TEDGlobal 2010
Mitchell Besser: Mothers helping mothers fight HIV
Mitchell Besser: 母親互助抗愛滋
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在次撒哈拉非洲地區，愛滋病毒感染猖獗，醫生卻比其他地區少很多，由於醫療人員的缺乏，Mitchell Besser找來他的病人們，參與媽媽天地(mothers2mothers)的計畫，建起愛滋母親們互助的網路，互相扶持以改變自己，並拯救更多的生命。
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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請各位與我一起
00:18
Picture yourself driving
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想像你們開著車
00:20
down a small road in Africa,
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開在非洲的一條小路上
00:22
and as you drive along, you look off to the side,
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邊開邊注意到路邊的景象
00:25
and this is what you see:
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你會發現到的是這個
00:27
you see a field of graves.
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一片墓地
00:29
And you stop, and you get out of your car and you take a picture.
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然後你會停下來，下車，拍下照片
00:31
And you go into the town,
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繼續往城鎮開
00:33
and you inquire, "What's going on here?"
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然後你會問：「這裡發生了什麼事？」
00:35
and people are initially reluctant to tell you.
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居民一開始會不願意回答你
00:37
And then someone says,
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之後有人會向你坦白
00:39
"These are the recent AIDS deaths in our community."
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「這些是我們社區，最近因愛滋而死亡的人」
00:43
HIV isn't like other medical conditions;
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愛滋不像其他醫療疾病
00:45
it's stigmatizing.
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得愛滋是種恥辱
00:47
People are reluctant to talk about it --
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人們不願意多談
00:50
there's a fear associated with it.
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提到愛滋就一陣惶恐
00:52
And I'm going to talk about HIV today,
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我今天要談的是，關於愛滋、
00:54
about the deaths,
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關於死亡、
00:56
about the stigma.
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關於恥辱的故事
00:58
It's a medical story, but more than that, it's a social story.
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這是關於醫療的故事，但更重要的，是關於人們的故事
01:03
This map depicts the global distribution of HIV.
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這張地圖是全球愛滋分布圖
01:06
And as you can see,
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各位可以看到
01:08
Africa has a disproportionate share of the infection.
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非洲的愛滋感染分佈極不相稱
01:10
There are 33 million people
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現今有3300萬人
01:12
living with HIV in the world today.
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感染愛滋病
01:14
Of these, two-thirds, 22 million
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這當中有三分之二的人
01:17
are living in sub-Saharan Africa.
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2200萬人住在次撒哈拉非洲地區
01:20
There are 1.4 million pregnant women
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現在有140萬個愛滋媽媽
01:23
in low- and middle-income countries living with HIV
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來自於中低所得國家
01:26
and of these, 90 percent
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其中有九成
01:28
are in sub-Saharan Africa.
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就住在次撒哈拉非洲地區
01:32
We talk about things in relative terms.
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我們用相對的例子說明
01:34
And I'm going to talk about annual pregnancies
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我要談的是每年的懷孕率
01:36
and HIV-positive mothers.
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與愛滋媽媽
01:38
The United States -- a large country --
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美國這麼大一個國家
01:40
each year, 7,000 mothers with HIV
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每年有七千個愛滋媽媽
01:43
who give birth to a child.
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產下子女
01:46
But you go to Rwanda -- a very small country --
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但你看到盧安達，相對而言很小的國家
01:49
8,000 mothers with HIV who are pregnant.
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有8000個懷孕的愛滋媽媽
01:53
And then you go to Baragwanath Hospital,
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當你到巴拉瓜納醫院
01:56
outside of Johannesburg in South Africa,
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就在(南非)約翰尼斯堡附近
01:59
and 8,000 HIV-positive pregnant women
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醫院裡有約八千名懷孕的愛滋媽媽
02:01
giving birth --
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等著生產
02:03
a hospital the same as a country.
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光一家醫院的數量就如此龐大
02:06
And to realize that this is just the tip of an iceberg
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所以請了解，這只是冰山一角
02:09
that when you compare
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和南非相比
02:11
everything here to South Africa, it just pales,
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南非的情形可是一片慘澹
02:13
because in South Africa,
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因為在南非
02:16
each year 300,000 mothers with HIV
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每年有30萬個愛滋媽媽
02:19
give birth to children.
