Mental Health for All by Involving All | Vikram Patel | TED Talks

Translator: Joseph Geni Reviewer: Morton Bast

Prevoditelj: Senzos Osijek Recezent: Tilen Pigac - EFZG

I want you to imagine this for a moment.

Želim da zamislite ovo na trenutak.

Two men, Rahul and Rajiv,

Dvojica muškaraca, Rahul i Rajiv,

living in the same neighborhood,

žive u istom susjedstvu,

from the same educational background, similar occupation,

imaju istu obrazovnu pozadinu, slično zanimanje,

and they both turn up at their local accident emergency

i obojica se pojave u svojoj lokalnoj hitnoj

complaining of acute chest pain.

žaleći se na akutnu bol u prsima.

Rahul is offered a cardiac procedure,

Rahulu je ponuđena srčana procedura,

but Rajiv is sent home.

ali Rajiva pošalju doma.

What might explain the difference in the experience

Što bi moglo objasniti razliku u iskustvu

of these two nearly identical men?

ove dvojice skoro identičnih ljudi?

Rajiv suffers from a mental illness.

Rajiv pati od duševne bolesti.

The difference in the quality of medical care

Razlika u kvaliteti medicinske njege

received by people with mental illness is one of the reasons

koju primaju ljudi s mentalnim bolestima je jedan od razloga

why they live shorter lives

zašto žive kraće

than people without mental illness.

nego ljudi koji ne pate od duševnih bolesti.

Even in the best-resourced countries in the world,

Čak i u najbogatijim državama u svijetu,

this life expectancy gap is as much as 20 years.

razlika u životnom vijeku je 20 godina.

In the developing countries of the world, this gap

U državama koje se razvijaju, ova razlika

is even larger.

je još veća.

But of course, mental illnesses can kill in more direct ways

Naravno, duševne bolesti mogu usto ubiti na mnogo direktnije načine.

as well. The most obvious example is suicide.

Najočitiji primjer je samoubojstvo.

It might surprise some of you here, as it did me,

Možda može neke od vas ovdje iznenaditi, kao što je i mene,

when I discovered that suicide is at the top of the list

kad sam otkrio da je samoubojstvo na vrhu liste

of the leading causes of death in young people

vodećih uzroka smrti kod mladih ljudi

in all countries in the world,

u svim državama svijeta,

including the poorest countries of the world.

uključujući i najsiromašnije države.

But beyond the impact of a health condition

Ali više od učinka zdravstvenog stanja

on life expectancy, we're also concerned

na životni vijek, također smo zabrinuti

about the quality of life lived.

za kvalitetu proživljenog života.

Now, in order for us to examine the overall impact

Sad, kako bismo mogli istražiti sve učinke

of a health condition both on life expectancy

zdravstvenog stanja na životni vijek

as well as on the quality of life lived, we need to use

kao i na kvalitetu proživljenog života, moramo uzeti

a metric called the DALY,

mjeru nazvanu DALY,

which stands for a Disability-Adjusted Life Year.

koja znači godinu života prilagođenu invalidnošću (Disability-Adjusted Life Year).

Now when we do that, we discover some startling things

Kad učinimo to, otkrivamo neke uznemiravajuće stvari

about mental illness from a global perspective.

o duševnoj bolesti iz globalne perspektive.

We discover that, for example, mental illnesses are

Otkrivamo da su, na primjer, duševne bolesti

amongst the leading causes of disability around the world.

među vodećim uzrocima invalidnosti u svijetu.

Depression, for example, is the third-leading cause

Depresija, na primjer, je treći vodeći uzrok

of disability, alongside conditions such as

invalidnosti, uz stanja poput

diarrhea and pneumonia in children.

dijareje i upale pluća u djece.

When you put all the mental illnesses together,

Kad stavite sve mentalne bolesti zajedno,

they account for roughly 15 percent

one uključuju otprilike za 15%

of the total global burden of disease.

ukupnog tereta bolesti.

Indeed, mental illnesses are also very damaging

Doista, mentalne bolesti su također vrlo štetne

to people's lives, but beyond just the burden of disease,

za ljudske živote, ali osim samog tereta bolesti,

let us consider the absolute numbers.

razmotrimo apsolutne brojeve.

The World Health Organization estimates

Svjetska zdravstvena organizacija procjenjuje

that there are nearly four to five hundred million people

da 400 do 500 milijuna ljudi

living on our tiny planet

koji žive na našem sitnom planetu

who are affected by a mental illness.

pate od duševne bolesti.

