TEDMED 2012
Rebecca Onie: What if our health care system kept us healthy?
Rebecca Onie: Hvad hvis vores sundhedsvæsen holdte os sunde?
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Rebecca Onie stiller dristige spørgsmål: Hvad hvis venteværelser var et sted man kunne forbedre den daglige sundhedspleje? Hvad hvis læger kunne ordinere mad, bolig og varme om vinteren? Ved TEDMED beskriver hun Health Leads, en organisation der gør lige netop det -- og gør det ved at opbygge en base af frivillige, lige så ambitiøs og engageret som et universitets sports team.
Rebecca Onie - Health services innovator
Rebecca Onie is the founder of Health Leads, a program that connects patients to basic care and resources, such as food and housing, that are the root cause of many health problems. Full bio
Rebecca Onie is the founder of Health Leads, a program that connects patients to basic care and resources, such as food and housing, that are the root cause of many health problems. Full bio
Double-click the English transcript below to play the video.
00:16
So my freshman year of college
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I mit første år på universitetet
00:17
I signed up for an internship in the housing unit
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meldte jeg mig til et praktikophold i en boligblok
00:20
at Greater Boston Legal Services.
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på Greater Boston Legal Services.
00:22
Showed up the first day
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Jeg kom første dag
00:24
ready to make coffee and photocopies,
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klar til at lave kaffe og fotokopier,
00:26
but was paired with this righteous, deeply inspired attorney
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men blev sat sammen med denne retskafne, dybt inspirerede advokat
00:31
named Jeff Purcell,
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der hed Jeff Purcell,
00:32
who thrust me onto the front lines
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der skubbede mig ind i frontlinjen
00:35
from the very first day.
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fra den første dag.
00:37
And over the course of nine months
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Og i løbet af ni måneder
00:39
I had the chance
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fik jeg chancen
00:40
to have dozens of conversations
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for at have dusinvis af samtaler
00:41
with low-income families in Boston
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med lavindkomst familier i Boston
00:44
who would come in presenting with housing issues,
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der ville komme ind og præsentere boligproblemer,
00:47
but always had an underlying health issue.
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men havde altid underliggende helbredsproblemer.
00:51
So I had a client who came in,
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Så jeg havde en klient der kom ind,
00:53
about to be evicted because he hasn't paid his rent.
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der var på nippet til at blive sat på gaden, fordi han ikke havde betalt sin husleje.
00:55
But he hasn't paid his rent, of course,
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Men han havde ikke betalt sin husleje, selvfølgelig,
00:57
because he's paying for his HIV medication
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fordi han havde betalt for sin HIV medicin
01:00
and just can't afford both.
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og havde bare ikke råd til begge dele.
01:02
We had moms who would come in,
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Vi havde mødre der kom ind,
01:03
daughter has asthma,
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datteren har astma,
01:05
wakes up covered in cockroaches every morning.
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vågner dækket af kakerlakker hver morgen.
01:08
And one of our litigation strategies
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Og en af vores sagsanlægs strategier
01:10
was actually to send me into the home of these clients
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var faktisk at sende mig hjem til disse klienter
01:12
with these large glass bottles.
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med disse store flasker.
01:15
And I would collect the cockroaches,
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Og jeg samlede kakerlakkerne sammen,
01:17
hot glue-gun them to this poster board
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og brugte en limpistol til at lime dem til en opslagstavle
01:20
that we'd bring to court for our cases.
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som vi bragte med ind i retsalene til vores sager.
01:22
And we always won
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Og vi vandt altid
01:23
because the judges were just so grossed out.
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fordi dommerne synes det var så ulækkert.
01:26
Far more effective, I have to say,
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Meget mere effektivt, må jeg sige,
01:28
than anything I later learned in law school.
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end noget jeg lærte senere på det juridiske fakultet.
01:31
But over the course of these nine months,
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Men i løbet af disse ni måneder,
01:33
I grew frustrated with feeling
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blev jeg frustreret over følelsen
01:35
like we were intervening too far downstream
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at vi greb ind alt for langt nede ad floden
01:38
in the lives of our clients --
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i vores klienters liv --
01:40
that by the time they came to us,
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så til den tid de kom til os,
01:42
they were already in crisis.
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var de allerede i krise.
01:44
And at the end of my freshman year of college,
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Og ved slutningen af mit første år ved universitetet,
01:47
I read an article about the work
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læste jeg en artikel om det arbejde
01:49
that Dr. Barry Zuckerman was doing
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som Dr. Barry Zuckerman gjorde
01:50
as Chair of Pediatrics
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som Formand for Pædiatere
01:53
at Boston Medical Center.
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ved Boston Medical Center.
01:54
And his first hire was a legal services attorney
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Og hans første ansættelse var en juridisk sagfører
01:57
to represent the patients.
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til at repræsentere hans patienter.
01:59
So I called Barry,
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Så jeg ringede til Barry,
02:00
and with his blessing, in October 1995
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og med hans velsignelse, i oktober 1995
02:03
walked into the waiting room
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gik jeg ind i venteværelset
02:05
of the pediatrics clinic at Boston Medical Center.
