TEDMED 2012
Rebecca Onie: What if our health care system kept us healthy?
Rebecca Onie: E se o noso sistema sanitario nos mantivese sans?
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Rebecca Onie formula preguntas audaces:
E se as salas de espera fosen un lugar en que mellorar todos os días o noso sistema de saúde?
E se os médicos puidesen receitar comida, casa ou calefacción no inverno?
En TEDMED Rebecca presenta Health Leads, unha organización que fai exactamente iso, e faino construíndo un equipo de voluntarios como unha elite, dedicados como un equipo deportivo universitario.
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.
No meu primeiro ano de universidade
00:16
So my freshman year of college
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I signed up for an internship in the housing unit
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inscribinme nunha pasantía
na unidade de vivenda
na unidade de vivenda
00:20
at Greater Boston Legal Services.
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do estudo “Greater Boston Legal Services”.
00:22
Showed up the first day
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Presenteime o primeiro día
00:24
ready to make coffee and photocopies,
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lista para facer café e fotocopias,
00:26
but was paired with this righteous, deeply inspired attorney
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pero tocoume traballar cun avogado xusto
00:31
named Jeff Purcell,
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chamado Jeff Purcell
00:32
who thrust me onto the front lines
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quen me puxo na primeira fila
00:35
from the very first day.
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desde o primeiro día.
00:37
And over the course of nine months
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E durante nove meses
00:39
I had the chance
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tiven a oportunidade
00:40
to have dozens of conversations
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de ter unha chea de conversas
00:41
with low-income families in Boston
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con familias de baixos ingresos de Boston
00:44
who would come in presenting with housing issues,
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que tiñan problemas coas súas vivendas,
00:47
but always had an underlying health issue.
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e sempre tiñan algún problema de saúde.
00:51
So I had a client who came in,
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Tiven un cliente que se presentou
00:53
about to be evicted because he hasn't paid his rent.
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cando o ían desafiuzar
por non pagar a renda.
por non pagar a renda.
00:55
But he hasn't paid his rent, of course,
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E non a pagara,
00:57
because he's paying for his HIV medication
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porque estaba pagando a medicación do VIH
01:00
and just can't afford both.
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e non podía custear as dúas.
01:02
We had moms who would come in,
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Vin nais que viñan
01:03
daughter has asthma,
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porque a filla tiña asma,
01:05
wakes up covered in cockroaches every morning.
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e espertaba a diario cuberta de cascudas.
01:08
And one of our litigation strategies
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E unha das nosas estratexias de litigación
01:10
was actually to send me into the home of these clients
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era enviarme a esas casas
01:12
with these large glass bottles.
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con grandes botellas de vidrio
01:15
And I would collect the cockroaches,
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para atrapar as cascudas,
01:17
hot glue-gun them to this poster board
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pegalas con silicona quente
nunha cartolina
nunha cartolina
01:20
that we'd bring to court for our cases.
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e levalas ao xulgado para os nosos casos.
01:22
And we always won
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E sempre gañabamos,
01:23
because the judges were just so grossed out.
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porque os xuices morrían co noxo.
01:26
Far more effective, I have to say,
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Algo moito máis efectivo, abofé,
01:28
than anything I later learned in law school.
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ca calquera cousa que aprendera
na facultade de dereito.
na facultade de dereito.
01:31
But over the course of these nine months,
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Pero ao longo deses nove meses,
01:33
I grew frustrated with feeling
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frustrábame cada vez máis porque sentía
01:35
like we were intervening too far downstream
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que estabamos intervindo moi tarde
01:38
in the lives of our clients --
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nas vidas dos nosos clientes;
01:40
that by the time they came to us,
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no momento en que nos visitaban,
01:42
they were already in crisis.
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xa estaban en crise.
01:44
And at the end of my freshman year of college,
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E ao final do meu primeiro ano
na universidade,
na universidade,
01:47
I read an article about the work
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lin un artigo sobre o traballo
01:49
that Dr. Barry Zuckerman was doing
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do Dr. Barry Zuckerman
01:50
as Chair of Pediatrics
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como xefe de pediatría
01:53
at Boston Medical Center.
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do Boston Medical Center.
01:54
And his first hire was a legal services attorney
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A súa primeira contratación
foi un avogado de servizos legais
foi un avogado de servizos legais
01:57
to represent the patients.
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para representar os pacientes.
01:59
So I called Barry,
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Así que chamei a Barry
02:00
and with his blessing, in October 1995
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e coa súa aprobación, en outubro de 1995,
02:03
walked into the waiting room
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entrei na sala de espera
02:05
of the pediatrics clinic at Boston Medical Center.
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da clínica de pediatría
do Boston Medical Center.
do Boston Medical Center.
02:08
I'll never forget,
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Non esquecerei nunca
02:09
the TVs played this endless reel of cartoons.
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eses debuxos animados sen fin
na televisión.
na televisión.
