TEDGlobal 2012
Vikram Patel: Mental health for all by involving all
Vikram Patel: Mentalno zdravlje za sve gdje sudjeluju svi
Filmed:
Readability: 5.8
1,103,181 views
Skoro 450 milijuna ljudi u svijetu je duševno bolesno. U bogatijim narodima, samo pola prima prikladnu njegu, ali u zemljama u razvoju, skoro 90% prođe neliječeno jer pshijatara ima tako malo. Vikram Patel ističe vrlo obećavajuć pristup -- trenirati članove zajednica da pružaju intervencije za mentalno zdravlje, ojačavajući obične ljude da skrbe za druge.
Vikram Patel - Mental health care advocate
Vikram Patel helps bring better mental health care to low-resource communities -- by teaching ordinary people to deliver basic psychiatric services. Full bio
Vikram Patel helps bring better mental health care to low-resource communities -- by teaching ordinary people to deliver basic psychiatric services. Full bio
Double-click the English transcript below to play the video.
00:16
I want you to imagine this for a moment.
0
433
2771
Želim da zamislite ovo na trenutak.
00:19
Two men, Rahul and Rajiv,
1
3204
2895
Dvojica muškaraca, Rahul i Rajiv,
00:21
living in the same neighborhood,
2
6099
1858
žive u istom susjedstvu,
00:23
from the same educational background, similar occupation,
3
7957
3295
imaju istu obrazovnu pozadinu, slično zanimanje,
00:27
and they both turn up at their local accident emergency
4
11252
2768
i obojica se pojave u svojoj lokalnoj hitnoj
00:29
complaining of acute chest pain.
5
14020
2816
žaleći se na akutnu bol u prsima.
00:32
Rahul is offered a cardiac procedure,
6
16836
3124
Rahulu je ponuđena srčana procedura,
00:35
but Rajiv is sent home.
7
19960
2811
ali Rajiva pošalju doma.
00:38
What might explain the difference in the experience
8
22771
2510
Što bi moglo objasniti razliku u iskustvu
00:41
of these two nearly identical men?
9
25281
3252
ove dvojice skoro identičnih ljudi?
00:44
Rajiv suffers from a mental illness.
10
28533
3487
Rajiv pati od duševne bolesti.
00:47
The difference in the quality of medical care
11
32020
3099
Razlika u kvaliteti medicinske njege
00:51
received by people with mental illness is one of the reasons
12
35119
2861
koju primaju ljudi s mentalnim bolestima je jedan od razloga
00:53
why they live shorter lives
13
37980
1915
zašto žive kraće
00:55
than people without mental illness.
14
39895
1583
nego ljudi koji ne pate od duševnih bolesti.
00:57
Even in the best-resourced countries in the world,
15
41478
2670
Čak i u najbogatijim državama u svijetu,
01:00
this life expectancy gap is as much as 20 years.
16
44148
4770
razlika u životnom vijeku je 20 godina.
01:04
In the developing countries of the world, this gap
17
48918
1925
U državama koje se razvijaju, ova razlika
01:06
is even larger.
18
50843
2625
je još veća.
01:09
But of course, mental illnesses can kill in more direct ways
19
53468
2859
Naravno, duševne bolesti mogu usto ubiti na mnogo direktnije načine.
01:12
as well. The most obvious example is suicide.
20
56327
3361
Najočitiji primjer je samoubojstvo.
01:15
It might surprise some of you here, as it did me,
21
59688
2655
Možda može neke od vas ovdje iznenaditi, kao što je i mene,
01:18
when I discovered that suicide is at the top of the list
22
62343
2937
kad sam otkrio da je samoubojstvo na vrhu liste
01:21
of the leading causes of death in young people
23
65280
2565
vodećih uzroka smrti kod mladih ljudi
01:23
in all countries in the world,
24
67845
1648
u svim državama svijeta,
01:25
including the poorest countries of the world.
25
69493
3392
uključujući i najsiromašnije države.
01:28
But beyond the impact of a health condition
26
72885
2834
Ali više od učinka zdravstvenog stanja
01:31
on life expectancy, we're also concerned
27
75719
2370
na životni vijek, također smo zabrinuti
01:33
about the quality of life lived.
