ABOUT THE SPEAKER
Thulasiraj Ravilla - Vision activist
Thulasiraj Ravilla is the executive director of the Lions Aravind Institute of Community Ophthalmology, helping eye-care hospitals around the world build capacity to prevent blindness.

Why you should listen

As director of the Lions Aravind Institute of Community Opthalmology, Thulasiraj Ravilla is helping to promulgate the Aravind Eye Care System's exam, diagnosis and treatment model to find culturally relevant solutions to the problem of avoidable blindness throughout India, and throughout the world.

Ravilla serves as chair of the Southeast Asian arm of the International Agency for the Prevention of Blindness, and is head of Vision 2020: The Right to Sight, a global initiative for the elimination of blindness. He developed the LAICO-Aravind Eye Hospital Care System, and continues to lead it.

More profile about the speaker
Thulasiraj Ravilla | Speaker | TED.com
TEDIndia 2009

Thulasiraj Ravilla: How low-cost eye care can be world-class

图拉丝内贾 让维拉(Thulasiraj Ravilla):世界品质的低造价的眼护理

Filmed:
355,035 views

印度革命性的亚拉文视力保健相同给上万人带来了光明。亚拉文通过创新可以使得眼科治疗的费用降到很低,但同时又能保证质量。这对于我们思考其他服务行业的改革具有深远意义。
- Vision activist
Thulasiraj Ravilla is the executive director of the Lions Aravind Institute of Community Ophthalmology, helping eye-care hospitals around the world build capacity to prevent blindness. Full bio

