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

Translator: Timothy Covell Reviewer: Morton Bast

Translator: Francisco Caamano Reviewer: Xusto Rodriguez

So my freshman year of college

No meu primeiro ano de universidade

I signed up for an internship in the housing unit

inscribinme nunha pasantía na unidade de vivenda

at Greater Boston Legal Services.

do estudo “Greater Boston Legal Services”.

Showed up the first day

Presenteime o primeiro día

ready to make coffee and photocopies,

lista para facer café e fotocopias,

but was paired with this righteous, deeply inspired attorney

pero tocoume traballar cun avogado xusto

named Jeff Purcell,

chamado Jeff Purcell

who thrust me onto the front lines

quen me puxo na primeira fila

from the very first day.

desde o primeiro día.

And over the course of nine months

E durante nove meses

I had the chance

tiven a oportunidade

to have dozens of conversations

de ter unha chea de conversas

with low-income families in Boston

con familias de baixos ingresos de Boston

who would come in presenting with housing issues,

que tiñan problemas coas súas vivendas,

but always had an underlying health issue.

e sempre tiñan algún problema de saúde.

So I had a client who came in,

Tiven un cliente que se presentou

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

cando o ían desafiuzar por non pagar a renda.

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

E non a pagara,

because he's paying for his HIV medication

porque estaba pagando a medicación do VIH

and just can't afford both.

e non podía custear as dúas.

We had moms who would come in,

Vin nais que viñan

daughter has asthma,

porque a filla tiña asma,

wakes up covered in cockroaches every morning.

e espertaba a diario cuberta de cascudas.

And one of our litigation strategies

E unha das nosas estratexias de litigación

was actually to send me into the home of these clients

era enviarme a esas casas

with these large glass bottles.

con grandes botellas de vidrio

And I would collect the cockroaches,

para atrapar as cascudas,

hot glue-gun them to this poster board

pegalas con silicona quente nunha cartolina

that we'd bring to court for our cases.

e levalas ao xulgado para os nosos casos.

And we always won

E sempre gañabamos,

because the judges were just so grossed out.

porque os xuices morrían co noxo.

Far more effective, I have to say,

Algo moito máis efectivo, abofé,

than anything I later learned in law school.

ca calquera cousa que aprendera na facultade de dereito.

But over the course of these nine months,

Pero ao longo deses nove meses,

I grew frustrated with feeling

frustrábame cada vez máis porque sentía

like we were intervening too far downstream

que estabamos intervindo moi tarde

in the lives of our clients --

nas vidas dos nosos clientes;

that by the time they came to us,

no momento en que nos visitaban,

they were already in crisis.

xa estaban en crise.

And at the end of my freshman year of college,

E ao final do meu primeiro ano na universidade,

I read an article about the work

lin un artigo sobre o traballo

that Dr. Barry Zuckerman was doing

do Dr. Barry Zuckerman

as Chair of Pediatrics

como xefe de pediatría

at Boston Medical Center.

do Boston Medical Center.

And his first hire was a legal services attorney

A súa primeira contratación foi un avogado de servizos legais

to represent the patients.

para representar os pacientes.

So I called Barry,

Así que chamei a Barry

and with his blessing, in October 1995

e coa súa aprobación, en outubro de 1995,

walked into the waiting room

entrei na sala de espera

of the pediatrics clinic at Boston Medical Center.

da clínica de pediatría do Boston Medical Center.

I'll never forget,

Non esquecerei nunca

the TVs played this endless reel of cartoons.

eses debuxos animados sen fin na televisión.

And the exhaustion of mothers

E o esgotamento das nais

who had taken two, three, sometimes four buses

que colleran dous, tres ou catro autobuses

to bring their child to the doctor

para traer ao seu fillo ao médico

was just palpable.

podíase tocar

Parecía que os médicos

The doctors, it seemed,

never really had enough time for all the patients,

nunca tiñan tempo para todos os pacientes,

try as they might.

por máis que se esforzaban.

And over the course of six months,

E durante seis meses,

I would corner them in the hallway

parábaos nos corredores

and ask them a sort of naive but fundamental question:

e preguntáballes simplemente:

"If you had unlimited resources,

“Se tiveras medios ilimitados,

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

que lles darías aos teus pacientes?”

And I heard the same story again and again,

E sempre escoitaba o mesmo unha e outra vez,

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

algo que oín centos de veces desde aquela.

