TEDMED 2012
Rebecca Onie: What if our health care system kept us healthy?
Rebecca Onie: Što kad bi nas naš zdravstveni sustav održavao zdravima?
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Rebecca Onie postavlja smiona pitanja: Što bi bilo da su čekaonice mjesta za poboljšanje svakodenevne zdravstvene skrbi? Što kad bi liječnici mogli propisati hranu, smještaj i toplinu u zimi? Na TEDMED-u ona opisuje Health Leads, organizaciju koja radi upravo to – i to izgrađujući bazu volontera jednako elitnih i posvećenih kao sveučilišna sportska momčad.
Rebecca Onie - Health services innovator
Rebecca Onie is the founder of Health Leads, a program that connects patients to basic care and resources, such as food and housing, that are the root cause of many health problems. Full bio
Rebecca Onie is the founder of Health Leads, a program that connects patients to basic care and resources, such as food and housing, that are the root cause of many health problems. Full bio
Double-click the English transcript below to play the video.
00:16
So my freshman year of college
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Na prvoj godini fakulteta
00:17
I signed up for an internship in the housing unit
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prijavila sam se za staž u stambenoj jedinici
00:20
at Greater Boston Legal Services.
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u Greater Boston Legal Services (pravna služba).
00:22
Showed up the first day
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Pojavila sam se prvi dan
00:24
ready to make coffee and photocopies,
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spremna za kuhanje kave i fotokopiranje,
00:26
but was paired with this righteous, deeply inspired attorney
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ali bila sam uparena s korektnim,
duboko nadahnutim odvjetnikom
duboko nadahnutim odvjetnikom
00:31
named Jeff Purcell,
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po imenu Jeff Purcell,
00:32
who thrust me onto the front lines
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koji me od prvog dana
00:35
from the very first day.
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gurao u prve redove.
00:37
And over the course of nine months
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Tijekom devet mjeseci
00:39
I had the chance
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imala sam priliku
00:40
to have dozens of conversations
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voditi desetke razgovora
00:41
with low-income families in Boston
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s obiteljima niskih prihoda u Bostonu
00:44
who would come in presenting with housing issues,
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koje bi dolazile zbog svojih stambenih problema,
00:47
but always had an underlying health issue.
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ali uvijek su imale neki
zdravstveni problem u pozadini.
zdravstveni problem u pozadini.
00:51
So I had a client who came in,
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Dakle, došao mi je klijent
00:53
about to be evicted because he hasn't paid his rent.
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koji je trebao biti izbačen jer nije platio stanarinu.
00:55
But he hasn't paid his rent, of course,
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Ali, naravno, on nije platio stanarinu
00:57
because he's paying for his HIV medication
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zato što plaća lijekove za HIV
01:00
and just can't afford both.
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i jednostavno si ne može priuštiti oboje.
01:02
We had moms who would come in,
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Dolazile su majke,
01:03
daughter has asthma,
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kći ima astmu i
01:05
wakes up covered in cockroaches every morning.
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svako jutro budi se prekrivena žoharima.
01:08
And one of our litigation strategies
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Jedna od naših parničkih strategija
01:10
was actually to send me into the home of these clients
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zapravo je bila da ja odem u kuće tih klijenata
01:12
with these large glass bottles.
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s velikim staklenim bocama.
01:15
And I would collect the cockroaches,
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Prikupila bih žohare,
01:17
hot glue-gun them to this poster board
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pištoljem na vruće ljepilo zalijepili bismo ih na pano
01:20
that we'd bring to court for our cases.
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koji bismo ponijeli na sud za naše slučajeve.
01:22
And we always won
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I uvijek smo pobjeđivali
01:23
because the judges were just so grossed out.
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jer su suci bili toliko zgroženi.
01:26
Far more effective, I have to say,
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Daleko je djelotvornije, moram reći,
01:28
than anything I later learned in law school.
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nego bilo što što sam kasnije naučila
na pravnom fakultetu.
na pravnom fakultetu.
01:31
But over the course of these nine months,
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No, tijekom tih devet mjeseci,
01:33
I grew frustrated with feeling
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postala sam frustrirana osjećajem
01:35
like we were intervening too far downstream
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da interveniramo prekasno –
01:38
in the lives of our clients --
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da su naši klijenti
01:40
that by the time they came to us,
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već u krizi
01:42
they were already in crisis.
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kad dođu do nas.
01:44
And at the end of my freshman year of college,
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Na kraju moje prve godine fakulteta,
01:47
I read an article about the work
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pročitala sam članak o radu
01:49
that Dr. Barry Zuckerman was doing
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dr. Barryja Zuckermana koji je bio
01:50
as Chair of Pediatrics
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šef pedijatrije
01:53
at Boston Medical Center.
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u Boston Medical Center-u.
01:54
And his first hire was a legal services attorney
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Prvo je zaposlio odvjetnika
01:57
to represent the patients.
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da zastupa pacijente.
01:59
So I called Barry,
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Nazvala sam Barryja
02:00
and with his blessing, in October 1995
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te s njegovim blagoslovom,
02:03
walked into the waiting room
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u listopadu 1995. ušla u čekaonicu
02:05
of the pediatrics clinic at Boston Medical Center.
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pedijatrijske klinike u Boston Medical Center-u.
