Ernest Madu: Bringing world-class health care to the poorest

Traducător: Ana Maria Jurca Corector: Daniel Stanoescu

It is interesting that in the United States,

Este interesant ca in Statele Unite,

the most significant health-care budget

cel mai semnificativ buget pentru asistenta medicala

goes to cardiovascular disease care, whether it's private or public.

se acorda in cazul bolilor cardiovasculare, indiferent de sectorul privat sau cel public.

There's no comparison at all.

Nici nu se poate compara.

In Africa -- where it is a major killer -- it is totally ignored.

In Africa, unde produc enorm de multe decese, sunt ignorate in totalitate.

And that situation cannot be right. We must do something about it.

Aceasta situatie nu poate fi corecta. Trebuie sa facem ceva in privinta asta.

A health status of a nation parallels development of that nation.

Starea sanatatii unei natiuni reflecta nivelul de dezvoltare al acesteia.

17 million people die every year from heart disease.

17 milioane de oameni mor anual din cauza afectiunilor cardiace.

32 million heart attacks and strokes occur.

Se inregistreaza 32 milioane de cazuri de infarct si accidente vasculare.

Most of this is in developing countries, and the majority is in Africa.

Toate au loc in tarile in dezvoltare, majoritatea in Africa.

85 percent of global disease burden for cardiovascular disease

85% din cazurile raportate la nivel mondial de boli cardiovasculare

is in developing countries -- not in the West --

sunt raportate in tarile in dezvoltare, nu in cele vestice,

and yet 90 percent of the resources are in the West.

si totusi 90% din resursele alocate pentru aceasta sunt in tarile vestice.

Who is at risk? People like you.

Cine se afla in risc? Oamenii ca voi.

It's not just the Africans that should be concerned about that.

Nu doar africanii trebuie sa fie preocupati de asta.

All friends of Africa, that will have reason to be in Africa at some point in time,

Orice prieten al Africii, care ar avea un motiv sa se afle in Africa la un moment dat,

should be very concerned about this deplorable situation.

ar trebui sa se gandeasca bine la aceasta situatie deplorabila.

Has anyone here wondered what will happen

Si-a pus cineva intrebarea ce se va intampla

if you go back to your room at night,

daca te intorci in camera ta noaptea

and you start getting chest pains, shortness of breath, sweating?

si incepi sa acuzi dureri de piept, respiratie greoaie, transpiratii?

You're having a heart attack. What are you going to do?

Inseamna ca faci infarct. Ce optiuni ai?

Will you fly back to the U.S., Germany, Europe?

Sa zbori inapoi in SUA, Germania, Europa?

No, you will die. 50 percent will die within 24 hours, if not treated.

Nu, vei muri. 50% din persoane mor in 24 de ore daca nu primesc ingrijiri.

This is what's going on.

Asta se intampla.

In a look at the map of the U.S. -- the graph here,

Sa privim harta Statelor Unite -- din graficul acesta

10 million people here, 10 million here.

10 milioane de oameni aici, 10 milioane dincoace.

By the time you get to 50, it's almost no one left in Nigeria --

Cand ajungi la varsta de 50 de ani, nu mai ramane aproape nimeni in Nigeria --

life expectancy is 47.

speranta de viata e de 47 de ani.

It's not because some people don't survive childhood illnesses --

Si nu e fiindca unele persoane nu supravietuiesc unor boli din copilarie --

they do -- but they do not survive after the time that they reach

ei supravietuiesc - insa nu supravietuiesc

about 45 years old and 50 years old.

dupa ce ajung la varsta de 45 sau 50 de ani.

And those are the times they're most productive.

Si asta e varsta la care oamenii sunt cei mai productivi.

Those are the times that they should be contributing

E varsta cand ar trebui sa contribuie

to Africa's development. But they're not there.

la dezvoltarea Africii. Dar ei lipsesc.

The best way to spiral into a cycle of poverty is to kill the parents.

Cea mai buna metoda de a cadea intr-un ciclu al saraciei e sa ucizi categoria parintilor.

If you cannot secure the parents,

Daca parintii nu sunt salvati

you cannot guarantee the security of the African child.

nu poti garanta securitatea copilului african.

What are the risk factors?

Care sunt factorii de risc?

It's very well known. I'm not going to spend a lot of time on those.

Se stie foarte bine. Nu o sa intru in detalii asupra acestora.

These are just for information:

Sunt doar pentru informarea voastra:

hypertension, diabetes, obesity, lack of exercise. The usual suspects.

hipertensiunea, diabetul, obezitatea, lipsa de exercitiu. Suspiciunile obisnuite.

