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

圖拉斯兒賈 朗維拉:如何打造世界水準的平價眼科醫療

Filmed:
355,035 views

印度革命性的亞拉文眼科治療體系已經幫數百萬人重見光明.圖拉斯兒賈 朗維拉探討其中的創新方法如何降低治療成本卻提高醫療品質 並且主張其方法能帶動對所有人力服務的重新思考.
- 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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各位早安
00:17
I've come here to share分享 with you an experiment實驗
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我來這想跟各位分享一個實驗成果
00:21
of how to get rid擺脫 of one form形成 of human人的 suffering痛苦.
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如何擺脫一部分的眾生苦難
00:25
It really is a story故事 of Dr博士. VenkataswamyVenkataswamy.
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這實際上是一位醫生文卡塔斯瓦米的故事.
00:28
His mission任務 and his message信息 is about the Aravind亞拉文 Eye Care關心 System系統.
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他要傳達的使命訊息,是這個亞拉文眼科治療系統.
00:34
I think first it's important重要 for us to recognize認識 what it is to be blind.
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首先我認為大家要先了解失明代表了什麼.
00:39
(Music音樂)
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(背景音樂)
00:43
Woman女人: Everywhere到處 I went looking for work, they said no,
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婦人:所以我去求職的地方,他們都回答不要我.
00:47
what use do we have for a blind woman女人?
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不過是一個看不見的女人,我們有什麼用?
00:50
I couldn't不能 thread a needle or see the lice蝨子 in my hair頭髮.
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我不能在針頭上穿線或是看見我頭髮裡有蝨子
00:53
If an ant螞蟻 fell下跌 into my rice白飯, I couldn't不能 see that either.
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如果有螞蟻掉到我的飯裡,我也不知道
00:57
ThulasirajThulasiraj RavillaRavilla: Becoming變得 blind is a big part部分 of it,
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圖拉斯兒賈-朗維拉:失明是很大條的事情
00:59
but I think it also deprives剝奪 the person of their livelihood生計, their dignity尊嚴,
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但我覺得這奪走了人原有的生活、尊嚴、
01:04
their independence獨立, and their status狀態 in the family家庭.
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自立能力,還有在家庭中的地位
01:07
So she is just one amongst其中包括 the millions百萬 who are blind.
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她只是數百萬位盲人中的其中一位
01:11
And the irony諷刺 is that they don't need to be.
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諷刺的是他們本來不需要失明的
01:14
A simple簡單, well-proven充分證明 surgery手術 can restore恢復 sight視力 to millions百萬,
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一個簡單,可信賴的手術就能幫這數百萬人恢復視力
01:18
and something even simpler簡單, a pair of glasses眼鏡, can make millions百萬 more see.
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還有更簡單的,一副眼鏡就能幫數百萬人看得更清楚
01:23
If we add to that the many許多 of us here now
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如果我們算上在座的各位其中
01:26
who are more productive生產的 because they have a pair of glasses眼鏡,
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因為戴了眼鏡而能更有產值
01:30
then almost幾乎 one in five Indians印度人 will require要求 eye care關心,
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將近五位印度人中就有一位需要眼科治療
01:33
a staggering踉蹌 200 million百萬 people.
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驚人的2億人口中
01:36
Today今天, we're reaching到達 not even 10 percent百分 of them.
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直到今日,我們只能幫不到其中的百分之十
01:40
So this is the context上下文 in which哪一個 Aravind亞拉文 came來了 into existence存在
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而這就是亞拉文所存在的環境
01:43
about 30 years年份 back
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大約是30年前
01:46
as a post-retirement後退休 project項目 of Dr博士. V.
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文醫生退休後展開的計畫
01:49
He started開始 this with no money.
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他一無分文的開始這個工作
01:51
He had to mortgage抵押 all his life savings
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他得抵押所有他的畢生積蓄
01:54
to make a bank銀行 loan貸款.
