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

Translator: Timothy Covell Reviewer: Morton Bast

Prevoditelj: Senzos Osijek Recezent: Suzana Baric

So my freshman year of college

Na prvoj godini fakulteta

I signed up for an internship in the housing unit

prijavila sam se za staž u stambenoj jedinici

at Greater Boston Legal Services.

u Greater Boston Legal Services (pravna služba).

Showed up the first day

Pojavila sam se prvi dan

ready to make coffee and photocopies,

spremna za kuhanje kave i fotokopiranje,

but was paired with this righteous, deeply inspired attorney

ali bila sam uparena s korektnim, duboko nadahnutim odvjetnikom

named Jeff Purcell,

po imenu Jeff Purcell,

who thrust me onto the front lines

koji me od prvog dana

from the very first day.

gurao u prve redove.

And over the course of nine months

Tijekom devet mjeseci

I had the chance

imala sam priliku

to have dozens of conversations

voditi desetke razgovora

with low-income families in Boston

s obiteljima niskih prihoda u Bostonu

who would come in presenting with housing issues,

koje bi dolazile zbog svojih stambenih problema,

but always had an underlying health issue.

ali uvijek su imale neki zdravstveni problem u pozadini.

So I had a client who came in,

Dakle, došao mi je klijent

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

koji je trebao biti izbačen jer nije platio stanarinu.

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

Ali, naravno, on nije platio stanarinu

because he's paying for his HIV medication

zato što plaća lijekove za HIV

and just can't afford both.

i jednostavno si ne može priuštiti oboje.

We had moms who would come in,

Dolazile su majke,

daughter has asthma,

kći ima astmu i

wakes up covered in cockroaches every morning.

svako jutro budi se prekrivena žoharima.

And one of our litigation strategies

Jedna od naših parničkih strategija

was actually to send me into the home of these clients

zapravo je bila da ja odem u kuće tih klijenata

with these large glass bottles.

s velikim staklenim bocama.

And I would collect the cockroaches,

Prikupila bih žohare,

hot glue-gun them to this poster board

pištoljem na vruće ljepilo zalijepili bismo ih na pano

that we'd bring to court for our cases.

koji bismo ponijeli na sud za naše slučajeve.

And we always won

I uvijek smo pobjeđivali

because the judges were just so grossed out.

jer su suci bili toliko zgroženi.

Far more effective, I have to say,

Daleko je djelotvornije, moram reći,

than anything I later learned in law school.

nego bilo što što sam kasnije naučila na pravnom fakultetu.

But over the course of these nine months,

No, tijekom tih devet mjeseci,

I grew frustrated with feeling

postala sam frustrirana osjećajem

like we were intervening too far downstream

da interveniramo prekasno –

in the lives of our clients --

da su naši klijenti

that by the time they came to us,

već u krizi

they were already in crisis.

kad dođu do nas.

And at the end of my freshman year of college,

Na kraju moje prve godine fakulteta,

I read an article about the work

pročitala sam članak o radu

that Dr. Barry Zuckerman was doing

dr. Barryja Zuckermana koji je bio

as Chair of Pediatrics

šef pedijatrije

at Boston Medical Center.

u Boston Medical Center-u.

And his first hire was a legal services attorney

Prvo je zaposlio odvjetnika

to represent the patients.

da zastupa pacijente.

So I called Barry,

Nazvala sam Barryja

and with his blessing, in October 1995

te s njegovim blagoslovom,

walked into the waiting room

u listopadu 1995. ušla u čekaonicu

of the pediatrics clinic at Boston Medical Center.

pedijatrijske klinike u Boston Medical Center-u.

I'll never forget,

Nikad neću zaboraviti kako su se

the TVs played this endless reel of cartoons.

na TV-u u krug prikazivali crtići.

And the exhaustion of mothers

A iscrpljenost majki

who had taken two, three, sometimes four buses

koje su morale presjesti na dva, tri, ponekad četiri autobusa

to bring their child to the doctor

kako bi dovele svoje dijete k liječniku,

was just palpable.

bila je očigledna.

The doctors, it seemed,

Činilo se da liječnici

never really had enough time for all the patients,

nikad nisu imali dovoljno vremena za sve pacijente,

try as they might.

koliko god se trudili.