02:08
I'll never forget,
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Nikad neću zaboraviti kako su se
02:09
the TVs played this endless reel of cartoons.
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na TV-u u krug prikazivali crtići.
02:12
And the exhaustion of mothers
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A iscrpljenost majki
02:15
who had taken two, three, sometimes four buses
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koje su morale presjesti na dva, tri,
ponekad četiri autobusa
ponekad četiri autobusa
02:19
to bring their child to the doctor
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kako bi dovele svoje dijete k liječniku,
02:21
was just palpable.
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bila je očigledna.
02:22
The doctors, it seemed,
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Činilo se da liječnici
02:24
never really had enough time for all the patients,
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nikad nisu imali dovoljno vremena za sve pacijente,
02:25
try as they might.
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koliko god se trudili.
02:27
And over the course of six months,
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Tijekom šest mjeseci,
02:28
I would corner them in the hallway
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zaustavila bih ih na hodniku
02:29
and ask them a sort of naive but fundamental question:
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te ih upitala neka naivna, ali temeljna pitanja:
02:33
"If you had unlimited resources,
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"Kada biste imali neograničena sredstva,
02:36
what's the one thing you would give your patients?"
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koja je jedna stvar koju biste dali pacijentima?"
02:39
And I heard the same story again and again,
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I čula sam istu priču uvijek iznova,
02:42
a story we've heard hundreds of times since then.
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priču koju smo čuli stotine puta od tada.
02:45
They said, "Every day we have patients that come into the clinic --
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Rekli su: "Svaki dan imamo pacijente
koji dolaze u kliniku --
koji dolaze u kliniku --
02:48
child has an ear infection,
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dijete ima upalu uha
02:50
I prescribe antibiotics.
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i ja propišem antibiotike.
02:52
But the real issue is there's no food at home.
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Ali pravi problem je da nema hrane kod kuće.
02:55
The real issue
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Pravi problem je
02:56
is that child is living with 12 other people
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da dijete živi s još 12 drugih ljudi
02:59
in a two-bedroom apartment.
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u dvosobnom stanu.
03:00
And I don't even ask about those issues
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A ja čak ni ne pitam o tim problemima
03:02
because there's nothing I can do.
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jer ne mogu ništa učiniti.
03:05
I have 13 minutes with each patient.
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Imam 13 minuta za svakog pacijenta.
03:06
Patients are piling up in the clinic waiting room.
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Pacijenti se gomilaju u čekaonici.
03:09
I have no idea where the nearest food pantry is.
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Nemam pojma gdje je najbliža banka hrane.
03:12
And I don't even have any help."
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Čak nemam nikakvu pomoć. "
03:14
In that clinic, even today,
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U toj klinici, čak i danas,
03:15
there are two social workers
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postoje dva socijalna radnika
03:17
for 24,000 pediatric patients,
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za 24.000 pedijatrijskih pacijenata,
03:20
which is better than a lot of the clinics out there.
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što je bolja situacija
nego u mnogim drugim klinikama.
nego u mnogim drugim klinikama.
03:23
So Health Leads was born of these conversations --
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Dakle Health Leads je nastao iz tih razgovora --
03:26
a simple model
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jednostavan model
03:27
where doctors and nurses
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u kojem liječnici i medicinske sestre
03:28
can prescribe nutritious food,
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svojim pacijentima mogu propisati
03:30
heat in the winter
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hranu koja je hranjiva,
03:32
and other basic resources for their patients
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toplinu u zimi i druge osnovna sredstva
03:34
the same way they prescribe medication.
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na isti način na koji propisuju lijekove.
03:37
Patients then take their prescriptions
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Pacijenti zatim donesu svoj recept
03:39
to our desk in the clinic waiting room
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za naš stol u čekaonici
03:41
where we have a core of well-trained college student advocates
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gdje je naš tim dobro obučenih studenata prava
03:45
who work side by side with these families
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koji rade rame uz rame s tim obiteljima
03:48
to connect them out
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povezujući ih
03:49
to the existing landscape of community resources.
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s postojećom paletom sredstava zajednice.
03:52
So we began with a card table in the clinic waiting room --
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Dakle počeli smo sa stolom
s karticama u čekaonici klinike --
s karticama u čekaonici klinike --
03:56
totally lemonade stand style.
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u stilu štanda s limunadom.
03:58
But today we have a thousand college student advocates
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No, danas imamo tisuću studenata prava
04:01
who are working to connect nearly 9,000 patients and their families
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koji rade na povezivanju gotovo
9000 pacijenata i njihovih obitelji
9000 pacijenata i njihovih obitelji
04:05
with the resources that they need to be healthy.
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sa sredstvima koja su im potrebna da budu zdravi.
04:09
So 18 months ago
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Prije 18 mjeseci
04:10
I got this email that changed my life.
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primila sam e-mail koji mi je promijenio život.
04:13
And the email was from Dr. Jack Geiger,
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E-mail je bio od dr. Jacka Geigera,
04:15
who had written to congratulate me on Health Leads
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koji mi je pisao da mi čestita na Health Leads-u
04:18
and to share, as he said,
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te da podijeli, kako je rekao,
04:20
a bit of historical context.
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malo povijesnog konteksa.