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懷孕生子
02:23
So we talk about PMTCT,
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所以我要談PMTCT
02:25
and we refer to PMTCT, prevention of mother to child transmission.
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PMTCT代表：母子垂直感染的預防計畫
02:28
I think there's an assumption amongst most people in the public
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大家對於愛滋的普遍看法是
02:31
that if a mother is HIV-positive,
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當一名母親感染愛滋
02:33
she's going to infect her child.
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她的孩子也會受感染
02:35
The reality is really, very different.
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但事實並非如此
02:38
In resource-rich countries,
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在資源豐富的國家
02:40
with all the tests and treatment we currently have,
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我們已經有許多的測試與療法
02:42
less than two percent of babies are born HIV-positive --
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愛滋寶寶機率只有不到2%
02:45
98 percent of babies are born HIV-negative.
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98%的寶寶愛滋病毒會呈現陰性反應
02:49
And yet, the reality in resource-poor countries,
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然而在資源短缺國家
02:51
in the absence of tests and treatment,
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因為測試與治療的缺乏
02:53
40 percent -- 40 percent of children are infected --
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愛滋寶寶的機率高達40%
02:56
40 percent versus two percent --
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40%與2%的差距
02:58
an enormous difference.
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是非常驚人的
03:00
So these programs --
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所以這些計畫
03:02
and I'm going to refer to PMTCT though my talk --
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我接下來演講裡所說的PMTCT
03:04
these prevention programs,
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這些預防計畫
03:06
simply, they're the tests and the drugs that we give to mothers
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簡單說，母親能接受檢查與藥物治療
03:09
to prevent them from infecting their babies,
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來預防垂直感染
03:12
and also the medicines we give to mothers
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同時也必須服用藥物
03:14
to keep them healthy and alive to raise their children.
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讓母親們身體健康到能養育嬰兒
03:16
So it's the test a mother gets when she comes in.
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所以一開始的檢查很重要
03:18
It's the drugs she receives
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她要服用的藥很重要
03:20
to protect the baby that's inside the uterus and during delivery.
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能讓肚裡的寶寶能健康發育到出生
03:23
It's the guidance she gets around infant feeding
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嬰兒餵養的指導很重要
03:25
and safer sex.
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安全性行為也很重要
03:27
It's an entire package of services,
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這是關於完善的服務
03:30
and it works.
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而且是有效的
03:32
So in the United States,
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在美國
03:34
since the advent of treatment in the middle of the 1990s,
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1990年代中期，愛滋的治療出現後
03:37
there's been an 80-percent decline
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在愛滋寶寶的數量上
03:39
in the number of HIV-infected children.
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已經降低80%
03:41
Less than 100 babies are born with HIV
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美國每年的愛滋寶寶數量
03:43
each year in the United States
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不到100個
03:45
and yet, still,
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然而世界上
03:47
over 400,000 children
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每年還是有超過40萬名兒童
03:50
are born every year in the world today with HIV.
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一出生就感染愛滋
03:54
What does that mean?
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這代表了什麼？
03:56
It means 1,100 children infected each day --
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這代表每天就有1100個孩子受感染
03:59
1,100 children each day, infected with HIV.
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每天有1100個孩子感染愛滋
04:02
And where do they come from?
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這些寶寶從哪來？
04:04
Well, less than one comes from the United States.
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不到一個是來自美國
04:08
One, on average, comes from Europe.
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平均歐洲有一個
04:12
100 come from Asia and the Pacific.
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剩下有一百個來自亞洲、太平洋地區
04:16
And each day,
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然而每一天
04:18
a thousand babies -- a thousand babies
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有一千個寶寶，一千個愛滋寶寶
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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所以我們看看全球情況
04:28
and the disproportionate share of HIV in Africa.
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在非洲，愛滋分布不均的情況
04:31
And let's look at another map.
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我們來看另一個地圖
04:33
And here, again, we see
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可以再次看到
04:35
Africa has a disproportionate share of the numbers of doctors.
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在非洲，醫生數量也是分佈不均
04:38
That thin sliver you see here, that's Africa.
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圖中那條銀色細線，就是非洲
04:41
And it's the same with nurses.