And over the course of six months,

Tijekom šest mjeseci,

I would corner them in the hallway

zaustavila bih ih na hodniku

and ask them a sort of naive but fundamental question:

te ih upitala neka naivna, ali temeljna pitanja:

"If you had unlimited resources,

"Kada biste imali neograničena sredstva,

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

koja je jedna stvar koju biste dali pacijentima?"

And I heard the same story again and again,

I čula sam istu priču uvijek iznova,

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

priču koju smo čuli stotine puta od tada.

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

Rekli su: "Svaki dan imamo pacijente koji dolaze u kliniku --

child has an ear infection,

dijete ima upalu uha

I prescribe antibiotics.

i ja propišem antibiotike.

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

Ali pravi problem je da nema hrane kod kuće.

The real issue

Pravi problem je

is that child is living with 12 other people

da dijete živi s još 12 drugih ljudi

in a two-bedroom apartment.

u dvosobnom stanu.

And I don't even ask about those issues

A ja čak ni ne pitam o tim problemima

because there's nothing I can do.

jer ne mogu ništa učiniti.

I have 13 minutes with each patient.

Imam 13 minuta za svakog pacijenta.

Patients are piling up in the clinic waiting room.

Pacijenti se gomilaju u čekaonici.

I have no idea where the nearest food pantry is.

Nemam pojma gdje je najbliža banka hrane.

And I don't even have any help."

Čak nemam nikakvu pomoć. "

In that clinic, even today,

U toj klinici, čak i danas,

there are two social workers

postoje dva socijalna radnika

for 24,000 pediatric patients,

za 24.000 pedijatrijskih pacijenata,

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

što je bolja situacija nego u mnogim drugim klinikama.

So Health Leads was born of these conversations --

Dakle Health Leads je nastao iz tih razgovora --

a simple model

jednostavan model

where doctors and nurses

u kojem liječnici i medicinske sestre

can prescribe nutritious food,

svojim pacijentima mogu propisati

heat in the winter

hranu koja je hranjiva,

and other basic resources for their patients

toplinu u zimi i druge osnovna sredstva

the same way they prescribe medication.

na isti način na koji propisuju lijekove.

Patients then take their prescriptions

Pacijenti zatim donesu svoj recept

to our desk in the clinic waiting room

za naš stol u čekaonici

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

gdje je naš tim dobro obučenih studenata prava

who work side by side with these families

koji rade rame uz rame s tim obiteljima

to connect them out

povezujući ih

to the existing landscape of community resources.

s postojećom paletom sredstava zajednice.

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

Dakle počeli smo sa stolom s karticama u čekaonici klinike --

totally lemonade stand style.

u stilu štanda s limunadom.

But today we have a thousand college student advocates

No, danas imamo tisuću studenata prava

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

koji rade na povezivanju gotovo 9000 pacijenata i njihovih obitelji

with the resources that they need to be healthy.

sa sredstvima koja su im potrebna da budu zdravi.

So 18 months ago

Prije 18 mjeseci

I got this email that changed my life.

primila sam e-mail koji mi je promijenio život.

And the email was from Dr. Jack Geiger,

E-mail je bio od dr. Jacka Geigera,

who had written to congratulate me on Health Leads

koji mi je pisao da mi čestita na Health Leads-u

and to share, as he said,

te da podijeli, kako je rekao,

a bit of historical context.

malo povijesnog konteksa.

In 1965 Dr. Geiger founded

1965. godine dr. Geiger osnovao je

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

jedan od prva dva društvena zdravstvena centra u zemlji,

in a brutally poor area in the Mississippi Delta.

u strašno siromašnom području delte Mississippija.

And so many of his patients came in

Mnogi njegovi pacijenti dolazili su

presenting with malnutrition

dolazili su pothranjeni

that be began prescribing food for them.

pa smo im počeli propisivati hranu.

And they would take these prescriptions to the local supermarket,

Odnijeli bi te recepte do lokalnih trgovina,

which would fill them

koje bi ih ispunile,

and then charge the pharmacy budget of the clinic.

a zatim naplatiti troškove iz proračuna klinike za lijekove.