02:12
And the exhaustion of mothers
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E o esgotamento das nais
02:15
who had taken two, three, sometimes four buses
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que colleran dous, tres ou catro autobuses
02:19
to bring their child to the doctor
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para traer ao seu fillo ao médico
02:21
was just palpable.
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podíase tocar
Parecía que os médicos
02:22
The doctors, it seemed,
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nunca tiñan tempo para todos os pacientes,
02:24
never really had enough time for all the patients,
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02:25
try as they might.
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por máis que se esforzaban.
02:27
And over the course of six months,
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E durante seis meses,
02:28
I would corner them in the hallway
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parábaos nos corredores
02:29
and ask them a sort of naive but fundamental question:
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e preguntáballes simplemente:
02:33
"If you had unlimited resources,
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“Se tiveras medios ilimitados,
02:36
what's the one thing you would give your patients?"
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que lles darías aos teus pacientes?”
02:39
And I heard the same story again and again,
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E sempre escoitaba o mesmo
unha e outra vez,
unha e outra vez,
02:42
a story we've heard hundreds of times since then.
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algo que oín centos de veces desde aquela.
02:45
They said, "Every day we have patients that come into the clinic --
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Dicían: “Tódolos días temos pacientes
que chegan á clínica;
que chegan á clínica;
02:48
child has an ear infection,
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se un neno ten infección de oído,
02:50
I prescribe antibiotics.
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prescribo antibióticos.
02:52
But the real issue is there's no food at home.
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Pero o verdadeiro problema é
que na casa non hai que comer.
que na casa non hai que comer.
02:55
The real issue
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O verdadeiro problema
02:56
is that child is living with 12 other people
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é que ese neno vive con outras 12 persoas
02:59
in a two-bedroom apartment.
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nun apartamento de 2 cuartos.
03:00
And I don't even ask about those issues
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E nin sequera pregunto sobre iso
03:02
because there's nothing I can do.
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porque non podo facer nada.
03:05
I have 13 minutes with each patient.
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Teño 13 minutos por paciente.
03:06
Patients are piling up in the clinic waiting room.
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Os pacientes amoréanse na sala de espera.
03:09
I have no idea where the nearest food pantry is.
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Non sei onde está o comedor social
máis próximo.
máis próximo.
03:12
And I don't even have any help."
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E non teño axuda”.
03:14
In that clinic, even today,
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Nesa clínica, mesmo hoxe,
03:15
there are two social workers
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hai dous asistentes sociais
03:17
for 24,000 pediatric patients,
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para 24.000 pacientes pediátricos
03:20
which is better than a lot of the clinics out there.
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e están mellor ca noutros centros.
03:23
So Health Leads was born of these conversations --
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“Health Leads” naceu destas conversas,
03:26
a simple model
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un simple modelo
03:27
where doctors and nurses
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onde médicos e enfermeiras
03:28
can prescribe nutritious food,
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poidan receitar comida nutritiva,
03:30
heat in the winter
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calefacción no inverno
03:32
and other basic resources for their patients
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e outra asistencia básica para o paciente
03:34
the same way they prescribe medication.
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igual que receitan medicamentos.
03:37
Patients then take their prescriptions
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Os pacientes levan as súas receitas
03:39
to our desk in the clinic waiting room
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ao noso despacho na clínica
03:41
where we have a core of well-trained college student advocates
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onde temos de estudantes de dereito
ben formados
ben formados
03:45
who work side by side with these families
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que traballan con esas familias
03:48
to connect them out
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para conectalas
03:49
to the existing landscape of community resources.
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co abano de recursos comunitarios
existente.
existente.
03:52
So we began with a card table in the clinic waiting room --
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Así, empezamos cunha mesa pregable
na sala de espera da clínica,
na sala de espera da clínica,
03:56
totally lemonade stand style.
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estilo “posto de limonada”.
03:58
But today we have a thousand college student advocates
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Pero hoxe temos mil estudantes de dereito
04:01
who are working to connect nearly 9,000 patients and their families
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que están traballando para informar a
preto de 9.000 pacientes
preto de 9.000 pacientes
04:05
with the resources that they need to be healthy.
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do recursos que necesitan.
04:09
So 18 months ago
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Hai 18 meses,
04:10
I got this email that changed my life.
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recibín este correo electrónico
que me cambiou a vida.
que me cambiou a vida.
04:13
And the email was from Dr. Jack Geiger,
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Era do Dr. Jack Geiger,
04:15
who had written to congratulate me on Health Leads
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que me escribiu para felicitarme
por Health Leads
por Health Leads
e para compartir, como el dixo,
04:18
and to share, as he said,
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04:20
a bit of historical context.
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un pouco de contexto histórico.
04:22
In 1965 Dr. Geiger founded
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En 1965, o Dr. Geiger fundou
04:25
one of the first two community health centers in this country,
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un dos dous primeiros centrosde saúde
comunitarios deste país,
comunitarios deste país,
04:28
in a brutally poor area in the Mississippi Delta.
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nunha zona terriblemente deprimida
do delta do Mississippi.
do delta do Mississippi.