Now some of you here

Neki od vas ovdje

look a bit astonished by that number,

izgledaju iznenađeno tim brojem,

but consider for a moment the incredible diversity

ali razmotrite na trenutak nevjerojatnu razliku

of mental illnesses, from autism and intellectual disability

duševnih bolesti, od autizma i intelektualnih invalidnosti

in childhood, through to depression and anxiety,

u djetinjstvu, kroz depresiju i tjeskobu,

substance misuse and psychosis in adulthood,

zloporabu supstanci i prihoze kod odraslih,

all the way through to dementia in old age,

sve do demencije u starijim godinama

and I'm pretty sure that each and every one us

i siguran sam da svatko od nas

present here today can think of at least one person,

ovdje danas može se sjetiti bar jedne osobe,

at least one person, who's affected by mental illness

bar jedne osobe, koja pati od mentalne bolesti

in our most intimate social networks.

u našim najintimnijim društvenim mrežama.

I see some nodding heads there.

Vidim neke koji kimaju glavama tamo.

But beyond the staggering numbers,

Ali osim zapanjujućih brojeva,

what's truly important from a global health point of view,

što je uistinu bitno iz globalnog zdravstvenog pogleda,

what's truly worrying from a global health point of view,

što je uistinu zabrinjavajuće iz globalnog zdravstvenog pogleda

is that the vast majority of these affected individuals

je to što velika većina tih pojedinaca koji pate

do not receive the care

ne dobije njegu

that we know can transform their lives, and remember,

za koju znamo da može promijeniti njihove živote, i zapamtite,

we do have robust evidence that a range of interventions,

imamo snažne dokaze da mnoge intervencije,

medicines, psychological interventions,

lijekovi, psihološke intervencije

and social interventions, can make a vast difference.

i društvene intervencije mogu napraviti veliku razliku.

And yet, even in the best-resourced countries,

A ipak, čak i u najbogatijim državama,

for example here in Europe, roughly 50 percent

na primjer ovdje u Europi, otprilike 50%

of affected people don't receive these interventions.

ljudi koji pate, ne pruži im se takva intervencija.

In the sorts of countries I work in,

U državama u kojima radim,

that so-called treatment gap

ta takozvana razlika u tretmanu

approaches an astonishing 90 percent.

približava se zapanjujućih 90%.

It isn't surprising, then, that if you should speak

Nije iznenađujuće onda da ako pričate

to anyone affected by a mental illness,

s nekim tko pati od duševne bolesti,

the chances are that you will hear stories

šanse da ćete čuti priče

of hidden suffering, shame and discrimination

o skrivenoj patnji, sramu i diskriminaciji

in nearly every sector of their lives.

u skoro svakom dijelu njihovog života.

But perhaps most heartbreaking of all

Ali možda najsrceparajuće od svih

are the stories of the abuse

su priče o zloporabi

of even the most basic human rights,

čak i najosnovnijih ljudskih prava,

such as the young woman shown in this image here

poput mlade žene prikazane na ovoj slici

that are played out every day,

koje se događaju svaki dan,

sadly, even in the very institutions that were built to care

nažalost, čak i u samim institucijama koje su sagrađene za njegu

for people with mental illnesses, the mental hospitals.

za ljude s duševnim bolestima, u bolnicama za duševno bolesne.

It's this injustice that has really driven my mission

Ta nepravda je ono što je zapravo vodilo moju misiju

to try to do a little bit to transform the lives

da pokušam učiniti nešto da promijenim živote

of people affected by mental illness, and a particularly

ljudi koji pate od duševnih bolesti i posebno

critical action that I focused on is to bridge the gulf

kritična akcija na koju sam se usredotočio je premostiti jaz

between the knowledge we have that can transform lives,

između znanja koje imamo koje može promijeniti živote,

the knowledge of effective treatments, and how we actually

znanja učinkovitog tretmana i kako zapravo

use that knowledge in the everyday world.

koristimo to znanje u svakodnevnom svijetu.

And an especially important challenge that I've had to face

I jako bitan izazov s kojim sam se morao suočiti

is the great shortage of mental health professionals,

je veliki nedostatak profesionalaca koji se bave duševnim bolestima,

such as psychiatrists and psychologists,

poput psihijatara i psihologa,

particularly in the developing world.

pogotovo u svijetu koji se razvija.

Now I trained in medicine in India, and after that

Obučen sam za medicinu u Indiji i nakon toga

I chose psychiatry as my specialty, much to the dismay

sam odabrao psihijatriju kao svoju specijalizaciju, na zaprepaštenje

of my mother and all my family members who

moje majke i svih svojih članova obitelji koji su

kind of thought neurosurgery would be

nekako mislili da bi neurokirurgija bio

a more respectable option for their brilliant son.

puno ugledniji izbor za njihovog briljantnog sina.