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ved pediætrisk klinik ved Boston Medical Center.
02:08
I'll never forget,
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Jeg glemmer aldrig,
02:09
the TVs played this endless reel of cartoons.
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tv'ene der spillede endeløse bånd med tegneserier.
02:12
And the exhaustion of mothers
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Og mødrenes udmattelse
02:15
who had taken two, three, sometimes four buses
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der nogen gange havde taget to, tre nogen gange fire busser
02:19
to bring their child to the doctor
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for at tage deres barn med til lægen
02:21
was just palpable.
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var utrolig håndgribelig.
02:22
The doctors, it seemed,
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Lægerne, virkede det som om,
02:24
never really had enough time for all the patients,
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havde egentlig aldrig nok tid til alle deres patienter,
02:25
try as they might.
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selvom de prøvede.
02:27
And over the course of six months,
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Og i løbet af seks måneder,
02:28
I would corner them in the hallway
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ville jeg trænge dem op i en krog i gangene
02:29
and ask them a sort of naive but fundamental question:
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og stile dem et naivt men fundamentalt spørgsmål:
02:33
"If you had unlimited resources,
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"Hvis du havde uendelige ressourcer,
02:36
what's the one thing you would give your patients?"
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hvad er den ene ting du ville give dine patienter?"
02:39
And I heard the same story again and again,
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Og jeg hørte den samme historie igen og igen,
02:42
a story we've heard hundreds of times since then.
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en historie vi har hørt hundredvis af gange siden.
02:45
They said, "Every day we have patients that come into the clinic --
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De sagde, "Hver dag har vi patienter der ind i klinikken --
02:48
child has an ear infection,
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et barn med en øreinfektion,
02:50
I prescribe antibiotics.
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jeg udskriver antibiotika.
02:52
But the real issue is there's no food at home.
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Men det rigtige problem er, at der ikke er noget mad i hjemmet.
02:55
The real issue
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Det rigtige problem
02:56
is that child is living with 12 other people
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er at det barn bor sammen med 12 andre mennesker
02:59
in a two-bedroom apartment.
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i en to-værelses lejlighed.
03:00
And I don't even ask about those issues
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Og jeg spørger ikke engang til de problemer
03:02
because there's nothing I can do.
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fordi jeg kan ikke gøre noget.
03:05
I have 13 minutes with each patient.
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Jeg har 13 minutter med hver patient.
03:06
Patients are piling up in the clinic waiting room.
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Patienter hober sig op i klinikkens venteværelse.
03:09
I have no idea where the nearest food pantry is.
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Jeg aner ikke hvor det nærmest mad
03:12
And I don't even have any help."
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Og jeg får ikke engang noget hjælp."
03:14
In that clinic, even today,
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I den klinik, selv i dag,
03:15
there are two social workers
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er der to socialrådgivere
03:17
for 24,000 pediatric patients,
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til 24.000 pediætriske patienter,
03:20
which is better than a lot of the clinics out there.
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hvilket er bedre end hos de fleste kliniker der er.
03:23
So Health Leads was born of these conversations --
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Så Health Leads blev affødt af disse samtaler --
03:26
a simple model
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en simpel model
03:27
where doctors and nurses
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hvor læger og sygeplejersker
03:28
can prescribe nutritious food,
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kan ordinere nærende mad
03:30
heat in the winter
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varme om vinteren
03:32
and other basic resources for their patients
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og andre basis ressourcer til deres patienter
03:34
the same way they prescribe medication.
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på samme måde som de ordinerer medicin.
03:37
Patients then take their prescriptions
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Patienter kan tage deres recepter
03:39
to our desk in the clinic waiting room
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med til vores disk i klinikkens venteværelse
03:41
where we have a core of well-trained college student advocates
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hvor vi har en kerne af veltrænede advokatstuderende
03:45
who work side by side with these families
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der arbejder side om side med disse familier
03:48
to connect them out
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til at forbinde dem ud
03:49
to the existing landscape of community resources.
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af det eksisterende landskab af samfundets ressourcer.
03:52
So we began with a card table in the clinic waiting room --
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Så vi begyndte med et kortbord i klinikkens venteværelse --
03:56
totally lemonade stand style.
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total juicebod stil.
03:58
But today we have a thousand college student advocates
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Men i dag har vi tusind advokatstuderende
04:01
who are working to connect nearly 9,000 patients and their families
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der arbejder med at forbinde næsten 9.000 patienter og deres familier
04:05
with the resources that they need to be healthy.
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med ressourcerne de har brug for, for at være sunde.
04:09
So 18 months ago
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Så for 18 måneder siden
04:10
I got this email that changed my life.
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fik jeg denne mail der ændrede mit liv.
04:13
And the email was from Dr. Jack Geiger,
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Og mailen var fra Dr. Jack Geiger,
04:15
who had written to congratulate me on Health Leads
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der havde skrevet for at lykønske mig med Health Leads
04:18
and to share, as he said,
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og til at dele, som han sagde,
04:20
a bit of historical context.
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en smule historisk kontekst.
