TEDMED 2014
Gail Reed: Where to train the world's doctors? Cuba.
盖尔•里德: 古巴——培养全世界的医生 | 盖尔·里德 | TEDMED2014
Filmed:
Readability: 5.1
824,908 views
非常问题需要非常手段，非常手段由伟大的观念、想象力和胆量激发。在这个演讲中，记者盖尔•里德描绘了值得关注的非常手段：哈瓦那拉丁美洲医学院，这里培养了遍布世界各地的医生，来服务最需要他们的当地社区。
Gail Reed - Cuban health care expert
American journalist and Havana resident Gail Reed spotlights a Cuban medical school that trains doctors from low-income countries who pledge to serve communities like their own. Full bio
American journalist and Havana resident Gail Reed spotlights a Cuban medical school that trains doctors from low-income countries who pledge to serve communities like their own. Full bio
Double-click the English transcript below to play the video.
00:12
I want to tell you
0
537
1622
我想为你们讲述
00:14
how 20,000 remarkable young people
1
2159
4691
来自超过100个国家的
20,000个杰出的年轻人，
00:18
from over 100 countries
2
6850
1856
如何在古巴相聚，
00:20
ended up in Cuba
3
8706
1812
00:22
and are transforming health in their communities.
4
10518
3803
并改变他们所在社区的医疗状况。
00:26
Ninety percent of them would never
5
14321
2080
他们中，
如果不是因为有去古巴学医的奖学金，
00:28
have left home at all
6
16401
1572
90%的人原来根本不会离开家。
00:29
if it weren't for a scholarship
to study medicine in Cuba
to study medicine in Cuba
7
17973
3344
00:33
and a commitment to go back
8
21317
1811
他们这么做也是想今后献身于
00:35
to places like the ones they'd come from —
9
23128
3628
他们走出来的地方，
00:38
remote farmlands, mountains, ghettos —
10
26756
3447
偏远农村、山区，以及贫民窟，
00:42
to become doctors for people like themselves,
11
30203
3486
成为医生去帮助那些像他们一样的人，
00:45
to walk the walk.
12
33689
2092
将梦想「付诸行动」。
00:47
Havana's Latin American Medical School:
13
35781
2666
哈瓦那的拉丁美洲医学院，
00:50
It's the largest medical school in the world,
14
38447
2925
是世界上最大的医学院。
00:53
graduating 23,000 young doctors
15
41372
2902
自2005年第一班毕业生以来，
00:56
since its first class of 2005,
16
44274
2728
已培养了23,000名年轻的医生，
00:59
with nearly 10,000 more in the pipeline.
17
47002
3609
另有近10,000名正在就读中。
01:02
Its mission, to train physicians for the people
18
50611
3821
其使命是，
为那些最需要医生的人们培养医生：
01:06
who need them the most:
19
54432
2051
01:08
the over one billion
20
56483
1936
那些超过10亿的
01:10
who have never seen a doctor,
21
58419
2263
从没见过医生的人们。
01:12
the people who live and die
22
60682
3833
这些人从出生到死亡，
01:16
under every poverty line ever invented.
23
64515
3494
一辈子生活在各种贫困线之下。
01:20
Its students defy all norms.
24
68009
2250
这些学生不同寻常，
01:22
They're the school's biggest risk
25
70259
2271
他们既是学校最大的风险所在，
01:24
and also its best bet.
26
72530
2460
也是学校的一张王牌。
01:26
They're recruited from the poorest,
27
74990
2515
他们来自地球上最贫穷、
01:29
most broken places on our planet
28
77505
2571
最破败的地区，
01:32
by a school that believes they can become
29
80076
2274
被一所相信他们可以成为
01:34
not just the good
30
82350
1507
不仅优秀的，
01:35
but the excellent physicians
31
83857
1935
更是卓越的医生的学校录取，
01:37
their communities desperately need,
32
85792
2753
而卓越的医生正是他们的社区亟需的。
01:40
that they will practice where most doctors don't,
33
88545
3652
他们将在大多数医生不愿意去的地方行医，
01:44
in places not only poor
34
92197
2426
那些地方不仅贫穷，
01:46
but oftentimes dangerous,
35
94623
2553
还时常危险，
01:49
carrying venom antidotes in their backpacks
36
97176
3026
他们的背包里要常备解毒药，
01:52
or navigating neighborhoods
37
100202
2619
或游走于
01:54
riddled by drugs, gangs and bullets,
38
102821
3321
充满毒品、帮派、炮火的邻里乡间，
这就是他们的家乡。
01:58
their home ground.