28
78089
2694
za kvalitetu proživljenog života.
01:36
Now, in order for us to examine the overall impact
29
80783
2249
Sad, kako bismo mogli istražiti sve učinke
01:38
of a health condition both on life expectancy
30
83032
2373
zdravstvenog stanja na životni vijek
01:41
as well as on the quality of life lived, we need to use
31
85405
3158
kao i na kvalitetu proživljenog života, moramo uzeti
01:44
a metric called the DALY,
32
88563
1386
mjeru nazvanu DALY,
01:45
which stands for a Disability-Adjusted Life Year.
33
89949
4287
koja znači godinu života prilagođenu invalidnošću (Disability-Adjusted Life Year).
01:50
Now when we do that, we discover some startling things
34
94236
2521
Kad učinimo to, otkrivamo neke uznemiravajuće stvari
01:52
about mental illness from a global perspective.
35
96757
2822
o duševnoj bolesti iz globalne perspektive.
01:55
We discover that, for example, mental illnesses are
36
99579
3264
Otkrivamo da su, na primjer, duševne bolesti
01:58
amongst the leading causes of disability around the world.
37
102843
4588
među vodećim uzrocima invalidnosti u svijetu.
02:03
Depression, for example, is the third-leading cause
38
107431
2735
Depresija, na primjer, je treći vodeći uzrok
02:06
of disability, alongside conditions such as
39
110166
2972
invalidnosti, uz stanja poput
02:09
diarrhea and pneumonia in children.
40
113138
3352
dijareje i upale pluća u djece.
02:12
When you put all the mental illnesses together,
41
116490
2104
Kad stavite sve mentalne bolesti zajedno,
02:14
they account for roughly 15 percent
42
118594
2262
one uključuju otprilike za 15%
02:16
of the total global burden of disease.
43
120856
3206
ukupnog tereta bolesti.
02:19
Indeed, mental illnesses are also very damaging
44
124062
4511
Doista, mentalne bolesti su također vrlo štetne
02:24
to people's lives, but beyond just the burden of disease,
45
128573
5445
za ljudske živote, ali osim samog tereta bolesti,
02:29
let us consider the absolute numbers.
46
134018
2712
razmotrimo apsolutne brojeve.
02:32
The World Health Organization estimates
47
136730
2059
Svjetska zdravstvena organizacija procjenjuje
02:34
that there are nearly four to five hundred million people
48
138789
3105
da 400 do 500 milijuna ljudi
02:37
living on our tiny planet
49
141894
2183
koji žive na našem sitnom planetu
02:39
who are affected by a mental illness.
50
144077
1661
pate od duševne bolesti.
02:41
Now some of you here
51
145738
1719
Neki od vas ovdje
02:43
look a bit astonished by that number,
52
147457
2598
izgledaju iznenađeno tim brojem,
02:45
but consider for a moment the incredible diversity
53
150055
2493
ali razmotrite na trenutak nevjerojatnu razliku
02:48
of mental illnesses, from autism and intellectual disability
54
152548
3154
duševnih bolesti, od autizma i intelektualnih invalidnosti
02:51
in childhood, through to depression and anxiety,
55
155702
2681
u djetinjstvu, kroz depresiju i tjeskobu,
02:54
substance misuse and psychosis in adulthood,
56
158383
2281
zloporabu supstanci i prihoze kod odraslih,
02:56
all the way through to dementia in old age,
57
160664
1636
sve do demencije u starijim godinama
02:58
and I'm pretty sure that each and every one us
58
162300
2954
i siguran sam da svatko od nas
03:01
present here today can think of at least one person,
59
165254
3352
ovdje danas može se sjetiti bar jedne osobe,
03:04
at least one person, who's affected by mental illness
60
168606
3322
bar jedne osobe, koja pati od mentalne bolesti
03:07
in our most intimate social networks.
61
171928
4431
u našim najintimnijim društvenim mrežama.
03:12
I see some nodding heads there.
62
176359
3205
Vidim neke koji kimaju glavama tamo.