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

00:15
Good morning早上.
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早上好。
00:17
I've come here to share分享 with you an experiment实验
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让我来很你们分享一个
00:21
of how to get rid摆脱 of one form形成 of human人的 suffering痛苦.
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可以让人摆脱苦难的实验。
00:25
It really is a story故事 of Dr博士. VenkataswamyVenkataswamy.
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这是维卡塔丝维敏博士(Dr. Venkataswamy)的故事。
00:28
His mission任务 and his message信息 is about the Aravind亚拉文 Eye Care关心 System系统.
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他的目标和他从亚拉文(Aravind)眼保健系统所发出的信号。
00:34
I think first it's important重要 for us to recognize认识 what it is to be blind.
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我想重要的是,我们首先得意识到失明意味着什么。
00:39
(Music音乐)
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(音乐)
00:43
Woman女人: Everywhere到处 I went looking for work, they said no,
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女人:当我去找工作得时候,每个人都说不可以,
00:47
what use do we have for a blind woman女人?
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我们要一个瞎女人有什么用?
00:50
I couldn't不能 thread线 a needle or see the lice虱子 in my hair头发.
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我不能穿针,也看不见我头发里得虱子。
00:53
If an ant蚂蚁 fell下跌 into my rice白饭, I couldn't不能 see that either.
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如果一个蚂蚁掉到我得米饭里,我也看不见。
00:57
ThulasirajThulasiraj RavillaRavilla: Becoming变得 blind is a big part部分 of it,
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图拉丝内贾 让维拉(Thulasiraj Ravilla):看不见就是这样的,
00:59
but I think it also deprives剥夺 the person of their livelihood生计, their dignity尊严,
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但是我想这也剥夺了一个人的生命, 和他们的尊严,
01:04
their independence独立, and their status状态 in the family家庭.
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他们的独立性,以及他们在家庭里的地位。
01:07
So she is just one amongst其中包括 the millions百万 who are blind.
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她只是成千上万盲人中的一个。
01:11
And the irony讽刺 is that they don't need to be.
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讽刺的是他们本可以避免失明。
01:14
A simple简单, well-proven充分证明 surgery手术 can restore恢复 sight视力 to millions百万,
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一个简单可行的手术可以让上千万人重见光明,
01:18
and something even simpler简单, a pair of glasses眼镜, can make millions百万 more see.
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或者更简单,一副眼镜,可以让更多的人看见。
01:23
If we add to that the many许多 of us here now
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如果看看在座各位都有谁
01:26
who are more productive生产的 because they have a pair of glasses眼镜,
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因为佩戴了眼镜而使得自己的效率得以提升,
01:30
then almost几乎 one in five Indians印度人 will require要求 eye care关心,
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那么五分之一的印度人都会需要视力保健,
01:33
a staggering踉跄 200 million百万 people.
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这个数字加起来有2亿
01:36
Today今天, we're reaching到达 not even 10 percent百分 of them.
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现在,我们还照顾不到他们中的10%。
01:40
So this is the context上下文 in which哪一个 Aravind亚拉文 came来了 into existence存在
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所以这是在亚拉文30年前
01:43
about 30 years年份 back
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面临的挑战。
01:46
as a post-retirement后退休 project项目 of Dr博士. V.
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而这所医院也成为了维博士 (Dr. V.)的退休后的心血工程。
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He started开始 this with no money.
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他白手起家。
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He had to mortgage抵押 all his life savings
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他用他毕生的积蓄
01:54
to make a bank银行 loan贷款.
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从银行贷款。
01:56
And over time, we have grown长大的 into a network网络 of five hospitals医院,
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现在,我们已经发展到5个医院的业务网里,
02:00
predominately主要 in the state of Tamil泰米尔人 Nadu德邦 and Puducherry本地治里,
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以泰米尔纳德邦和浦度查里邦为主,
02:04
and then we added添加 several一些, what we call Vision视力 Centers中心
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然后,我们加入了一些,我们称之为眼科中心的地方,
02:08
as a hub-and-spoke轮毂和辐条 model模型.
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于是形成了核心加辐射的模式。
02:10
And then more recently最近 we started开始 managing管理的 hospitals医院
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最近我们也开始在国家的其他地区
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in other parts部分 of the country国家
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管理医院
02:15
and also setting设置 up hospitals医院 in other parts部分 of the world世界 as well.
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同时在世界的其他地方也开始有所涉足。
02:19
The last three decades几十年,
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在上30年里,
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we have doneDONE about three-and-a-half三和半 million百万 surgeries手术,
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我们做了35万例手术,
02:25
a vast广大 majority多数 of them for the poor较差的 people.
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绝大多数是穷人。
02:29
Now, each year we perform演出 about 300,000 surgeries手术.
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现在,我们每年会做300000例手术。
02:34
A typical典型 day at Aravind亚拉文, we would do about a thousand surgeries手术,
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这是在亚拉文的一天,我们会做到大概近千例手术,
02:38