Right here in Tanzania, 30 percent of individuals have hypertension.

Chiar aici in Tanzania, 30% din populatie are hipertensiune.

20 percent are getting treated.

20% primesc ingrijiri medicale.

Only less than one percent are adequately treated.

Insa mai putin de 1% sunt tratati cum trebuie.

If we can treat hypertension alone in Africa,

Daca am putea trata numai hipertensiunea in Africa,

we'll save 250,000 lives a year. That's quite significant!

deja am salva 250.000 de vieti pe an. Un numar semnificativ!

Easy to treat. Look at the situation in Mauritius.

E usor de tratat. Priviti situatia din Mauritiu.

In eight short years -- we're here talking about HIV, malaria,

Doar in 8 ani -- vorbim de HIV, malarie

which is all good.

lucururi ok.

We cannot make the mistakes we've made with malaria and HIV.

Nu putem face aceleasi greseli ca si in cazul malariei si al HIV-ului.

In eight short years, non-communicable diseases

Doar in 8 ani, bolile netransmisibile

will become the leading causes of death in Africa.

vor deveni principala cauza a mortalitatii in Africa.

That is something to keep in mind. We can't deal with it with situations like this.

Sa tinem minte asta. Nu putem face fata unor situatii de acest gen.

This is a typical African hospital. We can't depend on the elites --

Acesta este un spital african obisnuit. Nu putem depinde de elitele -

they go to USA, Germany, U.K. for treatment. Unbelievable.

care au plecat in State, Germania, Marea Britanie pentru a fi tratati. Incredibil.

You can't depend on foreign aid alone.

Nu te poti baza doar pe ajutorul altor tari.

Here is the situation: countries are turning inwards.

Asta este situatia actuala: ficare tara isi vede de problemele ei interne.

Post-9/11, [the] United States has had a lot of trouble

Dupa 9/11, Statele Unite au avut dificultati mari

to deal with, their own internal issues.

in a se ocupa de problemele lor interne.

So, they spend their money trying to fix those problems.

Iar banii si i-au folosit incercand sa rezolve aceste probleme.

You can't rightly -- it's not their responsibility,

Nu poti sa astepti -- nu e responsabilitatea lor,

it is my responsibility. I have to take care of my own problems.

e a mea. Eu trebuie sa am grija de problemele proprii.

If they help, that's good! But that is not my expectation.

Daca ne ajuta, e bine! Dar nu astea sunt asteptarile mele.

These worsening indices of health care or health studies in Africa

Acesti indici din ce in ce mai gravi ai asistentei medicale sau al studiilor de sanatate in Africa

demand a new look. We cannot keep on doing things

trebuie priviti din nou. Nu putem sa facem lucrurile

the way we've always done them.

la fel ca si pana acum.

If they have not worked, we have to look for alternative solutions.

Daca nu au functionat, trebuie sa cautam solutii alternative

I'm here to talk to you about solutions.

Sunt aici sa va vorbesc despre solutii.

This has been -- what has been a difficult sign to some of us.

Acesta a fost un semn dificil petru unii dintre noi.

Several years ago, we started thinking about it.

Acum cativa ani am inceput sa ne gandim la asta.

Everyone knows the problem. No one knows what the solutions are.

Toata lumea cunoaste problema. Insa nimeni nu are solutii pentru ea.

We decided that we needed to put our money where our mouth is.

Am decis ca e necesar sa investim bani.

Everyone is ready to throw in money,

Lumea e pregatita sa ofere ajutoare in bani

in terms of free money aid to developing countries.

pentru tarile in curs de dezvoltare.

Talk about sustainable investment, no one is interested.

Insa cand vine vorba de o investite sustinuta, nimeni nu e interesat.

You can't raise money.

Nu ai cum sa aduni bani.

I have done businesses in healthcare in the United States --

Am facut afaceri in domeniul asistentei medicale in Statele Unite --

I live in Nashville, Tennessee, health care capital of America.

Traiesc in Nashville, Tennessee, capitala asistentei medicale din America.

[It's] very easy to raise money for health-care ventures.

Acolo e foarte usor sa aduni bani pentru cooperari in domeniul asistentei medicale

But start telling them, you know,

Cand incerci sa le zic, stiti,

we're going to try to do it in Nigeria -- everyone runs away.

o sa incercam sa facem asta in Nigeria -- toata lumea dispare.

That is totally wrong. Those of you in the audience here,

Asta este in totalitate gresit. Voi, cei din audienta,

if you want to help Africa, invest money in sustainable development.

daca vreti sa ajutati Africa: investiti bani pentru o dezvoltare sustinuta.