03:15
But beyond the staggering numbers,
63
179564
2970
Ali osim zapanjujućih brojeva,
03:18
what's truly important from a global health point of view,
64
182534
3009
što je uistinu bitno iz globalnog zdravstvenog pogleda,
03:21
what's truly worrying from a global health point of view,
65
185543
2545
što je uistinu zabrinjavajuće iz globalnog zdravstvenog pogleda
03:23
is that the vast majority of these affected individuals
66
188088
3168
je to što velika većina tih pojedinaca koji pate
03:27
do not receive the care
67
191256
2009
ne dobije njegu
03:29
that we know can transform their lives, and remember,
68
193265
2466
za koju znamo da može promijeniti njihove živote, i zapamtite,
03:31
we do have robust evidence that a range of interventions,
69
195731
3061
imamo snažne dokaze da mnoge intervencije,
03:34
medicines, psychological interventions,
70
198792
2452
lijekovi, psihološke intervencije
03:37
and social interventions, can make a vast difference.
71
201244
3488
i društvene intervencije mogu napraviti veliku razliku.
03:40
And yet, even in the best-resourced countries,
72
204732
2251
A ipak, čak i u najbogatijim državama,
03:42
for example here in Europe, roughly 50 percent
73
206983
2935
na primjer ovdje u Europi, otprilike 50%
03:45
of affected people don't receive these interventions.
74
209918
3117
ljudi koji pate, ne pruži im se takva intervencija.
03:48
In the sorts of countries I work in,
75
213035
2317
U državama u kojima radim,
03:51
that so-called treatment gap
76
215352
2150
ta takozvana razlika u tretmanu
03:53
approaches an astonishing 90 percent.
77
217502
4887
približava se zapanjujućih 90%.
03:58
It isn't surprising, then, that if you should speak
78
222389
3212
Nije iznenađujuće onda da ako pričate
04:01
to anyone affected by a mental illness,
79
225601
2431
s nekim tko pati od duševne bolesti,
04:03
the chances are that you will hear stories
80
228032
2812
šanse da ćete čuti priče
04:06
of hidden suffering, shame and discrimination
81
230844
4050
o skrivenoj patnji, sramu i diskriminaciji
04:10
in nearly every sector of their lives.
82
234894
2949
u skoro svakom dijelu njihovog života.
04:13
But perhaps most heartbreaking of all
83
237843
2710
Ali možda najsrceparajuće od svih
04:16
are the stories of the abuse
84
240553
2689
su priče o zloporabi
04:19
of even the most basic human rights,
85
243242
2532
čak i najosnovnijih ljudskih prava,
04:21
such as the young woman shown in this image here
86
245774
2857
poput mlade žene prikazane na ovoj slici
04:24
that are played out every day,
87
248631
2064
koje se događaju svaki dan,
04:26
sadly, even in the very institutions that were built to care
88
250695
3944
nažalost, čak i u samim institucijama koje su sagrađene za njegu
04:30
for people with mental illnesses, the mental hospitals.
89
254639
3835
za ljude s duševnim bolestima, u bolnicama za duševno bolesne.
04:34
It's this injustice that has really driven my mission
90
258474
3028
Ta nepravda je ono što je zapravo vodilo moju misiju
04:37
to try to do a little bit to transform the lives
91
261502
2392
da pokušam učiniti nešto da promijenim živote
04:39
of people affected by mental illness, and a particularly
92
263894
2746
ljudi koji pate od duševnih bolesti i posebno
04:42
critical action that I focused on is to bridge the gulf
93
266640
3849
kritična akcija na koju sam se usredotočio je premostiti jaz
04:46
between the knowledge we have that can transform lives,
94
270489
2786
između znanja koje imamo koje može promijeniti živote,
04:49
the knowledge of effective treatments, and how we actually
95
273275
2442
znanja učinkovitog tretmana i kako zapravo
04:51
use that knowledge in the everyday world.
96
275717
3422
koristimo to znanje u svakodnevnom svijetu.