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

Dicían: “Tódolos días temos pacientes que chegan á clínica;

child has an ear infection,

se un neno ten infección de oído,

I prescribe antibiotics.

prescribo antibióticos.

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

Pero o verdadeiro problema é que na casa non hai que comer.

The real issue

O verdadeiro problema

is that child is living with 12 other people

é que ese neno vive con outras 12 persoas

in a two-bedroom apartment.

nun apartamento de 2 cuartos.

And I don't even ask about those issues

E nin sequera pregunto sobre iso

because there's nothing I can do.

porque non podo facer nada.

I have 13 minutes with each patient.

Teño 13 minutos por paciente.

Patients are piling up in the clinic waiting room.

Os pacientes amoréanse na sala de espera.

I have no idea where the nearest food pantry is.

Non sei onde está o comedor social máis próximo.

And I don't even have any help."

E non teño axuda”.

In that clinic, even today,

Nesa clínica, mesmo hoxe,

there are two social workers

hai dous asistentes sociais

for 24,000 pediatric patients,

para 24.000 pacientes pediátricos

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

e están mellor ca noutros centros.

So Health Leads was born of these conversations --

“Health Leads” naceu destas conversas,

a simple model

un simple modelo

where doctors and nurses

onde médicos e enfermeiras

can prescribe nutritious food,

poidan receitar comida nutritiva,

heat in the winter

calefacción no inverno

and other basic resources for their patients

e outra asistencia básica para o paciente

the same way they prescribe medication.

igual que receitan medicamentos.

Patients then take their prescriptions

Os pacientes levan as súas receitas

to our desk in the clinic waiting room

ao noso despacho na clínica

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

onde temos de estudantes de dereito ben formados

who work side by side with these families

que traballan con esas familias

to connect them out

para conectalas

to the existing landscape of community resources.

co abano de recursos comunitarios existente.

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

Así, empezamos cunha mesa pregable na sala de espera da clínica,

totally lemonade stand style.

estilo “posto de limonada”.

But today we have a thousand college student advocates

Pero hoxe temos mil estudantes de dereito

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

que están traballando para informar a preto de 9.000 pacientes

with the resources that they need to be healthy.

do recursos que necesitan.

So 18 months ago

Hai 18 meses,

I got this email that changed my life.

recibín este correo electrónico que me cambiou a vida.

And the email was from Dr. Jack Geiger,

Era do Dr. Jack Geiger,

who had written to congratulate me on Health Leads

que me escribiu para felicitarme por Health Leads

and to share, as he said,

e para compartir, como el dixo,

a bit of historical context.

un pouco de contexto histórico.

In 1965 Dr. Geiger founded

En 1965, o Dr. Geiger fundou

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

un dos dous primeiros centrosde saúde comunitarios deste país,

in a brutally poor area in the Mississippi Delta.

nunha zona terriblemente deprimida do delta do Mississippi.

And so many of his patients came in

E eran tantos os pacientes que chegaban

presenting with malnutrition

con malnutrición

that be began prescribing food for them.

que empezou a receitarlles comida.

And they would take these prescriptions to the local supermarket,

E eles levaban as receitas ao supermercado

which would fill them

que llas despachaba

and then charge the pharmacy budget of the clinic.

e logo cargábaas ao presuposto de farmacia da clínica.

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

E cando na Oficina de Oportunidades Económicas en Washington D.C.

which was funding Geiger's clinic --

–que financiaba a clínica de Geiger–

found out about this,

o souberon,

they were furious.

puxéronse furiosos.

And they sent this bureaucrat down

E enviaron un burócrata

to tell Geiger that he was expected to use their dollars

dicirlle a Geiger que se esperaba que usara os seus dólares

for medical care --

para atención médica,

to which Geiger famously and logically responded,

ao que Geiger respondeu dun xeito distinguido e lóxico:

"The last time I checked my textbooks,

“A última vez que revisei os meus libros,

the specific therapy for malnutrition was food."

a terapia específica para a malnutrición era a comida”.

(Laughter)

(Risas)

So when I got this email from Dr. Geiger,

Así que ao recibir o correo do Dr. Geiger,

I knew I was supposed to be proud

souben que debía estar orgullosa

to be part of this history.

de formar parte desta historia.

But the truth is

Pero a verdade é

I was devastated.

que estaba desconsolada.

Here we are,

E aquí estamos,

45 years after Geiger has prescribed food for his patients,

45 anos despois de que Geiger lles receitara comida aos pacientes,

and I have doctors telling me,

e hai médicos que me din:

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

“Neses asuntos temos unha política de ‘non pregunte, non conte’”.