04:31
And so many of his patients came in
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E eran tantos os pacientes que chegaban
04:34
presenting with malnutrition
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con malnutrición
04:36
that be began prescribing food for them.
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que empezou a receitarlles comida.
04:39
And they would take these prescriptions to the local supermarket,
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E eles levaban as receitas ao supermercado
04:42
which would fill them
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que llas despachaba
04:43
and then charge the pharmacy budget of the clinic.
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e logo cargábaas ao presuposto
de farmacia da clínica.
de farmacia da clínica.
E cando na Oficina de Oportunidades
Económicas en Washington D.C.
Económicas en Washington D.C.
04:46
And when the Office of Economic Opportunity in Washington, D.C. --
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04:49
which was funding Geiger's clinic --
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–que financiaba a clínica de Geiger–
04:50
found out about this,
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o souberon,
04:52
they were furious.
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puxéronse furiosos.
04:53
And they sent this bureaucrat down
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E enviaron un burócrata
04:55
to tell Geiger that he was expected to use their dollars
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dicirlle a Geiger que se esperaba
que usara os seus dólares
que usara os seus dólares
04:58
for medical care --
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para atención médica,
04:59
to which Geiger famously and logically responded,
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ao que Geiger respondeu
dun xeito distinguido e lóxico:
dun xeito distinguido e lóxico:
05:02
"The last time I checked my textbooks,
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“A última vez que revisei os meus libros,
05:05
the specific therapy for malnutrition was food."
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a terapia específica para a malnutrición
era a comida”.
era a comida”.
05:09
(Laughter)
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(Risas)
05:10
So when I got this email from Dr. Geiger,
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Así que ao recibir o correo do Dr. Geiger,
05:13
I knew I was supposed to be proud
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souben que debía estar orgullosa
05:16
to be part of this history.
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de formar parte desta historia.
05:17
But the truth is
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Pero a verdade é
05:18
I was devastated.
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que estaba desconsolada.
05:20
Here we are,
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E aquí estamos,
05:22
45 years after Geiger has prescribed food for his patients,
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45 anos despois de que Geiger
lles receitara comida aos pacientes,
lles receitara comida aos pacientes,
05:26
and I have doctors telling me,
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e hai médicos que me din:
05:28
"On those issues, we practice a 'don't ask, don't tell' policy."
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“Neses asuntos temos unha política de
‘non pregunte, non conte’”.
‘non pregunte, non conte’”.
05:32
Forty-five years after Geiger,
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45 anos despois de Geiger,
05:34
Health Leads has to reinvent
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Health Leads ten que reinventar
05:36
the prescription for basic resources.
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a prescrición de recursos básicos.
05:39
So I have spent hours upon hours
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Así que pasei horas e horas
05:42
trying to make sense of this weird Groundhog Day.
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tratando de encontrar o sentido
deste extraño “Día da Marmota”.
deste extraño “Día da Marmota”.
05:45
How is it that if for decades
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Se durante décadas
05:48
we had a pretty straightforward tool for keeping patients,
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tivemos unha ferramenta sinxela
para mantener a saúde
para mantener a saúde
05:50
and especially low-income patients, healthy,
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especialmente nos pacientes pobres,
05:53
that we didn't use it?
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por que non a usamos?
05:55
If we know what it takes to have a healthcare system
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Se sabemos o que fai falta para ter
un sistema de saúde,
un sistema de saúde,
05:58
rather than a sick-care system,
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no canto dun sistema que coida enfermos,
06:01
why don't we just do it?
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por que simplemente non o facemos?
06:03
These questions, in my mind,
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Para min, estas preguntas
06:05
are not hard because the answers are complicated,
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son difíciles, non porque as respostas
sexan complicadas,
sexan complicadas,
06:08
they are hard because they require that we be honest with ourselves.
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senón porque requiren que sexamos sinceros
con nós mesmos.
con nós mesmos.
06:13
My belief is that it's almost too painful
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Creo que é demasiado difícil
06:16
to articulate our aspirations for our healthcare system,
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expresar as nosas aspiracións
para o noso sistema de saúde,
para o noso sistema de saúde,
06:19
or even admit that we have any at all.
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ou tan sequera admitir que temos algunha.
06:22
Because if we did,
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Porque se o fixeramos,
06:23
they would be so removed
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estas estarían moi afastadas
06:25
from our current reality.
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da realidade actual.
06:27
But that doesn't change my belief
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Pero iso non cambia a miña convición
06:30
that all of us, deep inside,
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de que todos nós, no fondo,
06:33
here in this room and across this country,
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aquí nesta sala e en todo o país,
06:37
share a similar set of desires.
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compartimos un conxunto similar
de desexos.
de desexos.
06:39
That if we are honest with ourselves
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Que se somos sinceros con nós mesmos
06:42
and listen quietly,
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e escoitamos en silencio,
06:44
that we all harbor
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todos albergamos
06:46
one fiercely held aspiration for our healthcare:
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una aspiración ben arraigada sobre o noso
sistema de saúde:
sistema de saúde:
06:50
that it keep us healthy.