Any case, I went on, I soldiered on with psychiatry,

U svakom slučaju, nastavio sam, borio sam se s psihijatrijom

and found myself training in Britain in some of

i našao se trenirajući u Britaniji u nekima od

the best hospitals in this country. I was very privileged.

najboljih bolnica u ovoj državi. Bio sam vrlo privilegiran.

I worked in a team of incredibly talented, compassionate,

Radio sam u timu nevjerojatno talentiranih, suosjećajnih,

but most importantly, highly trained, specialized

ali najvažnije, vrhunski obučenih, specijaliziranih

mental health professionals.

profesionalaca za duševne bolesti.

Soon after my training, I found myself working

Ubrzo nakon moje obuke, našao sam se radeći

first in Zimbabwe and then in India, and I was confronted

prvo u Zimbabveu i onda u Indiji te sam se suočio

by an altogether new reality.

s potpuno novom stvanošću.

This was a reality of a world in which there were almost no

To je bila stvarnost svijeta u kojem nije bilo skoro uopće

mental health professionals at all.

profesionalaca za duševne bolesti.

In Zimbabwe, for example, there were just about

U Zimbabveu, na primjer, bilo je otprilike

a dozen psychiatrists, most of whom lived and worked

12 psihijatara, od kojih je većina živjela i radila

in Harare city, leaving only a couple

u gradu Harare, ostavljajući samo par njih

to address the mental health care needs

da se bave potrebama njege duševnog zdravlja

of nine million people living in the countryside.

9 milijuna ljudi koji žive na selu.

In India, I found the situation was not a lot better.

U Indiji sam saznao da situacija nije puno bolja.

To give you a perspective, if I had to translate

Kako bih vam dao perspektivu, kad bih trebao prevesti

the proportion of psychiatrists in the population

proporcije psihijarata u populaciji

that one might see in Britain to India,

koju možete vidjeti u Britaniji na Indiju,

one might expect roughly 150,000 psychiatrists in India.

netko bi očekivao otprilike 150.000 psihijatara u Indiji.

In reality, take a guess.

U stvarnosti, pogađajte.

The actual number is about 3,000,

Stvaran broj je oko 3.000,

about two percent of that number.

oko 2% tog broja.

It became quickly apparent to me that I couldn't follow

Postalo mi je ubrzo jasno da neću moći pratiti

the sorts of mental health care models that I had been trained in,

vrstu modela duševne zdravstvene njege u kojoj sam obučen,

one that relied heavily on specialized, expensive

koja se jako oslanjala na specijalizirane, skupe

mental health professionals to provide mental health care

profesionalce za duševno zdravlje koji bi pružali njegu duševno bolesnima

in countries like India and Zimbabwe.

u državama poput Indije ili Zimbabvea.

I had to think out of the box about some other model

Morao sam razmišljati van kutije o nekom drugom modelu

of care.

njege.

It was then that I came across these books,

Tad sam naletio na ove knjige

and in these books I discovered the idea of task shifting

i u tim knjigama otkrio ideju izmjenjivanja zadataka

in global health.

u globalnom zdravstvu.

The idea is actually quite simple. The idea is,

Ideja je zapravo vrlo jednostavna. Ideja je,

when you're short of specialized health care professionals,

kad imate manjak specijaliziranih profesionalaca za zdravlje,

use whoever is available in the community,

koristite bilo kog tko je slobodan u zajednici,

train them to provide a range of health care interventions,

obučite ga da pruža raznolike zdravstvene intervencije,

and in these books I read inspiring examples,

i u ovim knjigama sam pročitao inspirirajuće primjere,

for example of how ordinary people had been trained

na primjer kako obični ljudi koji su obučeni

to deliver babies,

porađati djecu,

diagnose and treat early pneumonia, to great effect.

dijagnosticirati i liječiti ranu upalu pluća, uz velik učinak.

And it struck me that if you could train ordinary people

I shvatio sam da ako možete obučiti obične ljude

to deliver such complex health care interventions,

da pružaju tako složene zdravstvene intervencije,

then perhaps they could also do the same

onda bi možda mogli također napraviti isto

with mental health care.

s njegom za duševne bolesti.

Well today, I'm very pleased to report to you

Danas mi je veliko zadovoljstvo izvijestiti vas

that there have been many experiments in task shifting

da su bili mnogi eksperimenti u izmijeni zadataka

in mental health care across the developing world

u njezi za duševno bolesne u zemljama u razvoju

over the past decade, and I want to share with you

u zadnjem desetljeću i želim podijeliti s vama

the findings of three particular such experiments,

nalaze tri određena takva eksperimenta,

all three of which focused on depression,

sva tri su se usredotočila na depresiju,

the most common of all mental illnesses.

najčešću od svih duševnih bolesti.

