TEDGlobal 2010
Mitchell Besser: Mothers helping mothers fight HIV
Mitchell Besser: 母亲互助同抗艾滋
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在非洲撒哈拉以南地区, 艾滋传染极为严重,而医生则比世界上任何其他地方都更为紧缺. 在缺乏职业医疗人员的情况下,Mitchell Besser 通过招募他的病人来建立了mothers2mothers -- 这个非凡的由艾滋感染女性组成的互助组织正在改善和拯救着生命.
Mitchell Besser - HIV/AIDS fighter
How can mothers with HIV avoid passing it to their kids? In South Africa, Mitchell Besser tapped a new resource for healthcare: moms themselves. The program he started, mothers2mothers, trains new mothers to educate and support other moms. Full bio
How can mothers with HIV avoid passing it to their kids? In South Africa, Mitchell Besser tapped a new resource for healthcare: moms themselves. The program he started, mothers2mothers, trains new mothers to educate and support other moms. Full bio
Double-click the English transcript below to play the video.
00:16
I want you to take a trip with me.
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我要你们和我一起去体验一段旅程.
00:18
Picture yourself driving
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想象你们开着车
00:20
down a small road in Africa,
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行驶在非洲的一条小路上,
00:22
and as you drive along, you look off to the side,
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行驶途中, 当你透过车窗,望向路旁,
00:25
and this is what you see:
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这是你所看到的景象:
00:27
you see a field of graves.
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你看到一片坟墓.
00:29
And you stop, and you get out of your car and you take a picture.
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你停下来,走下车,将这一幕拍下.
00:31
And you go into the town,
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然后你到了镇里,
00:33
and you inquire, "What's going on here?"
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问人们, "照片上这个地方发生了什么事情?"
00:35
and people are initially reluctant to tell you.
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大家一开始不愿意告诉你.
00:37
And then someone says,
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然后有人说,
00:39
"These are the recent AIDS deaths in our community."
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"这些是最近在我们这里因为艾滋病而死的人."
00:43
HIV isn't like other medical conditions;
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艾滋病不像别的病;
00:45
it's stigmatizing.
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它让人觉得羞耻自卑.
00:47
People are reluctant to talk about it --
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人们不愿意谈及它.
00:50
there's a fear associated with it.
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它让人感到恐惧.
00:52
And I'm going to talk about HIV today,
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而我今天将会谈及艾滋病,
00:54
about the deaths,
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谈及由它引起的死亡,
00:56
about the stigma.
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以及人们关于对艾滋病的这种羞耻心理.
00:58
It's a medical story, but more than that, it's a social story.
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这不仅是一个医学上的问题, 也是一个社会问题.
01:03
This map depicts the global distribution of HIV.
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这幅地图描绘了全球艾滋病的分布情况.
01:06
And as you can see,
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同时, 你们可以看见,
01:08
Africa has a disproportionate share of the infection.
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非洲受感染比例大大超出平均水平.
01:10
There are 33 million people
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今天全球有3300万
01:12
living with HIV in the world today.
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艾滋病带菌者.
01:14
Of these, two-thirds, 22 million
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其中,三分之二, 也即2200万,
01:17
are living in sub-Saharan Africa.
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生活在撒哈拉以南非洲.
01:20
There are 1.4 million pregnant women
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有140万怀孕的女性
01:23
in low- and middle-income countries living with HIV
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带着艾滋病病毒生活在中低收入国家,
01:26
and of these, 90 percent
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而其中的90%
01:28
are in sub-Saharan Africa.
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就在撒哈拉以南的非洲.
01:32
We talk about things in relative terms.
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让我们通过对比来说明问题.
01:34
And I'm going to talk about annual pregnancies
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以每年怀孕
01:36
and HIV-positive mothers.
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的带有艾滋病病毒的母亲为例.
01:38
The United States -- a large country --
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在美国 -- 一个大国 --
01:40
each year, 7,000 mothers with HIV
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每年有七千带有艾滋病病毒的母亲
01:43
who give birth to a child.
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生下孩子.
01:46
But you go to Rwanda -- a very small country --
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但在卢旺达 -- 一个很小的国家 --
01:49
8,000 mothers with HIV who are pregnant.
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每年就有8千个带有艾滋病病毒的母亲怀孕.
01:53
And then you go to Baragwanath Hospital,
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Baragwanath医院,
01:56
outside of Johannesburg in South Africa,
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位于南非约翰内斯堡的远郊,
01:59
and 8,000 HIV-positive pregnant women
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那儿每年有八千个携有艾滋病病毒的母亲
02:01
giving birth --
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临产 --
02:03
a hospital the same as a country.
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一个医院就抵过一个国家.
02:06
And to realize that this is just the tip of an iceberg
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想一想这只是冰山一角,
02:09
that when you compare
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因此, 当你拿这里所发生的一切
02:11
everything here to South Africa, it just pales,
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与南非相比, 都显得不值一提,
02:13
because in South Africa,
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因为,在南非,
02:16
each year 300,000 mothers with HIV
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每年就有30万携带艾滋病病毒的母亲
02:19
give birth to children.