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護士也一樣
04:44
The truth is sub-Saharan Africa
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事實上，次撒哈拉非洲地區
04:46
has 24 percent
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包含了24%的
04:48
of the global disease burden
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世界疾病數量
04:50
and yet only three percent of the world's health care workers.
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但醫療人員數量卻只有全世界的3%
04:53
That means doctors and nurses
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這表示，這裡的醫生護士
04:55
simply don't have the time to take care of patients.
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根本沒有時間照顧好每個病人
04:58
A nurse in a busy clinic
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較忙的診所裡，每天
05:00
will see 50 to 100 patients in a day,
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每位護士要照看50到100位病人
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which leaves her just minutes per patient --
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一個病人只有幾分鐘時間
05:04
minutes per patient.
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短短幾分鐘
05:06
And so when we look at these PMTCT programs, what does it mean?
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當我們看看這些PMTCT計畫，代表了什麼？
05:09
Well, back in 2001,
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我們先回到2001年
05:11
when there was just a simple test
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當時要做的檢查很簡單
05:13
and a single dose of a drug,
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藥也只有一顆
05:15
a nurse, in the course of her few minutes with a patient,
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一位護士可以在幾分鐘內
05:18
would have to counsel for the HIV test, perform the HIV test,
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提供病人愛滋病諮詢、檢查、
05:21
explain the results, dispense a single dose of the drug, Nevirapine,
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解釋檢查結果、發藥(因為只有一顆：Nevirapine)、
05:24
explain how to take it, discuss infant feeding options, reinforce infant feeding,
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解釋服藥方式、討論嬰兒的服藥選擇、加強嬰兒餵食、
05:27
and test the baby -- in minutes.
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替嬰兒檢查，幾分鐘內就要完成
05:30
Well, fortunately since 2001,
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幸運的是，從2001以後
05:32
we've got new treatments, new tests,
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我們有了新治療、新測試
05:34
and we're far more successful,
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能更加成功地對抗愛滋了
05:36
but we don't have any more nurses.
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但護士還是不夠多
05:38
And so these are the tests
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這些測試是
05:41
a nurse now has to do
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現在的護士
05:43
in those same few minutes.
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短短幾分鐘內就要完成的
05:45
It's not possible --
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這根本不可能
05:47
it doesn't work.
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根本辦不到
05:49
And so we need to find
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所以我們需要的是
05:51
better ways of providing care.
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提供更好的醫療照顧
05:56
This is a picture of a maternal health clinic in Africa --
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這照片是非洲一家婦產科診所
05:59
mothers coming, pregnant and with their babies.
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許多的母親來到這，有懷孕的、帶著孩子的
06:02
These women are here for care,
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這些婦女來這裡接受照顧
06:04
but we know that just doing a test,
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我們都知道只做測試
06:06
just giving someone a drug,
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給他們藥物吃
06:08
it's not enough.
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是不夠的
06:11
Meds don't equal medical care.
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藥品不等於醫療照顧
06:14
Doctors and nurses, frankly,
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老實說，醫生護士們
06:16
don't have the time or skills
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根本沒有時間、能力
06:18
to tell people what to do in ways they understand.
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去好好解釋給病人聽
06:20
I'm a doctor -- I tell people things to do,
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我是個醫生，我給病人指示
06:23
and I expect them to follow my guidance --
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希望他們能照我說的去做
06:25
because I'm a doctor; I went to Harvard --
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因為我是個醫生，我哈佛畢業的
06:27
but the reality is,
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但事實上
06:29
if I tell a patient, "You should have safer sex.
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如果跟病人說：「你要有安全的性行為」
06:31
You should always use a condom,"
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「一定要用保險套」
06:33
and yet, in her relationship, she's not empowered --
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但他們的社會裡，女人沒有權利
06:36
what's going to happen?
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會發生什麼事？
06:38
If I tell her to take her medicines every day
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如果我告訴她，每天按時服藥
06:41
and yet, no one in the household knows about her illness, so
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但她家裡沒人知道她生病了又有什麼用
06:44
it's just not going to work.
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這是行不通的
06:47
And so we need to do more,
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所以我們必須做更多
06:49
we need to do it differently,
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必須換種方式
06:51
we need to do it in ways that are affordable
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這方式要我們能夠負擔
06:54
and accessible and can be taken to scale,
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能夠接觸到更多人
06:56
which means it can be done everywhere.