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

Kad je Ured za ekonomske prilike u Washingtonu –

which was funding Geiger's clinic --

koji je financirao Geigerovu kliniku –

found out about this,

saznao za to,

they were furious.

bili su bijesni.

And they sent this bureaucrat down

Poslali su birokrata da

to tell Geiger that he was expected to use their dollars

kaže Geigeru kako se od njega očekuje da njihov novac

for medical care --

koristi za medicinsku skrb --

to which Geiger famously and logically responded,

na što je Geiger slavno i logički odgovorio:

"The last time I checked my textbooks,

"Zadnji put kad sam provjeravao svoje udžbenike,

the specific therapy for malnutrition was food."

terapija za pothranjenost bila je hrana."

(Laughter)

(Smijeh)

So when I got this email from Dr. Geiger,

Kad sam dobila ovaj e-mail od dr. Geigera,

I knew I was supposed to be proud

znala sam da trebam biti ponosna

to be part of this history.

što sam dio ove povijesti.

But the truth is

No, istina je da

I was devastated.

sam bila očajna.

Here we are,

Prošlo je 45 godina

45 years after Geiger has prescribed food for his patients,

otkako je Geiger propisao hranu svojima pacijentima,

and I have doctors telling me,

a liječnici mi kažu da

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

kod takvih problema radije ništa ne pitaju.

Forty-five years after Geiger,

45 godina nakon Geigera,

Health Leads has to reinvent

Health Leads treba ponovno izumiti

the prescription for basic resources.

recepte za osnovna sredstva.

So I have spent hours upon hours

Tako sam provela sate i sate

trying to make sense of this weird Groundhog Day.

pokušavajući naći smisao ovom čudnom stanju koje nikako da završi.

How is it that if for decades

Ako smo već desetljećima

we had a pretty straightforward tool for keeping patients,

imali prilično jednostavan alat za održavanje pacijenata zdravima,

and especially low-income patients, healthy,

a posebice pacijenata s niskim primanjima,

that we didn't use it?

kako to da ga nismo koristili?

If we know what it takes to have a healthcare system

Ako znamo što je potrebno da bismo imali zdravstveni sustav,

rather than a sick-care system,

a ne bolesni sustav,

why don't we just do it?

zašto to jednostavno ne učinimo?

These questions, in my mind,

Ta pitanja, u mojoj glavi,

are not hard because the answers are complicated,

nisu teška zato što su odgovori komplicirani,

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

već su teška jer zahtijevaju da budemo iskreni sami sa sobom.

My belief is that it's almost too painful

Moje uvjerenje je da je gotovo prebolno

to articulate our aspirations for our healthcare system,

izgovoriti naše težnje za naš zdravstveni sustav,

or even admit that we have any at all.

ili čak priznati da ih uopće imamo.

Because if we did,

Jer ako bismo to i učinili,

they would be so removed

one bi bile toliko daleke

from our current reality.

od naše trenutne stvarnosti.

But that doesn't change my belief

Ali to ne mijenja moje uvjerenje

that all of us, deep inside,

da svi mi, duboko u sebi,

here in this room and across this country,

u ovoj sobi i diljem zemlje,

share a similar set of desires.

dijelimo slične želje.

That if we are honest with ourselves

Ako smo iskreni sami sa sobom

and listen quietly,

i tiho osluškujemo,

that we all harbor

svi mi imamo

one fiercely held aspiration for our healthcare:

čvrsto usidrenu nadu za našu zdravstvenu skrb,

that it keep us healthy.

a to je da nas održava zdravima.

This aspiration that our healthcare keep us healthy

Ta težnja da nas naša zdravstvena skrb održava zdravima

is an enormously powerful one.

neizmjerno je moćna.

And the way I think about this

Način na koji ja razmišljam o tome

is that healthcare is like any other system.

jest da je zdravstvena skrb kao i svaki drugi sustav.

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

To je samo niz izbora koje ljudi čine.

What if we decided

Što ako odlučimo

to make a different set of choices?

napraviti drugi niz izbora?

