TED2017
Raj Panjabi: No one should die because they live too far from a doctor
拉吉．潘賈比: 不該有人只因為住得離醫生太遠就喪命
Filmed:
Readability: 3.9
1,337,947 views
疾病都是全球性的──而照護資源卻不是。拉吉．潘賈比醫生有個遠大的夢想，要把醫療資源帶給世界上的每一個人。潘賈比用 2017 TED 獎金，打造社區健康學院，它是個全球性的平台，目標是要讓社區健康工作者，用更現代化的方法學習救命技能，同時也創造更多工作機會。
Raj Panjabi - Physician
A billion people around the world lack access to health care because they live too far from a clinic. 2017 TED Prize winner Raj Panjabi aims to extend health services to the last mile. Full bio
A billion people around the world lack access to health care because they live too far from a clinic. 2017 TED Prize winner Raj Panjabi aims to extend health services to the last mile. Full bio
Double-click the English transcript below to play the video.
00:12
I want to share with you
something my father taught me:
something my father taught me:
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我想與大家分享的
是我父親教我的一個道理：
是我父親教我的一個道理：
00:17
no condition is permanent.
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沒有什麼狀況是永恆不變的。
00:21
It's a lesson he shared with me
again and again,
again and again,
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他一再地告訴我這個道理，
00:24
and I learned it to be true the hard way.
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我也花費了一番功夫才學會。
00:28
Here I am in my fourth-grade class.
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照片是我與小學四年級的班級，
00:31
This is my yearbook picture
taken in my class in school
taken in my class in school
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來自學校的畢業紀念冊，
學校位在賴比瑞亞的蒙羅維亞市。
00:35
in Monrovia, Liberia.
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00:37
My parents migrated from India
to West Africa in the 1970s,
to West Africa in the 1970s,
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我父母在 70 年代
從印度移居到西非，
從印度移居到西非，
00:41
and I had the privilege
of growing up there.
of growing up there.
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我有幸在那兒成長。
00:45
I was nine years old,
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我當時九歲，
00:46
I loved kicking around a soccer ball,
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熱愛踢足球，
00:48
and I was a total math and science geek.
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更是個熱愛數學和科學的怪胎。
00:51
I was living the kind of life
that, really, any child would dream of.
that, really, any child would dream of.
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我過著所有孩子們所憧憬的生活，
00:57
But no condition is permanent.
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但沒有什麼狀況是永恆不變的。
01:00
On Christmas Eve in 1989,
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1989 年的聖誕夜，
01:03
civil war erupted in Liberia.
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賴比瑞亞內戰爆發。
01:07
The war started in the rural countryside,
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戰事從偏鄉引爆，
01:09
and within months, rebel armies
had marched towards our hometown.
had marched towards our hometown.
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幾個月內，反叛軍進軍我們的家鄉。
01:12
My school shut down,
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我的學校關閉，
01:14
and when the rebel armies captured
the only international airport,
the only international airport,
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當反叛軍佔領唯一的國際機場時，
01:17
people started panicking and fleeing.
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人們開始驚慌逃難。
01:21
My mom came knocking one morning
and said, "Raj, pack your things --
and said, "Raj, pack your things --
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某個早晨，我母親邊敲門邊說：
「拉吉，快打包，我們得離開了。」
01:25
we have to go."
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01:26
We were rushed to the center of town,
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我們趕往鎮中心，
01:29
and there on a tarmac,
we were split into two lines.
we were split into two lines.
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在飛機跑道上，
人們被分成兩排隊伍。
人們被分成兩排隊伍。
01:34
I stood with my family in one line,
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我和我家人置身其中一排，
01:37
and we were stuffed into the cargo hatch
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然後從貨艙口
擠進救援飛機裡。
01:39
of a rescue plane.
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01:41
And there on a bench,
I was sitting with my heart racing.
I was sitting with my heart racing.
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坐在長凳上，我的心跳加速，
01:44
As I looked out the open hatch,
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我從打開的貨艙口看出去，
01:46
I saw hundreds of Liberians
in another line,
in another line,
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看到數以百計的賴比瑞亞人
在另一排隊伍中，
在另一排隊伍中，
01:49
children strapped to their backs.
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有人背著孩子。
01:52
When they tried to jump in with us,
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當他們試圖跳上我們的飛機，
01:55
I watched soldiers restrain them.
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我眼見士兵制止他們，
01:58
They were not allowed to flee.
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他們不被允許逃離。
02:01
We were the lucky ones.
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我們是幸運兒。
02:03
We lost what we had,
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我們失去曾擁有的一切，
02:05
but we resettled in America,
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但我們重新在美國落腳。
02:07
and as immigrants, we benefitted
from the community of supporters
from the community of supporters
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在新社區中，許多的支持者
對我們這些移民都非常的照顧。
02:10
that rallied around us.
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02:13
They took my family into their home,
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他們讓我們一家人住進他們家，
02:15
they mentored me.
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他們教導我，
02:18
And they helped my dad
start a clothing shop.
start a clothing shop.
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他們也協助我父親開了一間服飾店。
02:20
I'd visit my father
on weekends as a teenager
on weekends as a teenager
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我青少年時，週末都會拜訪父親，
02:22
to help him sell sneakers and jeans.
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幫他賣運動鞋和牛仔褲。
02:25
And every time business would get bad,
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每當生意不好時，
02:27
he'd remind me of that mantra:
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他總會提醒我那句真言，
02:29
no condition is permanent.
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沒有什麼狀況是永恆不變的。
02:32
That mantra and my parents' persistence
and that community of supporters
and that community of supporters
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因為那句真言、我雙親的堅持毅力、
和社區人們的支持下，
和社區人們的支持下，
02:37
made it possible for me
to go through college
to go through college
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我才得以上大學，
02:39
and eventually to medical school.
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最終進入醫學院就讀。
02:42
I'd once had my hopes crushed in a war,
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我的希望曾被戰爭毀滅，
02:46
but because of them,
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但因為他們，
02:47
I had a chance to pursue my dream
to become a doctor.
to become a doctor.
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我有機會去追逐成為醫生的夢想，
02:51
My condition had changed.