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來拿到銀行貸款
01:56
And over time, we have grown長大的 into a network網絡 of five hospitals醫院,
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然後慢慢的我們已經成長到5間醫院的一個體系
02:00
predominately主要 in the state of Tamil泰米爾人 Nadu德邦 and Puducherry本地治裡,
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以泰米爾納德和旁迪切里為主
02:04
and then we added添加 several一些, what we call Vision視力 Centers中心
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然後我們增加了幾個我們稱作視力中心的地方
02:08
as a hub-and-spoke輪轂和輻條 model模型.
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作為轉診的集散中心點
02:10
And then more recently最近 we started開始 managing管理的 hospitals醫院
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然後最近我們開始代管醫院
02:13
in other parts部分 of the country國家
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在印度其他地區
02:15
and also setting設置 up hospitals醫院 in other parts部分 of the world世界 as well.
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也在世界上不同的角落設立醫院
02:19
The last three decades幾十年,
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這近30年
02:21
we have doneDONE about three-and-a-half三和半 million百萬 surgeries手術,
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我們已經完成350萬人次的手術
02:25
a vast廣大 majority多數 of them for the poor較差的 people.
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絕大多數都是替窮人做的
02:29
Now, each year we perform演出 about 300,000 surgeries手術.
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現在 我們每年執行約30萬次手術
02:34
A typical典型 day at Aravind亞拉文, we would do about a thousand surgeries手術,
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亞拉文中心一天能做約1000次手術
02:38
maybe see about 6,000 patients耐心,
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約看診6000人次
02:42
send發送 out teams球隊 into the villages村莊 to examine檢查, bring帶來 back patients耐心,
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派出團隊到鄉村看診然後帶回病人
02:47
lots of telemedicine遠程醫療 consultations磋商,
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許多次的遠距醫療評估
02:50
and, on top最佳 of that, do a lot of training訓練,
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然後更重要的是完成許多的訓練
02:53
both for doctors醫生 and technicians技師 who will become成為 the future未來 staff員工 of Aravind亞拉文.
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給亞拉文中心未來的員工 醫生或是技術人員
03:00
And then doing this day-in日式 and day-out一天出, and doing it well,
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而且我們每天不停地做然後做得很好
03:04
requires要求 a lot of inspiration靈感 and a lot of hard work.
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這需要許多的創意還有大量的苦功
03:08
And I think this was possible可能 thanks謝謝 to the building建造 blocks
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而我認為能做到這些要歸功於一些重要的根基
03:11
put in place地點 by Dr博士. V.,
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由文醫生所建立起來的
03:14
a value system系統, an efficient高效 delivery交貨 process處理,
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一個價值體系,一個高效率的配送程序
03:18
and fostering培育 the culture文化 of innovation革新.
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還有鼓勵創新的養成文化
03:21
(Music音樂)
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(音樂)
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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文醫生:我常跟鄉村老百姓在一起,因為我同樣來自鄉村
03:33
and suddenly突然 you turn around and seem似乎 to be in contact聯繫 with his inner being存在,
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而當你環顧四周,突然間你跟他的內心有所共鳴
03:37
you seem似乎 to be one with him.
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好像你跟他合為一體
03:40
Here is a soul靈魂 which哪一個 has got all the simplicity簡單 of confidence置信度.
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有一個完全信任你的靈魂
03:45
Doctor醫生, whatever隨你 you say, I accept接受 it.
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醫生,無論你怎麼說我都接受
03:48
An implicit含蓄 faith信仰 in you
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對你無瑕的信任
03:50
and then you respond響應 to it.
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然後你有所回應
03:52
Here is an old lady淑女 who has got so much faith信仰 in me, I must必須 do my best最好 for her.
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這裡有一個老婦人對我有這麼大的信心,我一定要給她最好的
03:57
When we grow增長 in spiritual精神 consciousness意識,
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當你增長靈智的時候
04:00
we identify鑑定 ourselves我們自己 with all that is in the world世界,
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我們認同世上所有事物
04:03
so there is no exploitation開發.
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所以不存在剝削,
04:06
It is ourselves我們自己 we are helping幫助.
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我們所幫助的正是自己
04:09
It is ourselves我們自己 we are healing復原.