Forty-five years after Geiger,

45 anos despois de Geiger,

Health Leads has to reinvent

Health Leads ten que reinventar

the prescription for basic resources.

a prescrición de recursos básicos.

So I have spent hours upon hours

Así que pasei horas e horas

trying to make sense of this weird Groundhog Day.

tratando de encontrar o sentido deste extraño “Día da Marmota”.

How is it that if for decades

Se durante décadas

we had a pretty straightforward tool for keeping patients,

tivemos unha ferramenta sinxela para mantener a saúde

and especially low-income patients, healthy,

especialmente nos pacientes pobres,

that we didn't use it?

por que non a usamos?

If we know what it takes to have a healthcare system

Se sabemos o que fai falta para ter un sistema de saúde,

rather than a sick-care system,

no canto dun sistema que coida enfermos,

why don't we just do it?

por que simplemente non o facemos?

These questions, in my mind,

Para min, estas preguntas

are not hard because the answers are complicated,

son difíciles, non porque as respostas sexan complicadas,

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

senón porque requiren que sexamos sinceros con nós mesmos.

My belief is that it's almost too painful

Creo que é demasiado difícil

to articulate our aspirations for our healthcare system,

expresar as nosas aspiracións para o noso sistema de saúde,

or even admit that we have any at all.

ou tan sequera admitir que temos algunha.

Because if we did,

Porque se o fixeramos,

they would be so removed

estas estarían moi afastadas

from our current reality.

da realidade actual.

But that doesn't change my belief

Pero iso non cambia a miña convición

that all of us, deep inside,

de que todos nós, no fondo,

here in this room and across this country,

aquí nesta sala e en todo o país,

share a similar set of desires.

compartimos un conxunto similar de desexos.

That if we are honest with ourselves

Que se somos sinceros con nós mesmos

and listen quietly,

e escoitamos en silencio,

that we all harbor

todos albergamos

one fiercely held aspiration for our healthcare:

una aspiración ben arraigada sobre o noso sistema de saúde:

that it keep us healthy.

que poida manternos sans.

This aspiration that our healthcare keep us healthy

Esta aspiración

is an enormously powerful one.

é enormemente poderosa.

And the way I think about this

E tal como eu o vexo,

is that healthcare is like any other system.

o sistema da saude é como calquera outro.

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

Unicamente un conxunto de decisións.

What if we decided

Que pasaría se decidísemos

to make a different set of choices?

tomar outras decisións?

Que pasaría se decidísemos ver todas as partes do sistema de saúde,

What if we decided to take all the parts of healthcare

that have drifted away from us

tamén as que se nos foron á deriva?,

and stand firm and say, "No.

e nos plantamos e dicimos: “Non.

These things are ours.

Estas cousas son nosas.

They will be used for our purposes.

Usarémolas para os nosos propósitos.

They will be used to realize

Usarémolas para acadar

our aspiration"?

as nosas aspiracións”?

Que pasaría se todo o que necesitamos

What if everything we needed

para decatarnos das nosas aspiracións sobre o sistema de saúde

to realize our aspiration for healthcare

was right there in front of us

estivera aí fronte a nós

just waiting to be claimed?

esperando que o reivindiquemos?

So that's where Health Leads began.

Así que aí foi onde empezou Health Leads.

We started with the prescription pad --

Empezamos co talonario de receitas,

a very ordinary piece of paper --

--simplemente unha folla de papel--

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

y non nos preguntamos que necesitan os pacientes para curarse

antibiotics, an inhaler, medication --

–antibióticos, un inhalador, medicación–

but what do patients need to be healthy,

senón, que necesitan para estar sans,

to not get sick in the first place?

para non enfermar?

And we chose to use the prescription

E optamos por usar as receitas

for that purpose.

para iso.

So just a few miles from here

Así que só a uns kilómetros de aquí

at Children's National Medical Center,

no Centro Médico Nacional Infantil,

when patients come into the doctor's office,

cando os pacientes chegan á consulta,

they're asked a few questions.

fánselles unhas preguntas:

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

“Chégalle a comida ata fin de mes?

Do you have safe housing?"

Ten unha vivenda segura?”

And when the doctor begins the visit,

E cando o doutor comeza a consulta,

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

sabe a altura e o peso, se hai comida na casa,

is the family living in a shelter.

se a familia vive nun albergue.