In rural Uganda, Paul Bolton and his colleagues,

U ruralnoj Ugandi, Paul Bolton i njegovi kolege

using villagers, demonstrated that they could deliver

koristeći stanovnike sela, demonstrirali su da mogu pružati

interpersonal psychotherapy for depression

međusobnu psihoterapiju za depresiju

and, using a randomized control design,

i koristeći dizajn nasumične kontrole,

showed that 90 percent of the people receiving

pokazali da 90% ljudi koji su primili

this intervention recovered as compared

takve intervencije su se oporavili uspoređeno

to roughly 40 percent in the comparison villages.

s otprilike 40% u sličnim selima.

Similarly, using a randomized control trial in rural Pakistan,

Slično, koristeći ispitivanje nasumične kontrole u ruralnom Pakistanu,

Atif Rahman and his colleagues showed

Atif Rahman i njegovi kolege pokazali su

that lady health visitors, who are community maternal

da žene koje povremeno pomažu u zdravstvenom radu, koje su društvene zdravstvene radnice za majke

health workers in Pakistan's health care system,

u pakistanskom zdravstvenom sustavu,

could deliver cognitive behavior therapy for mothers

mogu pružiti terapiju za kognitivno ponašanje za majke

who were depressed, again showing dramatic differences

koje su bile depresivne, opet pokazujući dramatičnu razliku

in the recovery rates. Roughly 75 percent of mothers

u brzini oporavka. Otprilike 75% majki

recovered as compared to about 45 percent

se oporavilo uspoređujući s 45%

in the comparison villages.

u sličnim selima.

And in my own trial in Goa, in India, we again showed

. I u mom vlastitom testiranju u Goi, u Indiji, opet smo pokazali

that lay counselors drawn from local communities

da savjetnici laici uzeti iz lokalnih zajednica

could be trained to deliver psychosocial interventions

mogu biti obučeni da pruže psihološku intervenciju

for depression, anxiety, leading to 70 percent

za depresiju, tjeskobu, dovodeći do 70%

recovery rates as compared to 50 percent

većih razina oporavka uspoređujući s 50%

in the comparison primary health centers.

u sličnim primanim zdravstvenim centrima.

Now, if I had to draw together all these different

Kad bih trebao prikazati sve ove različite

experiments in task shifting, and there have of course

eksperimente u izmjeni zadataka, a naravno

been many other examples, and try and identify

da je bilo još mnogo takvih primjera, i pokušao identificirati

what are the key lessons we can learn that makes

koje su ključne lekcije koje možemo naučiti da mogu dovesti

for a successful task shifting operation,

do uspješnog pogona izmjene zadataka,

I have coined this particular acronym, SUNDAR.

skovao sam poseban akronim, SUNDAR.

What SUNDAR stands for, in Hindi, is "attractive."

Što SUNDAR predstavlja, u hindiju, je "privlačan".

It seems to me that there are five key lessons

Čini mi se da postoji 5 ključnih lekcija

that I've shown on this slide that are critically important

koje sam prikazao na ovom slajdu koji su kritično bitni

for effective task shifting.

za učinkovito izmjenjivanje zadataka.

The first is that we need to simplify the message

Prva je da moramo pojednostaviti poruku

that we're using, stripping away all the jargon

koju koristimo, skidajući sav žargon

that medicine has invented around itself.

koji je medicina izmislila oko sebe.

We need to unpack complex health care interventions

Trebamo otpakirati složene zdravstvene intervencije

into smaller components that can be more easily

u manje dijelove koji se mogu mnogo lakše

transferred to less-trained individuals.

prenijeti manje obučenim pojedincima.

We need to deliver health care, not in large institutions,

Moramo pružati zdravstvenu njegu, ne u velikim institucijama,

but close to people's homes, and we need to deliver

već blizu domova, a moramo i pružiti

health care using whoever is available and affordable

zdravstvenu njegu koristeći bilo kog tko je dostupan i kog se može priuštiti

in our local communities.

u našoj lokalnoj zajednici.

And importantly, we need to reallocate the few specialists

I najbitnije, moramo preraspodijeliti tih par specijalista

who are available to perform roles

koji su dostupni da izvrše uloge

such as capacity-building and supervision.

poput povećanja kapaciteta i nadgledanja.