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我們所醫治的也是自己
04:17
(Applause掌聲)
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(掌聲)
04:23
This helped幫助 us build建立 a very ethical合乎道德的 and very highly高度 patient-centric以病人為中心 organization組織
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這讓我們建立了一個非常有原則而且高度以病人為核心的組織
04:29
and systems系統 that support支持 it.
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還有支持這樣的各種機制
04:31
But on a practical實際的 level水平, you also have to deliver交付 services服務 efficiently有效率的,
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但是在實務上,你還必須有效率地提供服務
04:37
and, odd as it may可能 seem似乎, the inspiration靈感 came來了 from McDonald's麥當勞.
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而乍看之下很奇特,這樣的靈感來自於麥當勞
04:41
Dr博士. V: See, McDonald's'麥當勞“ concept概念 is simple簡單.
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文醫生:麥當勞的概念是很簡單的
04:45
They feel they can train培養 people all over the world世界,
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他們覺得他們能訓練世界上所有的人
04:53
irrespective不管 of different不同 religions宗教, cultures文化, all those things,
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無論是不同的宗教,文化,各種不同的差異
04:56
to produce生產 a product產品 in the same相同 way
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用同樣的方式來製造同樣的產品
05:00
and deliver交付 it in the same相同 manner方式
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並且用同樣的態度提供服務
05:03
in hundreds數以百計 of places地方.
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在數百個不同的地方
05:05
Larry拉里 Brilliant輝煌: He kept不停 talking about McDonalds麥當勞 and hamburgers漢堡包,
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賴瑞-布里安特:他不斷的提到麥當勞與漢堡
05:07
and none沒有 of it made製作 any sense to us.
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而那些我們一點都不懂
05:13
He wanted to create創建 a franchise專營權,
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他想要創造一種加盟
05:16
a mechanism機制 of delivery交貨 of eye care關心
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一個提供眼科醫療的機制
05:19
with the efficiency效率 of McDonald's麥當勞.
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有如麥當勞的運作效率
05:22
Dr博士. V: Supposing假如 I'm able能夠 to produce生產 eye care關心,
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文醫生:如果我能生產眼科醫療
05:24
techniques技術, methods方法, all in the same相同 way,
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技術方法,都是用同樣的方式
05:28
and make it available可得到 in every一切 corner of the world世界.
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同時能提供給世界上不同角落
05:31
The problem問題 of blindness失明 is gone走了.
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失明的問題就沒了
05:34
TRTR: If you think about it, I think the eyeball眼球 is the same相同,
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圖拉斯兒賈-朗維拉:想一下,人的眼球都是一樣的
05:37
as American美國 or African非洲人,
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美國人的或是非洲人的
05:39
the problem問題 is the same相同, the treatment治療 is the same相同.
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問題都是一樣的,治療方法也是一樣的
05:42
And yet然而, why should there be so much variation變異 in quality質量 and in service服務,
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所以那為何有有這麼多不同的服務方式與醫療品質呢
05:46
and that was the fundamental基本的 principle原理 that we followed其次
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這個就是我們在追求的根本主軸
05:49
when we designed設計 the delivery交貨 systems系統.
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當我們在規劃配送系統的時候
05:52
And, of course課程, the challenge挑戰 was that it's a huge巨大 problem問題,
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當然,考驗的是這確實是很大的問題
05:55
we are talking of millions百萬 of people,
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我們在考慮的是數百萬人
05:58
very little resource資源 to deal合同 with it,
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而只有一點點資源來完成目標
06:01
and then lots of logistics後勤 and affordability承受能力 issues問題.
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還有許多物流,定價問題要考慮
06:05
And then so, one had to constantly經常 innovate創新.
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也就是因為如此,我們必須不斷的創新
06:08
And one of the early innovations創新, which哪一個 still continues繼續,
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而其中一個初期的創新,仍然沿用的
06:11
is to create創建 ownership所有權 in the community社區 to the problem問題,
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就是設立社區裡的針對問題的所有權
06:15
and then engage從事 with them as a partner夥伴,
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然後對待他們如同夥伴
06:18
and here is one such這樣 event事件.