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

E iso non só leva a un mellor conxunto de decisións clínicas,

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

senón que o doutor pode prescribir eses recursos para o paciente,

using Health Leads like any other sub-specialty referral.

usando Health Leads como cualquera outra subespecialidade de interconsulta.

The problem is,

O problema é

que así que lle colles o gusto

once you get a taste of what it's like

to realize your aspiration for healthcare,

a realizar as túas aspiracións no coidado da saúde,

you want more.

queres máis.

Así que pensamos,

So we thought,

se podemos conseguir que os doutores

if we can get individual doctors

to prescribe these basic resources for their patients,

prescriban estes recursos básicos

could we get an entire healthcare system

poderíamos lograr que todo un sistema de saúde

to shift its presumption?

cambie as súas premisas?

And we gave it a shot.

E tentámolo.

So now at Harlem Hospital Center

E agora no Harlem Hospital Center

when patients come in with an elevated body mass index,

cando un paciente ingresa cun IMC elevado,

the electronic medical record

a historia clínica electrónica

automatically generates a prescription for Health Leads.

xera automaticamente unha prescrición para Health Leads.

E os nosos voluntarios poden traballar con eles

And our volunteers can then work with them

to connect patients to healthy food and excercise programs

para conectalos cos programas de comida saudable e exercicio físico

in their communities.

dos seus barrios.

We've created a presumption

Creamos a premisa

that if you're a patient at that hospital

de que se es un paciente nese hospital

with an elevated BMI,

con IMC elevado,

the four walls of the doctor's office

as catro paredes da consulta

probably aren't going to give you everything

probablemente non che darán

you need to be healthy.

todo o que necesitas.

You need more.

Necesitas máis.

So on the one hand,

Así que por un lado,

this is just a basic recoding

isto é só un redeseño básico

of the electronic medical record.

da historia clínica electrónica.

And on the other hand,

E por outro,

it's a radical transformation

é unha transformación radical

of the electronic medical record

da historia clínica electrónica

from a static repository of diagnostic information

dun repositorio estático de información de diagnóstico

to a health promotion tool.

a unha ferramenta de promoción da saúde.

In the private sector,

No sector privado,

when you squeeze that kind of additional value

se se extrae esa clase de valor adicional

out of a fixed-cost investment,

dun investimento de custo fixo,

it's called a billion-dollar company.

chámaselle "compañía de miles de millóns de dólares".

But in my world,

Pero no meu mundo,

it's called reduced obesity and diabetes.

chámase redución da obesidade e diabetes.

It's called healthcare --

Chámase coidado da saúde:

a system where doctors can prescribe solutions

un sistema no que os médicos poidan prescribir solucións

to improve health,

para mejorar a saúde,

not just manage disease.

non só controlar enfermidades.

E o mesmo na sala de espera da clínica.

Same thing in the clinic waiting room.

So every day in this country

Así, cada día neste país

three million patients

tres millóns de pacientes

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

pasan por cerca de 150.000 salas de espera de clínicas .

And what do they do when they're there?

E que fan cando chegan alí?

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

Sentan, observan os peixes de cores do acuario,

they read extremely old copies

len número atrasados

of Good Housekeeping magazine.

de revistas femininas.

But mostly we all just sit there forever, waiting.

Pero principalmente todos sentamos alí sempre, a esperar.

How did we get here

Como chegamos a isto,

where we devote hundreds of acres and thousands of hours

a dedicar horas e horas

to waiting?

a esperar?

Que tal se houbera unha sala de espera

What if we had a waiting room

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

onde non só nos sentamos se enfermamos,

but where you go to get healthy.

senón á que imos tamén para curarnos?

If airports can become shopping malls

Se os aeroportos poden converterse en centros comerciais

and McDonald's can become playgrounds,

e os McDonald’s en parques de xogo,

surely we can reinvent the clinic waiting room.

seguro que podemos reinventar a sala de espera.

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

E iso é o que Health Leads trata de facer

to reclaim that real estate and that time

para recuperar ese espazo e ese tempo

and to use it as a gateway

e usalo como un acceso

to connect patients

para conectar os pacientes

to the resources they need to be healthy.

cos recursos que precisan para estar sans.

So it's a brutal winter in the Northeast,

No nordeste, o inverno é terrible,

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

o teu fillo ten asma, acaban de cortarche a calefacción,

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

e por suposto estás na sala de espera de urxencias,

because the cold air triggered your child's asthma.

porque o aire frío provocoulle a asma.