04:22
In 1965 Dr. Geiger founded
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1965. godine dr. Geiger osnovao je
04:25
one of the first two community health centers in this country,
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jedan od prva dva društvena
zdravstvena centra u zemlji,
zdravstvena centra u zemlji,
04:28
in a brutally poor area in the Mississippi Delta.
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u strašno siromašnom području delte Mississippija.
04:31
And so many of his patients came in
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Mnogi njegovi pacijenti dolazili su
04:34
presenting with malnutrition
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dolazili su pothranjeni
04:36
that be began prescribing food for them.
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pa smo im počeli propisivati hranu.
04:39
And they would take these prescriptions to the local supermarket,
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Odnijeli bi te recepte do lokalnih trgovina,
04:42
which would fill them
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koje bi ih ispunile,
04:43
and then charge the pharmacy budget of the clinic.
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a zatim naplatiti troškove
iz proračuna klinike za lijekove.
iz proračuna klinike za lijekove.
04:46
And when the Office of Economic Opportunity in Washington, D.C. --
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Kad je Ured za ekonomske prilike u Washingtonu –
04:49
which was funding Geiger's clinic --
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koji je financirao Geigerovu kliniku –
04:50
found out about this,
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saznao za to,
04:52
they were furious.
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bili su bijesni.
04:53
And they sent this bureaucrat down
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Poslali su birokrata da
04:55
to tell Geiger that he was expected to use their dollars
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kaže Geigeru kako se od njega
očekuje da njihov novac
očekuje da njihov novac
04:58
for medical care --
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koristi za medicinsku skrb --
04:59
to which Geiger famously and logically responded,
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na što je Geiger slavno i logički odgovorio:
05:02
"The last time I checked my textbooks,
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"Zadnji put kad sam provjeravao svoje udžbenike,
05:05
the specific therapy for malnutrition was food."
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terapija za pothranjenost bila je hrana."
05:09
(Laughter)
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(Smijeh)
05:10
So when I got this email from Dr. Geiger,
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Kad sam dobila ovaj e-mail od dr. Geigera,
05:13
I knew I was supposed to be proud
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znala sam da trebam biti ponosna
05:16
to be part of this history.
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što sam dio ove povijesti.
05:17
But the truth is
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No, istina je da
05:18
I was devastated.
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sam bila očajna.
05:20
Here we are,
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Prošlo je 45 godina
05:22
45 years after Geiger has prescribed food for his patients,
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otkako je Geiger propisao
hranu svojima pacijentima,
hranu svojima pacijentima,
05:26
and I have doctors telling me,
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a liječnici mi kažu da
05:28
"On those issues, we practice a 'don't ask, don't tell' policy."
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kod takvih problema radije ništa ne pitaju.
05:32
Forty-five years after Geiger,
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45 godina nakon Geigera,
05:34
Health Leads has to reinvent
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Health Leads treba ponovno izumiti
05:36
the prescription for basic resources.
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recepte za osnovna sredstva.
05:39
So I have spent hours upon hours
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Tako sam provela sate i sate
05:42
trying to make sense of this weird Groundhog Day.
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pokušavajući naći smisao ovom
čudnom stanju koje nikako da završi.
čudnom stanju koje nikako da završi.
05:45
How is it that if for decades
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Ako smo već desetljećima
05:48
we had a pretty straightforward tool for keeping patients,
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imali prilično jednostavan alat
za održavanje pacijenata zdravima,
za održavanje pacijenata zdravima,
05:50
and especially low-income patients, healthy,
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a posebice pacijenata s niskim primanjima,
05:53
that we didn't use it?
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kako to da ga nismo koristili?
05:55
If we know what it takes to have a healthcare system
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Ako znamo što je potrebno da
bismo imali zdravstveni sustav,
bismo imali zdravstveni sustav,
05:58
rather than a sick-care system,
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a ne bolesni sustav,
06:01
why don't we just do it?
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zašto to jednostavno ne učinimo?
06:03
These questions, in my mind,
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Ta pitanja, u mojoj glavi,
06:05
are not hard because the answers are complicated,
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nisu teška zato što su odgovori komplicirani,
06:08
they are hard because they require that we be honest with ourselves.
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već su teška jer zahtijevaju da
budemo iskreni sami sa sobom.
budemo iskreni sami sa sobom.
06:13
My belief is that it's almost too painful
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Moje uvjerenje je da je gotovo prebolno
06:16
to articulate our aspirations for our healthcare system,
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izgovoriti naše težnje za naš zdravstveni sustav,
06:19
or even admit that we have any at all.
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ili čak priznati da ih uopće imamo.
06:22
Because if we did,
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Jer ako bismo to i učinili,
06:23
they would be so removed
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one bi bile toliko daleke
06:25
from our current reality.
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od naše trenutne stvarnosti.
06:27
But that doesn't change my belief
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Ali to ne mijenja moje uvjerenje
06:30
that all of us, deep inside,
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da svi mi, duboko u sebi,
06:33
here in this room and across this country,
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u ovoj sobi i diljem zemlje,
06:37
share a similar set of desires.
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dijelimo slične želje.