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我的狀況改變了，
02:54
It had been 15 years
since I escaped that airfield,
since I escaped that airfield,
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我逃離那機場已是 15 年前的事，
02:57
but the memory of those two lines
had not escaped my mind.
had not escaped my mind.
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但那兩排隊伍的記憶，
仍在我腦海裡揮之不去。
仍在我腦海裡揮之不去。
03:00
I was a medical student in my mid-20s,
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在我 25 歲左右，
還是醫學生的時候，
還是醫學生的時候，
03:02
and I wanted to go back
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我想要回去，
03:04
to see if I could serve
the people we'd left behind.
the people we'd left behind.
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看能否幫助被我們丟下的人們。
03:07
But when I got back,
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但在我回去後，
03:08
what I found was utter destruction.
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只看見滿目瘡痍，
03:10
The war had left us with just 51 doctors
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一個四百萬人口的國家
03:12
to serve a country of four million people.
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在戰後只剩下 51 名醫生在服務，
03:15
It would be like the city of San Francisco
having just 10 doctors.
having just 10 doctors.
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這就像整個舊金山
只有 10 個醫生一樣。
只有 10 個醫生一樣。
03:19
So if you got sick in the city
where those few doctors remain,
where those few doctors remain,
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若你在城市中生病，
有少數幾個醫生還留在那裡，
有少數幾個醫生還留在那裡，
03:22
you might stand a chance.
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你可能還有機會看病。
03:23
But if you got sick in the remote,
rural rainforest communities,
rural rainforest communities,
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但若你在偏僻的雨林社區裡生病，
03:27
where you could be days
from the nearest clinic --
from the nearest clinic --
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離最近的診所是好幾天的路程──
03:30
I was seeing my patients die
from conditions no one should die from,
from conditions no one should die from,
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我曾目睹我的病患，
死於不該命絕的病症，
死於不該命絕的病症，
03:34
all because they were
getting to me too late.
getting to me too late.
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只因為他們太晚才來到我這裡。
03:36
Imagine you have a two-year-old
who wakes up one morning with a fever,
who wakes up one morning with a fever,
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想像你的兩歲小孩
某天早上起床就發起高燒，
某天早上起床就發起高燒，
03:39
and you realize she could have malaria,
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你驚覺她可能染上瘧疾。
03:42
and you know the only way to get her
the medicine she needs
the medicine she needs
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你知道只有一個方法
可以取得她需要的藥物，
可以取得她需要的藥物，
03:45
would be to take her to the riverbed,
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就是帶著她到河邊，
03:46
get in a canoe, paddle to the other side
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划著獨木舟到對岸，
03:49
and then walk for up to two days
through the forest
through the forest
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然後走上兩天的路，穿過森林，
03:51
just to reach the nearest clinic.
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只為了到達最近的診所。
03:54
One billion people live
in the world's most remote communities,
in the world's most remote communities,
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十億人口住在世界最偏遠的社區，
03:57
and despite the advances we've made
in modern medicine and technology,
in modern medicine and technology,
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儘管現代醫學與科技如此進步，
04:00
our innovations are not
reaching the last mile.
reaching the last mile.
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我們的創新卻無法觸及
那些最後一英里的人們。
那些最後一英里的人們。
04:03
These communities have been left behind,
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這些社區遭到遺忘，
04:05
because they've been thought
too hard to reach
too hard to reach
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因為它們被認為太遠、難以抵達，
04:07
and too difficult to serve.
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且太難給以協助。
04:10
Illness is universal;
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疾病是全球性的；
04:11
access to care is not.
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但醫療照護的資源卻不是。
04:14
And realizing this lit a fire in my soul.
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了解到這點，點燃了我靈魂中的火。
04:16
No one should die because they live
too far from a doctor or clinic.
too far from a doctor or clinic.
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沒有人應該因為住處
離醫生、診所太遠而喪命。
離醫生、診所太遠而喪命。
04:21
No condition should be permanent.
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這樣的狀況不應該是永恆不變的。
04:25
And help in this case
didn't come from the outside,
didn't come from the outside,
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在這個案例中，他們沒有外援，
04:28
it actually came from within.
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得到的協助是來自社區內部。
04:29
It came from the communities themselves.
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來自於這個社區本身。
04:32
Meet Musu.
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她是姆索。
04:33
Way out in rural Liberia,
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在賴比瑞亞偏僻的鄉下，
04:34
where most girls have not had
a chance to finish primary school,
a chance to finish primary school,
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當地大多數女孩都沒機會讀完小學。
04:39
Musu had been persistent.
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但姆索堅毅不拔，
04:42
At the age of 18,
she completed high school,
she completed high school,
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她 18 歲讀完了高中，
04:44
and she came back to her community.
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然後返回自己的社區，
04:46
She saw that none of the children
were getting treatment
were getting treatment
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眼見社區裡孩子
生病時無法能得到應有的治療──
04:49
for the diseases
they needed treatment for --
they needed treatment for --
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04:51
deadly diseases, like malaria
and pneumonia.
and pneumonia.
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例如像可能致命的瘧疾和肺炎，
04:53
So she signed up to be a volunteer.
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她因此自願成為義工。
04:57
There are millions of volunteers like Musu
in rural parts around our world,
in rural parts around our world,
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全世界偏遠區域
有數百萬名像姆索這樣的義工，
有數百萬名像姆索這樣的義工，
05:01
and we got to thinking --
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這讓我們思考──
05:03
community members like Musu
could actually help us solve a puzzle.
could actually help us solve a puzzle.
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像姆索這樣的社區成員
能幫我們解決難題。
能幫我們解決難題。
05:08
Our health care system
is structured in such a way
is structured in such a way
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我們的醫療保健制度的
結構是這樣的：
結構是這樣的：
05:10
that the work of diagnosing disease
and prescribing medicines
and prescribing medicines
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診斷疾病和開藥的工作
05:14
is limited to a team of nurses
and doctors like me.
and doctors like me.
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只能由像我這種醫師
及護士的團隊來做。
及護士的團隊來做。
05:18
But nurses and doctors
are concentrated in cities,
are concentrated in cities,
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但醫生和護士都集中在城市，
05:21
so rural communities like Musu's
have been left behind.
have been left behind.