04:22
In 1965 Dr. Geiger founded
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I 1965 startede Dr. Geiger
04:25
one of the first two community health centers in this country,
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en af landets første to lokalsamfunds sundhedscentre,
04:28
in a brutally poor area in the Mississippi Delta.
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i et utrolig fattigt kvarter i Mississippi Deltaet.
04:31
And so many of his patients came in
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Så mange af hans patienter kom ind
04:34
presenting with malnutrition
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med underernæring
04:36
that be began prescribing food for them.
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som han begyndte at ordinere mad til.
04:39
And they would take these prescriptions to the local supermarket,
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Og de ville tage disse recepter med til det lokale supermarked,
04:42
which would fill them
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som ville fylde dem
04:43
and then charge the pharmacy budget of the clinic.
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og sætte regningen på klinikkens medicinbudget.
04:46
And when the Office of Economic Opportunity in Washington, D.C. --
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Og da Office of Economic Opportunity i Washington, D.C. --
04:49
which was funding Geiger's clinic --
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der finansierede Geigers klinik --
04:50
found out about this,
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fandt ud af dette,
04:52
they were furious.
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blev de rasende.
04:53
And they sent this bureaucrat down
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Og de havde sendt en bureaukrat ned
04:55
to tell Geiger that he was expected to use their dollars
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for at fortælle Geiger at det forventedes af ham at han brugte deres dollars
04:58
for medical care --
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på medicinsk behandling --
04:59
to which Geiger famously and logically responded,
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hvor Geiger glimrende og logisk svarede,
05:02
"The last time I checked my textbooks,
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"Sidste gang jeg kiggede i min lærebog,
05:05
the specific therapy for malnutrition was food."
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var mad den specifikke behandling mod underernæring."
05:09
(Laughter)
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(Latter)
05:10
So when I got this email from Dr. Geiger,
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Så da jeg fik denne mail fra Dr. Geiger,
05:13
I knew I was supposed to be proud
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vidste jeg at jeg burde være stolt
05:16
to be part of this history.
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af at være en del af denne historie.
05:17
But the truth is
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Men sandheden er
05:18
I was devastated.
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at jeg blev slået helt ud.
05:20
Here we are,
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Her er vi,
05:22
45 years after Geiger has prescribed food for his patients,
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45 år efter Geiger har ordineret mad til hans patienter,
05:26
and I have doctors telling me,
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og jeg har læger der fortæller mig,
05:28
"On those issues, we practice a 'don't ask, don't tell' policy."
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"På disse områder, praktiserer vi en "don't ask, don't tell" politik."
05:32
Forty-five years after Geiger,
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Femogfyrre år efter Geiger,
05:34
Health Leads has to reinvent
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skal Health Leads genopfinde
05:36
the prescription for basic resources.
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recepten på basale ressourcer.
05:39
So I have spent hours upon hours
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Så jeg har brugt timer på timer
05:42
trying to make sense of this weird Groundhog Day.
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på at prøve at få denne mærkelige Groundhog Day til at give mening.
05:45
How is it that if for decades
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Hvordan kan det være, at hvis vi i årtier
05:48
we had a pretty straightforward tool for keeping patients,
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havde et temmelig direkte værktøj til at holde patienter,
05:50
and especially low-income patients, healthy,
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især lavindkomst patienter, sunde
05:53
that we didn't use it?
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at vi ikke bruger det?
05:55
If we know what it takes to have a healthcare system
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Hvis vi ved hvad det kræver at have et sundhedsvæsen
05:58
rather than a sick-care system,
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i stedet for et sygevæsen,
06:01
why don't we just do it?
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hvorfor gør vi det så ikke bare?
06:03
These questions, in my mind,
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Disse spørgsmål, i mit sind,
06:05
are not hard because the answers are complicated,
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er ikke svære fordi svarene er komplicerede,
06:08
they are hard because they require that we be honest with ourselves.
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de er svære fordi de kræver at vi er ærlige overfor os selv.
06:13
My belief is that it's almost too painful
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Min tro er, at det næsten er for smertefuldt
06:16
to articulate our aspirations for our healthcare system,
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at artikulere vores ambitioner for vores sundhedsvæsen,
06:19
or even admit that we have any at all.
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eller selv indrømme at vi overhovedet har nogen.
06:22
Because if we did,
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Fordi hvis vi gjorde,
06:23
they would be so removed
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ville de være så fjerne
06:25
from our current reality.
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fra vores nuværende virkelighed.
06:27
But that doesn't change my belief
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Men det ændrer ikke min tro på
06:30
that all of us, deep inside,
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at vi allesammen, dybt indeni,
06:33
here in this room and across this country,
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her i dette lokale og over hele landet,
06:37
share a similar set of desires.
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deler lignende ønsker.
06:39
That if we are honest with ourselves
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At hvis vi var ærlige overfor os selv
06:42
and listen quietly,
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og lytter stille,
06:44
that we all harbor
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at vi alle nærer
06:46
one fiercely held aspiration for our healthcare:
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en intens ambition for vores sundhedsvæsen:
06:50
that it keep us healthy.