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临产.
02:23
So we talk about PMTCT,
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当我们谈到PMTCT,
02:25
and we refer to PMTCT, prevention of mother to child transmission.
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我们所说的PMTCT, 即防止母子垂直传染.
02:28
I think there's an assumption amongst most people in the public
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我想大部分公众会认为
02:31
that if a mother is HIV-positive,
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如果一个母亲是艾滋病带菌者,
02:33
she's going to infect her child.
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那么, 她就会把这个病毒传染给她的孩子.
02:35
The reality is really, very different.
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这与事实却相去甚远.
02:38
In resource-rich countries,
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在资源富足的国家,
02:40
with all the tests and treatment we currently have,
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在我们现有的检测和治疗条件下,
02:42
less than two percent of babies are born HIV-positive --
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仅有不到2%的婴儿生下来后艾滋病病毒检测是呈阳性.
02:45
98 percent of babies are born HIV-negative.
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98%的婴儿在生下来的时候艾滋病病毒检测是阴性.
02:49
And yet, the reality in resource-poor countries,
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但是, 现实是在资源稀缺的国家,
02:51
in the absence of tests and treatment,
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在缺乏检测和治疗条件下,
02:53
40 percent -- 40 percent of children are infected --
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40%, 40% 的孩子生下来就被感染了艾滋病病毒 --
02:56
40 percent versus two percent --
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40% 比 2% --
02:58
an enormous difference.
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是相当大的差距.
03:00
So these programs --
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而这些项目--
03:02
and I'm going to refer to PMTCT though my talk --
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我将在我的讲话里称之为PMTCT --
03:04
these prevention programs,
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这些预防项目,
03:06
simply, they're the tests and the drugs that we give to mothers
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简单的说, 是指为母亲们提供检测和药物
03:09
to prevent them from infecting their babies,
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来防止她们将病毒传染给她们的孩子,
03:12
and also the medicines we give to mothers
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同时, 我们也为母亲们提供药品
03:14
to keep them healthy and alive to raise their children.
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以便她们能够健康地活着并带大她们的孩子.
03:16
So it's the test a mother gets when she comes in.
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所以, 母亲们来到这里时会接受这样一个检测,
03:18
It's the drugs she receives
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这是给她的药品
03:20
to protect the baby that's inside the uterus and during delivery.
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用来保护婴儿在子宫里和生产过程中不受感染
03:23
It's the guidance she gets around infant feeding
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这是她所接受的关于哺乳
03:25
and safer sex.
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和性生活的辅导
03:27
It's an entire package of services,
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这是这一整套的服务,
03:30
and it works.
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而它是行而有效的.
03:32
So in the United States,
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所以在美国,
03:34
since the advent of treatment in the middle of the 1990s,
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自从上个世纪90年代中在艾滋病治疗上取得进步以后,
03:37
there's been an 80-percent decline
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就实现了80%的减幅,
03:39
in the number of HIV-infected children.
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在艾滋病带菌儿童的数目上.
03:41
Less than 100 babies are born with HIV
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仅有不到100个婴儿是生下来就带着艾滋病病毒的,
03:43
each year in the United States
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每年, 在美国.
03:45
and yet, still,
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但是, 目前
03:47
over 400,000 children
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每年全球仍然有超过40万儿童
03:50
are born every year in the world today with HIV.
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生下来就是艾滋病带菌者.
03:54
What does that mean?
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这意味着什么呢?
03:56
It means 1,100 children infected each day --
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这意味着每天有1,100个儿童受感染 --
03:59
1,100 children each day, infected with HIV.
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每天1,100个儿童感染艾滋病病毒.
04:02
And where do they come from?
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他们来自哪里呢?
04:04
Well, less than one comes from the United States.
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这个, 来自美国的少于一个.
04:08
One, on average, comes from Europe.
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平均来自欧洲的有一个.
04:12
100 come from Asia and the Pacific.
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100个来自亚太地区.
04:16
And each day,
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而每天,
04:18
a thousand babies -- a thousand babies
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就有一千个携带艾滋病病毒的婴儿, 一千个,
04:21
are born each day with HIV in Africa.
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在非洲出生.
04:26
So again, I look at the globe here
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因此, 当我再看看这张全球分布图
04:28
and the disproportionate share of HIV in Africa.
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能看到, 非洲在艾滋病带菌者分布上的高比例.
04:31
And let's look at another map.
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让我们来看另外一幅地图.
04:33
And here, again, we see
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在这里我们再次看到
04:35
Africa has a disproportionate share of the numbers of doctors.
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非洲的医生数量远远低于平均水平.
04:38
That thin sliver you see here, that's Africa.
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那薄薄的银色部分, 就是非洲了.
04:41
And it's the same with nurses.
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护士的数量也一样.