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因此像姆索所居住的
偏鄉社區就被遺忘了。
偏鄉社區就被遺忘了。
05:24
So we started asking some questions:
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這讓我們提出幾個問題：
05:26
What if we could reorganize
the medical care system?
the medical care system?
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若我們能重整
醫療照護制度，會如何？
醫療照護制度，會如何？
05:29
What if we could have community
members like Musu
members like Musu
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假如能讓像姆索這樣的社區成員，
05:32
be a part or even be the center
of our medical team?
of our medical team?
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加入甚至成為
醫療團隊中的主要角色呢？
醫療團隊中的主要角色呢？
05:35
What if Musu could help us bring
health care from clinics in cities
health care from clinics in cities
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若姆索能幫我們
將城市診所提供的醫療
將城市診所提供的醫療
05:39
to the doorsteps of her neighbors?
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帶到她鄰居的門口呢？
05:43
Musu was 48 when I met her.
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我認識姆索時，她 48 歲。
05:46
And despite her amazing talent and grit,
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儘管她擁有驚人的天賦與膽量，
05:49
she hadn't had a paying job in 30 years.
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她 30 年來都沒有領過任何薪水。
05:53
So what if technology could support her?
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所以如果科技能支助她呢？
05:56
What if we could invest in her
with real training,
with real training,
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若我們能投資讓她受真正的訓練，
06:00
equip her with real medicines,
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讓她帶著真正的藥品，
06:03
and have her have a real job?
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擁有一份真正的工作呢？
06:08
Well, in 2007, I was trying
to answer these questions,
to answer these questions,
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2007 年，我試著去回答這些問題。
06:12
and my wife and I were
getting married that year.
getting married that year.
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我和我太太在那年結婚，
06:16
We asked our relatives to forgo
the wedding registry gifts
the wedding registry gifts
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我們讓親友不要送新婚禮物，
06:20
and instead donate some money
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而以捐款取代，
06:22
so we could have some start-up money
to launch a nonprofit.
to launch a nonprofit.
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好讓我們有一些基金
去成立一個非營利機構。
去成立一個非營利機構。
06:26
I promise you, I'm a lot
more romantic than that.
more romantic than that.
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我保證，我其實比那更浪漫很多的。
06:28
(Laughter)
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（笑聲）
06:30
We ended up raising $6,000,
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我們最後籌到了六千元，
06:32
teamed up with some
Liberians and Americans
Liberians and Americans
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與一些賴比瑞亞人和美國人合作，
06:34
and launched a nonprofit
called Last Mile Health.
called Last Mile Health.
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共同成立一個非營利組織
叫做「最後一英哩醫療」。
叫做「最後一英哩醫療」。
06:37
Our goal is to bring a health worker
within reach of everyone, everywhere.
within reach of everyone, everywhere.
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我們的目標是要讓每個地方每個人
都能接觸得到這些醫療工作者。
都能接觸得到這些醫療工作者。
06:42
We designed a three-step process --
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我們設計了一個三步驟的流程──
06:44
train, equip and pay --
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訓練、裝備、付款──
06:45
to invest more deeply
in volunteers like Musu
in volunteers like Musu
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更扎實地資助像姆索這樣的義工，
06:49
to become paraprofessionals,
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成為協助提供醫療的專業人員，
06:50
to become community health workers.
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成為社區健康工作者。
06:53
First we trained Musu to prevent,
diagnose and treat
diagnose and treat
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我們先訓練姆索，
針對影響她村落族人的前十大疾病，
針對影響她村落族人的前十大疾病，
06:57
the top 10 diseases afflicting
families in her village.
families in her village.
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做預防、診斷、與治療。
07:01
A nurse supervisor visited her
every month to coach her.
every month to coach her.
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每月有護士訪視並指導姆索，
07:05
We equipped her with modern
medical technology,
medical technology,
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我們提供她現代醫療技術，
07:08
like this $1 malaria rapid test,
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像這個一塊錢的瘧疾快速檢測，
07:11
and put it in a backpack
full of medicines like this
full of medicines like this
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放在裝滿這類配備的背包中，
07:15
to treat infections like pneumonia,
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來治療像肺炎這類的感染。
07:18
and crucially,
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重要的是，
07:20
a smartphone, to help her track
and report on epidemics.
and report on epidemics.
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給她一隻智慧手機協助她
追縱和回報傳染病。
追縱和回報傳染病。
07:25
Last, we recognized
the dignity in Musu's work.
the dignity in Musu's work.
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最後，我們表彰姆索的努力，
07:28
With the Liberian government,
we created a contract,
we created a contract,
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和賴比瑞亞政府合作
我們立了一張合約，
我們立了一張合約，
07:30
paid her
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來支付她薪水，
07:32
and gave her the chance
to have a real job.
to have a real job.
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給她一個機會擁有一份真正的工作。
07:34
And she's amazing.
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她真的很棒，
07:35
Musu has learned over 30 medical skills,
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姆索學習了超過 30 種醫療技能，
07:39
from screening children for malnutrition,
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從篩檢營養不良兒童，
07:41
to assessing the cause
of a child's cough with a smartphone,
of a child's cough with a smartphone,
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到用智慧手機來
評估孩童咳嗽的原因，
評估孩童咳嗽的原因，
07:45
to supporting people with HIV
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到協助愛滋病患者，
07:48
and providing follow-up care
to patients who've lost their limbs.
to patients who've lost their limbs.
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並提供後續照護給失去肢體的病人。
07:53
Working as part of our team,
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以我們團隊隊員的身份工作，
07:56
working as paraprofessionals,
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以協助性醫療人員的身份工作，
07:57
community health workers can help ensure
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讓社區健康工作者能確保
07:59
that a lot of what
your family doctor would do
your family doctor would do
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你家庭醫生能提供的那些服務，
08:02
reaches the places that most
family doctors could never go.
family doctors could never go.
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大部份也能被提供到
多數家庭醫師不會去的地方。
多數家庭醫師不會去的地方。
08:06
One of my favorite things to do
is to care for patients
is to care for patients
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我最喜歡做的事情之一，
就是與這些社區健康工作者
就是與這些社區健康工作者
08:09
with community health workers.