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at det holder os sunde.
06:52
This aspiration that our healthcare keep us healthy
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Den ambition, at vores sundhedsvæsen holder os sunde
06:55
is an enormously powerful one.
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er en utrolig stærk en.
06:58
And the way I think about this
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Og måden hvorpå jeg tænker om dette
07:00
is that healthcare is like any other system.
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er at sundhedsvæsnet er ligesom hvilket som helst andet system.
07:02
It's just a set of choices that people make.
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Der er bare et sæt valg mennesker laver.
07:05
What if we decided
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Hvad hvis vi besluttede
07:07
to make a different set of choices?
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at have en andet sæt valg?
07:09
What if we decided to take all the parts of healthcare
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Hvad hvis vi besluttede at tage alle delene af sundhedsvæsnet
07:12
that have drifted away from us
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der er drevet væk fra os
07:14
and stand firm and say, "No.
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og stå fast og sige, "Nej.
07:17
These things are ours.
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Dette er vores ting.
07:19
They will be used for our purposes.
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De vil blive brugt til vores formål.
07:21
They will be used to realize
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De vil blive brugt til at realisere
07:23
our aspiration"?
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vores ambition"?
07:24
What if everything we needed
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Hvad nu hvis alt vi har brug for
07:26
to realize our aspiration for healthcare
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til at realisere vores ambition for sundhedsvæsnet
07:28
was right there in front of us
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var lige foran os
07:30
just waiting to be claimed?
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og bare ventede på at blive krævet?
07:32
So that's where Health Leads began.
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Så det er der Health Leads begyndte.
07:34
We started with the prescription pad --
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Vi startede med recept papiret --
07:36
a very ordinary piece of paper --
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et meget almindeligt stykke papir --
07:38
and we asked, not what do patients need to get healthy --
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og vi spurgte, ikke hvad patienter har brug for, for at blive raske --
07:42
antibiotics, an inhaler, medication --
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antibiotika, en inhalator, medicin --
07:45
but what do patients need to be healthy,
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men hvad har brug for, for at være sunde,
07:48
to not get sick in the first place?
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til ikke at blive syge for det første?
07:50
And we chose to use the prescription
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Og vi valgte at bruge recepten
07:52
for that purpose.
192
456755
1782
til det formål.
07:54
So just a few miles from here
193
458537
1202
Så bare et par kilometer herfra
07:55
at Children's National Medical Center,
194
459739
1784
ved Children's National Medical Center,
07:57
when patients come into the doctor's office,
195
461523
2266
når patienter kom ind i lægens kontor,
07:59
they're asked a few questions.
196
463789
1685
stille de et par spørgsmål.
08:01
They're asked, "Are you running out of food at the end of the month?
197
465474
2664
De spurgte, "Løbet du tør for mad i slutningen af måneden?
08:04
Do you have safe housing?"
198
468138
1566
Har du en pålidelig bolig?"
08:05
And when the doctor begins the visit,
199
469704
2069
Og når lægen begyndte konsultationerne,
08:07
she knows height, weight, is there food at home,
200
471773
2833
kender hun højde, vægt, er der mad i hjemmet,
08:10
is the family living in a shelter.
201
474606
1616
bor familien på et herberg.
08:12
And that not only leads to a better set of clinical choices,
202
476222
2884
Og det leder ikke kun til et sæt bedre kliniske valg,
08:15
but the doctor can also prescribe those resources for the patient,
203
479106
4050
men lægen kan også give recepter på de ressourcer til patienten,
08:19
using Health Leads like any other sub-specialty referral.
204
483156
3666
ved hjælp af Health Leads ligesom enhver anden speciel henvisning.
08:22
The problem is,
205
486822
2233
Problemet er,
08:24
once you get a taste of what it's like
206
489055
2199
at når man først prøver hvordan det er
08:27
to realize your aspiration for healthcare,
207
491254
2235
at realisere ens ambitioner for sundhedsvæsnet,
08:29
you want more.
208
493489
1518
vil man have mere.
08:30
So we thought,
209
495007
763
Så vi tænkte,
08:31
if we can get individual doctors
210
495770
1601
hvis vi kan få individuelle læger
08:33
to prescribe these basic resources for their patients,
211
497371
3217
til at ordinere disse basale ressourcer til deres patienter,
08:36
could we get an entire healthcare system
212
500588
2717
kunne vi få et helt sundhedsvæsen
08:39
to shift its presumption?
213
503305
2752
til at ændre dets formodninger?
08:41
And we gave it a shot.
214
506057
1247
Og vi gav det et forsøg.
08:43
So now at Harlem Hospital Center
215
507304
1435
Nu på Harlem Hospital Center
08:44
when patients come in with an elevated body mass index,
216
508739
3786
når patienter kommer in med en forhøjet body mass index,
08:48
the electronic medical record
217
512525
1864
vil den elektroniske lægelige journal
08:50
automatically generates a prescription for Health Leads.
218
514389
3800
automatisk generere en recept til Health Leads.