What if we decided to take all the parts of healthcare

Što ako smo odlučili uzeti sve dijelove zdravstvene skrbi

that have drifted away from us

koji su se udaljili od nas

and stand firm and say, "No.

te zauzmemo čvrsti stav i kažemo: "Ne.

These things are ours.

To su naše stvari.

They will be used for our purposes.

Koristit će se za naše potrebe.

They will be used to realize

Koristit će se za ostvarenje

our aspiration"?

naših težnji"?

What if everything we needed

Što ako je sve što potrebno

to realize our aspiration for healthcare

za ostvarenje naše težnje za zdravstvenu skrb

was right there in front of us

upravo ovdje ispred nas,

just waiting to be claimed?

samo čeka da se uzme?

So that's where Health Leads began.

Dakle, tu je Health Leads počeo.

We started with the prescription pad --

Počeli smo s blokom s receptima --

a very ordinary piece of paper --

vrlo običnim komadom papira --

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

i pitali smo, ne što pacijenti trebaju da bi ozdravili --

antibiotics, an inhaler, medication --

antibiotike, inhalator, lijekove --

but what do patients need to be healthy,

nego ono što pacijenti trebaju da bi bili zdravi,

to not get sick in the first place?

da se uopće ne razbole.

And we chose to use the prescription

Odlučili smo koristiti recepte

for that purpose.

u tu svrhu.

So just a few miles from here

Dakle, samo nekoliko kilometara odavde,

at Children's National Medical Center,

u Children's National Medical Center-u,

when patients come into the doctor's office,

kad pacijenti dođu kod liječnika

they're asked a few questions.

postavlja im se par pitanja.

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

Pita ih se: "Ponestaje li vam hrane krajem mjeseca?

Do you have safe housing?"

Imate li siguran smještaj?".

And when the doctor begins the visit,

I kad liječnica krene u vizitu,

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

zna visinu, težinu, ima li hrane kod kuće,

is the family living in a shelter.

živi li obitelj u prihvatilištu.

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

I to ne dovodi samo do bolje palete kliničkih izbora,

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

već liječnik može propisati ta sredstva za pacijenta,

using Health Leads like any other sub-specialty referral.

koristeći Health Leads kao bilo koju drugu pod-specijalističku uputnicu.

The problem is,

Problem je da,

once you get a taste of what it's like

nakon što okusite kako je to kad

to realize your aspiration for healthcare,

ostvarite svoju težnju za zdravstvenom skrbi,

you want more.

želite više.

So we thought,

Pa smo pomislili,

if we can get individual doctors

ako možemo nagovoriti pojedine liječnike

to prescribe these basic resources for their patients,

da propisuju ova osnovna sredstva za svoje pacijente,

could we get an entire healthcare system

možemo li postići da cijeli zdravstveni sustav

to shift its presumption?

promijeni svoje pretpostavke?

And we gave it a shot.

I pokušali smo to učiniti.

So now at Harlem Hospital Center

Tako sad u bolničkom centru u Harlemu

when patients come in with an elevated body mass index,

kad pacijenti dođu s povišenim indeksom tjelesne mase,

the electronic medical record

elektronički medicinski registar

automatically generates a prescription for Health Leads.

automatski stvara recept za Health Leads.

And our volunteers can then work with them

Naši volonteri mogu tad raditi s njima

to connect patients to healthy food and excercise programs

kako bi povezali pacijente sa zdravom hranom i programom vježbe

in their communities.

u njihovim zajednicama.

We've created a presumption

Stvorili smo pretpostavku da vam,

that if you're a patient at that hospital

ako ste pacijent u bolnici

with an elevated BMI,

s povišenim indeksom tjelesne mase,

the four walls of the doctor's office

četiri zida liječničke ordinacije

probably aren't going to give you everything

vjerojatno neće dati sve

you need to be healthy.

što vam treba da biste bili zdravi.

You need more.

Trebate više.

So on the one hand,

Dakle, s jedne strane,

this is just a basic recoding

to je samo osnovno rekodiranje

of the electronic medical record.

elektroničkog medicinskog registra.

And on the other hand,

A s druge strane,

it's a radical transformation

to je radikalna transformacija

of the electronic medical record

elektroničkog medicinskog registra

from a static repository of diagnostic information

iz statičkog spremišta dijagnostičkih informacija

to a health promotion tool.

u alat za promicanje zdravlja.

