Rebecca Onie: What if our healthcare system kept us healthy?

Translator: Timothy Covell Reviewer: Morton Bast

Translator: David J. Kreps Finnemann Reviewer: Anders Finn Jørgensen

So my freshman year of college

I mit første år på universitetet

I signed up for an internship in the housing unit

meldte jeg mig til et praktikophold i en boligblok

at Greater Boston Legal Services.

på Greater Boston Legal Services.

Showed up the first day

Jeg kom første dag

ready to make coffee and photocopies,

klar til at lave kaffe og fotokopier,

but was paired with this righteous, deeply inspired attorney

men blev sat sammen med denne retskafne, dybt inspirerede advokat

named Jeff Purcell,

der hed Jeff Purcell,

who thrust me onto the front lines

der skubbede mig ind i frontlinjen

from the very first day.

fra den første dag.

And over the course of nine months

Og i løbet af ni måneder

I had the chance

fik jeg chancen

to have dozens of conversations

for at have dusinvis af samtaler

with low-income families in Boston

med lavindkomst familier i Boston

who would come in presenting with housing issues,

der ville komme ind og præsentere boligproblemer,

but always had an underlying health issue.

men havde altid underliggende helbredsproblemer.

So I had a client who came in,

Så jeg havde en klient der kom ind,

about to be evicted because he hasn't paid his rent.

der var på nippet til at blive sat på gaden, fordi han ikke havde betalt sin husleje.

But he hasn't paid his rent, of course,

Men han havde ikke betalt sin husleje, selvfølgelig,

because he's paying for his HIV medication

fordi han havde betalt for sin HIV medicin

and just can't afford both.

og havde bare ikke råd til begge dele.

We had moms who would come in,

Vi havde mødre der kom ind,

daughter has asthma,

datteren har astma,

wakes up covered in cockroaches every morning.

vågner dækket af kakerlakker hver morgen.

And one of our litigation strategies

Og en af vores sagsanlægs strategier

was actually to send me into the home of these clients

var faktisk at sende mig hjem til disse klienter

with these large glass bottles.

med disse store flasker.

And I would collect the cockroaches,

Og jeg samlede kakerlakkerne sammen,

hot glue-gun them to this poster board

og brugte en limpistol til at lime dem til en opslagstavle

that we'd bring to court for our cases.

som vi bragte med ind i retsalene til vores sager.

And we always won

Og vi vandt altid

because the judges were just so grossed out.

fordi dommerne synes det var så ulækkert.

Far more effective, I have to say,

Meget mere effektivt, må jeg sige,

than anything I later learned in law school.

end noget jeg lærte senere på det juridiske fakultet.

But over the course of these nine months,

Men i løbet af disse ni måneder,

I grew frustrated with feeling

blev jeg frustreret over følelsen

like we were intervening too far downstream

at vi greb ind alt for langt nede ad floden

in the lives of our clients --

i vores klienters liv --

that by the time they came to us,

så til den tid de kom til os,

they were already in crisis.

var de allerede i krise.

And at the end of my freshman year of college,

Og ved slutningen af mit første år ved universitetet,

I read an article about the work

læste jeg en artikel om det arbejde

that Dr. Barry Zuckerman was doing

som Dr. Barry Zuckerman gjorde

as Chair of Pediatrics

som Formand for Pædiatere

at Boston Medical Center.

ved Boston Medical Center.

And his first hire was a legal services attorney

Og hans første ansættelse var en juridisk sagfører

to represent the patients.

til at repræsentere hans patienter.

So I called Barry,

Så jeg ringede til Barry,

and with his blessing, in October 1995

og med hans velsignelse, i oktober 1995

walked into the waiting room

gik jeg ind i venteværelset

of the pediatrics clinic at Boston Medical Center.

ved pediætrisk klinik ved Boston Medical Center.

I'll never forget,

Jeg glemmer aldrig,

the TVs played this endless reel of cartoons.

tv'ene der spillede endeløse bånd med tegneserier.

And the exhaustion of mothers

Og mødrenes udmattelse

who had taken two, three, sometimes four buses

der nogen gange havde taget to, tre nogen gange fire busser

to bring their child to the doctor

for at tage deres barn med til lægen

was just palpable.

var utrolig håndgribelig.