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que poida manternos sans.
06:52
This aspiration that our healthcare keep us healthy
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Esta aspiración
06:55
is an enormously powerful one.
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é enormemente poderosa.
06:58
And the way I think about this
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E tal como eu o vexo,
07:00
is that healthcare is like any other system.
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o sistema da saude é como
calquera outro.
calquera outro.
07:02
It's just a set of choices that people make.
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Unicamente un conxunto de decisións.
07:05
What if we decided
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Que pasaría se decidísemos
07:07
to make a different set of choices?
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tomar outras decisións?
Que pasaría se decidísemos ver
todas as partes do sistema de saúde,
todas as partes do sistema de saúde,
07:09
What if we decided to take all the parts of healthcare
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07:12
that have drifted away from us
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tamén as que se nos foron á deriva?,
07:14
and stand firm and say, "No.
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e nos plantamos e dicimos: “Non.
07:17
These things are ours.
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Estas cousas son nosas.
07:19
They will be used for our purposes.
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Usarémolas para os nosos propósitos.
07:21
They will be used to realize
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Usarémolas para acadar
07:23
our aspiration"?
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as nosas aspiracións”?
Que pasaría se todo o que necesitamos
07:24
What if everything we needed
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para decatarnos das nosas aspiracións
sobre o sistema de saúde
sobre o sistema de saúde
07:26
to realize our aspiration for healthcare
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07:28
was right there in front of us
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estivera aí fronte a nós
07:30
just waiting to be claimed?
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esperando que o reivindiquemos?
07:32
So that's where Health Leads began.
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Así que aí foi onde empezou Health Leads.
07:34
We started with the prescription pad --
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Empezamos co talonario de receitas,
07:36
a very ordinary piece of paper --
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--simplemente unha folla de papel--
07:38
and we asked, not what do patients need to get healthy --
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y non nos preguntamos que necesitan
os pacientes para curarse
os pacientes para curarse
07:42
antibiotics, an inhaler, medication --
188
446556
3018
–antibióticos, un inhalador, medicación–
07:45
but what do patients need to be healthy,
189
449574
2783
senón, que necesitan para estar sans,
07:48
to not get sick in the first place?
190
452357
2547
para non enfermar?
07:50
And we chose to use the prescription
191
454904
1851
E optamos por usar as receitas
07:52
for that purpose.
192
456755
1782
para iso.
Así que só a uns kilómetros de aquí
07:54
So just a few miles from here
193
458537
1202
07:55
at Children's National Medical Center,
194
459739
1784
no Centro Médico Nacional Infantil,
07:57
when patients come into the doctor's office,
195
461523
2266
cando os pacientes chegan á consulta,
07:59
they're asked a few questions.
196
463789
1685
fánselles unhas preguntas:
08:01
They're asked, "Are you running out of food at the end of the month?
197
465474
2664
“Chégalle a comida ata fin de mes?
08:04
Do you have safe housing?"
198
468138
1566
Ten unha vivenda segura?”
08:05
And when the doctor begins the visit,
199
469704
2069
E cando o doutor comeza a consulta,
08:07
she knows height, weight, is there food at home,
200
471773
2833
sabe a altura e o peso,
se hai comida na casa,
se hai comida na casa,
08:10
is the family living in a shelter.
201
474606
1616
se a familia vive nun albergue.
08:12
And that not only leads to a better set of clinical choices,
202
476222
2884
E iso non só leva a un mellor conxunto
de decisións clínicas,
de decisións clínicas,
08:15
but the doctor can also prescribe those resources for the patient,
203
479106
4050
senón que o doutor pode prescribir
eses recursos para o paciente,
eses recursos para o paciente,
08:19
using Health Leads like any other sub-specialty referral.
204
483156
3666
usando Health Leads como cualquera outra
subespecialidade de interconsulta.
subespecialidade de interconsulta.
08:22
The problem is,
205
486822
2233
O problema é
que así que lle colles o gusto
08:24
once you get a taste of what it's like
206
489055
2199
a realizar as túas aspiracións
no coidado da saúde,
no coidado da saúde,
08:27
to realize your aspiration for healthcare,
207
491254
2235
08:29
you want more.
208
493489
1518
queres máis.
Así que pensamos,
08:30
So we thought,
209
495007
763
se podemos conseguir que os doutores
08:31
if we can get individual doctors
210
495770
1601
08:33
to prescribe these basic resources for their patients,
211
497371
3217
prescriban estes recursos básicos
08:36
could we get an entire healthcare system
212
500588
2717
poderíamos lograr
que todo un sistema de saúde
que todo un sistema de saúde
08:39
to shift its presumption?
213
503305
2752
cambie as súas premisas?
08:41
And we gave it a shot.
214
506057
1247
E tentámolo.
08:43
So now at Harlem Hospital Center
215
507304
1435
E agora no Harlem Hospital Center
08:44
when patients come in with an elevated body mass index,
216
508739
3786
cando un paciente ingresa cun IMC elevado,
08:48
the electronic medical record
217
512525
1864
a historia clínica electrónica
08:50
automatically generates a prescription for Health Leads.