In the private sector,

U privatnom sektoru,

when you squeeze that kind of additional value

kad ugurate takvu dodatnu vrijednost

out of a fixed-cost investment,

iz ulaganja fiksne cijene,

it's called a billion-dollar company.

to se zove multimilijarderska tvrtka.

But in my world,

No, u mom svijetu,

it's called reduced obesity and diabetes.

to se zove smanjene pretilosti i dijabetesa.

It's called healthcare --

To se zove zdravstvena skrb --

a system where doctors can prescribe solutions

sustav u kojem liječnici mogu propisati rješenja

to improve health,

za poboljšanje zdravlja,

not just manage disease.

a ne samo upravljati bolestima.

Same thing in the clinic waiting room.

Ista stvar u kliničkoj čekaonici.

So every day in this country

Dakle, svaki dan u ovoj zemlji

three million patients

3 milijuna pacijenata

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

prođe kroz otprilike 150.000 čekaonica u klinikama u ovoj zemlji.

And what do they do when they're there?

A što rade kad su ondje?

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

Sjede, gledaju zlatne ribice u akvariju,

they read extremely old copies

čitaju prastare primjerke časopisa

of Good Housekeeping magazine.

o kućanskim poslovima.

But mostly we all just sit there forever, waiting.

No, uglavnom svi samo sjedimo ondje cijelu vječnost, čekajući.

How did we get here

Kako smo dospjeli ovdje

where we devote hundreds of acres and thousands of hours

gdje posvećujemo stotine hektara i

to waiting?

tisuće sati čekanju?

What if we had a waiting room

Što kad bismo imali čekaonicu

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

u kojoj ne sjediš samo kad si bolestan,

but where you go to get healthy.

već gdje ideš da bi postao zdrav?

If airports can become shopping malls

Ako zračne luke mogu postati trgovački centri,

and McDonald's can become playgrounds,

a McDonalds igralište,

surely we can reinvent the clinic waiting room.

zasigurno možemo ponovno osmisliti čekaonicu.

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

I to je ono što je Health Leads pokušao učiniti,

to reclaim that real estate and that time

vratiti tu nekretninu i to vrijeme

and to use it as a gateway

te ih iskoristiti kao prolaz

to connect patients

za povezivanje pacijenata

to the resources they need to be healthy.

sa sredstvima koja im trebaju da bi bili zdravi.

So it's a brutal winter in the Northeast,

Dakle, oštra je zima na sjeveroistoku,

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

vaše dijete ima astmu, upravo su vam isključili grijanje,

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

a vi ste naravno u čekaonici Hitne,

because the cold air triggered your child's asthma.

jer je hladan zrak pokrenuo astmu vašeg djeteta.

But what if instead of waiting for hours anxiously,

No što ako umjesto zabrinutog višesatnog čekanja

the waiting room became the place

čekaonica postane mjesto

where Health Leads turned your heat back on?

gdje Health Leads ponovno uključi vaše grijanje?

And of course all of this requires

Naravno, sve to zahtijeva

a broader workforce.

više radne snage.

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

No, ako smo kreativni, to već imamo.

We know that our doctors and nurses

Znamo da naši liječnici, medicinske sestre

and even social workers

pa čak i socijalni radnici,

aren't enough,

nisu dovoljni,

that the ticking minutes of health care

da vrijeme zdravstvene skrbi koje istječe

are too constraining.

previša ograničava.

Health just takes more time.

Za zdravlje jednostavno treba više vremena.

It requires a non-clinical army

Ono zahtijeva nekliničku vojsku

of community health workers and case managers

zdravstvenih radnika iz zajednice i menadžera slučaja

and many others.

te mnoge druge.

What if a small part of that next healthcare workforce

Što kad bi mali dio te buduće zdravstvene radne snage

were the 11 million college students in this country?

bilo 11 milijuna studenata ove zemlje?