The doctors, it seemed,

Lægerne, virkede det som om,

never really had enough time for all the patients,

havde egentlig aldrig nok tid til alle deres patienter,

try as they might.

selvom de prøvede.

And over the course of six months,

Og i løbet af seks måneder,

I would corner them in the hallway

ville jeg trænge dem op i en krog i gangene

and ask them a sort of naive but fundamental question:

og stile dem et naivt men fundamentalt spørgsmål:

"If you had unlimited resources,

"Hvis du havde uendelige ressourcer,

what's the one thing you would give your patients?"

hvad er den ene ting du ville give dine patienter?"

And I heard the same story again and again,

Og jeg hørte den samme historie igen og igen,

a story we've heard hundreds of times since then.

en historie vi har hørt hundredvis af gange siden.

They said, "Every day we have patients that come into the clinic --

De sagde, "Hver dag har vi patienter der ind i klinikken --

child has an ear infection,

et barn med en øreinfektion,

I prescribe antibiotics.

jeg udskriver antibiotika.

But the real issue is there's no food at home.

Men det rigtige problem er, at der ikke er noget mad i hjemmet.

The real issue

Det rigtige problem

is that child is living with 12 other people

er at det barn bor sammen med 12 andre mennesker

in a two-bedroom apartment.

i en to-værelses lejlighed.

And I don't even ask about those issues

Og jeg spørger ikke engang til de problemer

because there's nothing I can do.

fordi jeg kan ikke gøre noget.

I have 13 minutes with each patient.

Jeg har 13 minutter med hver patient.

Patients are piling up in the clinic waiting room.

Patienter hober sig op i klinikkens venteværelse.

I have no idea where the nearest food pantry is.

Jeg aner ikke hvor det nærmest mad

And I don't even have any help."

Og jeg får ikke engang noget hjælp."

In that clinic, even today,

I den klinik, selv i dag,

there are two social workers

er der to socialrådgivere

for 24,000 pediatric patients,

til 24.000 pediætriske patienter,

which is better than a lot of the clinics out there.

hvilket er bedre end hos de fleste kliniker der er.

So Health Leads was born of these conversations --

Så Health Leads blev affødt af disse samtaler --

a simple model

en simpel model

where doctors and nurses

hvor læger og sygeplejersker

can prescribe nutritious food,

kan ordinere nærende mad

heat in the winter

varme om vinteren

and other basic resources for their patients

og andre basis ressourcer til deres patienter

the same way they prescribe medication.

på samme måde som de ordinerer medicin.

Patients then take their prescriptions

Patienter kan tage deres recepter

to our desk in the clinic waiting room

med til vores disk i klinikkens venteværelse

where we have a core of well-trained college student advocates

hvor vi har en kerne af veltrænede advokatstuderende

who work side by side with these families

der arbejder side om side med disse familier

to connect them out

til at forbinde dem ud

to the existing landscape of community resources.

af det eksisterende landskab af samfundets ressourcer.

So we began with a card table in the clinic waiting room --

Så vi begyndte med et kortbord i klinikkens venteværelse --

totally lemonade stand style.

total juicebod stil.

But today we have a thousand college student advocates

Men i dag har vi tusind advokatstuderende

who are working to connect nearly 9,000 patients and their families

der arbejder med at forbinde næsten 9.000 patienter og deres familier

with the resources that they need to be healthy.

med ressourcerne de har brug for, for at være sunde.

So 18 months ago

Så for 18 måneder siden

I got this email that changed my life.

fik jeg denne mail der ændrede mit liv.

And the email was from Dr. Jack Geiger,

Og mailen var fra Dr. Jack Geiger,

who had written to congratulate me on Health Leads

der havde skrevet for at lykønske mig med Health Leads

and to share, as he said,

og til at dele, som han sagde,

a bit of historical context.

en smule historisk kontekst.

In 1965 Dr. Geiger founded

I 1965 startede Dr. Geiger

one of the first two community health centers in this country,

en af landets første to lokalsamfunds sundhedscentre,

in a brutally poor area in the Mississippi Delta.

i et utrolig fattigt kvarter i Mississippi Deltaet.

And so many of his patients came in

Så mange af hans patienter kom ind

presenting with malnutrition

med underernæring

that be began prescribing food for them.

som han begyndte at ordinere mad til.