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這邊就有一個例子
06:20
Here a community社區 camp just organized有組織的
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有一個社區營地剛成立
06:23
by the community社區 themselves他們自己,
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由這個社區自己組的
06:26
where they find a place地點, organize組織 volunteers志願者,
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他們自己找場地,組織義工
06:29
and then we'll do our part部分. You know, check their vision視力,
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然後我們來做我們的事情,也就是 檢查他們的視力
06:34
and then you have doctors醫生 who you find out what the problem問題 is
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然後你讓醫生去發現問題是什麼
06:37
and then determine確定 what further進一步 testing測試 should be doneDONE,
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然後決定那些進一步的檢查該去處理
06:40
and then those tests測試 are doneDONE by technicians技師
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然後由技術人員去做這些檢查
06:45
who check for glasses眼鏡,
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有的是檢查眼鏡
06:49
or check for glaucoma青光眼.
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有的是檢查青光眼
06:53
And then, with all these results結果, the doctor醫生 makes品牌 a final最後 diagnosis診斷,
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然後根據這些檢查結果醫生做出最後的診斷
06:57
and then prescribes規定 a line of treatment治療,
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然後列出治療的處方
07:00
and if they need a pair of glasses眼鏡, they are available可得到 right there at the camp site現場,
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如果需要一副眼鏡,在營地現場就有提供
07:04
usually平時 under a tree.
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通常是在樹下
07:06
But they get glasses眼鏡 in the frames of their choice選擇,
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還有他們自己選好鏡框
07:09
and that's very important重要 because I think glasses眼鏡,
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這點非常重要 因為我認為眼鏡
07:12
in addition加成 to helping幫助 people see,
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除了幫助人看見
07:14
is also a fashion時尚 statement聲明, and they're willing願意 to pay工資 for it.
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同時也是一種品味的表示,而他們願意為此付費
07:22
So they get it in about 20 minutes分鐘
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這樣他們在20分鐘左右拿到眼鏡
07:25
and those who require要求 surgery手術, are counseled勸告,
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那些需要手術的則給予建議
07:28
and then there are buses公共汽車 waiting等候,
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然後有巴士在那等著
07:31
which哪一個 will transport運輸 them to the base基礎 hospital醫院.
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會載他們去基地醫院
07:34
And if it was not for this kind of logistics後勤 and support支持,
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如果不是使用這樣的物流跟協助
07:39
many許多 people like this would probably大概 never get services服務,
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許多人可能根本無法得到服務
07:42
and certainly當然 not when they most need it.
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尤其是在他們最需要的時候
07:46
They receive接收 surgery手術 the following以下 day,
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他們在隔天接受手術
07:50
and then they will stay for a day or two,
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然後他們會住院一兩天
07:53
and then they are put back on the buses公共汽車
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然後送他們上巴士
07:55
to be taken採取 back to where they came來了 from,
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帶他們回到他們來的地方
07:58
and where their families家庭 will be waiting等候 to take them back home.
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那裏他們的家人會在那等著接他們回家
08:03
(Applause掌聲)
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(掌聲)
08:09
And this happens發生 several一些 thousand times each year.
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這樣的方式每年發生數千次
08:14
It may可能 sound聲音 impressive有聲有色 that we're seeing眼看 lots of patients耐心,
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乍聽之下會覺得很驚人 我們看了這麼多的病人
08:17
very efficient高效 process處理,
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非常有效率的程序
08:19
but we looked看著 at, are we solving the problem問題?
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但是我們仔細看.我們解決問題了嗎?
08:23
We did a study研究, a scientifically科學 designed設計 process處理,
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我們做過一個研究,一個科學規劃過的程序
08:25
and then, to our dismay沮喪,
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但是讓我們失望的是
08:27
we found發現 this was only reaching到達 seven percent百分 of those in need,
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我們發現這樣只接觸到百分之七的有需要的人
08:32
and we're not adequately充分 addressing解決 more, bigger problems問題.
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我們並沒有針對到更大的問題
08:36
So we had to do something different不同,
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所以我們必須做些不同的事情
08:38
so we set up what we call primary eye care關心 centers中心, vision視力 centers中心.