04:55
And an especially important challenge that I've had to face
97
279139
3159
I jako bitan izazov s kojim sam se morao suočiti
04:58
is the great shortage of mental health professionals,
98
282298
2925
je veliki nedostatak profesionalaca koji se bave duševnim bolestima,
05:01
such as psychiatrists and psychologists,
99
285223
1672
poput psihijatara i psihologa,
05:02
particularly in the developing world.
100
286895
2788
pogotovo u svijetu koji se razvija.
05:05
Now I trained in medicine in India, and after that
101
289683
2685
Obučen sam za medicinu u Indiji i nakon toga
05:08
I chose psychiatry as my specialty, much to the dismay
102
292368
3419
sam odabrao psihijatriju kao svoju specijalizaciju, na zaprepaštenje
05:11
of my mother and all my family members who
103
295787
2228
moje majke i svih svojih članova obitelji koji su
05:13
kind of thought neurosurgery would be
104
298015
1703
nekako mislili da bi neurokirurgija bio
05:15
a more respectable option for their brilliant son.
105
299718
3169
puno ugledniji izbor za njihovog briljantnog sina.
05:18
Any case, I went on, I soldiered on with psychiatry,
106
302887
2734
U svakom slučaju, nastavio sam, borio sam se s psihijatrijom
05:21
and found myself training in Britain in some of
107
305621
2295
i našao se trenirajući u Britaniji u nekima od
05:23
the best hospitals in this country. I was very privileged.
108
307916
2375
najboljih bolnica u ovoj državi. Bio sam vrlo privilegiran.
05:26
I worked in a team of incredibly talented, compassionate,
109
310291
3543
Radio sam u timu nevjerojatno talentiranih, suosjećajnih,
05:29
but most importantly, highly trained, specialized
110
313834
3251
ali najvažnije, vrhunski obučenih, specijaliziranih
05:32
mental health professionals.
111
317085
2191
profesionalaca za duševne bolesti.
05:35
Soon after my training, I found myself working
112
319276
1972
Ubrzo nakon moje obuke, našao sam se radeći
05:37
first in Zimbabwe and then in India, and I was confronted
113
321248
2443
prvo u Zimbabveu i onda u Indiji te sam se suočio
05:39
by an altogether new reality.
114
323691
2860
s potpuno novom stvanošću.
05:42
This was a reality of a world in which there were almost no
115
326551
3346
To je bila stvarnost svijeta u kojem nije bilo skoro uopće
05:45
mental health professionals at all.
116
329897
2365
profesionalaca za duševne bolesti.
05:48
In Zimbabwe, for example, there were just about
117
332262
2034
U Zimbabveu, na primjer, bilo je otprilike
05:50
a dozen psychiatrists, most of whom lived and worked
118
334296
3060
12 psihijatara, od kojih je većina živjela i radila
05:53
in Harare city, leaving only a couple
119
337356
2126
u gradu Harare, ostavljajući samo par njih
05:55
to address the mental health care needs
120
339482
2393
da se bave potrebama njege duševnog zdravlja
05:57
of nine million people living in the countryside.
121
341875
3668
9 milijuna ljudi koji žive na selu.
06:01
In India, I found the situation was not a lot better.
122
345543
3617
U Indiji sam saznao da situacija nije puno bolja.
06:05
To give you a perspective, if I had to translate
123
349160
2423
Kako bih vam dao perspektivu, kad bih trebao prevesti
06:07
the proportion of psychiatrists in the population
124
351583
2208
proporcije psihijarata u populaciji
06:09
that one might see in Britain to India,
125
353791
2382
koju možete vidjeti u Britaniji na Indiju,
06:12
one might expect roughly 150,000 psychiatrists in India.
126
356173
5609
netko bi očekivao otprilike 150.000 psihijatara u Indiji.
06:17
In reality, take a guess.
127
361782
3031
U stvarnosti, pogađajte.
06:20
The actual number is about 3,000,
128
364813
2565
Stvaran broj je oko 3.000,
06:23
about two percent of that number.
129
367378
2464
oko 2% tog broja.