Unencumbered by clinical responsibilities,

Neopterećeni kliničkom odgovornošću,

unwilling to take no for an answer

nespremni prihvatiti "ne" kao odogovor

from those bureaucracies

od tih birokrata

that tend to crush patients,

koji pokušavaju slomiti pacijente

and with an unparalleled ability

te s neusporedivom sposobnošću

for information retrieval

pronalaženja informacija,

honed through years of using Google.

izbrušenom višegodišnjom upotrebom Googlea.

Now lest you think it improbable

Ako mislite da je nevjerojatno

that a college volunteer

da se student volonter

can make this kind of commitment,

može tako obvezati,

I have two words for you:

imam dvije riječi za vas:

March Madness.

March Madness (košarkaški turnir).

The average NCAA Division I men's basketball player

Prosječni NCAA Division 1 igrač košarke

dedicates 39 hours a week to his sport.

posvećuje 39 sati tjedno svome sportu.

Now we may think that's good or bad,

Možemo misliti da je to dobro ili loše,

but in either case it's real.

no u svakom slučaju je istinito.

And Health Leads is based on the presumption

I Health Leads temelji se na pretpostavci

that for too long

da smo predugo

we have asked too little of our college students

premalo tražili od svojih studenata

when it comes to real impact in vulnerable communities.

kad se radi o pravom utjecaju na ugrožene zajednicame.

College sports teams say,

Sveučilišni sportski klubovi kažu:

"We're going to take dozens of hours

"Mi ćemo uzeti desetke sati

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

na nekom području blizu kampusa u nekom ranom jutarnjem satu

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

te ćemo mjeriti tvoju izvedbu i izvedbu tvoga tima,

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

a ako nisi dovoljno dobar ili ako se ne pojaviš,

we're going to cut you off the team.

ispast ćeš iz tima.

But we'll make huge investments

Ali mnogo ćemo uložiti u

in your training and development,

tvoj trening i razvoj

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

te ćemo ti dati izvanrednu zajednicu vršnjaka."

And people line up out the door

I ljudi se poredaju pred vrata

just for the chance to be part of it.

samo da bi imali mogućnost biti dio toga.

So our feeling is,

Mi mislimo da

if it's good enough for the rugby team,

ako je to dovoljno dobro za ragbi momčad,

it's good enough for health and poverty.

dovoljno je dobro i za zdravlje i siromaštvo.

Health Leads too recruits competitively,

Health Leads također novači u natjecateljskom duhu,

trains intensively,

intenzivno trenira,

coaches professionally,

profesionalno podučava,

demands significant time,

zahtijeva značajno vrijeme,

builds a cohesive team

izgrađuje kohezivni tim

and measures results --

te mjeri rezultate –

a kind of Teach for America for healthcare.

nalik na Teach for America za zdravstvo.

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

Sad u top 10 gradova u SAD-u

with the largest number of Medicaid patients,

s najvećim brojem pacijenata zdravstvene pomoći,

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

svaki ima barem 20.000 studenata.

New York alone has half a million college students.

Samo u New Yorku je pola milijuna studenata.

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

Ovo nije samo neka vrsta kratkoročne radne snage

to connect patients to basic resources,

za spajanje pacijenata s osnovnim sredstvima,

it's a next generation healthcare leadership pipeline

to je nova generacija mreže zdravstvenog vodstva

who've spent two, three, four years

koja je provela dvije, tri ili četiri godine

in the clinic waiting room

u čekaonicama

talking to patients about their most basic health needs.

razgovarajući s pacijentima o njihovim osnovnim zdravstvenim potrebama.

And they leave with the conviction,

Oni odlaze sa svojim uvjerenjem,

the ability and the efficacy

sposobnostima i efikasnošću

to realize our most basic aspirations for health care.

da shvate naše najosnovnije potrebe zdravstvene skrbi.

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

Najbolja stvar je što je postoji na tisuće takvih ljudi.

So Mia Lozada is Chief Resident of Internal Medicine

Mia Lozada glavni je specijalizant interne medicine

at UCSF Medical Center,

na UCSF Medical Center-u,

but for three years as an undergraduate

ali tri godine preddiplomskog studija

she was a Health Leads volunteer

bila je volonter Health Leads-a

in the clinic waiting room at Boston Medical Center.

u čekaonici Boston Medical Center-a.