04:44
The truth is sub-Saharan Africa
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事实是, 在撒哈拉以南非洲
04:46
has 24 percent
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占了全球24%
04:48
of the global disease burden
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的疾病分布
04:50
and yet only three percent of the world's health care workers.
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但是,却仅有3%的医护人员在这里工作.
04:53
That means doctors and nurses
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这意味着医生和护士
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simply don't have the time to take care of patients.
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根本就没有时间去照顾病人.
04:58
A nurse in a busy clinic
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在一个繁忙的诊所里, 一个护士
05:00
will see 50 to 100 patients in a day,
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每天要看50 到100 个病人,
05:02
which leaves her just minutes per patient --
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在每个病人身上她只能花几分钟 --
05:04
minutes per patient.
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几分钟.
05:06
And so when we look at these PMTCT programs, what does it mean?
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所以, 当我们重新谈及PMTCT项目的时候, 这意味着什么呢？
05:09
Well, back in 2001,
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在2001年的时候,
05:11
when there was just a simple test
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那个时候只有一个简单的测试
05:13
and a single dose of a drug,
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和一剂药
05:15
a nurse, in the course of her few minutes with a patient,
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每个护士, 在跟一个病人相处的短短的几分钟里,
05:18
would have to counsel for the HIV test, perform the HIV test,
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她要对这个病人做艾滋病病毒检测,
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explain the results, dispense a single dose of the drug, Nevirapine,
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解释检测结果, 配一剂药- Nevirapine,
05:24
explain how to take it, discuss infant feeding options, reinforce infant feeding,
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向病人说明如何用药, 跟她讨论如何更好地哺育婴儿,,
05:27
and test the baby -- in minutes.
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还要在这几分钟里对婴儿进行检测.
05:30
Well, fortunately since 2001,
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幸好, 从2001年以后,
05:32
we've got new treatments, new tests,
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我们有了新的治疗方法, 新的检测手段,
05:34
and we're far more successful,
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我们的工作取得了很大的进步,
05:36
but we don't have any more nurses.
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但我们没有更多的护士.
05:38
And so these are the tests
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而这些测试是
05:41
a nurse now has to do
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一个护士必须完成的
05:43
in those same few minutes.
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在同样的短短几分钟里.
05:45
It's not possible --
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这样不行.
05:47
it doesn't work.
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这是没有效果的.
05:49
And so we need to find
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我们必须想出
05:51
better ways of providing care.
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更好的方法来护理这些病人.
05:56
This is a picture of a maternal health clinic in Africa --
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这个图显示了非洲的产妇健康诊所--
05:59
mothers coming, pregnant and with their babies.
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母亲们怀着她们的婴儿来到这些诊所.
06:02
These women are here for care,
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这些女人是来接受医疗护理的,
06:04
but we know that just doing a test,
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但是我们知道, 只做一个检测,
06:06
just giving someone a drug,
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只给她们一份药,
06:08
it's not enough.
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是不够的.
06:11
Meds don't equal medical care.
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药品并不等于医疗护理.
06:14
Doctors and nurses, frankly,
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坦白说, 医生和护士,
06:16
don't have the time or skills
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没有足够的时间和技巧
06:18
to tell people what to do in ways they understand.
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用人们能够明白的途径来告诉他们该怎么做.
06:20
I'm a doctor -- I tell people things to do,
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我是一个医生. 我告诉人们该做的事,
06:23
and I expect them to follow my guidance --
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而我也期待他们根据我的指引去做 --
06:25
because I'm a doctor; I went to Harvard --
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因为我是一个医生, 我在哈佛读过书 --
06:27
but the reality is,
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但实际上,
06:29
if I tell a patient, "You should have safer sex.
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如果我跟一个病人说, "你应该有更安全的性生活.
06:31
You should always use a condom,"
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你应该一直使用避孕套,"
06:33
and yet, in her relationship, she's not empowered --
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这不起作用, 因为在她和异性的关系里, 她并没有这种权力 --
06:36
what's going to happen?
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那接下来会发生什么呢?
06:38
If I tell her to take her medicines every day
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如果我让她每天吃药,
06:41
and yet, no one in the household knows about her illness, so
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但是, 她的家里没有人知道她的病, 那
06:44
it's just not going to work.
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这根本就不会起作用.
06:47
And so we need to do more,
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所以我们必须做更多,
06:49
we need to do it differently,
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我们必须采用不同的途径,
06:51
we need to do it in ways that are affordable
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我们必须通过更实际的
06:54
and accessible and can be taken to scale,
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更可行的的和更容易被推广的方式来做这些事情,
06:56
which means it can be done everywhere.
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这意味着它在什么地方都能使用.
06:59
So, I want to tell you a story --
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所以,我要告诉你们一个故事.
07:02
I want to take you on a little trip.
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我要带你们经历一段短暂的旅程
07:04
Imagine yourself, if you can,
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如果可以的话,你想象一下,
07:06
you're a young woman in Africa, you're going to the hospital or clinic.