maybe see about 6,000 patients耐心,
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接见大概6000名病人,
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send发送 out teams球队 into the villages村庄 to examine检查, bring带来 back patients耐心,
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发出小队去医院里检查,和带病人回来,
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lots of telemedicine远程医疗 consultations磋商,
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执行很多远程咨询,
02:50
and, on top最佳 of that, do a lot of training训练,
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最重要的是,做很多培训,
02:53
both for doctors医生 and technicians技师 who will become成为 the future未来 staff员工 of Aravind亚拉文.
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他们中的很多人成为未来亚拉文的员工包括医生的技工。
03:00
And then doing this day-in日式 and day-out一天出, and doing it well,
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能每年入一日的保持这样的工作
03:04
requires要求 a lot of inspiration灵感 and a lot of hard work.
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这需要很多的精力和勤劳的工作。
03:08
And I think this was possible可能 thanks谢谢 to the building建造 blocks
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我想这之所以能够实现,要感谢为这尽心尽力的
03:11
put in place地点 by Dr博士. V.,
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维博士。
03:14
a value system系统, an efficient高效 delivery交货 process处理,
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他建立了一套价值系统,一个高效的手术流程,
03:18
and fostering培育 the culture文化 of innovation革新.
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并启迪了一种创新的文化
03:21
(Music音乐)
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(音乐)
03:29
Dr博士. V: I used to sit with the ordinary普通 village man because I am from a village,
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维博士:我通常和一个普通的乡下人坐在一起,因为我就是从乡下来的
03:33
and suddenly突然 you turn around and seem似乎 to be in contact联系 with his inner being存在,
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然后突然之间你似乎可以和他的内心交流,
03:37
you seem似乎 to be one with him.
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你似乎和他是一体的.
03:40
Here is a soul灵魂 which哪一个 has got all the simplicity简单 of confidence置信度.
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这里似乎有着一个拥有一切信心的灵魂.
03:45
Doctor医生, whatever随你 you say, I accept接受 it.
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博士,无论你说什么,我都会接受.
03:48
An implicit含蓄 faith信仰 in you
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一个暗藏在你身体中的信心
03:50
and then you respond响应 to it.
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然后你会回应这个信心.
03:52
Here is an old lady淑女 who has got so much faith信仰 in me, I must必须 do my best最好 for her.
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有一个年迈的女士对我有极大的信心,我必须为她做到最好.
03:57
When we grow增长 in spiritual精神 consciousness意识,
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当我们在一个有灵性的良知的环境下成长,
04:00
we identify鉴定 ourselves我们自己 with all that is in the world世界,
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我们就会按照这个来定义我们的世界,
04:03
so there is no exploitation开发.
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所以这里没有剥削.
04:06
It is ourselves我们自己 we are helping帮助.
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帮助的是我们自己,
04:09
It is ourselves我们自己 we are healing复原.
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被疗救的也是我们自己。
04:17
(Applause掌声)
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(掌声)
04:23
This helped帮助 us build建立 a very ethical合乎道德的 and very highly高度 patient-centric以病人为中心 organization组织
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这帮助我们创建了一个十分道德的和非常以病人为中心的机构
04:29
and systems系统 that support支持 it.
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以及一个支持这个机构的系统.
04:31
But on a practical实际的 level水平, you also have to deliver交付 services服务 efficiently有效率的,
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但是在实践过程中.你必须能十分有效的去完成这个服务,
04:37
and, odd as it may可能 seem似乎, the inspiration灵感 came来了 from McDonald's麦当劳.
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然而,让很多人吃惊的是,灵感来自于麦当劳.
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Dr博士. V: See, McDonald's'麦当劳 concept概念 is simple简单.
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维博士:看,麦当劳的概念很简单.
04:45
They feel they can train培养 people all over the world世界,
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他们觉得他们可以训练世界各地的人,
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irrespective不管 of different不同 religions宗教, cultures文化, all those things,
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无论不同的宗教,文化,和其他所有的事情,
04:56
to produce生产 a product产品 in the same相同 way
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去用一样的方法来创造一个产品
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and deliver交付 it in the same相同 manner方式
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然后以同样的方式
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in hundreds数以百计 of places地方.
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在成百上千个不同地方推出
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Larry拉里 Brilliant辉煌: He kept不停 talking about McDonalds麦当劳 and hamburgers汉堡包,
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拉里·布利连(Larry Brilliant):他一直的谈论这麦当劳和汉堡,
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and none没有 of it made制作 any sense to us.
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然后这一切都让我们摸不着头脑.
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He wanted to create创建 a franchise专营权,
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他想创造一个连锁店,
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a mechanism机制 of delivery交货 of eye care关心
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一个拥有麦当劳效率的