06:39
That if we are honest with ourselves
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Ako smo iskreni sami sa sobom
06:42
and listen quietly,
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i tiho osluškujemo,
06:44
that we all harbor
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svi mi imamo
06:46
one fiercely held aspiration for our healthcare:
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čvrsto usidrenu nadu za našu zdravstvenu skrb,
06:50
that it keep us healthy.
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a to je da nas održava zdravima.
06:52
This aspiration that our healthcare keep us healthy
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Ta težnja da nas naša
zdravstvena skrb održava zdravima
zdravstvena skrb održava zdravima
06:55
is an enormously powerful one.
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neizmjerno je moćna.
06:58
And the way I think about this
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Način na koji ja razmišljam o tome
07:00
is that healthcare is like any other system.
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jest da je zdravstvena skrb kao i svaki drugi sustav.
07:02
It's just a set of choices that people make.
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To je samo niz izbora koje ljudi čine.
07:05
What if we decided
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Što ako odlučimo
07:07
to make a different set of choices?
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napraviti drugi niz izbora?
07:09
What if we decided to take all the parts of healthcare
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Što ako smo odlučili uzeti
sve dijelove zdravstvene skrbi
sve dijelove zdravstvene skrbi
07:12
that have drifted away from us
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koji su se udaljili od nas
07:14
and stand firm and say, "No.
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te zauzmemo čvrsti stav i kažemo: "Ne.
07:17
These things are ours.
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To su naše stvari.
07:19
They will be used for our purposes.
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Koristit će se za naše potrebe.
07:21
They will be used to realize
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2024
Koristit će se za ostvarenje
07:23
our aspiration"?
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1931
naših težnji"?
07:24
What if everything we needed
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429093
1750
Što ako je sve što potrebno
07:26
to realize our aspiration for healthcare
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2145
za ostvarenje naše težnje za zdravstvenu skrb
07:28
was right there in front of us
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1583
upravo ovdje ispred nas,
07:30
just waiting to be claimed?
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1884
samo čeka da se uzme?
07:32
So that's where Health Leads began.
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2050
Dakle, tu je Health Leads počeo.
07:34
We started with the prescription pad --
185
438505
1684
Počeli smo s blokom s receptima --
07:36
a very ordinary piece of paper --
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2399
vrlo običnim komadom papira --
07:38
and we asked, not what do patients need to get healthy --
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3968
i pitali smo, ne što pacijenti trebaju da bi ozdravili --
07:42
antibiotics, an inhaler, medication --
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3018
antibiotike, inhalator, lijekove --
07:45
but what do patients need to be healthy,
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2783
nego ono što pacijenti trebaju da bi bili zdravi,
07:48
to not get sick in the first place?
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2547
da se uopće ne razbole.
07:50
And we chose to use the prescription
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1851
Odlučili smo koristiti recepte
07:52
for that purpose.
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1782
u tu svrhu.
07:54
So just a few miles from here
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458537
1202
Dakle, samo nekoliko kilometara odavde,
07:55
at Children's National Medical Center,
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1784
u Children's National Medical Center-u,
07:57
when patients come into the doctor's office,
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2266
kad pacijenti dođu kod liječnika
07:59
they're asked a few questions.
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1685
postavlja im se par pitanja.
08:01
They're asked, "Are you running out of food at the end of the month?
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2664
Pita ih se: "Ponestaje li vam hrane krajem mjeseca?
08:04
Do you have safe housing?"
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1566
Imate li siguran smještaj?".
08:05
And when the doctor begins the visit,
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2069
I kad liječnica krene u vizitu,
08:07
she knows height, weight, is there food at home,
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2833
zna visinu, težinu, ima li hrane kod kuće,
08:10
is the family living in a shelter.
201
474606
1616
živi li obitelj u prihvatilištu.
08:12
And that not only leads to a better set of clinical choices,
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2884
I to ne dovodi samo do
bolje palete kliničkih izbora,
bolje palete kliničkih izbora,
08:15
but the doctor can also prescribe those resources for the patient,
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4050
već liječnik može propisati ta sredstva za pacijenta,
08:19
using Health Leads like any other sub-specialty referral.
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3666
koristeći Health Leads kao bilo koju
drugu pod-specijalističku uputnicu.
drugu pod-specijalističku uputnicu.
08:22
The problem is,
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2233
Problem je da,
08:24
once you get a taste of what it's like
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2199
nakon što okusite kako je to kad
08:27
to realize your aspiration for healthcare,
207
491254
2235
ostvarite svoju težnju za zdravstvenom skrbi,
08:29
you want more.
208
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1518
želite više.
08:30
So we thought,
209
495007
763
Pa smo pomislili,
08:31
if we can get individual doctors
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1601
ako možemo nagovoriti pojedine liječnike
08:33
to prescribe these basic resources for their patients,
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3217
da propisuju ova osnovna
sredstva za svoje pacijente,
sredstva za svoje pacijente,
08:36
could we get an entire healthcare system
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500588
2717
možemo li postići da cijeli zdravstveni sustav
08:39
to shift its presumption?
213
503305
2752
promijeni svoje pretpostavke?
08:41
And we gave it a shot.
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1247
I pokušali smo to učiniti.