And they would take these prescriptions to the local supermarket,

Og de ville tage disse recepter med til det lokale supermarked,

which would fill them

som ville fylde dem

and then charge the pharmacy budget of the clinic.

og sætte regningen på klinikkens medicinbudget.

And when the Office of Economic Opportunity in Washington, D.C. --

Og da Office of Economic Opportunity i Washington, D.C. --

which was funding Geiger's clinic --

der finansierede Geigers klinik --

found out about this,

fandt ud af dette,

they were furious.

blev de rasende.

And they sent this bureaucrat down

Og de havde sendt en bureaukrat ned

to tell Geiger that he was expected to use their dollars

for at fortælle Geiger at det forventedes af ham at han brugte deres dollars

for medical care --

på medicinsk behandling --

to which Geiger famously and logically responded,

hvor Geiger glimrende og logisk svarede,

"The last time I checked my textbooks,

"Sidste gang jeg kiggede i min lærebog,

the specific therapy for malnutrition was food."

var mad den specifikke behandling mod underernæring."

(Laughter)

(Latter)

So when I got this email from Dr. Geiger,

Så da jeg fik denne mail fra Dr. Geiger,

I knew I was supposed to be proud

vidste jeg at jeg burde være stolt

to be part of this history.

af at være en del af denne historie.

But the truth is

Men sandheden er

I was devastated.

at jeg blev slået helt ud.

Here we are,

Her er vi,

45 years after Geiger has prescribed food for his patients,

45 år efter Geiger har ordineret mad til hans patienter,

and I have doctors telling me,

og jeg har læger der fortæller mig,

"On those issues, we practice a 'don't ask, don't tell' policy."

"På disse områder, praktiserer vi en "don't ask, don't tell" politik."

Forty-five years after Geiger,

Femogfyrre år efter Geiger,

Health Leads has to reinvent

skal Health Leads genopfinde

the prescription for basic resources.

recepten på basale ressourcer.

So I have spent hours upon hours

Så jeg har brugt timer på timer

trying to make sense of this weird Groundhog Day.

på at prøve at få denne mærkelige Groundhog Day til at give mening.

How is it that if for decades

Hvordan kan det være, at hvis vi i årtier

we had a pretty straightforward tool for keeping patients,

havde et temmelig direkte værktøj til at holde patienter,

and especially low-income patients, healthy,

især lavindkomst patienter, sunde

that we didn't use it?

at vi ikke bruger det?

If we know what it takes to have a healthcare system

Hvis vi ved hvad det kræver at have et sundhedsvæsen

rather than a sick-care system,

i stedet for et sygevæsen,

why don't we just do it?

hvorfor gør vi det så ikke bare?

These questions, in my mind,

Disse spørgsmål, i mit sind,

are not hard because the answers are complicated,

er ikke svære fordi svarene er komplicerede,

they are hard because they require that we be honest with ourselves.

de er svære fordi de kræver at vi er ærlige overfor os selv.

My belief is that it's almost too painful

Min tro er, at det næsten er for smertefuldt

to articulate our aspirations for our healthcare system,

at artikulere vores ambitioner for vores sundhedsvæsen,

or even admit that we have any at all.

eller selv indrømme at vi overhovedet har nogen.

Because if we did,

Fordi hvis vi gjorde,

they would be so removed

ville de være så fjerne

from our current reality.

fra vores nuværende virkelighed.

But that doesn't change my belief

Men det ændrer ikke min tro på

that all of us, deep inside,

at vi allesammen, dybt indeni,

here in this room and across this country,

her i dette lokale og over hele landet,

share a similar set of desires.

deler lignende ønsker.

That if we are honest with ourselves

At hvis vi var ærlige overfor os selv

and listen quietly,

og lytter stille,

that we all harbor

at vi alle nærer

one fiercely held aspiration for our healthcare:

en intens ambition for vores sundhedsvæsen:

that it keep us healthy.

at det holder os sunde.

This aspiration that our healthcare keep us healthy

Den ambition, at vores sundhedsvæsen holder os sunde

is an enormously powerful one.

er en utrolig stærk en.

And the way I think about this

Og måden hvorpå jeg tænker om dette

is that healthcare is like any other system.

er at sundhedsvæsnet er ligesom hvilket som helst andet system.

It's just a set of choices that people make.

Der er bare et sæt valg mennesker laver.

What if we decided

Hvad hvis vi besluttede

to make a different set of choices?

at have en andet sæt valg?