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with the efficiency效率 of McDonald's麦当劳.
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视力保健连锁店.
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Dr博士. V: Supposing假如 I'm able能够 to produce生产 eye care关心,
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维博士:假设我可以提供视力保健,
05:24
techniques技术, methods方法, all in the same相同 way,
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技术,方法,都用同一种方法,
05:28
and make it available可得到 in every一切 corner of the world世界.
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使之在世界任何地方都能运作,
05:31
The problem问题 of blindness失明 is gone走了.
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失明的问题也就不是问题了.
05:34
TRTR: If you think about it, I think the eyeball眼球 is the same相同,
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TR:如果你想想看.我想眼球是一样的,
05:37
as American美国 or African非洲人,
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无论是美国人还是非洲人,
05:39
the problem问题 is the same相同, the treatment治疗 is the same相同.
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问题都是一样的,疗程也是一样的.
05:42
And yet然而, why should there be so much variation变异 in quality质量 and in service服务,
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不同的是,质量和服务上则是千变万化的,
05:46
and that was the fundamental基本的 principle原理 that we followed其次
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这也是我们在设计服务系统中
05:49
when we designed设计 the delivery交货 systems系统.
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所遵循的基本条例.
05:52
And, of course课程, the challenge挑战 was that it's a huge巨大 problem问题,
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当然,我们的挑战是,
05:55
we are talking of millions百万 of people,
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我们谈的是千千万万的病人,
05:58
very little resource资源 to deal合同 with it,
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但我们的资源非常非常少
06:01
and then lots of logistics后勤 and affordability承受能力 issues问题.
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并且很多人是住在偏远地区,也支付不起看病的费用,这就成为巨大的挑战。
06:05
And then so, one had to constantly经常 innovate创新.
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所以,我们必须不断的创新.
06:08
And one of the early innovations创新, which哪一个 still continues继续,
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一个早期的创新,也是一个沿用至今的
06:11
is to create创建 ownership所有权 in the community社区 to the problem问题,
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就是在一个社区内对问题创造一个所有权,
06:15
and then engage从事 with them as a partner伙伴,
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然后让他们像伙伴一样参与进来,
06:18
and here is one such这样 event事件.
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这里有这样一个事件,
06:20
Here a community社区 camp just organized有组织的
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这里一个被社区自己所规划的
06:23
by the community社区 themselves他们自己,
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一个社区营地,
06:26
where they find a place地点, organize组织 volunteers志愿者,
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在那里,他们自己找到用地,组织志愿者,
06:29
and then we'll do our part部分. You know, check their vision视力,
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然后我们就做我们该做的,就是检查他们的视力,
06:34
and then you have doctors医生 who you find out what the problem问题 is
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医生会找到问题在哪里
06:37
and then determine确定 what further进一步 testing测试 should be doneDONE,
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并决定有必要执行进一步的测试,
06:40
and then those tests测试 are doneDONE by technicians技师
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然后这些测试有医疗技术人员完成,
06:45
who check for glasses眼镜,
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他们会检查镜片,
06:49
or check for glaucoma青光眼.
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或检查青光眼.
06:53
And then, with all these results结果, the doctor医生 makes品牌 a final最后 diagnosis诊断,
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然后,综合所有的结果,医生会做出最终的诊断,
06:57
and then prescribes规定 a line线 of treatment治疗,
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然后开出处方,
07:00
and if they need a pair of glasses眼镜, they are available可得到 right there at the camp site现场,
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如果他们需要一副眼镜,在营地里就可以拿到,
07:04
usually平时 under a tree.
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通常在树下面.
07:06
But they get glasses眼镜 in the frames of their choice选择,
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但是他们可以自己选择镜框,
07:09
and that's very important重要 because I think glasses眼镜,
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那是很重要的,因为我想镜片
07:12
in addition加成 to helping帮助 people see,
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可以帮人们看见,
07:14
is also a fashion时尚 statement声明, and they're willing愿意 to pay工资 for it.
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但是同时也是一个时尚的宣言,他们愿意为这付款.
07:22
So they get it in about 20 minutes分钟
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所以,他们可以在20分钟内得到眼镜
07:25
and those who require要求 surgery手术, are counseled劝告,
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然而对于那些需要手术的,在跟病人知会的前提下,
07:28
and then there are buses公共汽车 waiting等候,
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会坐巴士,
07:31
which哪一个 will transport运输 them to the base基础 hospital醫院.
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去到我们的医院接受手术。
07:34
And if it was not for this kind of logistics后勤 and support支持,
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如果不是有这样的运输和支持,
07:39
many许多 people like this would probably大概 never get services服务,
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很多像这样的人就不会得到这样的服务,
07:42
and certainly当然 not when they most need it.
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当然也不会在他们需要的时候得到.