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你是一个年轻的非洲女性, 你要去一个医院或诊所.
07:09
You go in for a test
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你去做一个检测,
07:11
and you find out that you're pregnant, and you're delighted.
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然后, 你发现你怀孕了, 你很兴奋.
07:13
And then they give you another test
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但他们又让你做了另外一个测试,
07:15
and they tell you you're HIV-positive, and you're devastated.
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然后告诉你, 你对艾滋病病毒呈阳性反应, 你绝望了.
07:18
And the nurse takes you into a room,
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护士把你带到一个房间里,
07:20
and she tells you about the tests
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她跟你解释这些检测的项目,
07:22
and HIV and the medicines you can take
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解释什么是艾滋病,并告诉你该吃什么药,
07:24
and how to take care of yourself and your baby,
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怎么来照顾你自己和你的孩子,
07:26
and you hear none of it.
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但是你什么都听不进去.
07:28
All you're hearing is, "I'm going to die,
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你能听见的是, "我要死了,
07:30
and my baby is going to die."
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我的宝宝也要死了."
07:32
And then you're out on the street, and you don't know where to go.
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然后你走到街上, 你不知道要去什么地方,
07:34
And you don't know who you can talk to,
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你也不知道能跟谁倾诉,
07:36
because the truth is, HIV is so stigmatizing
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因为现实是,艾滋病是那么让人忌违
07:39
that if you partner, your family, anyone in your home,
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你的另一半,你的家人,家里任何一个人, 如果知道这件事的话,
07:42
you're likely to be thrown out
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你就很有可能会被赶出去
07:44
without any means of support.
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无依无靠.
07:46
And this -- this is the face and story
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而这个, 这个就是
07:48
of HIV in Africa today.
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今天艾滋病病人在非洲的处境, 以及她们的故事.
07:51
But we're here to talk about possible solutions
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但我们接下来还要谈可能的解决方案
07:54
and some good news.
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以及一些好消息.
07:56
And I want to change the story a little bit.
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而我要把这个故事稍稍改动一下.
07:59
Take the same mother, and the nurse, after she gives her her test,
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还是那个母亲, 还是那个护士。护士在给那个母亲做完检测以后,
08:02
takes her to a room.
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把她带到一个房间.
08:04
The door opens and there's a room full of mothers, mothers with babies,
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房间的门打开, 房间里都是母亲,带着婴儿的母亲,
08:07
and they're sitting, and they're talking, they're listening.
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她们坐在那里,谈话和聆听.
08:09
They're drinking tea, they're having sandwiches.
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她们在喝茶,她们在吃三文治.
08:12
And she goes inside, and woman comes up to her and says,
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她走进去, 女人们都过来跟她说,
08:14
"Welcome to mothers2mothers.
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"欢迎来到 mothers2mothers.
08:16
Have a seat. You're safe here.
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请坐下来. 你在这里很安全.
08:19
We're all HIV-positive.
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我们都是艾滋病带菌者.
08:21
You're going to be okay. You're going to live.
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你不会有事的, 你会生存下去.
08:24
Your baby is going to be HIV-negative."
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你的宝宝不会成为艾滋病带菌者."
08:29
We view mothers
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在我们的眼中,母亲们
08:31
as a community's single greatest resource.
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是这里最宝贵的资源.
08:33
Mothers take care of the children, take care of the home.
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她们照顾孩子,照顾家.
08:36
So often the men are gone.
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经常,男人们出去了.
08:38
They're working, or they're not part of the household.
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他们在外面工作, 或者并不跟孩子的母亲住在一起.
08:41
Our organization, mothers2mothers,
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我们的组织, mothers2mothers,
08:43
enlists women with HIV
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招募带有艾滋病病毒的女性
08:45
as care providers.
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来这里护理其他人。
08:47
We bring mothers who have HIV,
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我们让那些带有艾滋病病毒的母亲,
08:49
who've been through these PMTCT programs
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她们已经通过PMTCT项目
08:51
in the very facilities,
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特定疗程的治疗,
08:53
to come back and work side by side with doctors and nurses
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让她们回来和医生护士并肩工作
08:56
as part of the health care team.
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成为医疗护理队伍的一分子.
08:58
These mothers, we call them mentor mothers,
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这些母亲们,我们称她们为母亲指导员,
09:01
are able to engage women
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她们能够帮助那些
09:03
who, just like themselves, pregnant with babies,
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就像她们自己一样, 怀着孩子,
09:05
have found out about being HIV-positive,
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但又被发现是艾滋病带菌者,
09:07
who need support and education.
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需要支持和相关知识辅导的母亲.
09:10
And they support them around the diagnosis
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在诊疗的过程中, 她们提供的支持还包括：
09:12
and educate them about how to take their medicines,
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教她们怎样用药,
09:14
how to take care of themselves,
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如何照顾她们自己,
09:16
how to take care of their babies.
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如何照顾她们的孩子.