What if we decided to take all the parts of healthcare

Hvad hvis vi besluttede at tage alle delene af sundhedsvæsnet

that have drifted away from us

der er drevet væk fra os

and stand firm and say, "No.

og stå fast og sige, "Nej.

These things are ours.

Dette er vores ting.

They will be used for our purposes.

De vil blive brugt til vores formål.

They will be used to realize

De vil blive brugt til at realisere

our aspiration"?

vores ambition"?

What if everything we needed

Hvad nu hvis alt vi har brug for

to realize our aspiration for healthcare

til at realisere vores ambition for sundhedsvæsnet

was right there in front of us

var lige foran os

just waiting to be claimed?

og bare ventede på at blive krævet?

So that's where Health Leads began.

Så det er der Health Leads begyndte.

We started with the prescription pad --

Vi startede med recept papiret --

a very ordinary piece of paper --

et meget almindeligt stykke papir --

and we asked, not what do patients need to get healthy --

og vi spurgte, ikke hvad patienter har brug for, for at blive raske --

antibiotics, an inhaler, medication --

antibiotika, en inhalator, medicin --

but what do patients need to be healthy,

men hvad har brug for, for at være sunde,

to not get sick in the first place?

til ikke at blive syge for det første?

And we chose to use the prescription

Og vi valgte at bruge recepten

for that purpose.

til det formål.

So just a few miles from here

Så bare et par kilometer herfra

at Children's National Medical Center,

ved Children's National Medical Center,

when patients come into the doctor's office,

når patienter kom ind i lægens kontor,

they're asked a few questions.

stille de et par spørgsmål.

They're asked, "Are you running out of food at the end of the month?

De spurgte, "Løbet du tør for mad i slutningen af måneden?

Do you have safe housing?"

Har du en pålidelig bolig?"

And when the doctor begins the visit,

Og når lægen begyndte konsultationerne,

she knows height, weight, is there food at home,

kender hun højde, vægt, er der mad i hjemmet,

is the family living in a shelter.

bor familien på et herberg.

And that not only leads to a better set of clinical choices,

Og det leder ikke kun til et sæt bedre kliniske valg,

but the doctor can also prescribe those resources for the patient,

men lægen kan også give recepter på de ressourcer til patienten,

using Health Leads like any other sub-specialty referral.

ved hjælp af Health Leads ligesom enhver anden speciel henvisning.

The problem is,

Problemet er,

once you get a taste of what it's like

at når man først prøver hvordan det er

to realize your aspiration for healthcare,

at realisere ens ambitioner for sundhedsvæsnet,

you want more.

vil man have mere.

So we thought,

Så vi tænkte,

if we can get individual doctors

hvis vi kan få individuelle læger

to prescribe these basic resources for their patients,

til at ordinere disse basale ressourcer til deres patienter,

could we get an entire healthcare system

kunne vi få et helt sundhedsvæsen

to shift its presumption?

til at ændre dets formodninger?

And we gave it a shot.

Og vi gav det et forsøg.

So now at Harlem Hospital Center

Nu på Harlem Hospital Center

when patients come in with an elevated body mass index,

når patienter kommer in med en forhøjet body mass index,

the electronic medical record

vil den elektroniske lægelige journal

automatically generates a prescription for Health Leads.

automatisk generere en recept til Health Leads.

And our volunteers can then work with them

Og vores frivillige kan så arbejde med dem

to connect patients to healthy food and excercise programs

til at forbinde patienter med sund mad og træningsprogrammer

in their communities.

i deres samfund.

We've created a presumption

Vi har skabt en formodning

that if you're a patient at that hospital

at hvis man er en patient på et sygehus

with an elevated BMI,

med et forhøjet BMI,

the four walls of the doctor's office

vil de fire væge i lægens kontor

probably aren't going to give you everything

nok ikke give en alt det man har brug for

you need to be healthy.

for at være sund.

You need more.

Man har brug for mere.

So on the one hand,

Så på den ene side,

this is just a basic recoding

er dette bare en basal registrering

of the electronic medical record.

af den elektroniske lægelige journal.

And on the other hand,

Og på den anden side,

it's a radical transformation

er det en radikal ændring

of the electronic medical record

af den elektroniske lægelige journal

from a static repository of diagnostic information

fra et statisk depot af diagnostisk information

to a health promotion tool.

til et sundhedsfremmende redskab.