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因此我們設立了稱作初級眼科治療中心,視力中心
08:43
These are truly paperless無紙化 offices辦事處
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那是完全無紙化中心
08:45
with completely全然 electronic電子 medical records記錄 and so on.
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完全使用電子醫療紀錄等等
08:49
They receive接收 comprehensive全面 eye exams考試.
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他們能記錄複雜的眼科檢查
08:52
We kind of changed the simple簡單 digital數字 camera相機 into a retinal視網膜 camera相機,
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我們可說是把簡單的數位相機改成眼底攝影相機
08:56
and then every一切 patient患者 gets得到 their teleconsultation遠程會診 with a doctor醫生.
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然後每個病人透過遠端看診面對醫生
09:02
The effect影響 of this has been that, within the first year,
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這樣的效果是,在第一年
09:06
we really had a 40 percent百分 penetration滲透 in the market市場 that it served提供服務,
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我們就拿下市場上百分之四十的比例
09:11
which哪一個 is over 50,000 people.
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也就是超過了五萬人
09:13
And the second第二 year went up to 75 percent百分.
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第二年就達到了百分之七十五
09:15
So I think we have a process處理 by which哪一個
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所以我覺得我們有一個系統真的能
09:17
we can really penetrate穿透 into the market市場
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滲透進入市場
09:19
and reach達到 everyone大家 who needs需求 it,
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並且服務到每一個需要的人
09:22
and in this process處理 of using運用 technology技術, make sure
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在這個使用科技的過程
09:25
that most don't need to come to the base基礎 hospital醫院.
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找出大多數人不需要去基地醫院
09:28
And how much will they pay工資 for this?
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究竟他們需要付多少錢呢?
09:30
We fixed固定 the pricing價錢, taking服用 into account帳戶
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我們固定收費,並且以
09:33
what they would save保存 in bus總線 fare票價 in coming未來 to a city,
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他們能省到的往來城市的巴士開銷為準
09:37
so they pay工資 about 20 rupees盧比, and that's good for three consultations磋商.
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因此他們付大約15元台幣,而且包含三次看診.
09:41
(Applause掌聲)
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(掌聲)
09:44
The other challenge挑戰 was, how do you give high-tech高科技
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另一個挑戰則是,如何提供高科技
09:47
or more advanced高級 treatment治療 and care關心?
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或是更先進的醫療與照護?
09:50
We designed設計 a van麵包車 with a VSATVSAT,
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我們設計了一個裝有碟型衛星天線的箱型車
09:53
which哪一個 sends發送 out images圖片 of patients耐心 to the base基礎 hospital醫院
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能夠發送病人的影像給基地醫院
09:57
where it is diagnosed確診,
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在那邊完成診斷
10:00
and then as the patient患者 is waiting等候, the report報告 goes back to the patient患者,
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然後當病人在等待的時候,報告就能傳送回給病人
10:04
it gets得到 printed印刷的 out, the patient患者 gets得到 it,
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列印出來,病人就拿到了
10:07
and then gets得到 a consultation會診 about what they should be doing --
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然後他們會從諮詢中知道他們該做什麼
10:10
I mean, go see a doctor醫生 or come back after six months個月,
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我的意思是,去看個醫生或是六個月後再過來這樣的建議
10:13
and then this happens發生 as a way of
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所以這樣的方式
10:15
bridging橋接 the technology技術 competence權限.
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連結科技的能力
10:20
So the impact碰撞 of all this has been essentially實質上 one of growing生長 the market市場,
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這些影響是其中一個原因帶動市場的成長
10:24
because it focused重點 on the non-customer非客戶,
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因為我們專注在非付費客戶上
10:27
and then by reaching到達 the unreached未得,
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然後接觸到原本接觸不到的人
10:30
we're able能夠 to significantly顯著 grow增長 the market市場.
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我們能夠明顯的成長整個市場
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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另一方面就是你如何有效率的對應事情
10:36
when you have very few少數 ophthalmologists眼科醫生?
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當你只有很少的眼科專科醫師的時候?
10:39
So what is in this video視頻 is a surgeon外科醫生 operating操作,
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這影片裡是一個外科醫生手術的畫面
10:42
and then you see on the other side,
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你會看到另一邊
10:44
another另一個 patient患者 is getting得到 ready準備.