08:43
So now at Harlem Hospital Center
215
507304
1435
Tako sad u bolničkom centru u Harlemu
08:44
when patients come in with an elevated body mass index,
216
508739
3786
kad pacijenti dođu s povišenim
indeksom tjelesne mase,
indeksom tjelesne mase,
08:48
the electronic medical record
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1864
elektronički medicinski registar
08:50
automatically generates a prescription for Health Leads.
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514389
3800
automatski stvara recept za Health Leads.
08:54
And our volunteers can then work with them
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1466
Naši volonteri mogu tad raditi s njima
08:55
to connect patients to healthy food and excercise programs
220
519655
3217
kako bi povezali pacijente sa zdravom
hranom i programom vježbe
hranom i programom vježbe
08:58
in their communities.
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522872
1432
u njihovim zajednicama.
09:00
We've created a presumption
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524304
1134
Stvorili smo pretpostavku da vam,
09:01
that if you're a patient at that hospital
223
525438
1567
ako ste pacijent u bolnici
09:02
with an elevated BMI,
224
527005
1550
s povišenim indeksom tjelesne mase,
09:04
the four walls of the doctor's office
225
528555
2234
četiri zida liječničke ordinacije
09:06
probably aren't going to give you everything
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530789
1852
vjerojatno neće dati sve
09:08
you need to be healthy.
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1182
što vam treba da biste bili zdravi.
09:09
You need more.
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533823
1400
Trebate više.
09:11
So on the one hand,
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535223
681
Dakle, s jedne strane,
09:11
this is just a basic recoding
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1697
to je samo osnovno rekodiranje
09:13
of the electronic medical record.
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1705
elektroničkog medicinskog registra.
09:15
And on the other hand,
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1718
A s druge strane,
09:16
it's a radical transformation
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1649
to je radikalna transformacija
09:18
of the electronic medical record
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2168
elektroničkog medicinskog registra
09:20
from a static repository of diagnostic information
235
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3882
iz statičkog spremišta dijagnostičkih informacija
09:24
to a health promotion tool.
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548723
2834
u alat za promicanje zdravlja.
09:27
In the private sector,
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1117
U privatnom sektoru,
09:28
when you squeeze that kind of additional value
238
552674
2620
kad ugurate takvu dodatnu vrijednost
09:31
out of a fixed-cost investment,
239
555294
1747
iz ulaganja fiksne cijene,
09:32
it's called a billion-dollar company.
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557041
2600
to se zove multimilijarderska tvrtka.
09:35
But in my world,
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1381
No, u mom svijetu,
09:36
it's called reduced obesity and diabetes.
242
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3401
to se zove smanjene pretilosti i dijabetesa.
09:40
It's called healthcare --
243
564423
1883
To se zove zdravstvena skrb --
09:42
a system where doctors can prescribe solutions
244
566306
2983
sustav u kojem liječnici mogu propisati rješenja
09:45
to improve health,
245
569289
1550
za poboljšanje zdravlja,
09:46
not just manage disease.
246
570839
2149
a ne samo upravljati bolestima.
09:48
Same thing in the clinic waiting room.
247
572988
1534
Ista stvar u kliničkoj čekaonici.
09:50
So every day in this country
248
574522
1617
Dakle, svaki dan u ovoj zemlji
09:52
three million patients
249
576139
1500
3 milijuna pacijenata
09:53
pass through about 150,000 clinic waiting rooms in this country.
250
577639
4494
prođe kroz otprilike 150.000 čekaonica
u klinikama u ovoj zemlji.
u klinikama u ovoj zemlji.
09:58
And what do they do when they're there?
251
582144
1973
A što rade kad su ondje?
10:00
They sit, they watch the goldfish in the fish tank,
252
584117
3450
Sjede, gledaju zlatne ribice u akvariju,
10:03
they read extremely old copies
253
587567
2483
čitaju prastare primjerke časopisa
10:05
of Good Housekeeping magazine.
254
590050
2283
o kućanskim poslovima.
10:08
But mostly we all just sit there forever, waiting.
255
592333
3233
No, uglavnom svi samo sjedimo
ondje cijelu vječnost, čekajući.
ondje cijelu vječnost, čekajući.
10:11
How did we get here
256
595566
1351
Kako smo dospjeli ovdje
10:12
where we devote hundreds of acres and thousands of hours
257
596917
3349
gdje posvećujemo stotine hektara i
10:16
to waiting?
258
600266
1783
tisuće sati čekanju?
10:17
What if we had a waiting room
259
602049
1217
Što kad bismo imali čekaonicu
10:19
where you don't just sit when you're sick,
260
603266
2101
u kojoj ne sjediš samo kad si bolestan,
10:21
but where you go to get healthy.
261
605367
1866
već gdje ideš da bi postao zdrav?
10:23
If airports can become shopping malls
262
607233
2517
Ako zračne luke mogu postati trgovački centri,
10:25
and McDonald's can become playgrounds,
263
609750
2966
a McDonalds igralište,
10:28
surely we can reinvent the clinic waiting room.
264
612716
3433
zasigurno možemo
ponovno osmisliti čekaonicu.
ponovno osmisliti čekaonicu.
10:32
And that's what Health Leads has tried to do,
265
616149
2034
I to je ono što je Health Leads pokušao učiniti,
10:34
to reclaim that real estate and that time
266
618183
2283
vratiti tu nekretninu i to vrijeme
10:36
and to use it as a gateway
267
620466
1432
te ih iskoristiti kao prolaz
10:37
to connect patients
268
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1052
za povezivanje pacijenata
10:38
to the resources they need to be healthy.