09:19
Consider: if you needed surgery,
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试想一下: 如果你需要手术,
09:22
you would want the best possible technical surgeon, right?
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你会要技术最好的外科医生来帮你做手术, 对吧.
09:26
But if you wanted to understand
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但是如果你想搞清楚
09:28
what that surgery would do to your life,
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这个手术会对你的生活带来怎样的影响,
09:30
you'd like to engage someone,
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你该会希望能够与那些
09:32
someone who's had the procedure.
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做过这个手术的人沟通。
09:34
Patients are experts on their own experience,
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久病成医,
09:37
and they can share that experience with others.
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病人之间可以分享自己的经验.
09:41
This is the medical care that goes beyond just medicines.
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这是仅仅靠吃药无法达到的医疗护理.
09:45
So the mothers who work for us,
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所以这些为我们工作的母亲,
09:47
they come from the communities in which they work.
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她们来自于她们工作所在的地区.
09:49
They're hired -- they're paid as professional members of the health care teams,
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她们受雇成为职业医疗护理队伍的一员,
09:52
just like doctors and nurses.
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就像医生和护士一样.
09:54
And we open bank accounts for them
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我们为她们开了银行帐户,
09:56
and they're paid directly into the accounts,
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她们的薪水是直接存到她们的帐户里,
09:58
because their money's protected;
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这样她们的钱就是安全的;
10:00
the men can't take it away from them.
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男人们不能把这些钱从她们身上拿走.
10:03
They go through two to three weeks
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她们会接受两到三周的
10:05
of rigorous curriculum-based education, training.
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严格的课程式教育和训练.
10:08
Now, doctors and nurses -- they too get trained.
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现在, 医生和护士也会接受培训.
10:11
But so often, they only get trained once,
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但是经常, 他们只受到一次培训,
10:13
so they're not aware of new medicines,
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所以他们并不了解最新的医药,
10:15
new guidelines as they come out.
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和最新出来的医疗指导
10:17
Our mentor mothers get trained every single year
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我们的母亲指导员们每年都要接受培训
10:19
and retrained.
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和再培训.
10:21
And so doctors and nurses --
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所以医生和护士,
10:23
they look up to them as experts.
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他们把这些母亲指导员看成专家.
10:26
Imagine that: a woman, a former patient,
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想象一下: 一个女人, 之前是病人,
10:29
being able to educate her doctor for the first time
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现在却能够开始教她的医生
10:31
and educate the other patients
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还有其他病人 --
10:33
that she's taking care of.
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那些由她照顾的病人.
10:36
Our organization has three goals.
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我们的组织有三个目标.
10:38
The first, to prevent mother-to-child transmission.
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第一: 防止母子垂直传染.
10:42
The second: keep mothers healthy, keep mothers alive,
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第二: 保持母亲健康, 让她们生存下去.
10:45
keep the children alive --
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让孩子生存下去.
10:47
no more orphans.
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再也不让他们成为孤儿了.
10:49
And the third, and maybe the most grand,
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第三, 或许是最高的目标,
10:52
is to find ways to empower women,
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就是给这些女性予力量,
10:56
enable them to fight the stigma
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让她们克服羞耻感,
10:58
and to live positive and productive lives with HIV.
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积极向上、更好地活着, 即使她们是艾滋病患者.
11:02
So how do we do it?
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那我们怎样做到这些呢?
11:04
Well, maybe the most important engagement
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也许最重要的尝试就是,
11:06
is the one-to-one,
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一对一的沟通,
11:08
seeing patients one-to-one, educating them, supporting them,
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一对一的看望病人, 教他们, 支持她们,
11:11
explaining how they can take care of themselves.
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告诉她们如何去照顾自己.
11:14
We go beyond that;
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我们所做的还不仅限于此.
11:16
we try to bring in the husbands, the partners.
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我们尝试让丈夫们或者配偶们加入进来.
11:19
In Africa, it's very, very hard to engage men.
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在非洲, 我们很难说动男人, 让他们参与进来.
11:22
Men are not frequently part of pregnancy care.
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一般男人们都不是孕期护理的一分子.
11:26
But in Rwanda, in one country,
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但是在卢旺达, 就在这个国家,
11:28
they've got a policy
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他们制定了一个政策,
11:30
that a woman can't come for care
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即, 一个女人单凭自身是无法获得这里的医疗护理,
11:32
unless she brings the father of the baby with her --
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除非, 她将孩子的父亲也一并带来.
11:34
that's the rule.
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这是规定.
11:36
And so the father and the mother, together,
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因此, 孩子的父亲和母亲将一起,
11:38
go through the counseling and the testing.
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接受咨询辅导和疾病检测.
11:41
The father and the mother, together, they get the results.
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同样, 孩子的父亲和母亲将一起面对检测结果.
11:43
And this is so important in breaking through the stigma.
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这样做对于克服羞耻感是相当重要的一步.
11:47
Disclosure is so central to prevention.