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一同照顧病人。
08:10
So last year I was visiting A.B.,
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所以去年我去拜訪了艾畢，
08:12
and like Musu, A.B. had had
a chance to go to school.
a chance to go to school.
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艾畢和姆索一樣有機會去上學。
08:16
He was in middle school,
in the eighth grade,
in the eighth grade,
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他父母過世時，他讀中學，
08:19
when his parents died.
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才八年級，
08:20
He became an orphan and had to drop out.
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他因此成為孤兒，而必須輟學。
08:24
Last year, we hired and trained
A.B. as a community health worker.
A.B. as a community health worker.
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去年，我們僱用並訓練艾畢
成為社區健康工作者。
成為社區健康工作者。
08:30
And while he was making
door to door house calls,
door to door house calls,
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當他出診挨家挨戶拜訪時，
08:33
he met this young boy named Prince,
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他見到一個男孩，名叫普林斯，
08:35
whose mother had had trouble
breastfeeding him,
breastfeeding him,
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他的母親無法餵母奶。
08:38
and by the age of six months,
Prince had started to waste away.
Prince had started to waste away.
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六個月大時，普林斯開始消瘦。
08:41
A.B. had just been taught how to use
this color-coded measuring tape
this color-coded measuring tape
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艾畢才剛學會如何用
有顏色編碼的檢測帶，
有顏色編碼的檢測帶，
08:45
that wraps around the upper arm
of a child to diagnose malnutrition.
of a child to diagnose malnutrition.
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繞著孩童的手臂來診斷營養不良。
08:49
A.B. noticed that Prince
was in the red zone,
was in the red zone,
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艾畢注意到普林斯
是落在紅色區域，
是落在紅色區域，
08:51
which meant he had to be hospitalized.
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意味著他必須要住院。
08:53
So A.B. took Prince
and his mother to the river,
and his mother to the river,
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所以艾畢帶著普林斯
和他的母親到河邊，
和他的母親到河邊，
08:56
got in a canoe
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上了獨木舟，
08:57
and paddled for four hours
to get to the hospital.
to get to the hospital.
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划船划了四小時到醫院。
08:59
Later, after Prince was discharged,
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之後，普林斯出院後，
09:02
A.B. taught mom how to feed baby
a food supplement.
a food supplement.
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艾畢教母親如何
餵寶寶吃營養補給品。
餵寶寶吃營養補給品。
09:07
A few months ago,
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幾個月前，
09:09
A.B. took me to visit Prince,
and he's a chubby little guy.
and he's a chubby little guy.
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艾畢帶我去造訪普林斯，
他是個圓胖的小傢伙。
他是個圓胖的小傢伙。
09:13
(Laughter)
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（笑聲）
09:14
He's meeting his milestones,
he's pulled himself up to a stand,
he's pulled himself up to a stand,
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他走到了人生的幾個哩程碑，
他開始讓自己站立，
他開始讓自己站立，
09:17
and is even starting to say a few words.
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他甚至開始說了幾個字。
09:19
I'm so inspired by these
community health workers.
community health workers.
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這些社區健康工作者非常鼓舞我，
09:22
I often ask them why they do what they do,
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我常問他們為什麼要做這些，
09:24
and when I asked A.B.,
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當我問艾畢時，
09:26
he said, "Doc, since I dropped out
of school, this is the first time
of school, this is the first time
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他說：「醫生，從我輟學之後，
這是我第一次有機會拿著筆寫字，
09:30
I'm having a chance
to hold a pen to write.
to hold a pen to write.
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2379
09:34
My brain is getting fresh."
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我的頭腦變得精力充沛。」
09:38
The stories of A.B. and Musu
have taught me something fundamental
have taught me something fundamental
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艾畢和姆索的故事教導了我關於
09:41
about being human.
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身為人的根本道理。
09:44
Our will to serve others
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我們願意去服務他人的意願，
09:47
can actually help us
transform our own conditions.
transform our own conditions.
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其實能協助我們轉變
我們自身的現狀。
我們自身的現狀。
09:51
I was so moved by how powerful
the will to serve our neighbors can be
the will to serve our neighbors can be
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幾年前，這樣服務鄰居的意願強大到
09:55
a few years ago,
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讓我好感動。
09:58
when we faced a global catastrophe.
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當時我們在面對全球性災難，
10:00
In December 2013,
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2013 年 12 月，
10:02
something happened in the rainforests
across the border from us in Guinea.
across the border from us in Guinea.
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在幾內亞的雨林發生了些狀況。
10:05
A toddler named Emile fell sick
with vomiting, fever and diarrhea.
with vomiting, fever and diarrhea.
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一個才在學步的孩童艾米爾
感到噁心想吐、發燒、和痢疾。
感到噁心想吐、發燒、和痢疾。
10:10
He lived in an area
where the roads were sparse
where the roads were sparse
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他所住的地方，道路很稀少，
10:12
and there had been massive
shortages of health workers.
shortages of health workers.
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且健康工作者嚴重短缺。
10:16
Emile died,
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1156
後來艾米爾死了，
10:18
and a few weeks later his sister died,
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幾週後，他的姐妹也死了，
10:19
and a few weeks later his mother died.
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再幾週後，他的母親也死了。
10:21
And this disease would spread
from one community to another.
from one community to another.
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而這個疾病
從一個社區傳到另一個，
從一個社區傳到另一個，
10:25
And it wasn't until three months later
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一直到三個月後，
10:27
that the world recognized this as Ebola.
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世界才發現那是伊波拉病毒。
10:30
When every minute counted,
we had already lost months,
we had already lost months,
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當每一分鐘都是關鍵時，
我們卻已失去了幾個月的先機。
我們卻已失去了幾個月的先機。
10:33
and by then the virus had spread
like wildfire all across West Africa,
like wildfire all across West Africa,
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那時，病毒已經像野火
散佈到整個西非，
散佈到整個西非，
10:36
and eventually to other
parts of the world.
parts of the world.
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2026
後來也傳到世界的其他區域。
10:38
Businesses shut down,
airlines started canceling routes.
airlines started canceling routes.