07:46
They receive接收 surgery手术 the following以下 day,
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他们会在接下来的几天里得到手术,
07:50
and then they will stay for a day or two,
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然后他们会留院一两天,
07:53
and then they are put back on the buses公共汽车
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然后他们会搭乘巴士
07:55
to be taken采取 back to where they came来了 from,
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返回他们来的地方,
07:58
and where their families家庭 will be waiting等候 to take them back home.
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那里会有他们的家人等待领走他们.
08:03
(Applause掌声)
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(掌声)
08:09
And this happens发生 several一些 thousand times each year.
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这每年会发生上千次.
08:14
It may可能 sound声音 impressive有声有色 that we're seeing眼看 lots of patients耐心,
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也许我们接待很多病人是很让人惊叹的,
08:17
very efficient高效 process处理,
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一个十分有效的过程,
08:19
but we looked看着 at, are we solving the problem问题?
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但是我们看的是,我们在解决问题吗?
08:23
We did a study研究, a scientifically科学 designed设计 process处理,
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我们做了一个设计得非常好的调查,
08:25
and then, to our dismay沮丧,
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结果令我们十分沮丧,
08:27
we found发现 this was only reaching到达 seven percent百分 of those in need,
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我们发现我们只覆盖到了那些需要帮助的7%,
08:32
and we're not adequately充分 addressing解决 more, bigger problems问题.
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我们不能充分的解决更大的问题。
08:36
So we had to do something different不同,
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所以我们尝试了一些不同的事情,
08:38
so we set up what we call primary eye care关心 centers中心, vision视力 centers中心.
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所以我们架设起了我们叫做初级视力保健中心以及眼科中心。
08:43
These are truly paperless无纸化 offices办事处
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这是一个真正的无纸办公室
08:45
with completely全然 electronic电子 medical records记录 and so on.
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全部使用的都是电子医学设备。
08:49
They receive接收 comprehensive全面 eye exams考试.
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他们会收到一个全面的医学检查。
08:52
We kind of changed the simple简单 digital数字 camera相机 into a retinal视网膜 camera相机,
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我们把一个简单的数码照相机做成了一个视网膜照相机,
08:56
and then every一切 patient患者 gets得到 their teleconsultation远程会诊 with a doctor医生.
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然后每一位病人都会和一个医生做一次远程咨询。
09:02
The effect影响 of this has been that, within the first year,
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在第一年的效率是,
09:06
we really had a 40 percent百分 penetration渗透 in the market市场 that it served提供服务,
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我们的服务群体达至40%
09:11
which哪一个 is over 50,000 people.
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多达50000人。
09:13
And the second第二 year went up to 75 percent百分.
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然后第二年是75%。
09:15
So I think we have a process处理 by which哪一个
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我想我们得到了一个
09:17
we can really penetrate穿透 into the market市场
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通过渗透到市场
09:19
and reach达到 everyone大家 who needs需求 it,
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来给有需要的人提供服务的过程,
09:22
and in this process处理 of using运用 technology技术, make sure
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然后在这个过程中使用科技,来保证
09:25
that most don't need to come to the base基础 hospital醫院.
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大多数人不用去医院。
09:28
And how much will they pay工资 for this?
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然而,他们需要为此支付多少?
09:30
We fixed固定 the pricing价钱, taking服用 into account帐户
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每次诊疗的费用都是固定的
09:33
what they would save保存 in bus总线 fare票价 in coming未来 to a city,
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病人也省去了坐巴士去城市的价格,
09:37
so they pay工资 about 20 rupees卢比, and that's good for three consultations磋商.
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他们只需支付20印度卢比,那可以支付3次咨询。
09:41
(Applause掌声)
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(掌声)
09:44
The other challenge挑战 was, how do you give high-tech高科技
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另一个挑战是,我们如何能让高科技
09:47
or more advanced高级 treatment治疗 and care关心?
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给予治疗更多的便利?
09:50
We designed设计 a van面包车 with a VSATVSAT,
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我们在车里设计了透过卫星的网络连线
09:53
which哪一个 sends发送 out images图片 of patients耐心 to the base基础 hospital醫院
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可以将病人的图片送到医院里
09:57
where it is diagnosed确诊,
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在那里得出诊断,
10:00
and then as the patient患者 is waiting等候, the report报告 goes back to the patient患者,
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然后在病人等待的同时,报告就会及时送到病人身边,
10:04
it gets得到 printed印刷的 out, the patient患者 gets得到 it,
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打印出来,然后病人可以拿到,
10:07
and then gets得到 a consultation会诊 about what they should be doing --
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然后得到他们该做什么的咨询,
10:10
I mean, go see a doctor医生 or come back after six months个月,
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过去,病人去看一次医生要花半年的时间
10:13
and then this happens发生 as a way of