But what if instead of waiting for hours anxiously,

Pero, que se en vez de esperar horas, con ansiedade

the waiting room became the place

a sala de espera se convirtese no lugar

where Health Leads turned your heat back on?

onde Health Leads reconectara a túa calefacción?

And of course all of this requires

Por suposto, todo isto require

a broader workforce.

máis persoal.

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

Pero se somos creativos, tamén temos iso.

We know that our doctors and nurses

Sabemos que os nosos persoal médico e de enfermería

and even social workers

e mesmo os traballadores sociais

aren't enough,

non abondan,

that the ticking minutes of health care

que os poucos minutos da consulta

are too constraining.

son demasiado imperiosos.

Health just takes more time.

A saúde simplemente necesita máis tempo.

It requires a non-clinical army

Require un exército non clínico,

of community health workers and case managers

unha comunidade de traballadores da saúde, xestores

and many others.

e moitos outros.

Que pasaría se unha pequena parte dese próximo exército da atención sanitaria

What if a small part of that next healthcare workforce

were the 11 million college students in this country?

foran os 11 millóns de estudantes universitarios deste país?

Unencumbered by clinical responsibilities,

Libres de responsabilidades clínicas,

unwilling to take no for an answer

non dispostos a aceptar un “non”

from those bureaucracies

como resposta desas burocracias

that tend to crush patients,

que tenden a abrumar os pacientes,

and with an unparalleled ability

e cunha capacidade sen igual

for information retrieval

para atopar información

honed through years of using Google.

perfeccionada por anos de uso de Google.

Now lest you think it improbable

Pero se sodes dos que non credes

that a college volunteer

que un voluntario universitario

can make this kind of commitment,

poida asumir esta clase de compromiso,

I have two words for you:

teño dúas palabras para vós:

March Madness.

Loucura de Marzo [campionato da División I de baloncesto da NCAA].

The average NCAA Division I men's basketball player

O xogador tipo da División I da NCAA

dedicates 39 hours a week to his sport.

dedica 39 horas á semana ao deporte.

Now we may think that's good or bad,

Podemos pensar que iso é bo ou malo,

but in either case it's real.

pero é a realidade.

And Health Leads is based on the presumption

E Health Leads baséase na suposición

that for too long

de que durante moito tempo

we have asked too little of our college students

lles pedimos moi pouco aos nosos estudantes

when it comes to real impact in vulnerable communities.

cando se trata dun verdadeiro impacto en comunidades vulnerables.

College sports teams say,

Os equipos deportivos universitarios din:

"We're going to take dozens of hours

“Terás que dedicar horas e horas

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

en pistas de fóra do campus e a horas intempestivas,

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

e mediremos o teu funcionamento e o do teu equipo,

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

e se non estás á altura

we're going to cut you off the team.

teremos que botarte del.

But we'll make huge investments

Pero faremos grandes investimentos

in your training and development,

no teu adestramento,

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

e ofrecerémosche unha extraordinaria comunidade de amigos”.

And people line up out the door

E os estudantes fan fila na porta

just for the chance to be part of it.

só para intentar participar diso.

So our feeling is,

Así que cremos

if it's good enough for the rugby team,

que se es abondo bo para o equipo de rugby,

it's good enough for health and poverty.

tamén podes selo para a saúde e a pobreza.

Health Leads too recruits competitively,

Health Leads tamén selecciona competitivamente,

trains intensively,

adestra intensamente,

coaches professionally,

dirixe profesionalmente,

demands significant time,

demanda un tempo considerable,

builds a cohesive team

constrúe un equipo cohesionado

and measures results --

e mide resultados,

a kind of Teach for America for healthcare.

unha especie de “Teach for America” da saúde.

Agora mesmo, nas 10 principais cidades dos Estados Unidos

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

with the largest number of Medicaid patients,

con maior número de pacientes de “Medicaid”

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

cada unha ten polo menos 20.000 estudantes universitarios.

New York alone has half a million college students.

Só Nova York ten medio millón.

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

E esta non é só unha especie de forza de traballo a curto prazo

to connect patients to basic resources,

para conectar pacientes e recursos básicos,

it's a next generation healthcare leadership pipeline

é un reservorio de liderado en saúde da próxima xeración,

who've spent two, three, four years

xente que pasou dous, tres, catro anos

in the clinic waiting room

nas salas de espera das clínicas

talking to patients about their most basic health needs.

falando con pacientes das súas necesidades de saúde máis básicas.

And they leave with the conviction,

E vanse coa convición,

the ability and the efficacy

a capacidade e a eficacia

to realize our most basic aspirations for health care.

para facer realidade as nosas aspiracións.