39
106142
2700
02:00
The hope is that they will help
40
108842
1326
学校寄予学生的希望是，
02:02
transform access to care,
41
110168
2600
使当地人能够获取便捷的医疗服务，
02:04
the health picture in impoverished areas,
42
112768
2419
改变贫穷地区的医疗状况，
02:07
and even the way medicine itself
43
115187
2159
甚至学医和行医本身的
02:09
is learned and practiced,
44
117346
2543
践行方式。
并且，
02:11
and that they will become pioneers in our global reach
45
119889
4251
他们将成为先锋，
把医疗服务推向世界的各个角落，
02:16
for universal health coverage,
46
124140
2520
这诚然是个艰巨的任务。
02:18
surely a tall order.
47
126660
2718
02:21
Two big storms and this notion of "walk the walk"
48
129378
4126
两场大风暴和「付诸行动」的理念，
促成了拉丁美洲医学院在1998年的建校。
02:25
prompted creation of ELAM back in 1998.
49
133504
4084
02:29
The Hurricanes Georges and Mitch
50
137588
3003
乔治飓风和米契飓风
02:32
had ripped through the Caribbean
51
140591
1552
肆虐加勒比海和中美洲，
02:34
and Central America,
52
142143
2205
02:36
leaving 30,000 dead
53
144348
2379
造成了30,000人死亡，
02:38
and two and a half million homeless.
54
146727
2883
二百五十万人无家可归。
02:41
Hundreds of Cuban doctors
volunteered for disaster response,
volunteered for disaster response,
55
149610
3693
数以百计的古巴医生自愿为灾区服务，
02:45
but when they got there,
56
153303
1845
但当他们到达灾区，
02:47
they found a bigger disaster:
57
155148
2083
他们发现了更大的灾难：
02:49
whole communities with no healthcare,
58
157231
3196
整个社区都没有医疗服务，
02:52
doors bolted shut on rural hospitals
59
160427
2324
乡村医院因缺少医护人员
02:54
for lack of staff,
60
162751
1879
而门窗紧锁，
02:56
and just too many babies dying
61
164630
2671
太多的孩子
在第一个生日来临前死亡。
02:59
before their first birthday.
62
167301
2935
03:02
What would happen when these Cuban doctors left?
63
170236
3834
这些古巴医生离开后，会是怎样的情境？
03:06
New doctors were needed to make care sustainable,
64
174070
2714
需要有新的医生来持续提供医疗服务，
03:08
but where would they come from?
65
176784
1312
但他们从哪里来呢？
03:10
Where would they train?
66
178096
2805
他们在哪接受培训呢？
03:12
In Havana, the campus of a former naval academy
67
180901
4443
在哈瓦那，一座海军学院的旧校园，
被古巴卫生部接管，
03:17
was turned over to the Cuban Health Ministry
68
185344
2925
03:20
to become the Latin American Medical School,
69
188269
3351
后来变为拉丁美洲医学院，
03:23
ELAM.
70
191620
2013
也就是 ELAM。
03:25
Tuition, room and board, and a small stipend
71
193633
2474
学校提供学费、食宿、小额津贴
03:28
were offered to hundreds of students
72
196107
1911
给那些数以百计的
03:30
from the countries hardest hit by the storms.
73
198018
3033
来自受风暴影响最严重国家的学生。
03:33
As a journalist in Havana,
74
201051
2279
作为一个在哈瓦那的记者，
03:35
I watched the first 97 Nicaraguans arrive
75
203330
2717
我在1999年3月
看到第一批来自尼加拉瓜的97位学生，
03:38
in March 1999,
76
206047
2542
03:40
settling into dorms barely refurbished
77
208589
2716
入住进刚刚翻修过的宿舍里，
03:43
and helping their professors not
only sweep out the classrooms
only sweep out the classrooms
78
211305
3679
不仅帮助教授们清扫教室，
03:46
but move in the desks and the
chairs and the microscopes.
chairs and the microscopes.
79
214984
4679
还帮助他们搬入桌椅、显微镜。
03:51
Over the next few years,
80
219663
1879
几年后，
03:53
governments throughout the Americas
81
221542
1912
美洲的诸多政府
03:55
requested scholarships for their own students,
82
223454
3173
为本国的学生争取奖学金名额，
美国国会黑人同盟
03:58
and the Congressional Black Caucus
83
226627
1878
04:00
asked for and received hundreds of scholarships
84
228505
3375
为美国的年轻人
申请并获得了数以百计的奖学金名额。
04:03
for young people from the USA.