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另一個病人已經準備好
10:46
So, as they finish the surgery手術,
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所以 當他們完成手術時
10:49
they just swing搖擺 the microscope顯微鏡 over,
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他們直接把顯微鏡換過去
10:52
the tables are placed放置 so that their distance距離 is just right,
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手術台擺放的正好距離是剛好的
10:56
and then we need to do this, because, by doing this kind of process處理,
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我們需要這樣做,因為這樣的流程
10:59
we're able能夠 to more than quadruple the productivity生產率 of the surgeon外科醫生.
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我們能提高外科醫生四倍以上的產能
11:04
And then to support支持 the surgeon外科醫生,
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為了能協助外科醫生
11:06
we require要求 a certain某些 workforce勞動力.
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我們需要一群人協助
11:09
And then we focused重點 on village girls女孩 that we recruited應徵,
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然後我們專門招募鄉村女孩
11:13
and then they really are the backbone骨幹 of the organization組織.
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他們是整個組織的骨幹
11:16
They do almost幾乎 all of the skill-based技能為主 routine常規 tasks任務.
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他們執行幾乎所有需要技巧的例行工作
11:20
They do one thing at a time. They do it extremely非常 well.
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他們一次做一件事情,他們做的相當的好
11:23
With the result結果 we have very high productivity生產率,
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這樣的結果我們得到了非常高的產能
11:26
very high quality質量 at very, very low cost成本.
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非常好的醫療品質同時成本非常的低
11:31
So, putting all this together一起, what really happened發生 was
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所以整個來說,真正的結果是
11:34
the productivity生產率 of our staff員工 was
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我們的員工的生產力
11:37
significantly顯著 higher更高 than anyone任何人 else其他.
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遠高於其他任何人
11:40
(Applause掌聲)
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(掌聲)
11:46
This is a very busy table,
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這是一個非常忙碌的檯子
11:48
but what this really is conveying輸送 is that,
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但是實際上傳遞的
11:50
when it comes to quality質量, we have put in
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就醫療品質來說,我們放入了
11:52
very good quality-assurance質量保證 systems系統.
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一個非常好的品質管理系統
11:55
As a result結果, our complications並發症 are significantly顯著 lower降低
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因此我們這手術的併發症是相當的低的
11:58
than what has been reported報導 in the United聯合的 Kingdom王國,
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比在英國手術的併發症報告還低
12:01
and you don't see those kind of numbers數字 very often經常.
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而你不容易看到這樣的數據
12:04
(Applause掌聲)
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(掌聲)
12:06
So the final最後 part部分 of the puzzle難題 is,
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這個謎題的最後一部份是
12:08
how do you make all this work financially經濟,
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該如何讓這樣的工作收支平衡
12:11
especially特別 when the people can't pay工資 for it?
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尤其是當這些人無法付錢的時候
12:14
So what we did was, we gave away a lot of it for free自由,
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我們所做的其實是我們提供許多免費服務
12:18
and then those who pay工資, I mean, they paid支付 local本地 market市場 rates利率,
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然後那些付錢的人,我指的是,他們以當地市價支付
12:21
nothing more, and often經常 much less.
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不會比較高,而且通常是便宜很多
12:23
And we were helped幫助 by the market市場 inefficiency低效.
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然後我們得到市場低效的幫助
12:26
I think that has been a big savior救主, even now.
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我想即使至今都是超級省錢王
12:29
And, of course課程, one needs需求 the mindset心態 to be wanting希望 to give away
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當然我們需要保持樂於付出的心態
12:33
what you have as a surplus剩餘.
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我們所擁有的只是額外的
12:36
The result結果 has been, over the years年份,
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多年來這樣的成果是
12:38
the expenditure支出 has increased增加 with volumes.
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開銷與客流量一同增加
12:40
The revenues收入 increase增加 at a higher更高 level水平,
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收益增加到更高的比例
12:42
giving us a healthy健康 margin餘量
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給了我們很棒的利差
12:44
while you're treating治療 a large number of people for free自由.