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现在有了这样的科技,
10:15
bridging桥接 the technology技术 competence权限.
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他们可以迅速的获取他们所需的信息。
10:20
So the impact碰撞 of all this has been essentially实质上 one of growing生长 the market市场,
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所以这些所有的影响是市场增长的基本因素之一,
10:24
because it focused重点 on the non-customer非客户,
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因为这注重于非用户,
10:27
and then by reaching到达 the unreached未得,
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然后触及到了所没有触及的市场,
10:30
we're able能够 to significantly显著 grow增长 the market市场.
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我们可以显著的让市场成长。
10:32
The other aspect方面 is how do you deal合同 with this efficiently有效率的
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另一方面就是当医院的眼科医生很少的时候
10:36
when you have very few少数 ophthalmologists眼科医生?
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如何提高做手术的效率?
10:39
So what is in this video视频 is a surgeon外科医生 operating操作,
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所以这个视频显示的是一个外科手术,
10:42
and then you see on the other side,
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你可以看到在另外一个桌上,
10:44
another另一个 patient患者 is getting得到 ready准备.
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另外一个病人已经准备好了。
10:46
So, as they finish the surgery手术,
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这样,当他们完成手术后,
10:49
they just swing摇摆 the microscope显微镜 over,
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他们就会把显微镜移到另一边
10:52
the tables are placed放置 so that their distance距离 is just right,
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桌子放的距离恰到好处,
10:56
and then we need to do this, because, by doing this kind of process处理,
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我们必须这样做,因为,这样做的话
10:59
we're able能够 to more than quadruple the productivity生产率 of the surgeon外科医生.
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我们才有能力做到有效的手术。
11:04
And then to support支持 the surgeon外科医生,
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因此,为了支持手术,
11:06
we require要求 a certain某些 workforce劳动力.
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我买也雇佣了劳动力。
11:09
And then we focused重点 on village girls女孩 that we recruited应征,
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我们雇佣的都是乡下女孩,
11:13
and then they really are the backbone骨干 of the organization组织.
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她们给整个机构带来了底气。
11:16
They do almost几乎 all of the skill-based技能为主 routine常规 tasks任务.
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它们几乎做着所有技术为主的日程工作。
11:20
They do one thing at a time. They do it extremely非常 well.
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她们一心一意。完成的十分出色。
11:23
With the result结果 we have very high productivity生产率,
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结果就是,我们的花费十分低,
11:26
very high quality质量 at very, very low cost成本.
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但质量和效率都十分高。
11:31
So, putting all this together一起, what really happened发生 was
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所以,总而言之,事实是
11:34
the productivity生产率 of our staff员工 was
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我们员工的生产效率比
11:37
significantly显著 higher更高 than anyone任何人 else其他.
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任何人都要高出很多。
11:40
(Applause掌声)
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(掌声)
11:46
This is a very busy table,
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这是一个十分忙碌的办公桌,
11:48
but what this really is conveying输送 is that,
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但是这所传达的是,
11:50
when it comes to quality质量, we have put in
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当要保证质量的时候,我们有一个
11:52
very good quality-assurance质量保证 systems系统.
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能保障质量的系统。
11:55
As a result结果, our complications并发症 are significantly显著 lower降低
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结果就是,我们的并发症
11:58
than what has been reported报道 in the United联合的 Kingdom王国,
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要远比伦敦的低,
12:01
and you don't see those kind of numbers数字 very often经常.
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这样的数字你是很少会看到的。
12:04
(Applause掌声)
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(掌声)
12:06
So the final最后 part部分 of the puzzle难题 is,
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所以最后的迷题是,
12:08
how do you make all this work financially经济,
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我们如何保证资金运转正常?
12:11
especially特别 when the people can't pay工资 for it?
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要知道我们大部分病人都无法支付看病的费用!
12:14
So what we did was, we gave away a lot of it for free自由,
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我们的做法是,很多都是免费的,
12:18
and then those who pay工资, I mean, they paid支付 local本地 market市场 rates利率,
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对于那些有能力支付的病人,我们收取当地市场的价格
12:21
nothing more, and often经常 much less.
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不多于这个,通常是少于这个的,
12:23
And we were helped帮助 by the market市场 inefficiency低效.
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我们被市场的低效率性所帮助了。
12:26
I think that has been a big savior救主, even now.
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我想这是我们的救星,直到现在。
12:29
And, of course课程, one needs需求 the mindset心态 to be wanting希望 to give away
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当然了,一个人必须有一个能
12:33
what you have as a surplus剩余.
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放弃的的盈余的思维。
12:36
The result结果 has been, over the years年份,