85
231880
3240
04:07
Today, among the 23,000
86
235120
3712
如今，
这些23,000名已毕业的医生，
04:10
are graduates from 83 countries
87
238832
3015
分别来自于美洲、非洲、亚洲的83个国家，
04:13
in the Americas, Africa and Asia,
88
241847
3004
04:16
and enrollment has grown to 123 nations.
89
244851
5603
而入学学生的生源国已增长到123个国家。
04:22
More than half the students are young women.
90
250454
2204
学生中超过半数是年轻女性，
04:24
They come from 100 ethnic groups,
91
252658
1392
她们来自100个民族，
04:26
speak 50 different languages.
92
254050
2025
说着50种不同的语言。
04:28
WHO Director Margaret Chan said,
93
256075
3141
世界卫生组织总干事陈冯富珍说：
04:31
"For once, if you are poor, female,
94
259216
4038
「一旦你出身贫困、身为女性、
04:35
or from an indigenous population,
95
263254
2262
或来自当地族群，
04:37
you have a distinct advantage,
96
265516
1705
你就拥有了一种独特的优势，
04:39
an ethic that makes this medical school unique."
97
267221
4729
这套办学观念使这座医学院显得独一无二。」
04:43
Luther Castillo comes from San Pedro de Tocamacho
98
271950
4150
卢瑟•卡斯蒂略来自洪都拉斯大西洋沿岸的
04:48
on the Atlantic coast of Honduras.
99
276100
2870
圣佩德罗 图卡玛奇市。
04:50
There's no running water,
100
278970
1912
那里没有自来水，
04:52
no electricity there,
101
280882
1800
没有电，
04:54
and to reach the village, you have to walk for hours
102
282682
3600
你需要步行数小时才能到达那里的村庄，
04:58
or take your chances in a pickup truck like I did
103
286282
2913
或像我一样，靠运气搭上一辆卡车，
05:01
skirting the waves of the Atlantic.
104
289195
3295
在大西洋沿岸破浪前行。
05:04
Luther was one of 40 Tocamacho children
105
292490
4641
卢瑟是来自图卡玛奇市
40个的上过小学的孩子中的一员。
05:09
who started grammar school,
106
297131
2003
05:11
the sons and daughters of a black indigenous people
107
299134
2744
他们是的当地黑人原住民的孩子，
05:13
known as the Garífuna,
108
301878
1856
这些黑人被称为加利福纳人，
05:15
20 percent of the Honduran population.
109
303734
3476
占洪都拉斯人口数量的20%左右。
05:19
The nearest healthcare was fatal miles away.
110
307210
5153
最近的医疗服务竟有数英里远。
05:24
Luther had to walk three hours every day
111
312363
3487
卢瑟需要每天步行3小时
才能到中学。
05:27
to middle school.
112
315850
1901
那40个人中只有17人上了中学，
05:29
Only 17 made that trip.
113
317751
2081
05:31
Only five went on to high school,
114
319832
2104
只有5人上了高中，
05:33
and only one to university:
115
321936
2164
只有1人上了大学：
05:36
Luther, to ELAM,
116
324100
2021
他就是卢瑟，来到了拉丁美洲医学院，
05:38
among the first crop of Garífuna graduates.
117
326121
4009
成为第一批加利福纳人的毕业生。
05:42
Just two Garífuna doctors had preceded them
118
330130
2870
在洪都拉斯的历史上，这批学生之前，
05:45
in all of Honduran history.
119
333000
3044
只产生过两名加利福纳人医生。
仰赖于拉丁美洲医学院的培养，如今已有69名了。
05:48
Now there are 69, thanks to ELAM.
120
336044
5901
05:53
Big problems need big solutions,
121
341945
3200
非常问题需要非常手段，
05:57
sparked by big ideas, imagination and audacity,
122
345145
3792
这些非常手段由伟大的理念、想象力和胆识激发，
06:00
but also solutions that work.
123
348937
3003
也由已经见效的各种办法激发。
06:03
ELAM's faculty had no handy evidence base
124
351940
3330
拉丁美洲医学院的教员们，没有现成的经验
06:07
to guide them, so they learned the hard way,
125
355270
3520
来指导如此庞大的学生，因此他们只能艰苦地摸索，
06:10
by doing and correcting course as they went.