In the private sector,

I den private sektor,

when you squeeze that kind of additional value

når man klemmer den form for ekstra værdi

out of a fixed-cost investment,

ud af en fast omkostnings investering,

it's called a billion-dollar company.

det er kaldet et milliard dollar selskab.

But in my world,

Men i min verden,

it's called reduced obesity and diabetes.

er det kaldet reduceret fedme og diabetes.

It's called healthcare --

Det hedder sundhedsvæsen --

a system where doctors can prescribe solutions

et system hvor lægerne kan ordinere løsninger

to improve health,

til at forbedre sundhed,

not just manage disease.

ikke kun behandle sygdom.

Same thing in the clinic waiting room.

Den samme ting i denne klinik med venteværelse.

So every day in this country

Så hver dag i dette land

three million patients

kommer tre millioner patienter

pass through about 150,000 clinic waiting rooms in this country.

gennem cirka 150.000 klinikkers venteværelser i dette land.

And what do they do when they're there?

Og hvad laver de når de er der?

They sit, they watch the goldfish in the fish tank,

De sidder, de kigger på fisk i et akvarie,

they read extremely old copies

de læser ekstremt gamle kopier

of Good Housekeeping magazine.

af Good Housekeeping magasin.

But mostly we all just sit there forever, waiting.

Men for det meste sidder der bare der i al evighed, venter.

How did we get here

Hvordan kom vi til det punkt

where we devote hundreds of acres and thousands of hours

hvor vi helligere hundredvis af kvadratmeter og tusindvis af timer

to waiting?

på at vente?

What if we had a waiting room

Hvad hvis vi havde et venteværelse

where you don't just sit when you're sick,

hvor man ikke bare sidder hvor man er syg,

but where you go to get healthy.

men hvor man faktisk bliver sund.

If airports can become shopping malls

Hvis lufthavne kan blive indkøbscentre

and McDonald's can become playgrounds,

og McDonalds kan blive legepladser,

surely we can reinvent the clinic waiting room.

så kan vi da også genopfinde klinikkens venteværelse.

And that's what Health Leads has tried to do,

Og det er hvad Health Leads prøver på at gøre,

to reclaim that real estate and that time

for at generobre den faste ejendom og den tid

and to use it as a gateway

og bruge det som en flugt

to connect patients

til at forbinde patienter

to the resources they need to be healthy.

med de ressourcer de har brug for, for at være sunde.

So it's a brutal winter in the Northeast,

Så det er en brutal vinter i Northeast,

your kid has asthma, your heat just got turned off,

ens barn har astma, ens varme er lige blevet slukket,

and of course you're in the waiting room of the ER,

og selvfølgelig venter man på skadestuen.

because the cold air triggered your child's asthma.

fordi kulden har udløst ens barn astma.

But what if instead of waiting for hours anxiously,

Men hvad hvis man i stedet for at vente nervøst i timevis

the waiting room became the place

venteværelset blev det sted

where Health Leads turned your heat back on?

hvor Health Leads tændte for ens varme igen?

And of course all of this requires

Og selvfølgelig kræver alt dette

a broader workforce.

en bred arbejdsstyrke.

But if we're creative, we already have that too.

Men hvis vi er kreative, har vi også allerede det.

We know that our doctors and nurses

Vi ved at vores læger og sygeplejersker

and even social workers

og selv socialrådgivere

aren't enough,

ikke er nok,

that the ticking minutes of health care

at sundhedsvæsnets tikkende minutter

are too constraining.

er for begrænsende.

Health just takes more time.

Sundhed tager bare længere tid.

It requires a non-clinical army

Det kræver en ikke-klinisk hær

of community health workers and case managers

af lokalsamfunds sundhedspersonale og sagsbehandlere

and many others.

og mange andre.

What if a small part of that next healthcare workforce

Hvad hvis en lille del af den næste arbejdsstyrke i sundhedsvæsnet

were the 11 million college students in this country?

var 11 millioner universitetsstuderende i dette land?

Unencumbered by clinical responsibilities,

Ubekymrede over det kliniske ansvar,

unwilling to take no for an answer

uvillige til at få nej som svar

from those bureaucracies

fra de bureaukrater

that tend to crush patients,

det har tendens til at knuse patienterne

and with an unparalleled ability

med en evne uden sidestykke

for information retrieval

for informations søgning

honed through years of using Google.

finpudset ved gennem årene at bruge Google.