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所以一定要到處都可行
06:59
So, I want to tell you a story --
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我分享一個故事給各位
07:02
I want to take you on a little trip.
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帶你們來趟旅行
07:04
Imagine yourself, if you can,
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想想你們自己
07:06
you're a young woman in Africa, you're going to the hospital or clinic.
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是非洲的一名年輕女性，來到醫院或診所
07:09
You go in for a test
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你來做檢查
07:11
and you find out that you're pregnant, and you're delighted.
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你發現你懷孕了，很開心
07:13
And then they give you another test
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但他們要你做另一項檢查
07:15
and they tell you you're HIV-positive, and you're devastated.
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告訴你患有愛滋，你感到很絕望
07:18
And the nurse takes you into a room,
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然後護士帶你到另一個房間
07:20
and she tells you about the tests
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她告訴你一些檢查方式、
07:22
and HIV and the medicines you can take
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和需要服用的愛滋藥物
07:24
and how to take care of yourself and your baby,
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教你如何照顧自己和寶寶
07:26
and you hear none of it.
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你完全聽不進去啊
07:28
All you're hearing is, "I'm going to die,
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你聽到的只有「我快死了」
07:30
and my baby is going to die."
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「我的寶寶也會死」
07:32
And then you're out on the street, and you don't know where to go.
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然後你走出診所，沒有目標地晃
07:34
And you don't know who you can talk to,
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你不知道能向誰傾訴
07:36
because the truth is, HIV is so stigmatizing
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因為事實上，染上愛滋是很恥辱的事
07:39
that if you partner, your family, anyone in your home,
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你的伴侶、家人知道後
07:42
you're likely to be thrown out
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很可能把你趕出家門
07:44
without any means of support.
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不給你任何支柱
07:46
And this -- this is the face and story
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這就是非洲今日
07:48
of HIV in Africa today.
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對於愛滋病的樣貌
07:51
But we're here to talk about possible solutions
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今天要談的是可能的解決方式
07:54
and some good news.
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和一些好消息
07:56
And I want to change the story a little bit.
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我想要換個故事說
07:59
Take the same mother, and the nurse, after she gives her her test,
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一樣的母親、護士，在她做完檢查後
08:02
takes her to a room.
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護士帶她到另一個房間
08:04
The door opens and there's a room full of mothers, mothers with babies,
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門一打開，裡面全是媽媽們，與她們的孩子
08:07
and they're sitting, and they're talking, they're listening.
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他們坐著聊天，彼此傾聽
08:09
They're drinking tea, they're having sandwiches.
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他們喝著茶，吃著三明治
08:12
And she goes inside, and woman comes up to her and says,
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她走進去，這些女人們走向她，並說
08:14
"Welcome to mothers2mothers.
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「歡迎來到媽媽天地」
08:16
Have a seat. You're safe here.
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「請坐下吧，你很安全」
08:19
We're all HIV-positive.
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「我們都有愛滋」
08:21
You're going to be okay. You're going to live.
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「但我們都會沒事的，你不會死」
08:24
Your baby is going to be HIV-negative."
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「妳的寶寶不會得愛滋的」
08:29
We view mothers
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我們將母親視為
08:31
as a community's single greatest resource.
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社群裡最有力量的來源
08:33
Mothers take care of the children, take care of the home.
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母親們照顧幼小，照顧家園
08:36
So often the men are gone.
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男人常常不在家
08:38
They're working, or they're not part of the household.
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因為他們需要工作，不管家裡的事
08:41
Our organization, mothers2mothers,
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我們的組織「媽媽天地(mothers2mothers)」
08:43
enlists women with HIV
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讓那些愛滋媽媽
08:45
as care providers.
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成為照護人員
08:47
We bring mothers who have HIV,
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我們請那些有愛滋的母親們來
08:49
who've been through these PMTCT programs
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因為她們也經歷過PMTCT計畫
08:51
in the very facilities,
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熟悉設備
08:53
to come back and work side by side with doctors and nurses
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讓她們回來，與醫生護士們一起工作
08:56
as part of the health care team.