Mia says, "When my classmates write a prescription,

Mia kaže: "Kad moje kolege napišu recept,

they think their work is done.

misle da je njihov posao gotov.

When I write a prescription,

Kad ja napišen recept za lijek,

I think, can the family read the prescription?

uvijek pomislim: zna li obitelj pročitati recept?

Do they have transportation to the pharmacy?

Imaju li prijevoz do ljekarne?

Do they have food to take with the prescription?

Imaju li hranu koju trebaju pojesti uz propisani lijek?

Do they have insurance to fill the prescription?

Imaju li osiguranje koje će pokriti troškove propisanog lijeka?

Those are the questions I learned at Health Leads,

To su pitanja koja sam naučila u Health Leads-u,

not in medical school."

a ne na fakultetu."

Now none of these solutions --

Nijedno od ovih rješenja –

the prescription pad, the electronic medical record,

blok s receptima, elektronički medicinski registar,

the waiting room,

čekaonica,

the army of college students --

vojska studenata --

are perfect.

nije savršeno.

But they are ours for the taking --

No, oni su nam na raspolaganju –

simple examples

jednostavni primjeri

of the vast under-utilized healthcare resources

ogromne neiskorištenosti zdravstvenih sredstava

that, if we reclaimed and redeployed,

koji bi, ako ih vratimo i razmjestimo,

could realize our most basic aspiration

mogli ostvariti naše osnovne težnje

of healthcare.

za zdravstvenom skrbi.

So I had been at Legal Services for about nine months

Bila sam u pravnoj službi otprilike devet mjeseci

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

kad mi se ova ideja o Health Leads-u počela motati po glavi.

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

Znala sam da moram reći Jeffu Purcellu, svom odvjetniku,

that I needed to leave.

da moram otići.

And I was so nervous,

Bila sam tako nervozna,

because I thought he was going to be disappointed in me

zato što sam mislila da će biti razočaran mnome

for abandoning our clients for some crazy idea.

jer napuštam naše klijente zbog neke lude ideje.

And I sat down with him and I said,

Sjela sam s njim i rekla:

"Jeff, I have this idea

"Jeff, imam tu ideju

that we could mobilize college students

da bismo mogli pokrenuti studente

to address patients' most basic health needs."

da rješavaju najosnovnije zdravstvene potrebe pacijenata."

And I'll be honest,

Bit ću iskrena,

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

samo sam htjela da se ne ljuti na mene.

But he said this,

Ali rekao je ovo:

"Rebecca, when you have a vision,

"Rebecca, kad imaš viziju,

you have an obligation to realize that vision.

imaš obvezu ostvariti je.

You must pursue that vision."

Moraš slijediti tu viziju."

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

I moram reći, pomislila sam: "Hej.

That's a lot of pressure."

To je veliki pritisak."

I just wanted a blessing,

Samo sam htjela blagoslov,

I didn't want some kind of mandate.

a ne nekakvu obavezu.

But the truth is

No, istina je

I've spent every waking minute nearly since then

da sam od tad gotovo neprestano

chasing that vision.

jurila tu viziju.

I believe that we all have a vision

Vjerujem da svi imamo viziju

for healthcare in this country.

zdravstva u ovoj zemlji.

I believe that at the end of the day

Vjerujem da na kraju dana,

when we measure our healthcare,

kad mjerimo našu zdravstvenu skrb,

it will not be by the diseases cured,

to neće biti po izliječenim bolestima,

but by the diseases prevented.

već po spriječenim bolestima.

It will not be by the excellence of our technologies

To neće biti po izvrsnosti naših tehnologija

or the sophistication of our specialists,

ili profinjenosti naših specijalista,

but by how rarely we needed them.

već po tome koliko rijetko smo ih trebali.

And most of all,

I najvažnije od svega,

I believe that when we measure healthcare,

vjerujem da kad mjerimo zdravstvenu skrb,

it will be, not by what the system was,

da će to biti, ne po tome što je sistem bio,

but by what we chose it to be.

već po onome što smo mi izabrali da bude.

Thank you.

Hvala.

(Applause)

(Pljesak)

Thank you.

Hvala Vam.

(Applause)

(Pljesak)