Now lest you think it improbable

For at I ikke tror det er usandsynligt

that a college volunteer

at en frivillig fra universitetet

can make this kind of commitment,

vil lave dette slags engagement,

I have two words for you:

har jeg to ord til Jer:

March Madness.

March Madness.

The average NCAA Division I men's basketball player

Den gennemsnitlige NCAA division 1 spiller på mændenes basketball hold

dedicates 39 hours a week to his sport.

bruger 39 timer om ugen på hans sport.

Now we may think that's good or bad,

Det kan vi synes er godt eller dårligt,

but in either case it's real.

men i hvert tilfælde er det sandt.

And Health Leads is based on the presumption

Og Health Leads er baseret på den formodning

that for too long

at i for lang tid

we have asked too little of our college students

har vi bedt vores universitetsstuderende om for lidt,

when it comes to real impact in vulnerable communities.

når det kommer til reel indflydelse i skrøbelige samfund.

College sports teams say,

Universitets sports holdende siger

"We're going to take dozens of hours

"Vi vil tage dusinvis af timer

at some field across campus at some ungodly hour of the morning

på et eller andet felt på campus på et ugudeligt tidspunkt om morgenen

and we're going to measure your performance, and your team's performance,

og vi vil måle Jeres præstationsniveau, og dit holds præstationsniveau,

and if you don't measure up or you don't show up,

og hvis du ikke lever op, eller du ikke kommer,

we're going to cut you off the team.

smider vi dig af holdet.

But we'll make huge investments

Men vi vil lave store investeringer

in your training and development,

i din træning og udvikling,

and we'll give you an extraordinary community of peers."

og vi vil give dig et usædvanligt nærsamfund af jævnaldrende."

And people line up out the door

Og mennesker står i en kø der rækker ud af døren

just for the chance to be part of it.

bare for at få en chance for at være med.

So our feeling is,

Så vores fornemmelse er,

if it's good enough for the rugby team,

hvis det er godt nok til rugbyholdet,

it's good enough for health and poverty.

er det godt nok til helbred og fattigdom.

Health Leads too recruits competitively,

Health Leads rekrutterer konkurrencedygtigt,

trains intensively,

træner intensivt,

coaches professionally,

underviser professionelt,

demands significant time,

kræver betydelig tid,

builds a cohesive team

bygger et sammenhængende team

and measures results --

og måler resultater --

a kind of Teach for America for healthcare.

en slags Teach for America for sundhedsvæsnet.

Now in the top 10 cities in the U.S.

Nu i top 10 byerne i Amerika

with the largest number of Medicaid patients,

med det største antal af Medicaid patienter,

each of those has at least 20,000 college students.

hver af dem har mindst 20.000 universitetsstuderende.

New York alone has half a million college students.

New York har i sig selv en halv million universitetsstuderende.

And this isn't just a sort of short-term workforce

Og det er ikke nogen korttids arbejdsstyrke

to connect patients to basic resources,

til at forbinde at patienter med basale ressourcer,

it's a next generation healthcare leadership pipeline

det er næste generations sundhedsvæsens lederskab

who've spent two, three, four years

der har brugt to, tre, fire år

in the clinic waiting room

i klinikkens venteværelse

talking to patients about their most basic health needs.

med at tale til patienter om deres mest basale sundhedsbehov.

And they leave with the conviction,

Og de går med den overbevisning at,

the ability and the efficacy

evnen og gennemslagskraften

to realize our most basic aspirations for health care.

til at realisere vores mest banale ambitioner for sundhedsvæsnet.

And the thing is, there's thousands of these folks already out there.

Og det der er ved det er, at der er tusindvis af disse mennesker derude.

So Mia Lozada is Chief Resident of Internal Medicine

Så Mia Lozada er Chief Resident of Internal Medicine

at UCSF Medical Center,

ved UCSF Medical Center,

but for three years as an undergraduate

men i tre år som bachelor

she was a Health Leads volunteer

var hun en Health Leads frivillig

in the clinic waiting room at Boston Medical Center.

i klinikkens venteværelse ved Boston Medical Center.