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披露病情对疾病防预是很关键的环节.
11:50
How do you have safer sex, how do you use a condom regularly
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你如何能拥有更安全的性生活, 如何能有规律地使用避孕套?
11:53
if there hasn't been disclosure?
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如果没有披露病情的话.
11:55
Disclosure is so important to treatment,
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公开病情对治疗是如此的重要,
11:58
because again, people need the support of family members and friends
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因为, 同样的, 人们需要家人和朋友的支持
12:01
to take their medicines regularly.
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以帮助他们定期用药.
12:04
We also work in groups.
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我们也通过团队的方式来完成这些工作.
12:06
Now the groups, it's not like me lecturing,
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现在, 这些团队,并这不像我在讲课一样,
12:08
but what happens is women, they come together --
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而是, 女人们自己走到一起,
12:11
under the support and guidance of our mentor mothers --
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通过我们的母亲指导员的支持和引导
12:13
they come together, and they share their personal experiences.
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她们走到一起, 分享各自的经验.
12:16
And it's through the sharing
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正是通过这种交流,
12:18
that people get tactics of how to take care of themselves,
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人们学会如何照顾自己,
12:20
how to disclose how to take medicines.
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如何披露自己的病情, 如何用药.
12:24
And then there's the community outreach,
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还能在当地起到示范效应,
12:26
engaging women in their communities.
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鼓励当地的女性参与进来.
12:29
If we can change the way
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如果我们能够改变
12:31
households believe and think,
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每一户人家的所信和所想,
12:33
we can change the way communities believe and think.
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我们就能改变这个地区人们的所信和所想.
12:36
And if we can change enough communities,
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如果我们能够改变足够多的区域,
12:38
we can change national attitudes.
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我们就能改变整个国家的态度.
12:40
We can change national attitudes to women
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我们能够改变整个国家对女性的态度
12:42
and national attitudes to HIV.
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以及他们对艾滋病病毒的态度.
12:45
The hardest barrier really is around stigma reduction.
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其实最大的困难是减轻人们对艾滋病病毒的羞耻感.
12:47
We have the medicines, we have the tests,
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我们有药品, 我们有疾病检测。
12:49
but how do you reduce the stigma?
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但是我们如何减轻人们的羞耻感呢?
12:52
And it's important about disclosure.
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而这对病情能否披露又很重要.
12:54
So, a couple years ago, one of the mentor mothers came back,
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所以, 几年前, 有一个母亲指导员回来找我们,
12:56
and she told me a story.
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她跟我讲了一个故事.
12:58
She had been asked by one of the clients
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她的一个病人请求她
13:00
to go to the home of the client,
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到这个病人的家里,
13:02
because the client wanted to tell the mother and her brothers and sisters
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因为这个病人要告诉她的母亲,兄弟和姐妹
13:05
about her HIV status,
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她的艾滋病病情,
13:07
and she was afraid to go by herself.
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但她害怕一个人去.
13:09
And so the mentor mother went along with.
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所以这个母亲指导员就跟着去了.
13:11
And the patient walked into the house
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这病人走进屋子里
13:13
and said to her mother and siblings,
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跟她的母亲和兄弟姐妹说：
13:16
"I have something to tell you. I'm HIV-positive."
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"我想告诉你们一些事. 我是艾滋病带菌者."
13:19
And everybody was quiet.
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这时, 每个人都很安静.
13:21
And then her oldest brother stood up and said,
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随后, 她最大的哥哥站起来说：
13:23
"I too have something to tell you.
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"我也有些事要告诉你们.
13:25
I'm HIV-positive.
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我是艾滋病带菌者.
13:27
I've been afraid to tell everybody."
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我一直不敢告诉大家."
13:30
And then this older sister stood up and said,
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然后她的大姐站起来说,
13:32
"I too am living with the virus,
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"我也带着这种病毒,
13:35
and I've been ashamed."
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我一直觉得很羞耻."
13:37
And then her younger brother stood up and said,
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然后比她年轻一些的弟弟也站起来说,
13:40
"I'm also positive.
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"我也是呈阳性.
13:42
I thought you were going to throw me out of the family."
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我以为你们会把我赶出这个家."
13:44
And you see where this is going.
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你可以看出事情是如何发展的.
13:46
The last sister stood up and said, "I'm also positive.
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最后一个妹妹站起来说, "我也是呈阳性的.
13:48
I thought you were going to hate me."
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我以为你们都会讨厌我."
13:50
And there they were, all of them together for the first time
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就这样, 他们一家人终于
13:52
being able to share this experience for the first time
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能够一起分享经验,
13:55
and to support each other for the first time.
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也首次能够彼此互相支持.
13:58
(Video) Female Narrator: Women come to us,
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(视屏) 女声: 女人们来找我们,
14:00
and they are crying and scared.
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她们都在哭,很害怕。
14:03
I tell them my story,
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我告诉她们我的故事,
14:05
that I am HIV-positive,
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我是个艾滋病带菌者,
14:08
but my child is HIV-negative.