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當你免費治療大量的人的時候
12:48
I think in absolute絕對 terms條款,
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我指的是絕對的價值
12:50
last year we earned about 20-odd-奇 million百萬 dollars美元,
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去年我們賺了約2千萬美金
12:53
spent花費 about 13 million百萬, with over a 40 percent百分 EBITAEBITA.
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花了1千3百萬美金,這樣大約是百分之40的淨利加上孳息
12:58
(Applause掌聲)
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(掌聲)
13:06
But this really requires要求 going beyond what we do,
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要做到這樣需要我們超越極限
13:09
or what we have doneDONE,
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或是挑戰我們自己
13:12
if you really want to achieve實現 solving this problem問題 of blindness失明.
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如果你真的想解決失明這種問題
13:15
And what we did was a couple一對 of very counter-intuitive反直覺 things.
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我們所做的不過是一些違反直覺的事
13:19
We created創建 competition競爭 for ourselves我們自己,
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我們給自己帶來競爭
13:22
and then we made製作 eye care關心 affordable實惠
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然後我們讓眼科治療平價化
13:25
by making製造 low-cost低成本 consumables耗材.
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透過製作低成本的消費品
13:28
We proactively主動 and systematically系統
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我們自發的有系統的
13:31
promoted提拔 these practices做法 to many許多 hospitals醫院 in India印度,
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在印度的許多醫院推廣這些實務經驗
13:35
many許多 in our own擁有 backyards後院 and then in other parts部分 of the world世界 as well.
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在我們自家後院然後也在世界上不同的角落
13:38
The impact碰撞 of this has been that these hospitals醫院,
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這樣的效果是這那些醫院
13:42
in the second第二 year after our consultation會診,
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在我們輔導的第二年
13:45
are double their output產量
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就提高產能兩倍
13:47
and then achieve實現 financial金融 recovery復甦 as well.
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然後同樣財務上回收了那些投資
13:53
The other part部分 was how do you address地址
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另一部分則是你如何面對
13:56
this increase增加 in cost成本 of technology技術?
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技術設備成本的增加
14:00
There was a time when we failed失敗 to negotiate談判
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曾有一次我們沒辦法
14:03
the [intra-ocular lens鏡片] prices價格 to be at affordable實惠 levels水平,
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讓人工水晶體的價格談到可以接受的低
14:05
so we set up a manufacturing製造業 unit單元.
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所以我們成立製造部門
14:09
And then, over time, we were able能夠 to bring帶來 down the cost成本 significantly顯著
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然後沒多久我們就開始把成本降得更低
14:13
to about two percent百分 of what it used to be when we started開始 out.
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比一開始我們的成本還低百分之二
14:18
Today今天, we believe we have about seven percent百分 of the global全球 market市場,
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今天我們相信我們佔了全球市場的百分之七
14:22
and they're used in about 120-odd-奇 countries國家.
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然後在120多個國家中使用
14:26
To conclude得出結論, I mean, what we do, does it have a broader更廣泛 relevance關聯,
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總結來說,我們所做的究竟有更廣的影響
14:31
or is it just India印度 or developing發展 countries國家?
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或僅只在印度或是一些開發中國家?
14:36
So to address地址 this, we studied研究 UK聯合王國 versus Aravind亞拉文.
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為了解答這個問題我們研究了英國跟亞拉文的差別
14:43
What it shows節目 is that we do roughly大致 about 60 percent百分
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顯示出來我們所做大約是百分之六十
14:46
of the volume of what the UK聯合王國 does,
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的全英國所做的量
14:49
near a half-million半億 surgeries手術 as a whole整個 country國家.
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英國全境作了將近50萬次手術
14:52
And we do about 300,000.
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而我們做大約30萬次
14:55
And then we train培養 about 50 ophthalmologists眼科醫生
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然後我們有大約50位眼科專科醫生
14:58
against反對 the 70 trained熟練 by them,
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英國則有70位眼科專科醫生
15:01
comparable可比 quality質量, both in training訓練 and in patient患者 care關心.
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差不多相等的醫療品質就訓練跟病人照護上來比
15:04
So we're really comparing比較 apples蘋果 to apples蘋果.