269
622950
2767
sa sredstvima koja im trebaju da bi bili zdravi.
10:41
So it's a brutal winter in the Northeast,
270
625717
1516
Dakle, oštra je zima na sjeveroistoku,
10:43
your kid has asthma, your heat just got turned off,
271
627233
2467
vaše dijete ima astmu,
upravo su vam isključili grijanje,
upravo su vam isključili grijanje,
10:45
and of course you're in the waiting room of the ER,
272
629700
2167
a vi ste naravno u čekaonici Hitne,
10:47
because the cold air triggered your child's asthma.
273
631867
2532
jer je hladan zrak pokrenuo astmu vašeg djeteta.
10:50
But what if instead of waiting for hours anxiously,
274
634399
2917
No što ako umjesto zabrinutog višesatnog čekanja
10:53
the waiting room became the place
275
637316
2200
čekaonica postane mjesto
10:55
where Health Leads turned your heat back on?
276
639516
2484
gdje Health Leads ponovno uključi vaše grijanje?
10:57
And of course all of this requires
277
642000
1618
Naravno, sve to zahtijeva
10:59
a broader workforce.
278
643618
1948
više radne snage.
11:01
But if we're creative, we already have that too.
279
645566
3167
No, ako smo kreativni, to već imamo.
11:04
We know that our doctors and nurses
280
648733
2386
Znamo da naši liječnici, medicinske sestre
11:07
and even social workers
281
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1347
pa čak i socijalni radnici,
11:08
aren't enough,
282
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1468
nisu dovoljni,
11:09
that the ticking minutes of health care
283
653934
1649
da vrijeme zdravstvene skrbi koje istječe
11:11
are too constraining.
284
655583
1418
previša ograničava.
11:12
Health just takes more time.
285
657001
2049
Za zdravlje jednostavno treba više vremena.
11:14
It requires a non-clinical army
286
659050
2799
Ono zahtijeva nekliničku vojsku
11:17
of community health workers and case managers
287
661849
2684
zdravstvenih radnika iz zajednice
i menadžera slučaja
i menadžera slučaja
11:20
and many others.
288
664533
1616
te mnoge druge.
11:22
What if a small part of that next healthcare workforce
289
666149
3150
Što kad bi mali dio te buduće
zdravstvene radne snage
zdravstvene radne snage
11:25
were the 11 million college students in this country?
290
669299
3701
bilo 11 milijuna studenata ove zemlje?
11:28
Unencumbered by clinical responsibilities,
291
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2766
Neopterećeni kliničkom odgovornošću,
11:31
unwilling to take no for an answer
292
675766
2602
nespremni prihvatiti "ne" kao odogovor
11:34
from those bureaucracies
293
678368
1582
od tih birokrata
11:35
that tend to crush patients,
294
679950
1933
koji pokušavaju slomiti pacijente
11:37
and with an unparalleled ability
295
681883
1950
te s neusporedivom sposobnošću
11:39
for information retrieval
296
683833
1452
pronalaženja informacija,
11:41
honed through years of using Google.
297
685285
2981
izbrušenom višegodišnjom upotrebom Googlea.
11:44
Now lest you think it improbable
298
688266
2533
Ako mislite da je nevjerojatno
11:46
that a college volunteer
299
690799
1617
da se student volonter
11:48
can make this kind of commitment,
300
692416
1783
može tako obvezati,
11:50
I have two words for you:
301
694199
1567
imam dvije riječi za vas:
11:51
March Madness.
302
695766
2351
March Madness (košarkaški turnir).
11:54
The average NCAA Division I men's basketball player
303
698117
3967
Prosječni NCAA Division 1 igrač košarke
11:57
dedicates 39 hours a week to his sport.
304
702084
3265
posvećuje 39 sati tjedno svome sportu.
12:01
Now we may think that's good or bad,
305
705349
2152
Možemo misliti da je to dobro ili loše,
12:03
but in either case it's real.
306
707501
2682
no u svakom slučaju je istinito.
12:06
And Health Leads is based on the presumption
307
710183
2185
I Health Leads temelji se na pretpostavci
12:08
that for too long
308
712368
1382
da smo predugo
12:09
we have asked too little of our college students
309
713750
2550
premalo tražili od svojih studenata
12:12
when it comes to real impact in vulnerable communities.
310
716300
3765
kad se radi o pravom utjecaju na ugrožene zajednicame.
12:15
College sports teams say,
311
720065
1353
Sveučilišni sportski klubovi kažu:
12:17
"We're going to take dozens of hours
312
721418
2065
"Mi ćemo uzeti desetke sati
12:19
at some field across campus at some ungodly hour of the morning
313
723483
3884
na nekom području blizu kampusa
u nekom ranom jutarnjem satu
u nekom ranom jutarnjem satu
12:23
and we're going to measure your performance, and your team's performance,
314
727367
2816
te ćemo mjeriti tvoju izvedbu i izvedbu tvoga tima,
12:26
and if you don't measure up or you don't show up,
315
730183
2166
a ako nisi dovoljno dobar ili ako se ne pojaviš,
12:28
we're going to cut you off the team.