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商業停止，航空公司開始取消航線。
10:41
At the height of the crisis,
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在危機的最高峰，
10:43
when we were told that 1.4 million
people could be infected,
people could be infected,
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我們得知有 140 萬人可能受感染，
10:47
when we were told
that most of them would die,
that most of them would die,
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3503
我們得知他們大多難逃一死，
10:51
when we had nearly lost all hope,
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我們幾乎失去所有希望。
10:55
I remember standing with a group
of health workers
of health workers
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我還記得我與一群醫療工作者
10:58
in the rainforest where
an outbreak had just happened.
an outbreak had just happened.
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站在剛暴發過病情的雨林。
11:01
We were helping train and equip
them to put on the masks,
them to put on the masks,
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我們協助訓練他們，
讓他們戴上面罩、
讓他們戴上面罩、
手套、手術衣等等，
11:04
the gloves and the gowns that they needed
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他們需要這些裝備，
以防止在服務他們的病人時
以防止在服務他們的病人時
11:06
to keep themselves safe from the virus
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1995
11:08
while they were serving their patients.
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被病毒感染。
11:10
I remember the fear in their eyes.
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我記得他們眼中的恐懼，
11:14
And I remember staying up at night,
terrified if I'd made the right call
terrified if I'd made the right call
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我記得晚上無法入睡，
因為深怕我做錯決定，
因為深怕我做錯決定，
11:20
to keep them in the field.
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讓他們留在現場。
11:22
When Ebola threatened to bring
humanity to its knees,
humanity to its knees,
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當伊波拉病毒威脅要讓人類屈服，
11:27
Liberia's community health workers
didn't surrender to fear.
didn't surrender to fear.
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賴比瑞亞社區健康工作者
並沒有向恐懼投降，
並沒有向恐懼投降，
11:31
They did what they had always done:
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他們做的是他們一直在做的，
11:34
they answered the call
to serve their neighbors.
to serve their neighbors.
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他們回應了鄰居的求助。
11:37
Community members across Liberia
learned the symptoms of Ebola,
learned the symptoms of Ebola,
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整個賴比瑞亞的社區成員
學到了伊波拉病毒的症狀，
學到了伊波拉病毒的症狀，
11:41
teamed up with nurses and doctors
to go door-to-door to find the sick
to go door-to-door to find the sick
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3553
與護士及醫生合作
挨家挨戶去找出病人，
挨家挨戶去找出病人，
11:44
and get them into care.
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讓他們受到照護。
11:46
They tracked thousands of people
who had been exposed to the virus
who had been exposed to the virus
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3410
他們追縱了數千名
曝露在病毒中的人，
曝露在病毒中的人，
11:49
and helped break
the chain of transmission.
the chain of transmission.
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協助破壞了傳染鏈。
11:52
Some ten thousand community
health workers risked their own lives
health workers risked their own lives
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3310
數萬名社區健康工作者
冒著生命危險，
冒著生命危險，
11:55
to help hunt down this virus
and stop it in its tracks.
and stop it in its tracks.
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協助這些防止病毒傳播的工作。
11:59
(Applause)
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5885
（鼓掌）
12:06
Today, Ebola has come
under control in West Africa,
under control in West Africa,
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現今在西非，伊波拉病毒已受控制。
12:10
and we've learned a few things.
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1621
我們學到了幾件事，
12:12
We've learned that blind spots
in rural health care
in rural health care
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2598
我們學到偏遠地區健康照護的盲點，
12:14
can lead to hot spots of disease,
245
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1798
可能是疾病中重要的關鍵，
12:16
and that places all of us at greater risk.
246
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2416
而那個關鍵使我們暴露在高風險下。
12:19
We've learned that the most efficient
emergency system
emergency system
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2692
我們學到，最有效的緊急系統，
12:22
is actually an everyday system,
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2028
其實來自於日常的系統，
12:24
and that system has to reach
all communities,
all communities,
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2726
且那系統必須要能觸及所有社區，
12:27
including rural communities like Emile's.
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2275
包括偏遠地區社區，
像艾米爾的社區。
像艾米爾的社區。
12:30
And most of all,
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1151
最重要的，
12:31
we've learned from the courage
of Liberia's community health workers
of Liberia's community health workers
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3461
賴比瑞亞社區健康工作者的
勇氣讓我們學到，
勇氣讓我們學到，
12:35
that we as people are not defined
by the conditions we face,
by the conditions we face,
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3721
我們身為人並不是由
我們所面對的狀況所定義的，
我們所面對的狀況所定義的，
12:38
no matter how hopeless they seem.
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2064
不論那些狀況看來有多無望，
12:42
We're defined by how we respond to them.
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2132
是我們如何應對這些狀況
定義了我們。
定義了我們。
12:46
For the past 15 years,
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2051
過去 15 年，
12:49
I've seen the power of this idea
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757249
2003
我見識到這個想法的力量，
12:51
to transform everyday citizens
into community health workers --
into community health workers --
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4097
將平日的市民轉變成
社區健康工作者──
社區健康工作者──
12:55
into everyday heroes.
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1863
變成日常的無名英雄。
12:58
And I've seen it play out everywhere,
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1802
我看到這個現象在各處上演，
12:59
from the forest communities
of West Africa,
of West Africa,
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2058
從西非的森林社區，
13:02
to the rural fishing villages of Alaska.
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2245
到阿拉斯加的偏遠漁村。
13:04
It's true,
263
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1150
是真的。
13:06
these community health workers
aren't doing neurosurgery,
aren't doing neurosurgery,
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3049
這些社區健康工作者
並不是在做神經外科手術，
並不是在做神經外科手術，
13:09
but they're making it possible
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1492
但他們讓健康照護
13:10
to bring health care within reach
of everyone everywhere.
of everyone everywhere.
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3072
有機會被帶給任何地方的任何人。
13:15
So now what?
267
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1217
所以現在呢？
13:17
Well, we know that there are still
millions of people dying
millions of people dying
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3764
我們知道在全世界的偏遠社區中，
13:21
from preventable causes
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1749
還有數百萬的人正在與
可預防的疾病做死亡搏鬥，
可預防的疾病做死亡搏鬥，
13:23
in rural communities around the world.