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所以可以說我們是差不多的
15:07
We looked看著 at cost成本.
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我們來看看成本
15:09
(Laughter笑聲)
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(笑聲)
15:11
(Applause掌聲)
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(掌聲)
15:17
So, I think it is simple簡單 to say
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我想簡單的說
15:19
just because the U.K. isn't India印度 the difference區別 is happening事件.
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只因為英國不是印度 所以我們做到了
15:23
I think there is more to it.
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我看不只是這樣
15:25
I mean, I think one has to look at other aspects方面 as well.
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我認為你該去看其他面
15:27
Maybe there is --
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或許像是
15:29
the solution to the cost成本 could be in productivity生產率,
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達成這樣低成本的方案是可以複製的
15:33
maybe in efficiency效率, in the clinical臨床 process處理,
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在效率上在臨床流程上
15:36
or in how much they pay工資 for the lenses鏡頭 or consumables耗材,
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或是在病人買的眼鏡或是其他東西的價格上
15:39
or regulations法規, their defensive防禦性 practice實踐.
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或是法規,他們的防衛方式
15:42
So, I think decoding解碼 this can probably大概 bring帶來
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所以我認為把這些徹底學會了或許能
15:45
answers答案 to most developed發達 countries國家
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讓許多已開發國家
15:50
including包含 the U.S., and maybe
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包含美國,還有
15:52
Obama's奧巴馬 ratings評級 can go up again.
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讓美國總統歐巴馬的支持度再提升一次
15:55
(Laughter笑聲)
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(笑聲)
15:59
Another另一個 insight眼光, which哪一個, again, I want to leave離開 with you,
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另一個心得我想帶給你們的是
16:03
in conditions條件 where the problem問題 is very large,
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當這問題考驗著非常多人的時候
16:06
which哪一個 cuts削減 across橫過 all economic經濟 strata地層,
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包含了從窮人到有錢人
16:08
where we have a good solution,
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我們找到了很棒的解答
16:11
I think the process處理 I described描述,
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我認為我描述的流程
16:13
you know, productivity生產率, quality質量, patient-centered以病人為中心 care關心,
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你們看到的產能,品質,以病人為核心的照護
16:17
can give an answer回答,
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已經提出了解答
16:20
and there are many許多 which哪一個 fit適合 this paradigm範例.
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而且還有許多符合這樣的類型
16:22
You take dentistry牙科, hearing聽力 aid援助, maternity母道 and so on.
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你可以拿牙科,助聽器,育兒等等來看
16:25
There are many許多 where this paradigm範例 can now play,
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許多都能運用這個典範
16:28
but I think probably大概 one of the most challenging具有挑戰性的 things
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而我認為應該是其中最難的
16:30
is on the softer柔和 side.
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是在內心深處
16:32
Now, how do you create創建 compassion同情?
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如今你怎要找到熱情?
16:34
Now, how do you make people own擁有 the problem問題,
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如今你要如何讓人扛起這個問題
16:36
want to do something about it?
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讓他們覺得,這是他們想要做的東西?
16:38
There are a bit harder更難 issues問題.
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那是比較難的部分
16:40
And I'm sure people in this crowd人群 can probably大概 find the solutions解決方案 to these.
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我相信TED的各位應該找的到這問題的解答
16:44
So I want to end結束 my talk leaving離開 this thought and challenge挑戰 to you.
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在結束演說的同時,我用這段話,勉勵各位
16:47
Dr博士. V: When you grow增長 in spiritual精神 consciousness意識,
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V醫生:當你增長靈智的時候
16:50
we identify鑑定 with all that is in the world世界
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我們認同世上所有事物
16:53
so there is no exploitation開發.
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所以不存在剝削,
16:56
It is ourselves我們自己 we are helping幫助.
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我們所幫助的正是自己
16:58
It is ourselves我們自己 we are healing復原.
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我們所醫治的也是自己
17:01
TRTR: Thank you very much.
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圖拉斯兒賈 朗維拉:非常感謝
17:03
(Applause掌聲)
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(掌聲)
Translated by Sean Liu
Reviewed by Lin Su-Wei()

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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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