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结果就是,在近几年里,
12:38
the expenditure支出 has increased增加 with volumes.
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我们的支出显著增长,
12:40
The revenues收入 increase增加 at a higher更高 level水平,
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我们的收入则是以更高速度在增长
12:42
giving us a healthy健康 margin余量
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这样一来,我们可以保证有健康的盈余
12:44
while you're treating治疗 a large number of people for free自由.
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因为我们需要免费为很多病人提供治疗
12:48
I think in absolute绝对 terms条款,
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从绝对数字来说,
12:50
last year we earned about 20-odd-奇 million百万 dollars美元,
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去年,我们挣了大概2000万美元,
12:53
spent花费 about 13 million百万, with over a 40 percent百分 EBITAEBITA.
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用了1300万美元,超过税前利润40%。
12:58
(Applause掌声)
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(掌声)
13:06
But this really requires要求 going beyond what we do,
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但是这意味着我们要超越我们现在所做的,
13:09
or what we have doneDONE,
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或着我们已经做的,
13:12
if you really want to achieve实现 solving this problem问题 of blindness失明.
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如果你真的想去解决失明的问题。
13:15
And what we did was a couple一对 of very counter-intuitive反直觉 things.
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所以我们做了一些反直觉的事情。
13:19
We created创建 competition竞争 for ourselves我们自己,
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我们为我们自己创造了竞争对手,
13:22
and then we made制作 eye care关心 affordable实惠
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这样使得眼保健的价格降得更低
13:25
by making制造 low-cost低成本 consumables耗材.
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让更多人可以享受到这样的服务
13:28
We proactively主动 and systematically系统
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我们主动的,系统化的
13:31
promoted提拔 these practices做法 to many许多 hospitals医院 in India印度,
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在印度的很多医院里宣传这个实践,
13:35
many许多 in our own拥有 backyards后院 and then in other parts部分 of the world世界 as well.
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很多是在我们自己的地盘,也有世界其他地方。
13:38
The impact碰撞 of this has been that these hospitals医院,
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结果是,
13:42
in the second第二 year after our consultation会诊,
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那些我们提供咨询的医院
13:45
are double their output产量
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他们的手术数量翻了一番
13:47
and then achieve实现 financial金融 recovery复苏 as well.
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也使得收益得以改善
13:53
The other part部分 was how do you address地址
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另一个部分就是你这样对待
13:56
this increase增加 in cost成本 of technology技术?
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科技消费上的增长?
14:00
There was a time when we failed失败 to negotiate谈判
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我们后来没能谈下来一个
14:03
the [intra-ocular lens镜片] prices价格 to be at affordable实惠 levels水平,
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可以接受的内眼镜片的价格,
14:05
so we set up a manufacturing制造业 unit单元.
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于是我们干脆就设立了自己的流水线。
14:09
And then, over time, we were able能够 to bring带来 down the cost成本 significantly显著
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这样,一段时间后,我们就有能力将支出显著的降低
14:13
to about two percent百分 of what it used to be when we started开始 out.
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到我们开始的2个百分点。
14:18
Today今天, we believe we have about seven percent百分 of the global全球 market市场,
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现在,我们相信我们占有了全球市场的7%,
14:22
and they're used in about 120-odd-奇 countries国家.
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在大概120的国家里。
14:26
To conclude得出结论, I mean, what we do, does it have a broader更广泛 relevance关联,
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总而言之,我要提出的是,我们是要将这个模式推广出去,
14:31
or is it just India印度 or developing发展 countries国家?
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还是只是将它保留在印度或其他发展中国家?
14:36
So to address地址 this, we studied研究 UK联合王国 versus Aravind亚拉文.
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为了能说明这,我们比较了一下英国的眼科治疗和亚拉文。
14:43
What it shows节目 is that we do roughly大致 about 60 percent百分
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这显示了,我们做的是英国
14:46
of the volume of what the UK联合王国 does,
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的60倍大小,
14:49
near a half-million半亿 surgeries手术 as a whole整个 country国家.
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整个国家的手术有50万例。
14:52
And we do about 300,000.
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而我们的300000。
14:55
And then we train培养 about 50 ophthalmologists眼科医生
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而且我们训练大概50个眼科医生
14:58
against反对 the 70 trained熟练 by them,
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他们要训练70个,
15:01
comparable可比 quality质量, both in training训练 and in patient患者 care关心.
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训练和病人护理的质量都是同等级别的
15:04
So we're really comparing比较 apples苹果 to apples苹果.
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我们真的是用苹果来比较苹果。
15:07
We looked看着 at cost成本.
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我们看看消费上。
15:09
(Laughter笑声)
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(笑)
15:11
(Applause掌声)
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(鼓掌)
15:17
So, I think it is simple简单 to say