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但是我的孩子没有染上艾滋病病毒.
14:11
I tell them, "You are going to make it,
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我告诉她们, "你们都能够生存下去,
14:14
and you will raise a healthy baby."
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你们都会有一个健康的孩子."
14:18
I am proof that there is hope.
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我自己就是证明, 证明希望是存在的.
14:24
Mitchell Besser: Remember the images I showed you
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Mitchell Besser: 记住我给你们看的图像,
14:26
of how few doctors and nurses there are in Africa.
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在非洲, 那里的医生和护士是多么稀缺.
14:28
And it is a crisis in health care systems.
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这是一个当地医疗护理系统所存在的危机.
14:31
Even as we have more tests and more drugs,
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就算我们有更多的检测手段和药品,
14:33
we can't reach people; we don't have enough providers.
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我们也难以遍及这么多人; 我们没有足够的人手.
14:35
So we talk in terms of what we call task-shifting.
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所以, 我们提及所谓的任务转移.
14:37
Task-shifting is traditionally
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任务转移在传统上即
14:39
when you take health care services from one provider
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你在这个医疗服务提供者这里得到了
14:41
and have another provider do it.
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由另外一个人为你提供的医疗服务.
14:43
Typically, it's a doctor giving a job to a nurse.
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比如,一个医生将工作交给一个护士去完成.
14:45
And the issue in Africa
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但在非洲, 问题是
14:47
is that there are fewer nurses, really than doctors,
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那里的护士却比医生要少,
14:49
and so we need to find new paradigm for health care.
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所以我们要找到新的方式来提供医疗服务.
14:52
How do you build a better health care system?
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如何才能建立一个更好的医疗服务体系呢?
14:55
We've chosen to redefine the health care system
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我们选择将医疗服务体系重新界定为
14:57
as a doctor, a nurse and a mentor mother.
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由医生,护士和母亲指导员组合在一起的体系.
14:59
And so what nurses do
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护士们所做的
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is that they ask the mentor mothers to explain
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就是安排母亲指导员, 去告诉病人
15:03
how to take the drugs, the side effects.
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如何用药,有什么副作用.
15:05
They delegate education about infant feeding,
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母亲指导员教病人喂养婴儿,
15:08
family planning, safer sex,
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做生育计划, 并实现安全的性生活,
15:10
actions that nurses simple just don't have time for.
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这些都是护士们没有时间去做的事.
15:15
So we go back to the prevention of mother to child transmission.
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现在我们回到防止母子传染这个话题上来.
15:18
The world is increasingly seeing these programs
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人们越来越倾向于将这些项目看作是
15:20
as the bridge to comprehensive maternal and child health.
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通向实现母子全面健康的桥梁.
15:23
And our organization
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我们的组织则
15:25
helps women across that bridge.
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帮助女性跨过这座桥梁.
15:27
The care doesn't stop when the baby's born --
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这些护理并不会因为婴儿的出生就停止.
15:29
we deal with the ongoing health of the mother and baby,
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我们继续关注母亲和婴儿的健康,
15:32
ensuring that they live healthy,
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让他们过上健康、
15:35
successful lives.
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美好的生活.
15:37
Our organization works on three levels.
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我们的组织在三个层面上工作.
15:40
The first, at the patient level --
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第一, 在病人层面上--
15:42
mothers and babies keeping babies from getting HIV,
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着眼于母亲和孩子, 保护孩子, 不让他们感染艾滋病病毒,
15:44
keeping mothers healthy to raise them.
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让母亲能够健康地养育他们.
15:47
The second, communities --
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第二, 社区层面 --
15:49
empowering women.
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鼓励女性, 给她们力量.
15:51
They become leaders within their communities.
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让她们成为所在地区团体的领导.
15:54
They change the way communities think --
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去改变当地人们的的看法.
15:56
we need to change attitudes to HIV.
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我们需要改变人们对艾滋病病毒的态度.
15:59
We need to change attitudes to women in Africa.
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我们需要改变非洲人们对女性的态度.
16:01
We have to do that.
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我们必须做到这点.
16:03
And then rework the level of the health care systems,
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然后重新运作医疗服务体系, 在这个层面,
16:06
building stronger health care systems.
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建立更健全的医疗保健系统.
16:08
Our health care systems are broken.
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我们的医疗服务体系存在诸多漏洞.
16:10
They're not going to work the way they're currently designed.
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以现有的架构, 他们是难以起到作用的.
16:13
And so doctors and nurses
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因此,当医生和护士们,
16:15
who need to try to change people's behaviors
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当他们没有技巧, 也没有时间去帮助人们
16:17
don't have the skills, don't have the time --
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改变相应行为时,
16:19
our mentor mothers do.
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我们的母亲指导员们能做到这些.
16:21
And so in redefining the health care teams by bringing the mentor mothers in,
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所以,通过将母亲指导员引入医疗服务体系,
16:24
we can do that.