08:54
And our volunteers can then work with them
219
518189
1466
Og vores frivillige kan så arbejde med dem
08:55
to connect patients to healthy food and excercise programs
220
519655
3217
til at forbinde patienter med sund mad og træningsprogrammer
08:58
in their communities.
221
522872
1432
i deres samfund.
09:00
We've created a presumption
222
524304
1134
Vi har skabt en formodning
09:01
that if you're a patient at that hospital
223
525438
1567
at hvis man er en patient på et sygehus
09:02
with an elevated BMI,
224
527005
1550
med et forhøjet BMI,
09:04
the four walls of the doctor's office
225
528555
2234
vil de fire væge i lægens kontor
09:06
probably aren't going to give you everything
226
530789
1852
nok ikke give en alt det man har brug for
09:08
you need to be healthy.
227
532641
1182
for at være sund.
09:09
You need more.
228
533823
1400
Man har brug for mere.
09:11
So on the one hand,
229
535223
681
Så på den ene side,
09:11
this is just a basic recoding
230
535904
1697
er dette bare en basal registrering
09:13
of the electronic medical record.
231
537601
1705
af den elektroniske lægelige journal.
09:15
And on the other hand,
232
539306
1718
Og på den anden side,
09:16
it's a radical transformation
233
541024
1649
er det en radikal ændring
09:18
of the electronic medical record
234
542673
2168
af den elektroniske lægelige journal
09:20
from a static repository of diagnostic information
235
544841
3882
fra et statisk depot af diagnostisk information
09:24
to a health promotion tool.
236
548723
2834
til et sundhedsfremmende redskab.
09:27
In the private sector,
237
551557
1117
I den private sektor,
09:28
when you squeeze that kind of additional value
238
552674
2620
når man klemmer den form for ekstra værdi
09:31
out of a fixed-cost investment,
239
555294
1747
ud af en fast omkostnings investering,
09:32
it's called a billion-dollar company.
240
557041
2600
det er kaldet et milliard dollar selskab.
09:35
But in my world,
241
559641
1381
Men i min verden,
09:36
it's called reduced obesity and diabetes.
242
561022
3401
er det kaldet reduceret fedme og diabetes.
09:40
It's called healthcare --
243
564423
1883
Det hedder sundhedsvæsen --
09:42
a system where doctors can prescribe solutions
244
566306
2983
et system hvor lægerne kan ordinere løsninger
09:45
to improve health,
245
569289
1550
til at forbedre sundhed,
09:46
not just manage disease.
246
570839
2149
ikke kun behandle sygdom.
09:48
Same thing in the clinic waiting room.
247
572988
1534
Den samme ting i denne klinik med venteværelse.
09:50
So every day in this country
248
574522
1617
Så hver dag i dette land
09:52
three million patients
249
576139
1500
kommer tre millioner patienter
09:53
pass through about 150,000 clinic waiting rooms in this country.
250
577639
4494
gennem cirka 150.000 klinikkers venteværelser i dette land.
09:58
And what do they do when they're there?
251
582144
1973
Og hvad laver de når de er der?
10:00
They sit, they watch the goldfish in the fish tank,
252
584117
3450
De sidder, de kigger på fisk i et akvarie,
10:03
they read extremely old copies
253
587567
2483
de læser ekstremt gamle kopier
10:05
of Good Housekeeping magazine.
254
590050
2283
af Good Housekeeping magasin.
10:08
But mostly we all just sit there forever, waiting.
255
592333
3233
Men for det meste sidder der bare der i al evighed, venter.
10:11
How did we get here
256
595566
1351
Hvordan kom vi til det punkt
10:12
where we devote hundreds of acres and thousands of hours
257
596917
3349
hvor vi helligere hundredvis af kvadratmeter og tusindvis af timer
10:16
to waiting?
258
600266
1783
på at vente?
10:17
What if we had a waiting room
259
602049
1217
Hvad hvis vi havde et venteværelse
10:19
where you don't just sit when you're sick,
260
603266
2101
hvor man ikke bare sidder hvor man er syg,
10:21
but where you go to get healthy.
261
605367
1866
men hvor man faktisk bliver sund.
10:23
If airports can become shopping malls
262
607233
2517
Hvis lufthavne kan blive indkøbscentre
10:25
and McDonald's can become playgrounds,
263
609750
2966
og McDonalds kan blive legepladser,
10:28
surely we can reinvent the clinic waiting room.
264
612716
3433
så kan vi da også genopfinde klinikkens venteværelse.
10:32
And that's what Health Leads has tried to do,
265
616149
2034
Og det er hvad Health Leads prøver på at gøre,
10:34
to reclaim that real estate and that time
266
618183
2283
for at generobre den faste ejendom og den tid
10:36
and to use it as a gateway
267
620466
1432
og bruge det som en flugt
10:37
to connect patients
268
621898
1052
til at forbinde patienter
10:38
to the resources they need to be healthy.
269
622950
2767
med de ressourcer de har brug for, for at være sunde.
10:41
So it's a brutal winter in the Northeast,
270
625717
1516
Så det er en brutal vinter i Northeast,
10:43
your kid has asthma, your heat just got turned off,
271
627233
2467
ens barn har astma, ens varme er lige blevet slukket,
10:45
and of course you're in the waiting room of the ER,
272
629700
2167
og selvfølgelig venter man på skadestuen.