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1875
13:25
And we know that the great majority
of these deaths are happening
of these deaths are happening
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3841
且我們知道這些死亡
絕大多數發生在
絕大多數發生在
13:29
in these 75 blue-shaded countries.
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這 75 個標示藍色的國家。
13:31
What we also know
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我們同時知道，
13:33
is that if we trained an army
of community health workers
of community health workers
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如果我們能訓練
一群社區健康工作者，
一群社區健康工作者，
13:36
to learn even just 30 lifesaving skills,
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即使只是學習 30 項救命技能，
13:40
we could save the lives of nearly
30 million people by 2030.
30 million people by 2030.
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808508
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到 2030 年時，
也能夠拯救三千萬條性命。
也能夠拯救三千萬條性命。
13:45
Thirty services could save
30 million lives by 2030.
30 million lives by 2030.
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813652
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到 2030 年，30 項服務就能夠
拯救近三千萬條性命，
拯救近三千萬條性命，
13:50
That's not just a blueprint --
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那不只是藍圖──
13:52
we're proving this can be done.
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我們在證明它是可行的。
13:53
In Liberia,
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在賴比瑞亞，
13:55
the Liberian government is training
thousands of workers like A.B. and Musu
thousands of workers like A.B. and Musu
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賴比瑞亞政府正在訓練數以千計
像艾畢及姆索這樣的工作者，
像艾畢及姆索這樣的工作者，
13:59
after Ebola,
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在伊波拉事件之後，
14:00
to bring health care to every
child and family in the country.
child and family in the country.
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828562
3477
將健康照護帶給該國的
每個孩童與家庭。
每個孩童與家庭。
14:04
And we've been honored to work with them,
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我們過去有榮幸能與他們共事，
14:06
and are now teaming up
with a number of organizations
with a number of organizations
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現在我們在與其他國家的
14:08
that are working across other countries
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2222
幾個組織合作，
14:10
to try to help them do the same thing.
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838896
2023
試著協助他們做同樣的事。
14:14
If we could help these countries scale,
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如果我們能協助這些國家成長，
14:17
we could save millions of lives,
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我們就能拯救數百萬人的性命，
14:19
and at the same time,
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同時，
我們能創造數百萬個工作機會。
14:20
we could create millions of jobs.
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848586
1781
14:23
We simply can't do that, though,
without technology.
without technology.
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851875
2922
但，沒有科技我們是做不到的。
14:27
People are worried that technology
is going to steal our jobs,
is going to steal our jobs,
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855286
3088
人們在擔心科技可能會
搶了我們的飯碗，
搶了我們的飯碗，
14:30
but when it comes
to community health workers,
to community health workers,
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858398
2199
但對社區健康工作者的情況來說，
14:32
technology has actually
been vital for creating jobs.
been vital for creating jobs.
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科技是創造工作機會的關鍵。
14:35
Without technology --
without this smartphone,
without this smartphone,
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若沒有科技──沒有這些智慧手機、
14:38
without this rapid test --
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866341
2722
沒有這種快速檢測──
14:41
it would have been impossible for us
to be able to employ A.B. and Musu.
to be able to employ A.B. and Musu.
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4533
我們就不可能僱用艾畢及姆索。
14:47
And I think it's time
for technology to help us train,
for technology to help us train,
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875464
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我想，該是用科技
來協助我們訓練的時候了，
來協助我們訓練的時候了，
14:50
to help us train people faster
and better than ever before.
and better than ever before.
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878170
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協助我們用比以前
更快更好的方式來訓練人。
更快更好的方式來訓練人。
14:54
As a doctor,
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身為醫生，
14:55
I use technology to stay up-to-date
and keep certified.
and keep certified.
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883752
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我用科技來跟上最新發展
並保持讓自己隨時學習最新知識，
並保持讓自己隨時學習最新知識，
14:59
I use smartphones, I use apps,
I use online courses.
I use online courses.
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我用智慧手機、我用 app、
我用線上課程。
我用線上課程。
15:01
But when A.B. wants to learn,
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889986
2212
但當艾畢想要學習時，
15:04
he's got to jump back in that canoe
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892222
2095
他得要跳上那獨木舟，
15:07
and get to the training center.
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895152
1640
前往訓練中心。
15:08
And when Musu shows up for training,
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896816
2192
當姆索出席訓練時，
15:11
her instructors are stuck using
flip charts and markers.
flip charts and markers.
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899710
3605
她的指導員只能用
活動掛圖和麥克筆。
活動掛圖和麥克筆。
15:16
Why shouldn't they have the same
access to learn as I do?
access to learn as I do?
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904147
4533
為什麼他們不能和我
有同樣的學習資源？
有同樣的學習資源？
15:22
If we truly want community health workers
to master those lifesaving skills
to master those lifesaving skills
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910384
3628
如果我們真的想要讓社區健康
工作者能精通那些救命技能，
工作者能精通那些救命技能，
15:26
and even more,
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914036
1252
甚至做更多，
15:28
we've got to change this old-school
model of education.
model of education.
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916098
3254
那麼我們就得改變
這個老派的教育方式。
這個老派的教育方式。
15:32
Tech can truly be a game changer here.
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920282
1898
在這裡，科技會是這個
遊戲規則顛覆者。
遊戲規則顛覆者。
15:34
I've been in awe of the digital
education revolution
education revolution
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922204
3545
可汗學院及 edX 一直在引領
數位教育革命，這讓我心存敬畏。
15:37
that the likes of Khan Academy
and edX have been leading.
and edX have been leading.
315
925773
3160
15:42
And I've been thinking that it's time;
316
930041
2493
我一直在想，該是時候了，
15:44
it's time for a collision
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932558
1391
該是讓數位教育革命
15:45
between the digital education revolution
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933973
2311
與社區健康革命
15:48
and the community health revolution.
319
936308
2150
互相激起花火的時候了。
15:51
And so, this brings me
to my TED Prize wish.
to my TED Prize wish.
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939483
3220
所以這就帶到了
我的 TED 得獎願望，
我的 TED 得獎願望，
15:55
I wish --
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943759
1801
我希望──
15:57
I wish that you would help us recruit
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945584
2206
我希望你們能協助我們徵召
15:59
the largest army of community health
workers the world has ever known
workers the world has ever known
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947814
3928
世上前所未有最大的
社區健康工作者軍團，
社區健康工作者軍團，
16:04
by creating the Community Health Academy,
324
952068
2825
做法是創立社區健康學院，
16:06
a global platform to train,
connect and empower.
connect and empower.