316
732349
1450
ispast ćeš iz tima.
12:29
But we'll make huge investments
317
733799
1888
Ali mnogo ćemo uložiti u
12:31
in your training and development,
318
735687
1212
tvoj trening i razvoj
12:32
and we'll give you an extraordinary community of peers."
319
736899
3418
te ćemo ti dati izvanrednu zajednicu vršnjaka."
12:36
And people line up out the door
320
740317
1815
I ljudi se poredaju pred vrata
12:38
just for the chance to be part of it.
321
742132
2785
samo da bi imali mogućnost biti dio toga.
12:40
So our feeling is,
322
744917
1217
Mi mislimo da
12:42
if it's good enough for the rugby team,
323
746134
1483
ako je to dovoljno dobro za ragbi momčad,
12:43
it's good enough for health and poverty.
324
747617
2115
dovoljno je dobro i za zdravlje i siromaštvo.
12:45
Health Leads too recruits competitively,
325
749732
3268
Health Leads također novači
u natjecateljskom duhu,
u natjecateljskom duhu,
12:48
trains intensively,
326
753000
1481
intenzivno trenira,
12:50
coaches professionally,
327
754481
1969
profesionalno podučava,
12:52
demands significant time,
328
756450
1949
zahtijeva značajno vrijeme,
12:54
builds a cohesive team
329
758399
1367
izgrađuje kohezivni tim
12:55
and measures results --
330
759766
1484
te mjeri rezultate –
12:57
a kind of Teach for America for healthcare.
331
761250
2683
nalik na Teach for America za zdravstvo.
12:59
Now in the top 10 cities in the U.S.
332
763933
2100
Sad u top 10 gradova u SAD-u
13:01
with the largest number of Medicaid patients,
333
766033
2319
s najvećim brojem pacijenata zdravstvene pomoći,
13:04
each of those has at least 20,000 college students.
334
768352
3214
svaki ima barem 20.000 studenata.
13:07
New York alone has half a million college students.
335
771566
3201
Samo u New Yorku je pola milijuna studenata.
13:10
And this isn't just a sort of short-term workforce
336
774767
3049
Ovo nije samo neka vrsta kratkoročne radne snage
13:13
to connect patients to basic resources,
337
777816
2250
za spajanje pacijenata s osnovnim sredstvima,
13:15
it's a next generation healthcare leadership pipeline
338
780066
3601
to je nova generacija mreže zdravstvenog vodstva
13:19
who've spent two, three, four years
339
783667
2450
koja je provela dvije, tri ili četiri godine
13:22
in the clinic waiting room
340
786117
1501
u čekaonicama
13:23
talking to patients about their most basic health needs.
341
787618
3984
razgovarajući s pacijentima o njihovim
osnovnim zdravstvenim potrebama.
osnovnim zdravstvenim potrebama.
13:27
And they leave with the conviction,
342
791602
1749
Oni odlaze sa svojim uvjerenjem,
13:29
the ability and the efficacy
343
793351
1832
sposobnostima i efikasnošću
13:31
to realize our most basic aspirations for health care.
344
795183
3783
da shvate naše najosnovnije
potrebe zdravstvene skrbi.
potrebe zdravstvene skrbi.
13:34
And the thing is, there's thousands of these folks already out there.
345
798966
3018
Najbolja stvar je što je postoji
na tisuće takvih ljudi.
na tisuće takvih ljudi.
13:37
So Mia Lozada is Chief Resident of Internal Medicine
346
801984
3817
Mia Lozada glavni je specijalizant interne medicine
13:41
at UCSF Medical Center,
347
805801
1415
na UCSF Medical Center-u,
13:43
but for three years as an undergraduate
348
807216
2333
ali tri godine preddiplomskog studija
13:45
she was a Health Leads volunteer
349
809549
1633
bila je volonter Health Leads-a
13:47
in the clinic waiting room at Boston Medical Center.
350
811182
3002
u čekaonici Boston Medical Center-a.
13:50
Mia says, "When my classmates write a prescription,
351
814184
3715
Mia kaže: "Kad moje kolege napišu recept,
13:53
they think their work is done.
352
817899
2018
misle da je njihov posao gotov.
13:55
When I write a prescription,
353
819917
1716
Kad ja napišen recept za lijek,
13:57
I think, can the family read the prescription?
354
821633
2267
uvijek pomislim: zna li obitelj pročitati recept?
13:59
Do they have transportation to the pharmacy?
355
823900
2183
Imaju li prijevoz do ljekarne?
14:01
Do they have food to take with the prescription?
356
826083
2450
Imaju li hranu koju trebaju
pojesti uz propisani lijek?
pojesti uz propisani lijek?
14:04
Do they have insurance to fill the prescription?
357
828533
2250
Imaju li osiguranje koje će
pokriti troškove propisanog lijeka?
pokriti troškove propisanog lijeka?
14:06
Those are the questions I learned at Health Leads,
358
830783
2683
To su pitanja koja sam naučila u Health Leads-u,
14:09
not in medical school."
359
833466
1750
a ne na fakultetu."
14:11
Now none of these solutions --
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Nijedno od ovih rješenja –
14:13
the prescription pad, the electronic medical record,
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blok s receptima, elektronički medicinski registar,
14:16
the waiting room,
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čekaonica,
14:17
the army of college students --
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vojska studenata --
14:18
are perfect.