06:25
It became quickly apparent to me that I couldn't follow
130
369842
2497
Postalo mi je ubrzo jasno da neću moći pratiti
06:28
the sorts of mental health care models that I had been trained in,
131
372339
3061
vrstu modela duševne zdravstvene njege u kojoj sam obučen,
06:31
one that relied heavily on specialized, expensive
132
375400
2939
koja se jako oslanjala na specijalizirane, skupe
06:34
mental health professionals to provide mental health care
133
378339
2532
profesionalce za duševno zdravlje koji bi pružali njegu duševno bolesnima
06:36
in countries like India and Zimbabwe.
134
380871
2460
u državama poput Indije ili Zimbabvea.
06:39
I had to think out of the box about some other model
135
383331
2653
Morao sam razmišljati van kutije o nekom drugom modelu
06:41
of care.
136
385984
1623
njege.
06:43
It was then that I came across these books,
137
387607
3113
Tad sam naletio na ove knjige
06:46
and in these books I discovered the idea of task shifting
138
390720
3243
i u tim knjigama otkrio ideju izmjenjivanja zadataka
06:49
in global health.
139
393963
2068
u globalnom zdravstvu.
06:51
The idea is actually quite simple. The idea is,
140
396031
2276
Ideja je zapravo vrlo jednostavna. Ideja je,
06:54
when you're short of specialized health care professionals,
141
398307
3014
kad imate manjak specijaliziranih profesionalaca za zdravlje,
06:57
use whoever is available in the community,
142
401321
3049
koristite bilo kog tko je slobodan u zajednici,
07:00
train them to provide a range of health care interventions,
143
404370
2937
obučite ga da pruža raznolike zdravstvene intervencije,
07:03
and in these books I read inspiring examples,
144
407307
2868
i u ovim knjigama sam pročitao inspirirajuće primjere,
07:06
for example of how ordinary people had been trained
145
410175
2936
na primjer kako obični ljudi koji su obučeni
07:09
to deliver babies,
146
413111
1353
porađati djecu,
07:10
diagnose and treat early pneumonia, to great effect.
147
414464
3631
dijagnosticirati i liječiti ranu upalu pluća, uz velik učinak.
07:13
And it struck me that if you could train ordinary people
148
418095
2751
I shvatio sam da ako možete obučiti obične ljude
07:16
to deliver such complex health care interventions,
149
420846
2224
da pružaju tako složene zdravstvene intervencije,
07:18
then perhaps they could also do the same
150
423070
2073
onda bi možda mogli također napraviti isto
07:21
with mental health care.
151
425143
1992
s njegom za duševne bolesti.
07:23
Well today, I'm very pleased to report to you
152
427135
2869
Danas mi je veliko zadovoljstvo izvijestiti vas
07:25
that there have been many experiments in task shifting
153
430004
3112
da su bili mnogi eksperimenti u izmijeni zadataka
07:29
in mental health care across the developing world
154
433116
2771
u njezi za duševno bolesne u zemljama u razvoju
07:31
over the past decade, and I want to share with you
155
435887
2063
u zadnjem desetljeću i želim podijeliti s vama
07:33
the findings of three particular such experiments,
156
437950
2697
nalaze tri određena takva eksperimenta,
07:36
all three of which focused on depression,
157
440647
2087
sva tri su se usredotočila na depresiju,
07:38
the most common of all mental illnesses.
158
442734
2435
najčešću od svih duševnih bolesti.
07:41
In rural Uganda, Paul Bolton and his colleagues,
159
445169
3342
U ruralnoj Ugandi, Paul Bolton i njegovi kolege
07:44
using villagers, demonstrated that they could deliver
160
448511
3844
koristeći stanovnike sela, demonstrirali su da mogu pružati
07:48
interpersonal psychotherapy for depression
161
452355
2355
međusobnu psihoterapiju za depresiju
07:50
and, using a randomized control design,
162
454710
2672
i koristeći dizajn nasumične kontrole,
07:53
showed that 90 percent of the people receiving
163
457382
2245
pokazali da 90% ljudi koji su primili
07:55
this intervention recovered as compared
164
459627
1960
takve intervencije su se oporavili uspoređeno
07:57
to roughly 40 percent in the comparison villages.