10:47
because the cold air triggered your child's asthma.
273
631867
2532
fordi kulden har udløst ens barn astma.
10:50
But what if instead of waiting for hours anxiously,
274
634399
2917
Men hvad hvis man i stedet for at vente nervøst i timevis
10:53
the waiting room became the place
275
637316
2200
venteværelset blev det sted
10:55
where Health Leads turned your heat back on?
276
639516
2484
hvor Health Leads tændte for ens varme igen?
10:57
And of course all of this requires
277
642000
1618
Og selvfølgelig kræver alt dette
10:59
a broader workforce.
278
643618
1948
en bred arbejdsstyrke.
11:01
But if we're creative, we already have that too.
279
645566
3167
Men hvis vi er kreative, har vi også allerede det.
11:04
We know that our doctors and nurses
280
648733
2386
Vi ved at vores læger og sygeplejersker
11:07
and even social workers
281
651119
1347
og selv socialrådgivere
11:08
aren't enough,
282
652466
1468
ikke er nok,
11:09
that the ticking minutes of health care
283
653934
1649
at sundhedsvæsnets tikkende minutter
11:11
are too constraining.
284
655583
1418
er for begrænsende.
11:12
Health just takes more time.
285
657001
2049
Sundhed tager bare længere tid.
11:14
It requires a non-clinical army
286
659050
2799
Det kræver en ikke-klinisk hær
11:17
of community health workers and case managers
287
661849
2684
af lokalsamfunds sundhedspersonale og sagsbehandlere
11:20
and many others.
288
664533
1616
og mange andre.
11:22
What if a small part of that next healthcare workforce
289
666149
3150
Hvad hvis en lille del af den næste arbejdsstyrke i sundhedsvæsnet
11:25
were the 11 million college students in this country?
290
669299
3701
var 11 millioner universitetsstuderende i dette land?
11:28
Unencumbered by clinical responsibilities,
291
673000
2766
Ubekymrede over det kliniske ansvar,
11:31
unwilling to take no for an answer
292
675766
2602
uvillige til at få nej som svar
11:34
from those bureaucracies
293
678368
1582
fra de bureaukrater
11:35
that tend to crush patients,
294
679950
1933
det har tendens til at knuse patienterne
11:37
and with an unparalleled ability
295
681883
1950
med en evne uden sidestykke
11:39
for information retrieval
296
683833
1452
for informations søgning
11:41
honed through years of using Google.
297
685285
2981
finpudset ved gennem årene at bruge Google.
11:44
Now lest you think it improbable
298
688266
2533
For at I ikke tror det er usandsynligt
11:46
that a college volunteer
299
690799
1617
at en frivillig fra universitetet
11:48
can make this kind of commitment,
300
692416
1783
vil lave dette slags engagement,
11:50
I have two words for you:
301
694199
1567
har jeg to ord til Jer:
11:51
March Madness.
302
695766
2351
March Madness.
11:54
The average NCAA Division I men's basketball player
303
698117
3967
Den gennemsnitlige NCAA division 1 spiller på mændenes basketball hold
11:57
dedicates 39 hours a week to his sport.
304
702084
3265
bruger 39 timer om ugen på hans sport.
12:01
Now we may think that's good or bad,
305
705349
2152
Det kan vi synes er godt eller dårligt,
12:03
but in either case it's real.
306
707501
2682
men i hvert tilfælde er det sandt.
12:06
And Health Leads is based on the presumption
307
710183
2185
Og Health Leads er baseret på den formodning
12:08
that for too long
308
712368
1382
at i for lang tid
12:09
we have asked too little of our college students
309
713750
2550
har vi bedt vores universitetsstuderende om for lidt,
12:12
when it comes to real impact in vulnerable communities.
310
716300
3765
når det kommer til reel indflydelse i skrøbelige samfund.
12:15
College sports teams say,
311
720065
1353
Universitets sports holdende siger
12:17
"We're going to take dozens of hours
312
721418
2065
"Vi vil tage dusinvis af timer
12:19
at some field across campus at some ungodly hour of the morning
313
723483
3884
på et eller andet felt på campus på et ugudeligt tidspunkt om morgenen
12:23
and we're going to measure your performance, and your team's performance,
314
727367
2816
og vi vil måle Jeres præstationsniveau, og dit holds præstationsniveau,
12:26
and if you don't measure up or you don't show up,
315
730183
2166
og hvis du ikke lever op, eller du ikke kommer,
12:28
we're going to cut you off the team.
316
732349
1450
smider vi dig af holdet.
12:29
But we'll make huge investments
317
733799
1888
Men vi vil lave store investeringer
12:31
in your training and development,
318
735687
1212
i din træning og udvikling,
12:32
and we'll give you an extraordinary community of peers."
319
736899
3418
og vi vil give dig et usædvanligt nærsamfund af jævnaldrende."
12:36
And people line up out the door
320
740317
1815
Og mennesker står i en kø der rækker ud af døren
12:38
just for the chance to be part of it.