Mia says, "When my classmates write a prescription,

Mia siger, "Da mine klassekammerater skriver en recept,

they think their work is done.

tror de deres arbejde er gjort.

When I write a prescription,

Når jeg skriver en recept,

I think, can the family read the prescription?

tænker jeg, kan familien læse recepten?

Do they have transportation to the pharmacy?

Har de transportmulighed til apoteket?

Do they have food to take with the prescription?

Har de mad at indtage sammen med recepten?

Do they have insurance to fill the prescription?

Har de forsikring til at betale recepten?

Those are the questions I learned at Health Leads,

Det er de spørgsmål jeg lærte ved Health Leads,

not in medical school."

ikke ved lægeuddannelsen."

Now none of these solutions --

Nu er ingen af disse løsninger --

the prescription pad, the electronic medical record,

recepten, den elektroniske lægelige journal,

the waiting room,

venteværelset,

the army of college students --

hæren af universitetsstuderende --

are perfect.

er perfekt.

But they are ours for the taking --

Men det er vores --

simple examples

simple eksempler

of the vast under-utilized healthcare resources

på enormt under udnyttede sundhedsvæsen ressourcer

that, if we reclaimed and redeployed,

som, hvis vi generobrer og omplacerer,

could realize our most basic aspiration

ville forstå vores mest basale ambitioner

of healthcare.

af sundhedsvæsnet.

So I had been at Legal Services for about nine months

Så jeg havde siddet ved Legal Services i cirka ni måneder

when this idea of Health Leads started percolating in my mind.

da denne ide om Health Leads startede at løbe gennem mit hoved.

And I knew I had to tell Jeff Purcell, my attorney,

Og jeg vidste at jeg var nød til at fortælle Jeff Purcell, min advokat,

that I needed to leave.

at jeg var nød til at tage afsked.

And I was so nervous,

Og jeg var så nervøs,

because I thought he was going to be disappointed in me

fordi jeg troede at han ville blive skuffet over mig

for abandoning our clients for some crazy idea.

for at jeg efterlod vores klienter til fordel for en skør ide.

And I sat down with him and I said,

Og jeg satte mig ned sammen med ham og jeg sagde,

"Jeff, I have this idea

"Jeff, jeg har denne ide

that we could mobilize college students

at vi kunne mobilisere universitetsstuderende

to address patients' most basic health needs."

til at adressere patienters mest basale sundheds behov."

And I'll be honest,

Og jeg skal være ærlig,

all I wanted was for him to not be angry at me.

det eneste jeg ønskede, var at han ikke blev sur på mig.

But he said this,

Men han sagde dette,

"Rebecca, when you have a vision,

"Rebecca, når man har en vision,

you have an obligation to realize that vision.

har man en forpligtelse til at realisere den vision.

You must pursue that vision."

Du må forfølge den vision."

And I have to say, I was like "Whoa.

Og jeg må sige, jeg tænkte "Whoa.

That's a lot of pressure."

Det er et tungt pres."

I just wanted a blessing,

Jeg ville bare have en velsignelse,

I didn't want some kind of mandate.

jeg ville ikke have en slags mandat.

But the truth is

Men sandheden er

I've spent every waking minute nearly since then

at jeg har brugt hvert vågne minut, nærmest siden da,

chasing that vision.

på at forfølge den vision.

I believe that we all have a vision

Jeg tror på, at vi alle kan have en vision

for healthcare in this country.

for sundhedsvæsnet i dette land.

I believe that at the end of the day

Jeg tror på, at når dagen er omme,

when we measure our healthcare,

når vi måler vores sundhedsvæsen,

it will not be by the diseases cured,

vil det ikke være på de sygdomme der bliver kureret,

but by the diseases prevented.

men på de sygdomme der bliver forebygget.

It will not be by the excellence of our technologies

Det vil ikke være på vores fortræffelige teknologier

or the sophistication of our specialists,

eller vores specialisters raffinement,

but by how rarely we needed them.

men på hvor sjældent vi har brug for dem.

And most of all,

Og mest af alt,

I believe that when we measure healthcare,

tror jeg på at når vi måler sundhedsvæsnet,

it will be, not by what the system was,

vil det være, ikke på hvad systemet var,

but by what we chose it to be.

men på hvad vi vælger det er.

Thank you.

Tak.

(Applause)

(Bifald)

Thank you.

Tak.

(Applause)

(Bifald)