165
461587
3541
s otprilike 40% u sličnim selima.
08:01
Similarly, using a randomized control trial in rural Pakistan,
166
465128
4140
Slično, koristeći ispitivanje nasumične kontrole u ruralnom Pakistanu,
08:05
Atif Rahman and his colleagues showed
167
469268
2340
Atif Rahman i njegovi kolege pokazali su
08:07
that lady health visitors, who are community maternal
168
471608
2735
da žene koje povremeno pomažu u zdravstvenom radu, koje su društvene zdravstvene radnice za majke
08:10
health workers in Pakistan's health care system,
169
474343
2789
u pakistanskom zdravstvenom sustavu,
08:13
could deliver cognitive behavior therapy for mothers
170
477132
2217
mogu pružiti terapiju za kognitivno ponašanje za majke
08:15
who were depressed, again showing dramatic differences
171
479349
2508
koje su bile depresivne, opet pokazujući dramatičnu razliku
08:17
in the recovery rates. Roughly 75 percent of mothers
172
481857
2847
u brzini oporavka. Otprilike 75% majki
08:20
recovered as compared to about 45 percent
173
484704
2565
se oporavilo uspoređujući s 45%
08:23
in the comparison villages.
174
487269
2284
u sličnim selima.
08:25
And in my own trial in Goa, in India, we again showed
175
489553
3086
. I u mom vlastitom testiranju u Goi, u Indiji, opet smo pokazali
08:28
that lay counselors drawn from local communities
176
492639
2528
da savjetnici laici uzeti iz lokalnih zajednica
08:31
could be trained to deliver psychosocial interventions
177
495167
2684
mogu biti obučeni da pruže psihološku intervenciju
08:33
for depression, anxiety, leading to 70 percent
178
497851
2582
za depresiju, tjeskobu, dovodeći do 70%
08:36
recovery rates as compared to 50 percent
179
500433
2083
većih razina oporavka uspoređujući s 50%
08:38
in the comparison primary health centers.
180
502516
3206
u sličnim primanim zdravstvenim centrima.
08:41
Now, if I had to draw together all these different
181
505722
1969
Kad bih trebao prikazati sve ove različite
08:43
experiments in task shifting, and there have of course
182
507691
2532
eksperimente u izmjeni zadataka, a naravno
08:46
been many other examples, and try and identify
183
510223
2374
da je bilo još mnogo takvih primjera, i pokušao identificirati
08:48
what are the key lessons we can learn that makes
184
512597
2018
koje su ključne lekcije koje možemo naučiti da mogu dovesti
08:50
for a successful task shifting operation,
185
514615
3078
do uspješnog pogona izmjene zadataka,
08:53
I have coined this particular acronym, SUNDAR.
186
517693
3856
skovao sam poseban akronim, SUNDAR.
08:57
What SUNDAR stands for, in Hindi, is "attractive."
187
521549
4234
Što SUNDAR predstavlja, u hindiju, je "privlačan".
09:01
It seems to me that there are five key lessons
188
525783
2215
Čini mi se da postoji 5 ključnih lekcija
09:03
that I've shown on this slide that are critically important
189
527998
2599
koje sam prikazao na ovom slajdu koji su kritično bitni
09:06
for effective task shifting.
190
530597
2183
za učinkovito izmjenjivanje zadataka.
09:08
The first is that we need to simplify the message
191
532780
3026
Prva je da moramo pojednostaviti poruku
09:11
that we're using, stripping away all the jargon
192
535806
2384
koju koristimo, skidajući sav žargon
09:14
that medicine has invented around itself.
193
538190
3321
koji je medicina izmislila oko sebe.
09:17
We need to unpack complex health care interventions
194
541511
2957
Trebamo otpakirati složene zdravstvene intervencije
09:20
into smaller components that can be more easily
195
544468
2228
u manje dijelove koji se mogu mnogo lakše
09:22
transferred to less-trained individuals.
196
546696
2655
prenijeti manje obučenim pojedincima.