321
742132
2785
bare for at få en chance for at være med.
12:40
So our feeling is,
322
744917
1217
Så vores fornemmelse er,
12:42
if it's good enough for the rugby team,
323
746134
1483
hvis det er godt nok til rugbyholdet,
12:43
it's good enough for health and poverty.
324
747617
2115
er det godt nok til helbred og fattigdom.
12:45
Health Leads too recruits competitively,
325
749732
3268
Health Leads rekrutterer konkurrencedygtigt,
12:48
trains intensively,
326
753000
1481
træner intensivt,
12:50
coaches professionally,
327
754481
1969
underviser professionelt,
12:52
demands significant time,
328
756450
1949
kræver betydelig tid,
12:54
builds a cohesive team
329
758399
1367
bygger et sammenhængende team
12:55
and measures results --
330
759766
1484
og måler resultater --
12:57
a kind of Teach for America for healthcare.
331
761250
2683
en slags Teach for America for sundhedsvæsnet.
12:59
Now in the top 10 cities in the U.S.
332
763933
2100
Nu i top 10 byerne i Amerika
13:01
with the largest number of Medicaid patients,
333
766033
2319
med det største antal af Medicaid patienter,
13:04
each of those has at least 20,000 college students.
334
768352
3214
hver af dem har mindst 20.000 universitetsstuderende.
13:07
New York alone has half a million college students.
335
771566
3201
New York har i sig selv en halv million universitetsstuderende.
13:10
And this isn't just a sort of short-term workforce
336
774767
3049
Og det er ikke nogen korttids arbejdsstyrke
13:13
to connect patients to basic resources,
337
777816
2250
til at forbinde at patienter med basale ressourcer,
13:15
it's a next generation healthcare leadership pipeline
338
780066
3601
det er næste generations sundhedsvæsens lederskab
13:19
who've spent two, three, four years
339
783667
2450
der har brugt to, tre, fire år
13:22
in the clinic waiting room
340
786117
1501
i klinikkens venteværelse
13:23
talking to patients about their most basic health needs.
341
787618
3984
med at tale til patienter om deres mest basale sundhedsbehov.
13:27
And they leave with the conviction,
342
791602
1749
Og de går med den overbevisning at,
13:29
the ability and the efficacy
343
793351
1832
evnen og gennemslagskraften
13:31
to realize our most basic aspirations for health care.
344
795183
3783
til at realisere vores mest banale ambitioner for sundhedsvæsnet.
13:34
And the thing is, there's thousands of these folks already out there.
345
798966
3018
Og det der er ved det er, at der er tusindvis af disse mennesker derude.
13:37
So Mia Lozada is Chief Resident of Internal Medicine
346
801984
3817
Så Mia Lozada er Chief Resident of Internal Medicine
13:41
at UCSF Medical Center,
347
805801
1415
ved UCSF Medical Center,
13:43
but for three years as an undergraduate
348
807216
2333
men i tre år som bachelor
13:45
she was a Health Leads volunteer
349
809549
1633
var hun en Health Leads frivillig
13:47
in the clinic waiting room at Boston Medical Center.
350
811182
3002
i klinikkens venteværelse ved Boston Medical Center.
13:50
Mia says, "When my classmates write a prescription,
351
814184
3715
Mia siger, "Da mine klassekammerater skriver en recept,
13:53
they think their work is done.
352
817899
2018
tror de deres arbejde er gjort.
13:55
When I write a prescription,
353
819917
1716
Når jeg skriver en recept,
13:57
I think, can the family read the prescription?
354
821633
2267
tænker jeg, kan familien læse recepten?
13:59
Do they have transportation to the pharmacy?
355
823900
2183
Har de transportmulighed til apoteket?
14:01
Do they have food to take with the prescription?
356
826083
2450
Har de mad at indtage sammen med recepten?
14:04
Do they have insurance to fill the prescription?
357
828533
2250
Har de forsikring til at betale recepten?
14:06
Those are the questions I learned at Health Leads,
358
830783
2683
Det er de spørgsmål jeg lærte ved Health Leads,
14:09
not in medical school."
359
833466
1750
ikke ved lægeuddannelsen."
14:11
Now none of these solutions --
360
835216
1984
Nu er ingen af disse løsninger --
14:13
the prescription pad, the electronic medical record,
361
837200
2970
recepten, den elektroniske lægelige journal,
14:16
the waiting room,
362
840170
1147
venteværelset,
14:17
the army of college students --
363
841317
1168
hæren af universitetsstuderende --
14:18
are perfect.
364
842485
1183
er perfekt.
14:19
But they are ours for the taking --
365
843668
2500
Men det er vores --
14:22
simple examples
366
846168
1332
simple eksempler
14:23
of the vast under-utilized healthcare resources
367
847500
3501
på enormt under udnyttede sundhedsvæsen ressourcer
14:26
that, if we reclaimed and redeployed,
368
851001
2915
som, hvis vi generobrer og omplacerer,
14:29
could realize our most basic aspiration
369
853916
3417
ville forstå vores mest basale ambitioner
14:33
of healthcare.