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就像醫療團隊的一份子
08:58
These mothers, we call them mentor mothers,
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我們稱這些母親為心靈媽媽
09:01
are able to engage women
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她們能夠接觸其他女性
09:03
who, just like themselves, pregnant with babies,
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因為這些女人就像以前的她們一樣，身懷六甲
09:05
have found out about being HIV-positive,
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因為這些女人剛知道自己得了愛滋
09:07
who need support and education.
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需要支持與教育
09:10
And they support them around the diagnosis
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心靈媽媽能給病患們連續的扶持
09:12
and educate them about how to take their medicines,
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並教導他們如何服藥
09:14
how to take care of themselves,
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如何照顧自己
09:16
how to take care of their babies.
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如何照顧孩子
09:19
Consider: if you needed surgery,
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想想：如果你需要開刀
09:22
you would want the best possible technical surgeon, right?
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你會找最好的外科醫生，對吧
09:26
But if you wanted to understand
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但如果你想了解
09:28
what that surgery would do to your life,
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手術將造成的影響
09:30
you'd like to engage someone,
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你想找的會是
09:32
someone who's had the procedure.
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有過同樣手術的病人
09:34
Patients are experts on their own experience,
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病人他們自己疾病的專家
09:37
and they can share that experience with others.
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他們可以分享自己的經驗
09:41
This is the medical care that goes beyond just medicines.
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這才是所謂藥品以外的醫療照顧
09:45
So the mothers who work for us,
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這些替我們工作的母親們
09:47
they come from the communities in which they work.
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都來自於自己的社區
09:49
They're hired -- they're paid as professional members of the health care teams,
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我們雇用她們，支付與專業醫療人員般的薪水
09:52
just like doctors and nurses.
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就像醫生、護士
09:54
And we open bank accounts for them
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我們替他們開銀行帳戶
09:56
and they're paid directly into the accounts,
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薪水直接匯入銀行
09:58
because their money's protected;
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如此一來，能保護他們的所得
10:00
the men can't take it away from them.
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讓家中的男人拿不到
10:03
They go through two to three weeks
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他們必須接受二到三週的
10:05
of rigorous curriculum-based education, training.
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非常密集教育訓練
10:08
Now, doctors and nurses -- they too get trained.
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醫生護士們也接受訓練
10:11
But so often, they only get trained once,
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但通常只有一次而已
10:13
so they're not aware of new medicines,
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所以對於新藥品、
10:15
new guidelines as they come out.
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新的指導原則都不了解
10:17
Our mentor mothers get trained every single year
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但心靈媽媽每年接受訓練
10:19
and retrained.
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重新培訓
10:21
And so doctors and nurses --
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所以醫生護士們
10:23
they look up to them as experts.
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都把他們當成專家看待
10:26
Imagine that: a woman, a former patient,
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想像一下，過去也是病人的婦女
10:29
being able to educate her doctor for the first time
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竟能夠教育她的醫生
10:31
and educate the other patients
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教育其他病人
10:33
that she's taking care of.
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照顧其他病人
10:36
Our organization has three goals.
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我們的機構有三個目標
10:38
The first, to prevent mother-to-child transmission.
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第一：預防母子垂直感染
10:42
The second: keep mothers healthy, keep mothers alive,
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第二：照顧母親的身體健康，讓媽媽們活下去
10:45
keep the children alive --
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讓孩子們活下去
10:47
no more orphans.
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不再有孤兒
10:49
And the third, and maybe the most grand,
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第三點，也是最重要的一點
10:52
is to find ways to empower women,
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就是找到能賦予女性們力量的方法
10:56
enable them to fight the stigma
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讓她們能打破既有的印象
10:58
and to live positive and productive lives with HIV.
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雖患愛滋，但也能過著正向、有生產力的人生
11:02
So how do we do it?
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我們怎麼做的？
11:04
Well, maybe the most important engagement
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我想，最重要的就是"參與"
11:06
is the one-to-one,
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就是一對一
11:08
seeing patients one-to-one, educating them, supporting them,
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一對一的醫療諮詢及照顧
11:11
explaining how they can take care of themselves.
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教導他們如何照顧自己
11:14
We go beyond that;
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我們所做的不只如此
11:16
we try to bring in the husbands, the partners.
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我們找來她們的丈夫、伴侶
11:19
In Africa, it's very, very hard to engage men.
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在非洲，要男性們一起參與是很困難的
11:22
Men are not frequently part of pregnancy care.