09:25
We need to deliver health care, not in large institutions,
197
549351
2567
Moramo pružati zdravstvenu njegu, ne u velikim institucijama,
09:27
but close to people's homes, and we need to deliver
198
551918
2226
već blizu domova, a moramo i pružiti
09:30
health care using whoever is available and affordable
199
554144
2772
zdravstvenu njegu koristeći bilo kog tko je dostupan i kog se može priuštiti
09:32
in our local communities.
200
556916
2381
u našoj lokalnoj zajednici.
09:35
And importantly, we need to reallocate the few specialists
201
559297
2880
I najbitnije, moramo preraspodijeliti tih par specijalista
09:38
who are available to perform roles
202
562177
2068
koji su dostupni da izvrše uloge
09:40
such as capacity-building and supervision.
203
564245
3478
poput povećanja kapaciteta i nadgledanja.
09:43
Now for me, task shifting is an idea
204
567723
2332
Za mene, izmjena zadataka je ideja
09:45
with truly global significance,
205
570055
2959
s istinskim globalnim značenjem
09:48
because even though it has arisen out of the
206
573014
2533
jer iako se izrodilo iz
09:51
situation of the lack of resources that you find
207
575547
3498
manjka resursa koje možete naći
09:54
in developing countries, I think it has a lot of significance
208
579045
2959
u razvojnim državama, mislim da ima jako puno značaja
09:57
for better-resourced countries as well. Why is that?
209
582004
2881
i za bogatije države. Zašto je tako?
10:00
Well, in part, because health care in the developed world,
210
584885
3520
Pa, dijelom, jer zdravstvena njega u razvijenom svijetu,
10:04
the health care costs in the [developed] world,
211
588405
2475
troškovi zdravstvene njege u [razvijenom] svijetu,
10:06
are rapidly spiraling out of control, and a huge chunk
212
590880
2577
polako izmiču kontroli, i velik dio
10:09
of those costs are human resource costs.
213
593457
3420
tih troškova su troškovi ljudskih resursa.
10:12
But equally important is because health care has become
214
596877
2486
Ali jednako bitno je zato što je zdravstvena njega postala
10:15
so incredibly professionalized that it's become very remote
215
599363
3837
tako nevjerojatno profesionalizirana da je postala jako udaljena
10:19
and removed from local communities.
216
603200
2755
i pomaknuta iz lokalnih zajednica.
10:21
For me, what's truly sundar about the idea of task shifting,
217
605955
3722
Za mene, što je zbilja sundar kod ove ideje izmjene zadataka,
10:25
though, isn't that it simply makes health care
218
609677
1646
ipak, nije to što jednostavno čini zdravstvenu njegu
10:27
more accessible and affordable but that
219
611323
3158
pristupačnom i povoljnom već
10:30
it is also fundamentally empowering.
220
614481
2556
što temeljno ojačava.
10:32
It empowers ordinary people to be more effective
221
617037
3632
Ojačava obične ljude da budu učinkovitiji
10:36
in caring for the health of others in their community,
222
620669
2823
u brizi za zdravlje drugih u svojoj zajednici,
10:39
and in doing so, to become better guardians
223
623492
1489
i radeći to, postanu bolji čuvari
10:40
of their own health. Indeed, for me, task shifting
224
624981
3282
svog vlastitog zdravlja. Doista, za mene, izmjena zadataka
10:44
is the ultimate example of the democratization
225
628263
2687
je krajnji primjer demokratizacije
10:46
of medical knowledge, and therefore, medical power.
226
630950
5249
medicinskog znanja, i time, medicinske moći.
10:52
Just over 30 years ago, the nations of the world assembled
227
636199
3451
Prije samo 30 godina, narodi svijeta su se okupili
10:55
at Alma-Ata and made this iconic declaration.
228
639650
2973
u Alma-Ati i stvorili ovu ikoničnu deklaraciju.
10:58
Well, I think all of you can guess
229
642623
1605
Ali, mislim da svi vi možete nagađati
11:00
that 12 years on, we're still nowhere near that goal.
230
644228
3715
da 12 godina što smo uključeni, nismo nigdje blizu tog cilja.