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我们能做到这点.
16:27
I started the program in Capetown, South Africa
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我在南非开普敦开始了这个项目,
16:30
back in 2001.
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在2001年时,
16:32
It was at that point, just the spark of an idea.
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在那个时候, 这只是一个思想的火花.
16:35
Referencing Steven Johnson's very lovely speech yesterday
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想到Steven Johnson昨天所做的演讲
16:38
on where ideas come from,
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关于好主意的来源,
16:41
I was in the shower at the time --
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当这个思想火花闪现时,我正在洗澡.
16:44
I was alone.
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只有我一个人.
16:46
(Laughter)
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(笑声)
16:50
The program is now working in nine countries,
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这个项目现正在九个国家推广.
16:53
we have 670 program sites,
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我们有670个项目点.
16:56
we're seeing about 230,000
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我们每月接见大概23万
16:59
women every month,
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女性.
17:01
we're employing 1,600 mentor mothers,
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我们聘请1,600个母亲指导员.
17:04
and last year, they enrolled
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去年,她们共照看了
17:06
300,000 HIV-positive pregnant women and mothers.
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30万个带有艾滋病病毒的孕妇和母亲.
17:09
That is 20 percent
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这占到了全球20%的
17:12
of the global HIV-positive pregnant women --
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感染艾滋病病毒的怀孕妇女,
17:15
20 percent of the world.
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全世界的20%.
17:17
What's extraordinary is how simple the premise is.
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不可思议的是它的基本构思是多么的简单.
17:19
Mothers with HIV caring for mothers with HIV.
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用带有艾滋病毒的母亲来照顾带有艾滋病毒的母亲.
17:22
Past patients taking care of present patients.
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过去的病人来照顾现在的病人.
17:24
And empowerment through employment --
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和通过雇佣关系来给予他们权威和力量,
17:26
reducing stigma.
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减少忌讳和羞耻感.
17:28
(Video) Female Narrator: There is hope,
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(视屏)女声: 我们希望,
17:30
hope that one day
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希望有一天
17:32
we shall win this fight
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我们能赢得这场
17:34
against HIV and AIDS.
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对抗艾滋病病毒和艾滋病的战斗.
17:37
Each person must know
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每一个人都必须清楚
17:39
their HIV status.
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他们的艾滋病病毒感染情况.
17:42
Those who are HIV-negative
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那些不带有艾滋病菌的人
17:44
must know how to stay negative.
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必须知道怎样让自己不感染上艾滋病病毒.
17:48
Those who are HIV-infected
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那些受到艾滋病感染的人
17:51
must know how
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必须知道怎样
17:53
to take care of themselves.
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来照顾他们自己.
17:56
HIV-positive pregnant women
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带有艾滋病病毒的怀孕母亲
17:58
must get PMTCT services
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必须通过PMTCT治疗
18:01
in order to have
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以生出
18:03
HIV-negative babies.
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不带艾滋病病毒的婴儿.
18:05
All of this is possible,
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所有这些都是有可能的,
18:08
if we each contribute to this fight.
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如果我们每个人都投入这场战斗.
18:13
MB: Simple solutions to complex problems.
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MB: 用简单的方法来解决复杂的问题.
18:16
Mothers caring for mothers.
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母亲照顾母亲.
18:18
It's transformational.
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这将带来伟大的变革.
18:20
Thank you.
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谢谢你们.
18:22
(Applause)
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(鼓掌)
ABOUT THE SPEAKER
Mitchell Besser - HIV/AIDS fighterHow can mothers with HIV avoid passing it to their kids? In South Africa, Mitchell Besser tapped a new resource for healthcare: moms themselves. The program he started, mothers2mothers, trains new mothers to educate and support other moms.
Why you should listen
In the developed world, daily care and drugs have turned HIV/AIDS into a manageable condition, and mothers with HIV rarely, anymore, pass it along to their babies. (Take a minute to be grateful for that.) But in developing nations where access to healthcare is difficult, drugs and day-to-day care and support are harder to come by, and rates of maternal transmission of HIV are much higher. Doctor Mitchell Besser works in Cape Town, South Africa, and in 2001, he began a program called mothers2mothers that aims to close this gap, by drawing on the power of community support.
Mothers2mothers employs HIV-positive moms themselves to complement the work of doctors and nurses. After a two-month training, mentor mothers work with other moms with HIV to help them understand how to keep from transmitting HIV to their babies. Equally important, the members of mothers2mothers connect at an emotional level with other moms, offering the support of true peers, helping to reduce the social stigma around HIV diagnosis, and helping each mom stick to her own treatment regiment so she can watch her baby grow. From its beginnings in 2001, mothers2mothers now operates in 600 clinics in seven countries; 1,600 mentor mothers "touch" an estimated 200,000 patients a month -- accounting for 20 per cent of the HIV-positive patients in Africa.
Mitchell Besser | Speaker | TED.com