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所以,我想这要说的是
15:19
just because the U.K. isn't India印度 the difference区别 is happening事件.
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因为这在英国没成功但印度成功了。
15:23
I think there is more to it.
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我想还有更多的可以做。
15:25
I mean, I think one has to look at other aspects方面 as well.
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我的意思是,我想也要看看其他的方面。
15:27
Maybe there is --
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也许
15:29
the solution to the cost成本 could be in productivity生产率,
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降低成本的方法就在生产效率里,
15:33
maybe in efficiency效率, in the clinical临床 process处理,
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也许在高效里,在诊所的过程里,
15:36
or in how much they pay工资 for the lenses镜头 or consumables耗材,
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或者在他们能支付多贵的镜片里,
15:39
or regulations法规, their defensive防御性 practice实践.
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或条例里,或者在实践里。
15:42
So, I think decoding解码 this can probably大概 bring带来
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所以,我想破解这些也许可以
15:45
answers答案 to most developed发达 countries国家
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给大多数发达国家
15:50
including包含 the U.S., and maybe
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包括美国带来答案,或许
15:52
Obama's奥巴马 ratings评级 can go up again.
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奥巴马的支持率会再度升高。
15:55
(Laughter笑声)
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(笑)
15:59
Another另一个 insight眼光, which哪一个, again, I want to leave离开 with you,
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另外一个观点,就是,我想留给你们,
16:03
in conditions条件 where the problem问题 is very large,
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当问题十分大的时候,
16:06
which哪一个 cuts削减 across横过 all economic经济 strata地层,
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当问题是在这个经济阶层的时候,
16:08
where we have a good solution,
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当我们有一个好的方法,
16:11
I think the process处理 I described描述,
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我想我刚才已经描述了过程,
16:13
you know, productivity生产率, quality质量, patient-centered以病人为中心 care关心,
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你找到,生产率,质量,病人中心的护理,
16:17
can give an answer回答,
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可以给出答案,
16:20
and there are many许多 which哪一个 fit适合 this paradigm范例.
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有很多都很适合这个范例。
16:22
You take dentistry牙科, hearing听力 aid援助, maternity母道 and so on.
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你可以用到牙科,助听器,产假等。
16:25
There are many许多 where this paradigm范例 can now play,
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有很多这个范例都可以做到,
16:28
but I think probably大概 one of the most challenging具有挑战性的 things
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但是我想最有挑战力的事情
16:30
is on the softer柔和 side.
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是在“软件”上。
16:32
Now, how do you create创建 compassion同情?
287
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现在,你们怎样创造关怀?
16:34
Now, how do you make people own拥有 the problem问题,
288
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现在你怎样让群众拥有问题,
16:36
want to do something about it?
289
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让他们想对此做点什么?
16:38
There are a bit harder更难 issues问题.
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这样就是更难一点的问题。
16:40
And I'm sure people in this crowd人群 can probably大概 find the solutions解决方案 to these.
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我肯定在座的会有人找到答案。
16:44
So I want to end结束 my talk leaving离开 this thought and challenge挑战 to you.
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所以我想我用这个问题和挑战来结束这个演讲。
16:47
Dr博士. V: When you grow增长 in spiritual精神 consciousness意识,
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维博士:当你是在一个有灵性良心的环境下的时候,
16:50
we identify鉴定 with all that is in the world世界
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你会认为世界充满了这些
16:53
so there is no exploitation开发.
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所以就没有了压迫。
16:56
It is ourselves我们自己 we are helping帮助.
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我们帮助的最终是我们自己
16:58
It is ourselves我们自己 we are healing复原.
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我们疗救的最终也是我们自己。
17:01
TRTR: Thank you very much.
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主持人:十分感谢你。
17:03
(Applause掌声)
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(掌声)
Translated by Halei Liu
Reviewed by Tony Yet

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ABOUT THE SPEAKER
Thulasiraj Ravilla - Vision activist
Thulasiraj Ravilla is the executive director of the Lions Aravind Institute of Community Ophthalmology, helping eye-care hospitals around the world build capacity to prevent blindness.

Why you should listen

As director of the Lions Aravind Institute of Community Opthalmology, Thulasiraj Ravilla is helping to promulgate the Aravind Eye Care System's exam, diagnosis and treatment model to find culturally relevant solutions to the problem of avoidable blindness throughout India, and throughout the world.

Ravilla serves as chair of the Southeast Asian arm of the International Agency for the Prevention of Blindness, and is head of Vision 2020: The Right to Sight, a global initiative for the elimination of blindness. He developed the LAICO-Aravind Eye Hospital Care System, and continues to lead it.

More profile about the speaker
Thulasiraj Ravilla | Speaker | TED.com

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