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男人們通常不參與懷孕保健
11:26
But in Rwanda, in one country,
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但在盧安達這地方
11:28
they've got a policy
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他們有個政策就是
11:30
that a woman can't come for care
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婦女不能單獨尋求醫療照顧
11:32
unless she brings the father of the baby with her --
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一定要孩子的父親陪伴才行
11:34
that's the rule.
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這就是規定
11:36
And so the father and the mother, together,
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所以爸媽兩人會一起
11:38
go through the counseling and the testing.
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接受檢查與諮詢
11:41
The father and the mother, together, they get the results.
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爸媽兩人一起等待檢查報告
11:43
And this is so important in breaking through the stigma.
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這是打破原始印象很重要的一件事
11:47
Disclosure is so central to prevention.
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公開對於預防是很重要的
11:50
How do you have safer sex, how do you use a condom regularly
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要怎麼進行安全性行為？要怎麼定期使用保險套？
11:53
if there hasn't been disclosure?
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這些都是透過公開做到的
11:55
Disclosure is so important to treatment,
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公開對於治療也很重要
11:58
because again, people need the support of family members and friends
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因為，病人們需要家人朋友的支持
12:01
to take their medicines regularly.
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才能乖乖按時服藥
12:04
We also work in groups.
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我們也是以團體進行
12:06
Now the groups, it's not like me lecturing,
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在團體裡，講課的不是我
12:08
but what happens is women, they come together --
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而是這些女人們，聚在一起
12:11
under the support and guidance of our mentor mothers --
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在心靈媽媽的協助及輔導下
12:13
they come together, and they share their personal experiences.
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她們來到這裡，分享彼此的經驗
12:16
And it's through the sharing
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透過分享
12:18
that people get tactics of how to take care of themselves,
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病患們學會怎麼照顧自己
12:20
how to disclose how to take medicines.
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怎麼對他人坦白、如何服藥
12:24
And then there's the community outreach,
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接下來還要擴展到整個社區
12:26
engaging women in their communities.
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讓社區內的女人都一同參與
12:29
If we can change the way
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如果我們能改變一個家戶
12:31
households believe and think,
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的想法與信念
12:33
we can change the way communities believe and think.
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我們就能改變整個社群的想法信念
12:36
And if we can change enough communities,
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如果我們能改變整個社群
12:38
we can change national attitudes.
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我們就能改變整個國家態度
12:40
We can change national attitudes to women
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就能改變整個國家對女人的態度
12:42
and national attitudes to HIV.
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對愛滋病的態度
12:45
The hardest barrier really is around stigma reduction.
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最難的隔閡就是既有印象的破除
12:47
We have the medicines, we have the tests,
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我們有藥物，也有醫療檢查
12:49
but how do you reduce the stigma?
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但要如何破除既有印象？
12:52
And it's important about disclosure.
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這又回到公開的重要性了
12:54
So, a couple years ago, one of the mentor mothers came back,
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幾年前，有位心靈媽媽回來後
12:56
and she told me a story.
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告訴我個故事
12:58
She had been asked by one of the clients
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她有個病人，要求她
13:00
to go to the home of the client,
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陪她一起回家
13:02
because the client wanted to tell the mother and her brothers and sisters
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因為那病人想告訴自己的家人
13:05
about her HIV status,
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她患有愛滋
13:07
and she was afraid to go by herself.
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但她不敢一個人面對
13:09
And so the mentor mother went along with.
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所以心靈媽媽陪她一起去
13:11
And the patient walked into the house
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那病人走近家中
13:13
and said to her mother and siblings,
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對她的母親與手足說：
13:16
"I have something to tell you. I'm HIV-positive."
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「我要告訴你們一件事，我有愛滋」
13:19
And everybody was quiet.
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每個人都噤聲
13:21
And then her oldest brother stood up and said,
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然後他的大哥站起來說
13:23
"I too have something to tell you.
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「我也要告訴你們一件事」
13:25
I'm HIV-positive.
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「我也有愛滋」
13:27
I've been afraid to tell everybody."
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「我一直不敢跟你們說」
13:30
And then this older sister stood up and said,
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然後她姐姐也站起來說
13:32
"I too am living with the virus,
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「我也有愛滋」
13:35
and I've been ashamed."