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

E a cuestión é que xa hai miles, aí fóra.

So Mia Lozada is Chief Resident of Internal Medicine

Mia Lozada é xefa de residentes de Medicina Interna

no hospital UCSF [San Francisco].

at UCSF Medical Center,

but for three years as an undergraduate

Durante tres anos antes de graduarse

she was a Health Leads volunteer

foi voluntaria de Health Leads

in the clinic waiting room at Boston Medical Center.

na sala de espera da clínica do Boston Medical Center.

Mia says, "When my classmates write a prescription,

Mia di: “Cando os meus compañeiros de clase prescriben unha receita

they think their work is done.

pensan que acabaron o seu traballo.

When I write a prescription,

Cando eu prescribo unha receita

I think, can the family read the prescription?

penso: poderá entendela a familia?

Do they have transportation to the pharmacy?

Terán forma de ir á farmacia?

Do they have food to take with the prescription?

Terán comida para tomar co medicamento?

Do they have insurance to fill the prescription?

Terán seguro para pagar a receita?

Those are the questions I learned at Health Leads,

Estas preguntas aprendinas en Health Leads,

not in medical school."

non na universidade”.

Now none of these solutions --

Agora ben, ningunha destas solucións

the prescription pad, the electronic medical record,

--o talonario de receitas, a historia clínica electrónica,

the waiting room,

a sala de espera,

the army of college students --

o exército de estudantes universitarios-- é perfecta.

are perfect.

But they are ours for the taking --

Pero están alí para que as tomemos

simple examples

e son simples exemplos

of the vast under-utilized healthcare resources

dos moitos recursos infrautilizados no coidado da saúde

that, if we reclaimed and redeployed,

que, recuperados e redistribuídos,

could realize our most basic aspiration

poderían levar a cabo as nosas aspiracións máis básicas

of healthcare.

en materia de saúde.

So I had been at Legal Services for about nine months

Ben, levaba 9 meses en Legal Services

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

cando esta idea de Health Leads empezou a andarme na cabeza.

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

E vin que tiña que dicirlle a Jeff Purcell, o meu avogado,

that I needed to leave.

que necesitaba irme.

And I was so nervous,

E estaba nerviosísima,

because I thought he was going to be disappointed in me

porque pensaba que o ía decepcionar

for abandoning our clients for some crazy idea.

por abandonar os nosos clientes por unha idea tola.

And I sat down with him and I said,

E sentei con el e díxenlle:

"Jeff, I have this idea

“Jeff, ocorréuseme a idea

that we could mobilize college students

de que poderíamos mobilizar estudantes universitarios

to address patients' most basic health needs."

para atender as necesidades de saúde máis básicas dos pacientes”.

And I'll be honest,

E serei sincera,

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

só quería que non se enfadara comigo.

But he said this,

Pero respondeu:

"Rebecca, when you have a vision,

“Rebecca, se tes unha visión de futuro,

you have an obligation to realize that vision.

tes a obriga de levala a cabo.

You must pursue that vision."

Debes ir tras dela”.

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

E debo dicir que "Uauu.

That's a lot of pressure."

Que presión!”

I just wanted a blessing,

Eu só buscaba a súa aprobación,

I didn't want some kind of mandate.

non unha especie de mandato!

But the truth is

Pero a verdade é

I've spent every waking minute nearly since then

que cada minuto dende entón

chasing that vision.

estiven perseguindo esa visión de futuro.

I believe that we all have a vision

Creo que todos temos unha visión

for healthcare in this country.

para o sistema sanitario deste país.

I believe that at the end of the day

Creo que, ao final,

when we measure our healthcare,

cuando avaliemos o noso sistema

it will not be by the diseases cured,

non será polas enfermidades curadas,

but by the diseases prevented.

senón polas enfermidades evitadas.

It will not be by the excellence of our technologies

Non será pola excelencia das nosas tecnoloxías

or the sophistication of our specialists,

ou a sofisticación dos nosos especialistas,

but by how rarely we needed them.

senón polo pouco que os precisemos.

And most of all,

E sobre todo,

I believe that when we measure healthcare,

creo que cando avaliemos o sistema

it will be, not by what the system was,

será, non polo que o sistema era,

but by what we chose it to be.

senón polo que nós queiramos que sexa.

Thank you.

Grazas.

(Applause)

(Aplausos)

Thank you.

Grazas.

(Applause)

(Aplausos)