218
514389
3800
xera automaticamente unha prescrición
para Health Leads.
para Health Leads.
E os nosos voluntarios poden
traballar con eles
traballar con eles
08:54
And our volunteers can then work with them
219
518189
1466
08:55
to connect patients to healthy food and excercise programs
220
519655
3217
para conectalos cos programas
de comida saudable e exercicio físico
de comida saudable e exercicio físico
08:58
in their communities.
221
522872
1432
dos seus barrios.
09:00
We've created a presumption
222
524304
1134
Creamos a premisa
de que se es un paciente nese hospital
09:01
that if you're a patient at that hospital
223
525438
1567
09:02
with an elevated BMI,
224
527005
1550
con IMC elevado,
09:04
the four walls of the doctor's office
225
528555
2234
as catro paredes da consulta
09:06
probably aren't going to give you everything
226
530789
1852
probablemente non che darán
09:08
you need to be healthy.
227
532641
1182
todo o que necesitas.
09:09
You need more.
228
533823
1400
Necesitas máis.
Así que por un lado,
09:11
So on the one hand,
229
535223
681
09:11
this is just a basic recoding
230
535904
1697
isto é só un redeseño básico
09:13
of the electronic medical record.
231
537601
1705
da historia clínica electrónica.
09:15
And on the other hand,
232
539306
1718
E por outro,
09:16
it's a radical transformation
233
541024
1649
é unha transformación radical
09:18
of the electronic medical record
234
542673
2168
da historia clínica electrónica
09:20
from a static repository of diagnostic information
235
544841
3882
dun repositorio estático
de información de diagnóstico
de información de diagnóstico
09:24
to a health promotion tool.
236
548723
2834
a unha ferramenta de promoción da saúde.
09:27
In the private sector,
237
551557
1117
No sector privado,
09:28
when you squeeze that kind of additional value
238
552674
2620
se se extrae esa clase de valor adicional
09:31
out of a fixed-cost investment,
239
555294
1747
dun investimento de custo fixo,
09:32
it's called a billion-dollar company.
240
557041
2600
chámaselle "compañía
de miles de millóns de dólares".
de miles de millóns de dólares".
09:35
But in my world,
241
559641
1381
Pero no meu mundo,
09:36
it's called reduced obesity and diabetes.
242
561022
3401
chámase redución da obesidade e diabetes.
09:40
It's called healthcare --
243
564423
1883
Chámase coidado da saúde:
09:42
a system where doctors can prescribe solutions
244
566306
2983
un sistema no que os médicos
poidan prescribir solucións
poidan prescribir solucións
09:45
to improve health,
245
569289
1550
para mejorar a saúde,
09:46
not just manage disease.
246
570839
2149
non só controlar enfermidades.
E o mesmo na sala de espera da clínica.
09:48
Same thing in the clinic waiting room.
247
572988
1534
09:50
So every day in this country
248
574522
1617
Así, cada día neste país
09:52
three million patients
249
576139
1500
tres millóns de pacientes
09:53
pass through about 150,000 clinic waiting rooms in this country.
250
577639
4494
pasan por cerca de 150.000
salas de espera de clínicas .
salas de espera de clínicas .
09:58
And what do they do when they're there?
251
582144
1973
E que fan cando chegan alí?
10:00
They sit, they watch the goldfish in the fish tank,
252
584117
3450
Sentan, observan os peixes de cores
do acuario,
do acuario,
10:03
they read extremely old copies
253
587567
2483
len número atrasados
10:05
of Good Housekeeping magazine.
254
590050
2283
de revistas femininas.
10:08
But mostly we all just sit there forever, waiting.
255
592333
3233
Pero principalmente todos sentamos alí
sempre, a esperar.
sempre, a esperar.
10:11
How did we get here
256
595566
1351
Como chegamos a isto,
10:12
where we devote hundreds of acres and thousands of hours
257
596917
3349
a dedicar horas e horas
10:16
to waiting?
258
600266
1783
a esperar?
Que tal se houbera unha sala de espera
10:17
What if we had a waiting room
259
602049
1217
10:19
where you don't just sit when you're sick,
260
603266
2101
onde non só nos sentamos se enfermamos,
10:21
but where you go to get healthy.
261
605367
1866
senón á que imos tamén para curarnos?
10:23
If airports can become shopping malls
262
607233
2517
Se os aeroportos poden converterse
en centros comerciais
en centros comerciais
10:25
and McDonald's can become playgrounds,
263
609750
2966
e os McDonald’s en parques de xogo,
10:28
surely we can reinvent the clinic waiting room.
264
612716
3433
seguro que podemos reinventar
a sala de espera.
a sala de espera.