126
358790
3689
边做边学边调整。
06:14
Even the brightest students
127
362479
2262
即便是来自贫穷地区的
06:16
from these poor communities
128
364741
1913
最聪明的学生，
06:18
weren't academically prepared
129
366654
1676
也没在学业上做好
06:20
for six years of medical training,
130
368330
2693
接受六年医疗训练的准备，
06:23
so a bridging course was set up in sciences.
131
371023
3657
因此设立了一门衔接性课程。
06:26
Then came language:
132
374680
1575
然后是语言关：
06:28
these were Mapuche, Quechuas, Guaraní, Garífuna,
133
376255
3161
这里有马普切人、克丘亚人、瓜拉尼人、加利福那人，
06:31
indigenous peoples
134
379416
1777
都是当地的原住民。
06:33
who learned Spanish as a second language,
135
381193
2200
他们以西班牙语为第二语言，
06:35
or Haitians who spoke Creole.
136
383393
2797
或是讲克里奥耳语的海地人。
06:38
So Spanish became part
137
386190
1937
因此西班牙语
成了一门医学预预科的课程。
06:40
of the pre-pre-med curriculum.
138
388127
4158
即便如此，在古巴，
06:44
Even so, in Cuba,
139
392285
2942
06:47
the music, the food, the smells,
140
395227
3234
音乐、食物、气味，
几乎一切都不一样，
06:50
just about everything was different,
141
398461
2689
06:53
so faculty became family, ELAM home.
142
401150
5005
因此教职员工就像家人一样，拉丁美洲医学院就是家乡。
06:58
Religions ranged from indigenous beliefs
143
406155
2813
宗教信仰有当地的信仰、
07:00
to Yoruba, Muslim and Christian evangelical.
144
408968
4032
约鲁巴信仰、穆斯林信仰，以及基督教福音派信仰。
07:05
Embracing diversity became a way of life.
145
413000
4484
接受多元化成为了一种生活方式。
07:09
Why have so many countries
146
417484
1990
为何有这么多的国家
07:11
asked for these scholarships?
147
419474
2475
申请拉丁美洲医学院的奖学金？
07:13
First, they just don't have enough doctors,
148
421949
3252
第一，这些国家没有足够的医生，
07:17
and where they do, their distribution
149
425201
1766
即使在那些有足够数量的医生的国家，
07:18
is skewed against the poor,
150
426967
2442
医疗资源的分布也不利于穷人就医，
07:21
because our global health crisis
151
429409
2462
医护人员的人力资源缺乏
07:23
is fed by a crisis in human resources.
152
431871
2965
造成了全球医疗危机。
07:26
We are short four to seven million health workers
153
434836
3852
要满足基本医疗需求，
07:30
just to meet basic needs,
154
438688
2464
至少短缺400至700万的医护工作者，
这种短缺随处可见。
07:33
and the problem is everywhere.
155
441152
1858
07:35
Doctors are concentrated in the cities,
156
443010
2552
医生集中在城市，
07:37
where only half the world's people live,
157
445562
2610
而世界人口只有一半住在城市，
07:40
and within cities,
158
448172
1788
并且医生多在市区，
07:41
not in the shantytowns or South L.A.
159
449960
4179
不在贫民窟或南洛杉矶。
07:46
Here in the United States,
160
454139
1766
在美国，
07:47
where we have healthcare reform,
161
455905
2501
这里正在推行医疗改革，
07:50
we don't have the professionals we need.
162
458406
2548
可专业的医护人员仍显不足。
07:52
By 2020, we will be short
163
460954
2515
到2020年，
初级护理医师缺口将达45,000人，
07:55
45,000 primary care physicians.
164
463469
4139
我们也有部分责任：
07:59
And we're also part of the problem.
165
467608
2157
08:01
The United States is the number one importer
166
469765
2467
美国是最大的
发展中国家医生输入国。
08:04
of doctors from developing countries.
167
472232
4364
08:08
The second reasons students flock to Cuba
168
476596
2869
学生们涌向古巴的第二个原因，
08:11
is the island's own health report card,
169
479465
2227
是这个岛屿上
依赖强大的基础医疗护理的人们的健康水平。
08:13
relying on strong primary care.
170
481692
2970
08:16
A commission from The Lancet
171
484662
1822
《柳叶刀》的委员会，
08:18
rates Cuba among the best performing
172
486484
2506
将古巴列为
中等收入国家中健康水平最好的国家之一。
08:20
middle-income countries in health.
173
488990
2849
拯救儿童基金会将古巴列为
08:23
Save the Children ranks Cuba
174
491839
1946
08:25
the best country in Latin
America to become a mother.
America to become a mother.