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nije savršeno.
14:19
But they are ours for the taking --
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No, oni su nam na raspolaganju –
14:22
simple examples
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jednostavni primjeri
14:23
of the vast under-utilized healthcare resources
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ogromne neiskorištenosti zdravstvenih sredstava
14:26
that, if we reclaimed and redeployed,
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koji bi, ako ih vratimo i razmjestimo,
14:29
could realize our most basic aspiration
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mogli ostvariti naše osnovne težnje
14:33
of healthcare.
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za zdravstvenom skrbi.
14:35
So I had been at Legal Services for about nine months
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Bila sam u pravnoj službi otprilike devet mjeseci
14:38
when this idea of Health Leads started percolating in my mind.
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kad mi se ova ideja o Health Leads-u počela motati po glavi.
14:40
And I knew I had to tell Jeff Purcell, my attorney,
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Znala sam da moram reći
Jeffu Purcellu, svom odvjetniku,
Jeffu Purcellu, svom odvjetniku,
14:43
that I needed to leave.
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da moram otići.
14:45
And I was so nervous,
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Bila sam tako nervozna,
14:46
because I thought he was going to be disappointed in me
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zato što sam mislila da će biti razočaran mnome
14:48
for abandoning our clients for some crazy idea.
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jer napuštam naše klijente zbog neke lude ideje.
14:51
And I sat down with him and I said,
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Sjela sam s njim i rekla:
14:53
"Jeff, I have this idea
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"Jeff, imam tu ideju
14:55
that we could mobilize college students
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da bismo mogli pokrenuti studente
14:58
to address patients' most basic health needs."
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da rješavaju najosnovnije
zdravstvene potrebe pacijenata."
zdravstvene potrebe pacijenata."
15:01
And I'll be honest,
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Bit ću iskrena,
15:02
all I wanted was for him to not be angry at me.
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samo sam htjela da se ne ljuti na mene.
15:05
But he said this,
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Ali rekao je ovo:
15:07
"Rebecca, when you have a vision,
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"Rebecca, kad imaš viziju,
15:10
you have an obligation to realize that vision.
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imaš obvezu ostvariti je.
15:14
You must pursue that vision."
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Moraš slijediti tu viziju."
15:17
And I have to say, I was like "Whoa.
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I moram reći, pomislila sam: "Hej.
15:20
That's a lot of pressure."
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To je veliki pritisak."
15:23
I just wanted a blessing,
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Samo sam htjela blagoslov,
15:24
I didn't want some kind of mandate.
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a ne nekakvu obavezu.
15:25
But the truth is
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No, istina je
15:27
I've spent every waking minute nearly since then
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da sam od tad gotovo neprestano
15:30
chasing that vision.
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jurila tu viziju.
15:32
I believe that we all have a vision
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Vjerujem da svi imamo viziju
15:35
for healthcare in this country.
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zdravstva u ovoj zemlji.
15:37
I believe that at the end of the day
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Vjerujem da na kraju dana,
15:39
when we measure our healthcare,
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kad mjerimo našu zdravstvenu skrb,
15:41
it will not be by the diseases cured,
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to neće biti po izliječenim bolestima,
15:44
but by the diseases prevented.
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već po spriječenim bolestima.
15:46
It will not be by the excellence of our technologies
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To neće biti po izvrsnosti naših tehnologija
15:49
or the sophistication of our specialists,
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ili profinjenosti naših specijalista,
15:52
but by how rarely we needed them.
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već po tome koliko rijetko smo ih trebali.
15:54
And most of all,
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I najvažnije od svega,
15:56
I believe that when we measure healthcare,
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vjerujem da kad mjerimo zdravstvenu skrb,
15:58
it will be, not by what the system was,
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da će to biti, ne po tome što je sistem bio,
16:01
but by what we chose it to be.
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već po onome što smo mi izabrali da bude.
16:04
Thank you.
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Hvala.
16:05
(Applause)
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(Pljesak)
16:15
Thank you.
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Hvala Vam.
16:16
(Applause)
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(Pljesak)
ABOUT THE SPEAKER
Rebecca Onie - Health services innovatorRebecca Onie is the founder of Health Leads, a program that connects patients to basic care and resources, such as food and housing, that are the root cause of many health problems.
Why you should listen
In 1996, as a sophomore in college, Rebecca Onie had a realization: The health care system in the United States was not set up to diagnose nor treat the socioeconomic issues that lead to poor health, and that health care providers are not given tools to address basic problems like nutrition and housing.
So, while still a sophomore, she co-founded Health Leads, a program that assists low-income patients and their families to access food, heat, and other basic resources they need to be healthy. With the additional insight that college volunteers could be recruited and trained into an elite group just like a college sport team, she found the people and skills needed to produce such an audacious idea. Since then it has grown tremendously, and now operates in Baltimore, Boston, Chicago, New York, Providence, and Washington, DC, and in the last year assisted over 8,800 patients.
In 2009, Rebecca was awarded a MacArthur “Genius” Fellowship.
Photo: Courtesy of the John D. & Catherine T. MacArthur Foundation
Rebecca Onie | Speaker | TED.com