370
857333
1784
af sundhedsvæsnet.
14:35
So I had been at Legal Services for about nine months
371
859117
3216
Så jeg havde siddet ved Legal Services i cirka ni måneder
14:38
when this idea of Health Leads started percolating in my mind.
372
862333
2733
da denne ide om Health Leads startede at løbe gennem mit hoved.
14:40
And I knew I had to tell Jeff Purcell, my attorney,
373
865066
2934
Og jeg vidste at jeg var nød til at fortælle Jeff Purcell, min advokat,
14:43
that I needed to leave.
374
868000
1419
at jeg var nød til at tage afsked.
14:45
And I was so nervous,
375
869419
963
Og jeg var så nervøs,
14:46
because I thought he was going to be disappointed in me
376
870382
2534
fordi jeg troede at han ville blive skuffet over mig
14:48
for abandoning our clients for some crazy idea.
377
872916
3050
for at jeg efterlod vores klienter til fordel for en skør ide.
14:51
And I sat down with him and I said,
378
875966
1984
Og jeg satte mig ned sammen med ham og jeg sagde,
14:53
"Jeff, I have this idea
379
877950
1883
"Jeff, jeg har denne ide
14:55
that we could mobilize college students
380
879833
2419
at vi kunne mobilisere universitetsstuderende
14:58
to address patients' most basic health needs."
381
882252
2934
til at adressere patienters mest basale sundheds behov."
15:01
And I'll be honest,
382
885186
1581
Og jeg skal være ærlig,
15:02
all I wanted was for him to not be angry at me.
383
886767
3299
det eneste jeg ønskede, var at han ikke blev sur på mig.
15:05
But he said this,
384
890066
1467
Men han sagde dette,
15:07
"Rebecca, when you have a vision,
385
891533
3348
"Rebecca, når man har en vision,
15:10
you have an obligation to realize that vision.
386
894881
3851
har man en forpligtelse til at realisere den vision.
15:14
You must pursue that vision."
387
898732
3101
Du må forfølge den vision."
15:17
And I have to say, I was like "Whoa.
388
901833
3266
Og jeg må sige, jeg tænkte "Whoa.
15:20
That's a lot of pressure."
389
905099
2017
Det er et tungt pres."
15:23
I just wanted a blessing,
390
907116
1399
Jeg ville bare have en velsignelse,
15:24
I didn't want some kind of mandate.
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jeg ville ikke have en slags mandat.
15:25
But the truth is
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Men sandheden er
15:27
I've spent every waking minute nearly since then
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at jeg har brugt hvert vågne minut, nærmest siden da,
15:30
chasing that vision.
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på at forfølge den vision.
15:32
I believe that we all have a vision
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Jeg tror på, at vi alle kan have en vision
15:35
for healthcare in this country.
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for sundhedsvæsnet i dette land.
15:37
I believe that at the end of the day
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Jeg tror på, at når dagen er omme,
15:39
when we measure our healthcare,
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når vi måler vores sundhedsvæsen,
15:41
it will not be by the diseases cured,
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vil det ikke være på de sygdomme der bliver kureret,
15:44
but by the diseases prevented.
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men på de sygdomme der bliver forebygget.
15:46
It will not be by the excellence of our technologies
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Det vil ikke være på vores fortræffelige teknologier
15:49
or the sophistication of our specialists,
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eller vores specialisters raffinement,
15:52
but by how rarely we needed them.
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men på hvor sjældent vi har brug for dem.
15:54
And most of all,
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Og mest af alt,
15:56
I believe that when we measure healthcare,
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tror jeg på at når vi måler sundhedsvæsnet,
15:58
it will be, not by what the system was,
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vil det være, ikke på hvad systemet var,
16:01
but by what we chose it to be.
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men på hvad vi vælger det er.
16:04
Thank you.
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Tak.
16:05
(Applause)
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(Bifald)
16:15
Thank you.
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Tak.
16:16
(Applause)
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(Bifald)
ABOUT THE SPEAKER
Rebecca Onie - Health services innovatorRebecca Onie is the founder of Health Leads, a program that connects patients to basic care and resources, such as food and housing, that are the root cause of many health problems.
Why you should listen
In 1996, as a sophomore in college, Rebecca Onie had a realization: The health care system in the United States was not set up to diagnose nor treat the socioeconomic issues that lead to poor health, and that health care providers are not given tools to address basic problems like nutrition and housing.
So, while still a sophomore, she co-founded Health Leads, a program that assists low-income patients and their families to access food, heat, and other basic resources they need to be healthy. With the additional insight that college volunteers could be recruited and trained into an elite group just like a college sport team, she found the people and skills needed to produce such an audacious idea. Since then it has grown tremendously, and now operates in Baltimore, Boston, Chicago, New York, Providence, and Washington, DC, and in the last year assisted over 8,800 patients.
In 2009, Rebecca was awarded a MacArthur “Genius” Fellowship.
Photo: Courtesy of the John D. & Catherine T. MacArthur Foundation
Rebecca Onie | Speaker | TED.com