175
493785
4636
拉丁美洲最适合做母亲的国家。
08:30
Cuba has similar life expectancy
176
498421
2989
古巴居民预期寿命跟美国基本持平，
08:33
and lower infant mortality than the United States,
177
501410
3232
婴儿死亡率要比美国更低，
08:36
with fewer disparities,
178
504642
2181
不平等的地方更少，
08:38
while spending per person
179
506823
1800
而古巴人均医疗费用
08:40
one 20th of what we do on health
180
508623
3015
只是
08:43
here in the USA.
181
511638
2149
美国的二十分之一。
08:45
Academically, ELAM is tough,
182
513787
2992
拉丁美洲医学院对学业要求很严格，
08:48
but 80 percent of its students graduate.
183
516779
3631
但毕业率达到80%。
08:52
The subjects are familiar —
184
520410
1346
所学科目（跟别处相比）基本一样
08:53
basic and clinical sciences —
185
521756
2474
——基础和临床医学——
08:56
but there are major differences.
186
524230
2426
但也有很大的不同。
08:58
First, training has moved out of the ivory tower
187
526656
3611
第一，医护培训走出了象牙塔，
09:02
and into clinic classrooms and neighborhoods,
188
530267
2902
学生们可在临床教室和周边社区实践，
09:05
the kinds of places most of these grads will practice.
189
533169
3364
大部分毕业生都会在这样的地方锻炼。
09:08
Sure, they have lectures and hospital rotations too,
190
536533
4094
当然，他们也会听讲座，也会在医院轮班，
09:12
but community-based learning starts on day one.
191
540627
5030
但基于社区的医疗实习从第一天就开始了。
09:17
Second, students treat the whole patient,
192
545657
3766
第二，学生全方位的诊疗病人，
09:21
mind and body,
193
549423
1914
09:23
in the context of their
families, their communities
families, their communities
194
551337
2506
结合他们的家庭、社区、
文化背景，
09:25
and their culture.
195
553843
2147
给予他们身体和心理上的照料。
09:27
Third, they learn public health:
196
555990
2900
第三，他们学习公共卫生，
09:30
to assess their patients' drinking water, housing,
197
558890
3100
评估病人的饮用水、住房、
社会和经济状况。
09:33
social and economic conditions.
198
561990
3296
第四，他们已经懂得，
09:37
Fourth, they are taught
199
565286
2531
09:39
that a good patient interview
200
567817
2767
良好的问诊
09:42
and a thorough clinical exam
201
570584
2104
和细致的临床检查，
09:44
provide most of the clues for diagnosis,
202
572688
2835
已经能为诊断提供大部分线索，
09:47
saving costly technology for confirmation.
203
575523
3903
从而不需要使用昂贵的技术进行确诊。
09:51
And finally, they're taught over and over again
204
579426
3550
最后，他们被反复教导
预防的重要性，
09:54
the importance of prevention,
205
582976
2044
09:57
especially as chronic diseases
206
585020
2400
尤其是慢性疾病来说更是如此，
09:59
cripple health systems worldwide.
207
587420
4160
慢性疾病已经使世界各地的医疗系统不堪重负。
10:03
Such an in-service learning
208
591580
3190
这样的服务性学习，
10:06
also comes with a team approach,
209
594770
2600
团队合作的方式，
10:09
as much how to work in teams
210
597370
2867
使他们学会了如何以一种谦逊的态度
10:12
as how to lead them,
211
600237
1946
与别人协作，
10:14
with a dose of humility.
212
602183
2127
以及如何领导团队。
10:16
Upon graduation, these doctors share
213
604310
2800
毕业时，这些医生将自己的知识和经验
10:19
their knowledge with nurse's aids, midwives,
214
607110
2710
与护士、助产士、
社区医疗工作者分享，
10:21
community health workers,
215
609820
1970
10:23
to help them become better at what they do,
216
611790
2386
来帮助他们，而非要替代他们，
10:26
not to replace them,
217
614176
1945
让他们的工作更加优秀，
以及与萨满和传统疗法的医护者协作。
10:28
to work with shamans and traditional healers.
218
616121
3129
拉丁美洲医学院的毕业生：
10:33
ELAM's graduates:
219
621311
2559
10:35
Are they proving this audacious experiment right?
220
623870
4657
他们的实际行动证明了这项大胆的试验是正确的吗？
10:40
Dozens of projects give us an inkling
221
628527
2295
通过数十个项目的成效，
我们可对他们的能力略窥一二。
10:42
of what they're capable of doing.