10:32
And that's what Health Leads has tried to do,
265
616149
2034
E iso é o que Health Leads trata de facer
10:34
to reclaim that real estate and that time
266
618183
2283
para recuperar ese espazo e ese tempo
10:36
and to use it as a gateway
267
620466
1432
e usalo como un acceso
10:37
to connect patients
268
621898
1052
para conectar os pacientes
10:38
to the resources they need to be healthy.
269
622950
2767
cos recursos que precisan para estar sans.
No nordeste, o inverno é terrible,
10:41
So it's a brutal winter in the Northeast,
270
625717
1516
10:43
your kid has asthma, your heat just got turned off,
271
627233
2467
o teu fillo ten asma, acaban de cortarche
a calefacción,
a calefacción,
10:45
and of course you're in the waiting room of the ER,
272
629700
2167
e por suposto estás na sala de espera
de urxencias,
de urxencias,
10:47
because the cold air triggered your child's asthma.
273
631867
2532
porque o aire frío provocoulle a asma.
10:50
But what if instead of waiting for hours anxiously,
274
634399
2917
Pero, que se en vez de esperar horas,
con ansiedade
con ansiedade
10:53
the waiting room became the place
275
637316
2200
a sala de espera se convirtese no lugar
10:55
where Health Leads turned your heat back on?
276
639516
2484
onde Health Leads reconectara
a túa calefacción?
a túa calefacción?
10:57
And of course all of this requires
277
642000
1618
Por suposto, todo isto require
10:59
a broader workforce.
278
643618
1948
máis persoal.
11:01
But if we're creative, we already have that too.
279
645566
3167
Pero se somos creativos, tamén temos iso.
11:04
We know that our doctors and nurses
280
648733
2386
Sabemos que os nosos persoal médico
e de enfermería
e de enfermería
11:07
and even social workers
281
651119
1347
e mesmo os traballadores sociais
11:08
aren't enough,
282
652466
1468
non abondan,
11:09
that the ticking minutes of health care
283
653934
1649
que os poucos minutos da consulta
11:11
are too constraining.
284
655583
1418
son demasiado imperiosos.
11:12
Health just takes more time.
285
657001
2049
A saúde simplemente necesita máis tempo.
11:14
It requires a non-clinical army
286
659050
2799
Require un exército non clínico,
11:17
of community health workers and case managers
287
661849
2684
unha comunidade de traballadores da saúde,
xestores
xestores
11:20
and many others.
288
664533
1616
e moitos outros.
Que pasaría se unha pequena parte dese
próximo exército da atención sanitaria
próximo exército da atención sanitaria
11:22
What if a small part of that next healthcare workforce
289
666149
3150
11:25
were the 11 million college students in this country?
290
669299
3701
foran os 11 millóns de
estudantes universitarios deste país?
estudantes universitarios deste país?
11:28
Unencumbered by clinical responsibilities,
291
673000
2766
Libres de responsabilidades clínicas,
11:31
unwilling to take no for an answer
292
675766
2602
non dispostos a aceptar un “non”
11:34
from those bureaucracies
293
678368
1582
como resposta desas burocracias
11:35
that tend to crush patients,
294
679950
1933
que tenden a abrumar os pacientes,
11:37
and with an unparalleled ability
295
681883
1950
e cunha capacidade sen igual
11:39
for information retrieval
296
683833
1452
para atopar información
11:41
honed through years of using Google.
297
685285
2981
perfeccionada por anos de uso de Google.
11:44
Now lest you think it improbable
298
688266
2533
Pero se sodes dos que non credes
11:46
that a college volunteer
299
690799
1617
que un voluntario universitario
11:48
can make this kind of commitment,
300
692416
1783
poida asumir esta clase de compromiso,
11:50
I have two words for you:
301
694199
1567
teño dúas palabras para vós:
11:51
March Madness.
302
695766
2351
Loucura de Marzo [campionato
da División I de baloncesto da NCAA].
da División I de baloncesto da NCAA].
11:54
The average NCAA Division I men's basketball player
303
698117
3967
O xogador tipo da División I da NCAA
11:57
dedicates 39 hours a week to his sport.
304
702084
3265
dedica 39 horas á semana ao deporte.
12:01
Now we may think that's good or bad,
305
705349
2152
Podemos pensar que iso é bo ou malo,
12:03
but in either case it's real.
306
707501
2682
pero é a realidade.
12:06
And Health Leads is based on the presumption
307
710183
2185
E Health Leads baséase na suposición
12:08
that for too long
308
712368
1382
de que durante moito tempo
12:09
we have asked too little of our college students
309
713750
2550
lles pedimos moi pouco
aos nosos estudantes
aos nosos estudantes
12:12
when it comes to real impact in vulnerable communities.
310
716300
3765
cando se trata dun verdadeiro impacto
en comunidades vulnerables.
en comunidades vulnerables.