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「一直怕丟臉不敢說」
13:37
And then her younger brother stood up and said,
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同樣的，她弟弟也站起來說
13:40
"I'm also positive.
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「我也有愛滋」
13:42
I thought you were going to throw me out of the family."
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「我怕你們知道後，會把我趕出家門」
13:44
And you see where this is going.
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你們應該猜到後續發展了
13:46
The last sister stood up and said, "I'm also positive.
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最後，妹妹站起來說「我也有愛滋」
13:48
I thought you were going to hate me."
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「我怕你們會恨我」
13:50
And there they were, all of them together for the first time
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就這樣，他們第一次面對彼此
13:52
being able to share this experience for the first time
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第一次分享這個經驗
13:55
and to support each other for the first time.
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第一次給彼此支持
13:58
(Video) Female Narrator: Women come to us,
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(影片) 許多女人來到這
14:00
and they are crying and scared.
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哭喪著臉
14:03
I tell them my story,
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我分享自己的故事
14:05
that I am HIV-positive,
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告訴她們，我也是愛滋病患
14:08
but my child is HIV-negative.
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但我的孩子很健康
14:11
I tell them, "You are going to make it,
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我告訴她們，「你們辦得到的」
14:14
and you will raise a healthy baby."
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「你可以扶養出健康的寶寶。」
14:18
I am proof that there is hope.
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我就是最好的證明
14:24
Mitchell Besser: Remember the images I showed you
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記得我今天給各位看的
14:26
of how few doctors and nurses there are in Africa.
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非洲那極少數的醫生護士數量
14:28
And it is a crisis in health care systems.
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他們醫療系統的大問題
14:31
Even as we have more tests and more drugs,
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就算我們有再多的藥品、檢查
14:33
we can't reach people; we don't have enough providers.
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我們還是沒辦法接觸到很多人，因為協助不夠多
14:35
So we talk in terms of what we call task-shifting.
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所以我們講到任務轉換
14:37
Task-shifting is traditionally
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任務轉換通常是
14:39
when you take health care services from one provider
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當你從某個提供照護者的身上，獲得服務
14:41
and have another provider do it.
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會是由另一個照護者幫助你
14:43
Typically, it's a doctor giving a job to a nurse.
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正常來講，是由醫生囑咐護士
14:45
And the issue in Africa
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但非洲的問題是
14:47
is that there are fewer nurses, really than doctors,
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護士比醫生還少
14:49
and so we need to find new paradigm for health care.
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所以健保來說，需要有新規範
14:52
How do you build a better health care system?
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要怎麼建立更好的健保制度？
14:55
We've chosen to redefine the health care system
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我選擇去重新定義健保制度
14:57
as a doctor, a nurse and a mentor mother.
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新制度包含了醫生、護士，和心靈媽媽
14:59
And so what nurses do
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所以護士們能請
15:01
is that they ask the mentor mothers to explain
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心靈媽媽們向病人解釋
15:03
how to take the drugs, the side effects.
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服藥方式、及其副作用
15:05
They delegate education about infant feeding,
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她們教育這些媽媽餵食嬰兒的方式、
15:08
family planning, safer sex,
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家庭計劃、安全性行為
15:10
actions that nurses simple just don't have time for.
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這些都是護士們沒有時間做的
15:15
So we go back to the prevention of mother to child transmission.
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我們回到最初討論的，母子垂直感染的預防
15:18
The world is increasingly seeing these programs
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有越來越多人，將這類型的計畫
15:20
as the bridge to comprehensive maternal and child health.
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視為母子健康的全面性橋樑
15:23
And our organization
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而我們的組織
15:25
helps women across that bridge.
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就是要幫助女性跨越橋樑
15:27
The care doesn't stop when the baby's born --
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但醫療照顧不止於孩子出生而已
15:29
we deal with the ongoing health of the mother and baby,
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我們照顧母子後續的健康
15:32
ensuring that they live healthy,
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確保他們都能
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successful lives.
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健康地活下去
15:37
Our organization works on three levels.
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我們的組織有三個層面
15:40
The first, at the patient level --
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第一：病患層面
15:42
mothers and babies keeping babies from getting HIV,
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照顧母子，避免孩子傳染上愛滋病毒
15:44
keeping mothers healthy to raise them.