222
630822
2568
以加利福纳毕业生为例，
10:45
Take the Garífuna grads.
223
633390
1763
10:47
They not only went to work back home,
224
635153
2190
他们不仅回到家乡工作，
10:49
but they organized their communities to build
225
637343
2407
还联合当地社区，
10:51
Honduras' first indigenous hospital.
226
639750
3401
创办了洪都拉斯第一家本土医院。
受一位建筑师之助，
10:55
With an architect's help,
227
643151
2149
10:57
residents literally raised it from the ground up.
228
645300
4477
毫不夸张的说，人们从无到有地建立了这座医院。
11:01
The first patients walked through the doors
229
649777
2182
第一批病人
11:03
in December 2007,
230
651959
2340
在2007年12月步入医院大门，
11:06
and since then, the hospital has received
231
654299
2509
从那时起，
11:08
nearly one million patient visits.
232
656808
3150
医院接待了近100万人次病人求诊。
11:11
And government is paying attention,
233
659958
2161
政府对此也更加关注，
11:14
upholding the hospital as a model
234
662119
2521
将这所医院树立为
洪都拉斯农村公共医疗的典范。
11:16
of rural public health for Honduras.
235
664640
5179
拉丁美洲医学院的毕业生不但聪慧、
11:21
ELAM's graduates are smart,
236
669819
3648
11:25
strong and also dedicated.
237
673467
3453
坚强，而且极富使命感。
11:28
Haiti, January 2010.
238
676920
4354
海地，2010年1月，
11:33
The pain.
239
681274
1835
永远的伤痛。
11:35
People buried under 30 million tons of rubble.
240
683109
4003
人们被埋在3000万吨碎石下。
11:39
Overwhelming.
241
687112
2149
太让人难以接受了。
11:41
Three hundred forty Cuban doctors
242
689261
1878
340名古巴医生已就绪，
11:43
were already on the ground long term.
243
691139
2441
开展长期服务，
11:45
More were on their way. Many more were needed.
244
693580
2403
更多的人在前去的路上，但还需要更多。
11:47
At ELAM, students worked round the clock
245
695983
3244
在拉丁美洲医学院，
学生们昼夜不停地联系2000名毕业生，
11:51
to contact 2,000 graduates.
246
699227
3218
结果，数以百计的毕业生来到海地，
11:54
As a result, hundreds arrived in Haiti,
247
702445
3184
11:57
27 countries' worth, from Mali in the Sahara
248
705629
4297
他们从撒哈拉的马里共和国，
到圣卢西亚、玻利维亚、智利和美国等27个国家而来。
12:01
to St. Lucia, Bolivia, Chile and the USA.
249
709926
4488
12:06
They spoke easily to each other in Spanish
250
714414
3296
他们之间用西班牙语自如的沟通，
12:09
and listened to their patients in Creole
251
717710
2689
由于有古巴拉丁美洲医学院的
12:12
thanks to Haitian medical students
252
720399
2126
海地籍学生加入救援，
他们得以与伤者用克里奥耳语交流。
12:14
flown in from ELAM in Cuba.
253
722525
2227
很多人在此停留了数月，
12:16
Many stayed for months,
254
724752
1688
12:18
even through the cholera epidemic.
255
726440
2778
即使霍乱蔓延的情况下也是如此。
12:21
Hundreds of Haitian graduates
256
729218
2340
数以百计的海地毕业生
12:23
had to pick up the pieces,
257
731558
2722
不得不收拾残局，
暂搁自己的悲伤，
12:26
overcome their own heartbreak,
258
734280
2014
12:28
and then pick up the burden
259
736294
1866
扛起为海地建立
新的公共医疗系统的重担。
12:30
of building a new public health system for Haiti.
260
738160
3568
12:33
Today, with aid of organizations and governments
261
741728
2497
如今，
在挪威、古巴、巴西的政府和各类组织的帮助下，
12:36
from Norway to Cuba to Brazil,
262
744225
2553
数十个医疗中心已建立起来，医护人员也配备到位，
12:38
dozens of new health centers have been built,
263
746778
2226
12:41
staffed, and in 35 cases, headed
264
749004
3571
其中35个医疗中心，
由拉丁美洲医学院的毕业生主持工作。
12:44
by ELAM graduates.
265
752575
3922
12:48
Yet the Haitian story
266
756497
1868
海地的故事
12:50
also illustrates some of the bigger problems
267
758365
2059
也表明了其他诸多国家
12:52
faced in many countries.