Os equipos deportivos universitarios din:
12:15
College sports teams say,
311
720065
1353
12:17
"We're going to take dozens of hours
312
721418
2065
“Terás que dedicar horas e horas
12:19
at some field across campus at some ungodly hour of the morning
313
723483
3884
en pistas de fóra do campus e
a horas intempestivas,
a horas intempestivas,
12:23
and we're going to measure your performance, and your team's performance,
314
727367
2816
e mediremos o teu funcionamento
e o do teu equipo,
e o do teu equipo,
12:26
and if you don't measure up or you don't show up,
315
730183
2166
e se non estás á altura
12:28
we're going to cut you off the team.
316
732349
1450
teremos que botarte del.
12:29
But we'll make huge investments
317
733799
1888
Pero faremos grandes investimentos
12:31
in your training and development,
318
735687
1212
no teu adestramento,
e ofrecerémosche unha extraordinaria
comunidade de amigos”.
comunidade de amigos”.
12:32
and we'll give you an extraordinary community of peers."
319
736899
3418
E os estudantes fan fila na porta
12:36
And people line up out the door
320
740317
1815
12:38
just for the chance to be part of it.
321
742132
2785
só para intentar participar diso.
12:40
So our feeling is,
322
744917
1217
Así que cremos
que se es abondo bo
para o equipo de rugby,
para o equipo de rugby,
12:42
if it's good enough for the rugby team,
323
746134
1483
12:43
it's good enough for health and poverty.
324
747617
2115
tamén podes selo para a saúde e a pobreza.
12:45
Health Leads too recruits competitively,
325
749732
3268
Health Leads tamén selecciona
competitivamente,
competitivamente,
12:48
trains intensively,
326
753000
1481
adestra intensamente,
12:50
coaches professionally,
327
754481
1969
dirixe profesionalmente,
12:52
demands significant time,
328
756450
1949
demanda un tempo considerable,
constrúe un equipo cohesionado
12:54
builds a cohesive team
329
758399
1367
12:55
and measures results --
330
759766
1484
e mide resultados,
unha especie de “Teach for America”
da saúde.
da saúde.
12:57
a kind of Teach for America for healthcare.
331
761250
2683
Agora mesmo, nas 10 principais cidades
dos Estados Unidos
dos Estados Unidos
12:59
Now in the top 10 cities in the U.S.
332
763933
2100
13:01
with the largest number of Medicaid patients,
333
766033
2319
con maior número de pacientes
de “Medicaid”
de “Medicaid”
13:04
each of those has at least 20,000 college students.
334
768352
3214
cada unha ten polo menos
20.000 estudantes universitarios.
20.000 estudantes universitarios.
13:07
New York alone has half a million college students.
335
771566
3201
Só Nova York ten medio millón.
13:10
And this isn't just a sort of short-term workforce
336
774767
3049
E esta non é só unha especie de
forza de traballo a curto prazo
forza de traballo a curto prazo
13:13
to connect patients to basic resources,
337
777816
2250
para conectar pacientes
e recursos básicos,
e recursos básicos,
13:15
it's a next generation healthcare leadership pipeline
338
780066
3601
é un reservorio de liderado en saúde
da próxima xeración,
da próxima xeración,
13:19
who've spent two, three, four years
339
783667
2450
xente que pasou dous, tres, catro anos
nas salas de espera das clínicas
13:22
in the clinic waiting room
340
786117
1501
13:23
talking to patients about their most basic health needs.
341
787618
3984
falando con pacientes das
súas necesidades de saúde máis básicas.
súas necesidades de saúde máis básicas.
13:27
And they leave with the conviction,
342
791602
1749
E vanse coa convición,
13:29
the ability and the efficacy
343
793351
1832
a capacidade e a eficacia
13:31
to realize our most basic aspirations for health care.
344
795183
3783
para facer realidade as nosas aspiracións.
13:34
And the thing is, there's thousands of these folks already out there.
345
798966
3018
E a cuestión é que xa hai miles, aí fóra.
13:37
So Mia Lozada is Chief Resident of Internal Medicine
346
801984
3817
Mia Lozada é xefa de residentes
de Medicina Interna
de Medicina Interna
no hospital UCSF [San Francisco].
13:41
at UCSF Medical Center,
347
805801
1415
13:43
but for three years as an undergraduate
348
807216
2333
Durante tres anos antes de graduarse
13:45
she was a Health Leads volunteer
349
809549
1633
foi voluntaria de Health Leads
13:47
in the clinic waiting room at Boston Medical Center.
350
811182
3002
na sala de espera da clínica do
Boston Medical Center.
Boston Medical Center.
13:50
Mia says, "When my classmates write a prescription,
351
814184
3715
Mia di: “Cando os meus compañeiros
de clase prescriben unha receita
de clase prescriben unha receita
13:53
they think their work is done.
352
817899
2018
pensan que acabaron o seu traballo.
13:55
When I write a prescription,
353
819917
1716
Cando eu prescribo unha receita
13:57
I think, can the family read the prescription?
354
821633
2267
penso: poderá entendela a familia?
13:59
Do they have transportation to the pharmacy?
355
823900
2183
Terán forma de ir á farmacia?
14:01
Do they have food to take with the prescription?
356
826083
2450
Terán comida para tomar co medicamento?