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954917
3205
它是個全球平台，
用來訓練、連結、使人們更有能力。
用來訓練、連結、使人們更有能力。
16:10
(Applause)
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958797
1166
（鼓掌）
16:11
Thank you.
327
959988
1162
謝謝大家。
16:13
(Applause)
328
961175
3602
（鼓掌）
16:16
Thank you.
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964801
1158
謝謝大家。
16:19
Here's the idea:
330
967816
1544
想法是這樣的：
16:21
we'll create and curate
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969384
2070
我們會創造和策劃
16:24
the best in digital education resources.
332
972066
3875
最好的數位教育資源，
16:28
We will bring those to community
health workers around the world,
health workers around the world,
333
976802
4635
把這些資源帶給
全世界的社區健康工作者，
全世界的社區健康工作者，
16:33
including A.B. and Musu.
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981461
1253
包括艾畢與姆索。
16:34
They'll get video lessons
on giving kids vaccines
on giving kids vaccines
335
982738
2802
他們能看到如何為孩童
施打疫苗的教學課程影片，
施打疫苗的教學課程影片，
16:37
and have online courses
on spotting the next outbreak,
on spotting the next outbreak,
336
985564
3213
能取得關於如何發現
下次疫情爆發的線上課程，
下次疫情爆發的線上課程，
16:40
so they're not stuck using flip charts.
337
988801
1883
所以他們不會只用活動掛圖。
16:42
We'll help these countries
accredit these workers,
accredit these workers,
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990708
3836
我們會協助這些國家
來認可這些工作者，
來認可這些工作者，
16:46
so that they're not stuck remaining
an under-recognized, undervalued group,
an under-recognized, undervalued group,
339
994568
4707
他們才不會一直
不被承認、不被重視，
不被承認、不被重視，
16:51
but become a renowned,
empowered profession,
empowered profession,
340
999299
2737
而能成為有聲譽有能力的專業人士，
16:54
just like nurses and doctors.
341
1002060
1761
就像護士與醫生一樣。
16:57
And we'll create a network
of companies and entrepreneurs
of companies and entrepreneurs
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1005406
3323
我們會針對在拯救人命上
17:00
who've created innovations
that can save lives
that can save lives
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1008753
2276
做創新的公司及企業創立一個網路，
17:03
and help them connect
to workers like Musu,
to workers like Musu,
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1011053
2380
協助他們連結像姆索這樣的工作者，
17:05
so she can help better
serve her community.
serve her community.
345
1013457
2575
讓她能為她的社區做更好的服務。
17:08
And we'll work tirelessly
to persuade governments
to persuade governments
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1016959
3206
我們會不屈不撓地去說服政府，
17:12
to make community health workers
a cornerstone of their health care plans.
a cornerstone of their health care plans.
347
1020189
3982
讓社區健康工作者成為
其健康照護計畫的基石。
其健康照護計畫的基石。
17:17
We plan to test and prototype
the academy in Liberia
the academy in Liberia
348
1025734
3789
我們計畫要在賴比瑞亞
測試這個學院的原型，
測試這個學院的原型，
17:21
and a few other partner countries,
349
1029547
1872
另外也會在幾個合作國家進行，
17:23
and then we plan to take it global,
350
1031443
1787
接著我們的計畫是擴展到全球，
17:25
including to rural North America.
351
1033254
2223
包擴北美偏遠地區。
17:28
With the power of this platform,
352
1036103
1590
有這個平台的力量，
17:29
we believe countries can be more persuaded
353
1037717
2562
我們相信更有可能會說服各國，
17:32
that a health care revolution
really is possible.
really is possible.
354
1040303
3325
健康照護革命是真的可行的。
17:36
My dream is that this academy
will contribute to the training
will contribute to the training
355
1044470
4088
我的夢想是，這個學院能夠為訓練
17:40
of hundreds of thousands
of community members
of community members
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1048582
2212
無數社區成員上有所貢獻，
17:42
to help bring health care
to their neighbors --
to their neighbors --
357
1050818
2899
協助他們將健康照護
帶給他們的鄰居──
帶給他們的鄰居──
17:45
the hundreds of millions of them
358
1053741
1610
數千萬的人，
17:47
that live in the world's most
remote communities,
remote communities,
359
1055375
2621
住在世界上最偏遠社區的人。
17:50
from the forest communities
of West Africa,
of West Africa,
360
1058785
2081
從西非森林中的社區，
17:52
to the fishing villages of rural Alaska;
361
1060890
2140
到阿拉斯加偏遠漁村；
17:55
from the hilltops of Appalachia,
to the mountains of Afghanistan.
to the mountains of Afghanistan.
362
1063054
4062
從阿帕拉契山山頂，
到阿富汗的山區。
到阿富汗的山區。
17:59
If this vision is aligned with yours,
363
1067140
2690
如果這個憧憬跟你的相符，請造訪
18:01
head to communityhealthacademy.org,
364
1069854
3221
communityhealthacademy.org，
18:05
and join this revolution.
365
1073740
1680
加入這場革命。
18:08
Let us know if you or your organization
or someone you know could help us
or someone you know could help us
366
1076536
4653
如果你、你的組織、或你認識的人
能夠協助我們，請讓我們知道，
能夠協助我們，請讓我們知道，
18:13
as we try to build this academy
over the next year.
over the next year.
367
1081213
3231
協助我們在明年開始打造這所學院。
18:17
Now, as I look out into this room,
368
1085574
1956
我在這間演講廳中看過去，
18:20
I realize that our journeys
are not self-made;
are not self-made;
369
1088310
2706
我了解到我們的旅程
並不是靠自己獨立建造的，
並不是靠自己獨立建造的，
18:23
they're shaped by others.
370
1091040
1509
是由他人所塑造的。
18:24
And there have been so many here
that have been part of this cause.
that have been part of this cause.