11:03
Still, today, armed with that knowledge
231
647943
2665
I dalje, danas, naoružani tim znanjem
11:06
that ordinary people in the community
232
650608
2656
da obični ljudi u zajednici
11:09
can be trained and, with sufficient supervision and support,
233
653264
3163
mogu biti obučeni i, s dovoljno nadgledanja i potpore,
11:12
can deliver a range of health care interventions effectively,
234
656427
3272
mogu pružiti velik broj zdravstvenih intervencija učinkovito,
11:15
perhaps that promise is within reach now.
235
659699
3881
možda je to obećanje u dosegu.
11:19
Indeed, to implement the slogan of Health for All,
236
663580
3644
Doista, kako bismo implementirali slogan Zdravlje za Sve,
11:23
we will need to involve all
237
667224
1786
morat ćemo uključiti sve
11:24
in that particular journey,
238
669010
1659
u tom putovanju,
11:26
and in the case of mental health, in particular we would
239
670669
2946
i u slučaju duševnog zdravlja, posebno
11:29
need to involve people who are affected by mental illness
240
673615
2903
bismo morali uključiti ljude koji pate od duševnih bolesti
11:32
and their caregivers.
241
676518
1454
i njihove skrbnike.
11:33
It is for this reason that, some years ago,
242
677972
2536
Zbog tog razloga, prije par godina,
11:36
the Movement for Global Mental Health was founded
243
680508
1918
Pokret za Globalno Duševno Zdravlje je osnovan
11:38
as a sort of a virtual platform upon which professionals
244
682426
4023
kao vrsta virtualne platforme na kojoj bi profesionalci
11:42
like myself and people affected by mental illness
245
686449
2807
poput mene i ljudi koji pate od duševnih bolesti
11:45
could stand together, shoulder-to-shoulder,
246
689256
2712
mogli stajati zajedno, rame uz rame,
11:47
and advocate for the rights of people with mental illness
247
691968
2486
i zagovarati prava ljudi s duševnim bolestima
11:50
to receive the care that we know can transform their lives,
248
694454
3217
da prime njegu koju znamo da može promijeniti njihove živote,
11:53
and to live a life with dignity.
249
697671
3009
i da žive život dostojanstveno.
11:56
And in closing, when you have a moment of peace or quiet
250
700680
3517
I za kraj, kad imate trenutak mira ili tišine
12:00
in these very busy few days or perhaps afterwards,
251
704197
2826
ovih vrlo zaposlenih par dana ili možda kasnije,
12:02
spare a thought for that person you thought about
252
707023
2754
izdvojite misao za onu osobu na koju ste mislili
12:05
who has a mental illness, or persons that you thought about
253
709777
2577
koja ima duševnu bolest ili osobe na koje ste mislili
12:08
who have mental illness,
254
712354
1588
koje imaju duševnu bolest,
12:09
and dare to care for them. Thank you. (Applause)
255
713942
3804
i usudite se brinuti za njih. Hvala vam.
12:13
(Applause)
256
717746
4064
(Pljesak)
ABOUT THE SPEAKER
Vikram Patel - Mental health care advocateVikram Patel helps bring better mental health care to low-resource communities -- by teaching ordinary people to deliver basic psychiatric services.
Why you should listen
In towns and villages that have few clinics, doctors and nurses, one particular need often gets overlooked: mental health. When there is no psychiatrist, how do people get care when they need it? Vikram Patel studies how to treat conditions like depression and schizophrenia in low-resource communities, and he's come up with a powerful model: training the community to help.
Based in Goa for much of the year, Patel is part of a policy group that's developing India's first national mental health policy; he's the co-founder of Sangath, a local NGO dedicated to mental health and family wellbeing. In London, he co-directs the Centre for Global Mental Health at the London School of Hygiene & Tropical Medicine. And he led the efforts to set up the Movement for Global Mental Health, a network that supports mental health care as a basic human right.
From Sangath's mission statement: "At the heart of our vision lies the ‘treatment gap’ for mental disorders; the gap between the number of people with a mental disorder and the number who receive care for their mental disorders."
Vikram Patel | Speaker | TED.com