哈佛任職的機構和類似機構
需要從世界銀行
在阿富汗的經驗中學習,
11:48
from the World世界 Bank銀行 experience經驗
in Afghanistan阿富汗,
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11:50
and we need to -- and we will --
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我們需要並將會
11:52
build建立 robust強大的 platforms平台 to support支持
health健康 sector扇形 leaders領導者 like these.
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建立一個強大的平台來支援
這些衞生部門領袖。
11:58
These people risk風險 their lives生活.
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這些人都是冒著生命危險,
12:00
I think we can match比賽 their courage勇氣
with some support支持.
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我們應該以行動來支持他們的勇氣。
12:04
Number three:
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第三點:
12:05
we need to reach達到 out
and make new partnerships夥伴關係.
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我們需要積極溝通,
並建立新的伙伴關係。
12:08
At our global全球 health健康 center中央,
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在我們的環球衞生中心,
12:10
we have launched推出 a new initiative倡議
with NATO北約 and other security安全 policy政策 makers製造商
235
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我們與北約和其它安全決策者
發起了一個新舉措,
12:14
to explore探索 with them what they can do
to protect保護 health健康 system系統 institutions機構
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與他們探討如何
在部署期間維護當地的衞生系統。
12:19
during deployments部署.
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1715
12:21
We want them to see
238
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我們希望他們明白,
12:22
that protecting保護 health健康 systems系統
and other critical危急 social社會 institutions機構
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維護當地衞生系統和
其它關鍵社會體制
12:27
is an integral積分 part部分 of their mission任務.
240
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是他們任務的重要一環。
12:30
It's not just about avoiding避免
collateral抵押 damage損傷;
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這不僅是為了避免附帶損害,
更是為了締造和平。
12:33
it's about winning勝利 the peace和平.
242
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12:36
But the most important重要 partner夥伴
we need to engage從事 is you,
243
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但我們最需要的合作夥伴還是你們:
12:40
the American美國 public上市,
and indeed確實, the world世界 public上市.
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美國大眾,以至世界大眾。
12:43
Because unless除非 you understand理解
the value of social社會 institutions機構,
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除非你們能明白
社會體制的寶貴價值,
就像政局不穩環境下的衞生體制,
12:49
like health健康 systems系統
in these fragile脆弱 settings設置,
246
757508
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12:53
you won't慣於 support支持 efforts努力 to save保存 them.
247
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否則你們是不會支持維護它們的。
12:55
You won't慣於 click點擊 on that article文章
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2398
你不會點擊那篇文章,
12:57
that talks會談 about "Hey, all those
doctors醫生 are on the run in country國家 X.
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765760
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它在談論,「嘿,所有這些醫生
正從某國逃命。
我想知道這意味什麼:
13:02
I wonder奇蹟 what that means手段.
250
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13:05
I wonder奇蹟 what that means手段
251
773191
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究竟該國衞生系統
13:07
for that health健康 system's系統 ability能力
to, let's say, detect檢測 influenza流感."
252
775067
3952
有沒有能力檢測流行性感冒爆發?」
13:11
"Hmm, it's probably大概 not good."
That's what I'd tell you.
253
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「嗯,情況應該好不了那裡。」
我會這樣回答你。
13:15
Up on the screen屏幕,
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1164
在螢幕上,
13:16
I've put up my three favorite喜愛 American美國
institution機構 defenders捍衛者 and builders建設者.
255
784958
6280
是我最喜歡的三位捍衞和建設
社會體制的美國人。
13:23
Over here is George喬治 C. Marshall馬歇爾,
256
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在這邊是喬治·卡特萊特·馬歇爾,
13:26
he was the guy that proposed建議
the Marshall馬歇爾 Plan計劃
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794755
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他就是提出馬歇爾計劃的人,
13:29
to save保存 all of Europe's歐洲 economic經濟
institutions機構 after World世界 War戰爭 IIII.
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來拯救第二次世界大戰後
所有在歐洲的經濟制度。
13:34
And this Eleanor埃莉諾 Roosevelt羅斯福.
259
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這是愛蓮娜·羅斯福。
13:36
Her work on human人的 rights權利
really serves供應 as the foundation基礎
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她的人權工作真正為
我們所有國際人權組織奠定基礎。
13:39
for all of our international國際
human人的 rights權利 organizations組織.
261
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3028
13:43
Then my big favorite喜愛 is Ben Franklin富蘭克林,
262
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2040
這是我最喜歡的班傑明·富蘭克林,
13:45
who did many許多 things
in terms條款 of creating創建 institutions機構,
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他在創造制度方面做了很多貢獻,
13:48
but was the midwife助產士 of our constitution憲法.
264
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也是我們憲法得以誕生的助產士。
13:52
And I would say to you
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我可以這麼說,
13:54
that these are folks鄉親 who, when our
country國家 was threatened受威脅,
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這些人在我們國家受到威脅之時,
13:58
or our world世界 was threatened受威脅,
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2007
或是我們世界受到威脅之時,
14:00
they didn't retreat撤退.
268
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1303
並沒有退縮。
14:01
They didn't talk about building建造 walls牆壁.
269
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他們並沒有談論建圍牆,
14:03
They talked about building建造 institutions機構
to protect保護 human人的 security安全,
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他們談論的是建設制度
來保障人類安全,
14:10
for their generation and also for ours我們的.
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裨益他們那一代以至我們這一代。
14:13
And I think our generation
should do the same相同.
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所以我們這一代也應該
做同樣的事情。
謝謝。
14:16
Thank you.
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(掌聲)
14:17
(Applause掌聲)
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Translated by David Hsu
Reviewed by Winston Szeto

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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