371
1092573
3843
這裡有這麼多人為了
這個理想而努力，
這個理想而努力，
18:28
We're so honored to be part
of this community,
of this community,
372
1096440
3210
我們很榮幸能成為
這個社群的一份子，
這個社群的一份子，
18:31
and a community that's willing
to take on a cause
to take on a cause
373
1099674
2683
這個社群願意挑戰去達成一個理想，
像這個理想一樣大膽無畏的理想。
18:34
as audacious as this one,
374
1102381
1368
18:35
so I wanted to offer, as I end,
375
1103773
2075
所以我在最後，
18:37
a reflection.
376
1105872
1222
我想要提出一個反思。
18:39
I think a lot more about
what my father taught me.
what my father taught me.
377
1107986
2987
我想了很多我父親教我的事，
18:43
These days, I too have become a dad.
378
1111726
2201
這些日子，我自己也成了一個父親，
18:45
I have two sons,
379
1113951
2016
我有兩個兒子，
18:47
and my wife and I just learned
that she's pregnant with our third child.
that she's pregnant with our third child.
380
1115991
3988
我和我太太剛知道
她又懷了第三個孩子。
她又懷了第三個孩子。
18:52
(Applause)
381
1120003
1008
（鼓掌）
18:53
Thank you.
382
1121035
1067
謝謝大家。
18:54
(Applause)
383
1122126
1551
（鼓掌）
18:56
I was recently caring
for a woman in Liberia
for a woman in Liberia
384
1124056
2828
最近我在賴比瑞亞照顧一個女子，
18:58
who, like my wife,
was in her third pregnancy.
was in her third pregnancy.
385
1126908
2725
她跟我太太一樣懷了第三胎。
19:02
But unlike my wife,
386
1130371
1709
但跟我太太不一樣的是，
19:04
had had no prenatal care
with her first two babies.
with her first two babies.
387
1132958
2999
她懷前兩個孩子時沒得到產前照護。
19:09
She lived in an isolated community
in the forest that had gone for 100 years
in the forest that had gone for 100 years
388
1137549
4392
她居住在森林中與世隔離的社區，
這裡 100 年來都沒有任何健康照護，
19:13
without any health care
389
1141965
1389
19:16
until ...
390
1144513
1628
直到……
19:18
until last year when a nurse
trained her neighbors
trained her neighbors
391
1146165
3383
直到去年一名護士訓練她的鄰居
19:21
to become community health workers.
392
1149572
1711
成為社區健康工作者。
19:23
So here I was,
393
1151307
1292
所以，我在那裡
19:24
seeing this patient
who was in her second trimester,
who was in her second trimester,
394
1152623
4240
幫這個懷孕中期的病人看病。
19:28
and I pulled out the ultrasound
to check on the baby,
to check on the baby,
395
1156887
3272
我拿出超音波來檢查寶寶，
19:32
and she started telling us stories
about her first two kids,
about her first two kids,
396
1160183
3539
她開始告訴我們
她前兩個孩子的故事，
她前兩個孩子的故事，
19:35
and I had the ultrasound
probe on her belly,
probe on her belly,
397
1163746
3198
我用超音波在她的肚子上探測時，
19:38
and she just stopped mid-sentence.
398
1166968
2268
她停下了說到一半的句子。
19:43
She turned to me and she said,
399
1171221
1541
她轉向我，說：
19:44
"Doc, what's that sound?"
400
1172786
2294
「醫生，那是什麼聲音？」
19:49
It was the first time she'd ever heard
her baby's heartbeat.
her baby's heartbeat.
401
1177371
3178
那是她初次聽見她寶寶的心跳聲，
19:54
And her eyes lit up in the same way
my wife's eyes and my own eyes lit up
my wife's eyes and my own eyes lit up
402
1182111
5060
她的眼睛亮起來，
就像我太太和我在聽到我們寶寶的
就像我太太和我在聽到我們寶寶的
19:59
when we heard our baby's heartbeat.
403
1187195
2135
心跳聲時眼睛也亮起來那樣。
20:03
For all of human history,
404
1191544
2153
在所有的人類歷史上，
20:05
illness has been universal
and access to care has not.
and access to care has not.
405
1193721
4532
疾病都是全球性的，
而照護資源卻不是。
而照護資源卻不是。
20:10
But as a wise man once told me:
406
1198277
1886
但有位智者曾告訴我，
20:13
no condition is permanent.
407
1201690
2488
沒有什麼狀況是永恆不變的。
20:17
It's time.
408
1205491
1228
該是時候了，
20:18
It's time for us to go as far as it takes
409
1206743
2323
該是我們盡所能一起去
20:21
to change this condition together.
410
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改變這個狀況的時候了。
20:23
Thank you.
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謝謝大家。
20:24
(Applause)
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（鼓掌）
ABOUT THE SPEAKER
Raj Panjabi - PhysicianA billion people around the world lack access to health care because they live too far from a clinic. 2017 TED Prize winner Raj Panjabi aims to extend health services to the last mile.
Why you should listen
Raj Panjabi was nine when civil war broke out in his native country, Liberia. His family resettled in High Point, North Carolina, but he returned to Liberia as a medical student in 2005. He was shocked to find a health care system in total devastation. Only 50 doctors remained to treat a population of four million.
With a team of Liberian civil war survivors, American health workers and $6,000 he'd received as a wedding gift, Panjabi co-founded Last Mile Health. The organization saves lives in the world's most remote communities by partnering with governments to deploy, sustain and manage national networks of community health professionals. They currently support the Government of Liberia's deployment of more than 4,000 health workers to provide life-saving healthcare to 1.2 million people and protect against the next epidemic. Last Mile Health's network of community health workers can be leveraged in a crisis -- in the fight against Ebola, the organization aided government response by training health workers in southeastern Liberia.
Panjabi is a physician in the Division of Global Health Equity at Harvard Medical School, Brigham and Women's Hospital. He is a recipient of the Skoll Award for Social Entrepreneurship and was named to TIME's list of the "100 Most Influential People in the World" in 2016. As the winner of the 2017 TED Prize, Panjabi is creating the Community Health Academy, a global platform to train, connect and empower community health workers. The Academy aims to reinvent the education of community health workers -- and the leaders who support them -- for the digital age.
Raj Panjabi | Speaker | TED.com