14:04
Do they have insurance to fill the prescription?
357
828533
2250
Terán seguro para pagar a receita?
14:06
Those are the questions I learned at Health Leads,
358
830783
2683
Estas preguntas aprendinas
en Health Leads,
en Health Leads,
14:09
not in medical school."
359
833466
1750
non na universidade”.
14:11
Now none of these solutions --
360
835216
1984
Agora ben, ningunha destas solucións
14:13
the prescription pad, the electronic medical record,
361
837200
2970
--o talonario de receitas,
a historia clínica electrónica,
a historia clínica electrónica,
a sala de espera,
14:16
the waiting room,
362
840170
1147
o exército de estudantes universitarios--
é perfecta.
é perfecta.
14:17
the army of college students --
363
841317
1168
14:18
are perfect.
364
842485
1183
14:19
But they are ours for the taking --
365
843668
2500
Pero están alí para que as tomemos
14:22
simple examples
366
846168
1332
e son simples exemplos
14:23
of the vast under-utilized healthcare resources
367
847500
3501
dos moitos recursos infrautilizados
no coidado da saúde
no coidado da saúde
14:26
that, if we reclaimed and redeployed,
368
851001
2915
que, recuperados e redistribuídos,
14:29
could realize our most basic aspiration
369
853916
3417
poderían levar a cabo as nosas aspiracións
máis básicas
máis básicas
14:33
of healthcare.
370
857333
1784
en materia de saúde.
14:35
So I had been at Legal Services for about nine months
371
859117
3216
Ben, levaba 9 meses en Legal Services
cando esta idea de Health Leads empezou
a andarme na cabeza.
a andarme na cabeza.
14:38
when this idea of Health Leads started percolating in my mind.
372
862333
2733
14:40
And I knew I had to tell Jeff Purcell, my attorney,
373
865066
2934
E vin que tiña que dicirlle
a Jeff Purcell, o meu avogado,
a Jeff Purcell, o meu avogado,
14:43
that I needed to leave.
374
868000
1419
que necesitaba irme.
14:45
And I was so nervous,
375
869419
963
E estaba nerviosísima,
14:46
because I thought he was going to be disappointed in me
376
870382
2534
porque pensaba que o ía decepcionar
14:48
for abandoning our clients for some crazy idea.
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por abandonar os nosos clientes
por unha idea tola.
por unha idea tola.
14:51
And I sat down with him and I said,
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E sentei con el e díxenlle:
14:53
"Jeff, I have this idea
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“Jeff, ocorréuseme a idea
14:55
that we could mobilize college students
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de que poderíamos mobilizar
estudantes universitarios
estudantes universitarios
14:58
to address patients' most basic health needs."
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para atender as necesidades de saúde
máis básicas dos pacientes”.
máis básicas dos pacientes”.
15:01
And I'll be honest,
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E serei sincera,
15:02
all I wanted was for him to not be angry at me.
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só quería que non se enfadara comigo.
15:05
But he said this,
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Pero respondeu:
15:07
"Rebecca, when you have a vision,
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“Rebecca, se tes unha visión de futuro,
15:10
you have an obligation to realize that vision.
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tes a obriga de levala a cabo.
15:14
You must pursue that vision."
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Debes ir tras dela”.
15:17
And I have to say, I was like "Whoa.
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E debo dicir que "Uauu.
15:20
That's a lot of pressure."
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Que presión!”
Eu só buscaba a súa aprobación,
15:23
I just wanted a blessing,
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15:24
I didn't want some kind of mandate.
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non unha especie de mandato!
15:25
But the truth is
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Pero a verdade é
15:27
I've spent every waking minute nearly since then
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que cada minuto dende entón
15:30
chasing that vision.
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estiven perseguindo esa visión de futuro.
15:32
I believe that we all have a vision
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Creo que todos temos unha visión
15:35
for healthcare in this country.
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para o sistema sanitario deste país.
15:37
I believe that at the end of the day
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Creo que, ao final,
15:39
when we measure our healthcare,
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cuando avaliemos o noso sistema
15:41
it will not be by the diseases cured,
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non será polas enfermidades curadas,
15:44
but by the diseases prevented.
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senón polas enfermidades evitadas.
15:46
It will not be by the excellence of our technologies
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Non será pola excelencia
das nosas tecnoloxías
das nosas tecnoloxías
15:49
or the sophistication of our specialists,
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ou a sofisticación
dos nosos especialistas,
dos nosos especialistas,
15:52
but by how rarely we needed them.
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senón polo pouco que os precisemos.
E sobre todo,
15:54
And most of all,
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15:56
I believe that when we measure healthcare,
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creo que cando avaliemos o sistema
15:58
it will be, not by what the system was,
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será, non polo que o sistema era,
16:01
but by what we chose it to be.
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senón polo que nós queiramos que sexa.
16:04
Thank you.
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Grazas.
16:05
(Applause)
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(Aplausos)
16:15
Thank you.
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Grazas.
16:16
(Applause)
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(Aplausos)
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