268
760424
2216
面临的更大的问题。
12:54
Take a look:
269
762640
1744
看一下吧：
12:56
748 Haitian graduates by
2012, when cholera struck,
2012, when cholera struck,
270
764384
5782
2012年，在霍乱爆发时，748名海地毕业生，
13:02
nearly half working in the public health sector
271
770166
3746
接近一半在公共医疗机构工作，
13:05
but one quarter unemployed,
272
773912
2071
但有四分之一没有工作，
13:07
and 110 had left Haiti altogether.
273
775983
6110
110名已离开了海地。
13:14
So in the best case scenarios,
274
782093
2768
因此，在最好的情况下，
13:16
these graduates are staffing
275
784861
1870
这些学生都会有工作，
13:18
and thus strengthening public health systems,
276
786731
3249
加强公共医疗系统的服务，
13:21
where often they're the only doctors around.
277
789980
3179
在尚未有医疗服务的地区开展工作。
13:25
In the worst cases, there are simply not enough jobs
278
793159
2791
最糟糕的情况下，
公共医疗机构并没有足够多的工作机会，
13:27
in the public health sector,
279
795950
1642
13:29
where most poor people are treated,
280
797592
2566
而公共医疗机构正是大多数穷人看病的地方，
13:32
not enough political will, not enough resources,
281
800158
2799
政治意愿不够强烈，资源匮乏，
13:34
not enough anything —
282
802957
2206
一切都是缺乏的，
13:37
just too many patients with no care.
283
805163
3453
唯一不缺泛的，就是有太多的病人得不到医疗服务。
13:40
The grads face pressure from their families too,
284
808616
2984
毕业生也面临着来自家庭的压力，
13:43
desperate to make ends meet,
285
811600
2303
他们的家庭绝望的在温饱线上挣扎，
13:45
so when there are no public sector jobs,
286
813903
2576
因此，当缺少公共部门的就业机会时，
13:48
these new MDs decamp into private practice,
287
816479
2621
这些医学博士就进入私人执业，
13:51
or go abroad to send money home.
288
819100
4015
或出国工作，把钱寄回家。
13:55
Worst of all, in some countries,
289
823115
3185
最为糟糕的是，在一些国家，
13:58
medical societies influence accreditation bodies
290
826300
2936
在医疗协会的影响下，
认证机构不承认拉丁美洲医学院的学位，
14:01
not to honor the ELAM degree,
291
829236
3015
担心这些毕业生会抢他们的饭碗，
14:04
fearful these grads will take their jobs
292
832251
2317
14:06
or reduce their patient loads and income.
293
834568
3555
或者会减少病人的数量及他们的收入。
14:10
It's not a question of competencies.
294
838123
2981
这并非胜任力的问题。
14:13
Here in the USA, the California Medical Board
295
841104
2508
在美国，拉美医学院经过严格考核后，
14:15
accredited the school after rigorous inspection,
296
843612
3600
得到了加州医疗委员会的认证，
14:19
and the new physicians are making good
297
847212
2048
这些新医生不负众望，
14:21
on Cuba's big bet,
298
849260
2191
表现优异，
14:23
passing their boards and accepted
299
851451
1811
从纽约到芝加哥，到新墨西哥州，
14:25
into highly respected residencies
300
853262
2385
他们通过了审核，得到肯定，
14:27
from New York to Chicago to New Mexico.
301
855647
4091
成为受高度尊敬的新居民。
14:31
Two hundred strong, they're coming
302
859738
2625
200位毕业生回到美国，
14:34
back to the United States energized,
303
862363
2385
干劲十足，
14:36
and also dissatisfied.
304
864748
2587
但也有不满意的地方。
14:39
As one grad put it,
305
867335
1631
就像一位毕业生所说的，
14:40
in Cuba, "We are trained to provide quality care
306
868966
3454
在古巴，「我们学习在最有限的资源下
如何提供高质量的医疗护理，
14:44
with minimal resources,
307
872420
2002
所以当我看到我们在这所拥有的全部资源，
14:46
so when I see all the resources we have here,
308
874422
2576
14:48
and you tell me that's not possible,
309
876998
2162
你还告诉我那是不可能的，
14:51
I know it's not true.
310
879160
2170
我知道这不是事实。
14:53
Not only have I seen it work, I've done the work."
311
881330
5619
我不只是看到它能实现，我还亲自做成功了。」
14:58
ELAM's graduates,
312
886949
1961
拉丁美洲医学院的毕业生，
15:00
some from right here in D.C. and Baltimore,
313
888910
3517
有些就来自这儿，华盛顿特区和巴尔的摩，
15:04
have come from the poorest of the poor
314
892427
3168
有些来自最贫穷的地方，
15:07
to offer health, education
315
895595
2333
来为他们的社区提供医疗服务、教育，
15:09
and a voice to their communities.