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讓母親能健康地撫養小孩
15:47
The second, communities --
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第二：社群層面
15:49
empowering women.
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賦予女性力量
15:51
They become leaders within their communities.
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讓她們成為自己社群的領導者
15:54
They change the way communities think --
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讓她們改變社群的思考方式
15:56
we need to change attitudes to HIV.
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我們必須改變大家對愛滋的態度
15:59
We need to change attitudes to women in Africa.
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我們必須改變大家對非洲女性的態度
16:01
We have to do that.
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我們必須做到這些
16:03
And then rework the level of the health care systems,
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再來努力健保系統的部份
16:06
building stronger health care systems.
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建立更強大的醫療體制
16:08
Our health care systems are broken.
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因為現有的體制已經無效
16:10
They're not going to work the way they're currently designed.
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照現在制度是不可行的
16:13
And so doctors and nurses
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所以那些醫生護士們
16:15
who need to try to change people's behaviors
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必須負責改變病人的行為
16:17
don't have the skills, don't have the time --
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不過他們沒有能力，也沒時間
16:19
our mentor mothers do.
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但心靈媽媽們有
16:21
And so in redefining the health care teams by bringing the mentor mothers in,
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藉由心靈媽媽的加入，重新組織的醫療團隊才健全
16:24
we can do that.
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這我們做得到
16:27
I started the program in Capetown, South Africa
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我們的計畫最早從(南非)開普敦開始的
16:30
back in 2001.
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2001年那時候
16:32
It was at that point, just the spark of an idea.
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當時，只是個突想的點子
16:35
Referencing Steven Johnson's very lovely speech yesterday
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依據Steven Johnson昨天的演講
16:38
on where ideas come from,
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講述新點子是從哪裡來
16:41
I was in the shower at the time --
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我當時沖著澡
16:44
I was alone.
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獨自一人
16:46
(Laughter)
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(笑聲)
16:50
The program is now working in nine countries,
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我們的計畫已在九個國家實行
16:53
we have 670 program sites,
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共有670個據點
16:56
we're seeing about 230,000
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每個月能照顧到
16:59
women every month,
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23萬名婦女
17:01
we're employing 1,600 mentor mothers,
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共僱用1600個心靈媽媽
17:04
and last year, they enrolled
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去年，我們收了
17:06
300,000 HIV-positive pregnant women and mothers.
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30萬名愛滋媽媽
17:09
That is 20 percent
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這佔了全球
17:12
of the global HIV-positive pregnant women --
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愛滋媽媽的20%
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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這麼簡單的主張，這麼驚人的成果
17:19
Mothers with HIV caring for mothers with HIV.
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讓愛滋媽媽照顧愛滋媽媽
17:22
Past patients taking care of present patients.
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讓過去的病患照顧現在的病患
17:24
And empowerment through employment --
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讓就業賦予她們能力
17:26
reducing stigma.
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打破既有的看法
17:28
(Video) Female Narrator: There is hope,
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(影片) 希望是存在的
17:30
hope that one day
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我希望有天
17:32
we shall win this fight
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我們能贏得這場
17:34
against HIV and AIDS.
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對抗愛滋的戰爭
17:37
Each person must know
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每個人都要知道
17:39
their HIV status.
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自己的愛滋病毒情況
17:42
Those who are HIV-negative
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那些愛滋病毒成陰性反應的人
17:44
must know how to stay negative.
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要知道怎麼繼續保持陰性
17:48
Those who are HIV-infected
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已經感染愛滋病毒的人
17:51
must know how
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一定要知道
17:53
to take care of themselves.
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如何照顧自己
17:56
HIV-positive pregnant women
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感染愛滋的懷孕婦女
17:58
must get PMTCT services
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一定要加入PMTCT計畫
18:01
in order to have
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如此才能
18:03
HIV-negative babies.
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生下健康的寶寶
18:05
All of this is possible,
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這些是辦得到的
18:08
if we each contribute to this fight.
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只要每個人都盡一己之力
18:13
MB: Simple solutions to complex problems.
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這個複雜問題的簡單解答就是
18:16
Mothers caring for mothers.
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讓母親們相互照顧
18:18
It's transformational.
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這轉變是非常大的
18:20
Thank you.
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謝謝各位
18:22
(Applause)
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(掌聲)
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