Now for me, task shifting is an idea

Za mene, izmjena zadataka je ideja

with truly global significance,

s istinskim globalnim značenjem

because even though it has arisen out of the

jer iako se izrodilo iz

situation of the lack of resources that you find

manjka resursa koje možete naći

in developing countries, I think it has a lot of significance

u razvojnim državama, mislim da ima jako puno značaja

for better-resourced countries as well. Why is that?

i za bogatije države. Zašto je tako?

Well, in part, because health care in the developed world,

Pa, dijelom, jer zdravstvena njega u razvijenom svijetu,

the health care costs in the [developed] world,

troškovi zdravstvene njege u [razvijenom] svijetu,

are rapidly spiraling out of control, and a huge chunk

polako izmiču kontroli, i velik dio

of those costs are human resource costs.

tih troškova su troškovi ljudskih resursa.

But equally important is because health care has become

Ali jednako bitno je zato što je zdravstvena njega postala

so incredibly professionalized that it's become very remote

tako nevjerojatno profesionalizirana da je postala jako udaljena

and removed from local communities.

i pomaknuta iz lokalnih zajednica.

For me, what's truly sundar about the idea of task shifting,

Za mene, što je zbilja sundar kod ove ideje izmjene zadataka,

though, isn't that it simply makes health care

ipak, nije to što jednostavno čini zdravstvenu njegu

more accessible and affordable but that

pristupačnom i povoljnom već

it is also fundamentally empowering.

što temeljno ojačava.

It empowers ordinary people to be more effective

Ojačava obične ljude da budu učinkovitiji

in caring for the health of others in their community,

u brizi za zdravlje drugih u svojoj zajednici,

and in doing so, to become better guardians

i radeći to, postanu bolji čuvari

of their own health. Indeed, for me, task shifting

svog vlastitog zdravlja. Doista, za mene, izmjena zadataka

is the ultimate example of the democratization

je krajnji primjer demokratizacije

of medical knowledge, and therefore, medical power.

medicinskog znanja, i time, medicinske moći.

Just over 30 years ago, the nations of the world assembled

Prije samo 30 godina, narodi svijeta su se okupili

at Alma-Ata and made this iconic declaration.

u Alma-Ati i stvorili ovu ikoničnu deklaraciju.

Well, I think all of you can guess

Ali, mislim da svi vi možete nagađati

that 12 years on, we're still nowhere near that goal.

da 12 godina što smo uključeni, nismo nigdje blizu tog cilja.

Still, today, armed with that knowledge

I dalje, danas, naoružani tim znanjem

that ordinary people in the community

da obični ljudi u zajednici

can be trained and, with sufficient supervision and support,

mogu biti obučeni i, s dovoljno nadgledanja i potpore,

can deliver a range of health care interventions effectively,

mogu pružiti velik broj zdravstvenih intervencija učinkovito,

perhaps that promise is within reach now.

možda je to obećanje u dosegu.

Indeed, to implement the slogan of Health for All,

Doista, kako bismo implementirali slogan Zdravlje za Sve,

we will need to involve all

morat ćemo uključiti sve

in that particular journey,

u tom putovanju,

and in the case of mental health, in particular we would

i u slučaju duševnog zdravlja, posebno

need to involve people who are affected by mental illness

bismo morali uključiti ljude koji pate od duševnih bolesti

and their caregivers.

i njihove skrbnike.

It is for this reason that, some years ago,

Zbog tog razloga, prije par godina,

the Movement for Global Mental Health was founded

Pokret za Globalno Duševno Zdravlje je osnovan

as a sort of a virtual platform upon which professionals

kao vrsta virtualne platforme na kojoj bi profesionalci

like myself and people affected by mental illness

poput mene i ljudi koji pate od duševnih bolesti

could stand together, shoulder-to-shoulder,

mogli stajati zajedno, rame uz rame,

and advocate for the rights of people with mental illness

i zagovarati prava ljudi s duševnim bolestima

to receive the care that we know can transform their lives,

da prime njegu koju znamo da može promijeniti njihove živote,

and to live a life with dignity.

i da žive život dostojanstveno.

And in closing, when you have a moment of peace or quiet

I za kraj, kad imate trenutak mira ili tišine

in these very busy few days or perhaps afterwards,

ovih vrlo zaposlenih par dana ili možda kasnije,

spare a thought for that person you thought about

izdvojite misao za onu osobu na koju ste mislili

who has a mental illness, or persons that you thought about

koja ima duševnu bolest ili osobe na koje ste mislili

who have mental illness,

koje imaju duševnu bolest,

and dare to care for them. Thank you. (Applause)

i usudite se brinuti za njih. Hvala vam.

(Applause)

(Pljesak)