316
897928
2916
并为社区「代言」。
15:12
They've done the heavy lifting.
317
900844
2652
他们已扛起重担。
15:15
Now we need to do our part
318
903496
2014
现在我们要做的是
15:17
to support the 23,000 and counting,
319
905510
3617
支持这23000名及后续的毕业生。
我们所有的人——
15:21
All of us —
320
909127
1354
15:22
foundations, residency directors, press,
321
910481
3634
基金会、居委会理事、媒体、
企业家、政策制定者，以及我们大家——
15:26
entrepreneurs, policymakers, people —
322
914115
3184
都需要行动起来。
15:29
need to step up.
323
917299
2153
15:31
We need to do much more globally
324
919452
1991
我们需要在全球范围内
15:33
to give these new doctors the opportunity
325
921443
2939
为这些新医生提供更多的机会，
15:36
to prove their mettle.
326
924382
2393
使他们能够施展才华。
15:38
They need to be able
327
926775
1003
15:39
to take their countries' licensing exams.
328
927778
3204
他们需要
通过所在国家的执业考试，
15:42
They need jobs in the public health sector
329
930982
2948
他们需要有公共医疗机构
15:45
or in nonprofit health centers
330
933930
1755
或非营利医疗机构的工作，
15:47
to put their training and commitment to work.
331
935685
3847
来把他们所学和使命付诸实践。
15:51
They need the chance to be
332
939532
2283
他们需要得到机会，
15:53
the doctors their patients need.
333
941815
4859
成为病人所需的医生。
为了推进医疗事业，
15:58
To move forward,
334
946674
1857
16:00
we may have to find our way back
335
948531
2992
我们或许不得不
回到一位儿科医生的道路上来。
16:03
to that pediatrician who would
336
951523
2183
在我还是个孩子的时候，
16:05
knock on my family's door
337
953706
1687
他到我们位于南芝加哥的家来拜访。
16:07
on the South Side of Chicago when I was a kid,
338
955393
3186
16:10
who made house calls,
339
958579
1910
他上门服务，
16:12
who was a public servant.
340
960489
2891
他真是一位人民公仆。
16:15
These aren't such new ideas
341
963380
1823
这些内容，对于医疗服务来说，
16:17
of what medicine should be.
342
965203
2362
没有什么新颖之处。
16:19
What's new is the scaling up
343
967565
2725
新颖的是其覆盖范围的扩大，
16:22
and the faces of the doctors themselves:
344
970290
3383
以及医生的面庞：
拉丁美洲医学院的毕业生，
16:25
an ELAM graduate is more likely to be a she
345
973673
3457
更可能是一名女性而非男性；
16:29
than a he;
346
977130
1930
16:31
In the Amazon, Peru or Guatemala,
347
979060
2927
一位在亚马逊、秘鲁或危地马拉
当地行医的本土医生；
16:33
an indigenous doctor;
348
981987
2351
16:36
in the USA, a doctor of color
349
984338
3014
在美国，很可能是一位能说流利的西班牙语的
16:39
who speaks fluent Spanish.
350
987352
2396
有色人种医生。
16:41
She is well trained, can be counted on,
351
989748
3679
她们受过良好训练，值得信赖，
16:45
and shares the face and culture of her patients,
352
993427
3644
她们与病人来自同一种族，并有文化共通感，
16:49
and she deserves our support surely,
353
997071
3409
她们理应获得我们的支持，
16:52
because whether by subway, mule, or canoe,
354
1000480
4466
因为无论是坐着地铁、骑着骡子，还是乘着独木舟，
她们都在教我们怎样将想法「付诸行动」。
16:56
she is teaching us to walk the walk.
355
1004946
2998
16:59
Thank you. (Applause)
356
1007944
5570
谢谢。（掌声）
ABOUT THE SPEAKER
Gail Reed - Cuban health care expertAmerican journalist and Havana resident Gail Reed spotlights a Cuban medical school that trains doctors from low-income countries who pledge to serve communities like their own.
Why you should listen
Many of the doctors treating ebola patients in Africa were trained in Cuba. Why? In this informative talk, journalist Gail Reed spotlights a Cuban medical school that trains doctors from low-income countries -- if they pledge to serve the communities who need them most.
More profile about the speakerGail Reed | Speaker | TED.com