Let me lead you through a day in the life of the Heart Institute,

Lasati-ma sa va descriu o zi din viata Institutului Inimii

so you get a glimpse of what we do,

ca sa intelegeti ceea ce facem noi

and I'll talk a little bit more about it.

si sa va spun putin mai multe despre asta.

What we have done is to show that high-quality health care,

Am aratat ca o asistenta medicala la nivel inalt,

comparable to the best anywhere in the world,

comparabila cu cele mai bune din lume,

can be done in a developing country environment.

poate fi oferita intr-o tara in dezvoltare.

We have 25 positions right now -- all of them trained,

Avem 25 de posturi -- toate cu educatie

board certified in the USA, Canada or Britain.

si acreditate in SUA, Canada sau Marea Britanie.

We have every modality that can be done in Vanderbilt,

Exista toate procedurile care pot fi facute, spre exemplu, in Vanderbilt,

Cleveland Clinic -- everywhere in the U.S. --

Clinica din Cleveland -- sau oriunde in Statele Unite --

and we do it for about 10 percent of the cost

si noi le facem petru doar 10%

that you will need to do those things in the United States.

din cat ar costa aceste proceduri in Statele Unite.

(Applause)

(Aplauze)

Additionally, we have a policy

Mai mult decat atat, avem o politica

that no one is ever turned away because of ability to pay.

prin care nimeni nu este refuzat daca nu poate plati.

We take care of everyone.

Avem grija de toata lumea.

(Applause)

(Aplauze)

Whether you have one dollar, two dollars -- it doesn't matter.

Daca ai un dolar sau doi -- nu conteaza.

And I will tell you how we're able to do it.

Si o sa va explic cum reusim sa facem asta.

We make sure that we select our equipment properly.

Ne alegem echipamentul cu grija.

We go for modular units. Units that have multi-modality functions

Alegem unitati modulare. Unitati care sa fie multi-functionale

have modular components. Easy to repair, and because of that,

si sa aiba componente modulare. Sunt usor de reparat, si de aceea,

we do not take things that are not durable and cannot last.

nu achizitionam lucruri care nu sunt rezistente si durabile.

We emphasize training,

Punem accentul pe training

and we make sure that this process is regenerative.

si ne asiguram ca acest proces este regenerativ.

Very soon we will all be dead and gone, but the problems will stay,

Foarte curand o sa fim una cu pamantul, dar problemele vor ramane

unless we have people taking over from where we stopped.

daca nu avem oameni pregatiti sa preia stafeta.

We made sure that we produced some things ourselves.

Ne-am asigurat ca unele lucruri sunt produse de noi insine.

We do not buy unit doses of radiopharmaceuticals.

Nu cumparam unitati de radiofarmaceutice.

We get the generators from the companies.

Luam generatoarele de la companii.

We manufacture them in-house, ourselves. That keeps the costs down.

Producem dozele la noi. Asta mentine costurile scazute.

So, for a radiopharmaceutical in the U.S. --

Deci, pentru o unitate de radiofarmaceutice pe care in Statele Unite

that you'll get a unit dose for 250 dollars --

o poti lua la 250 de dolari,

when we're finished manufacturing it in-house,

in momentul in care am finalizat procesul de productie la noi

we come at a price of about two dollars.

ajungem la un pret de aproximativ 2 dolari.

(Applause)

(Aplauze)

We recognize that the only way to bridge the gap

Ne dam seama ca singura modalitate de a traversa prapastia

between the rich and poor countries

dintre tarile bogate si cele sarace

is through education and technology.

este prin educatie si tehnologie.

All these problems we're talking about --

Toate aceste probleme cu care ne confruntam

if we bring development, they will all disappear.

vor disparea daca investim in dezvoltare.

Technology is a great equalizer. How do we make it work?

Tehnologia este un important egalizator. Cum o facem sa functioneze?

It's been proved: self-care is cost-effective.

Este dovedit: asistenta prin masuri proprii reduce costurile.

It extends opportunity to the rural centers,

Oportunitatile se extind catre centre rurale,

and we can use expertise in a very smart way.

iar noi putem folosi expertiza intr-un mod inteligent.

This is the way our centers are set up.

Centrele noastre sunt astfel gandite.

We currently have three locations in the Caribbean,

Momentan avem trei locatii in Caraibe

and we're planning a fourth one.

si planuim sa deschidem o a patra.

And we have now decided to go into Africa.

Si am luat decizia sa intram in Africa.

We will be doing the West African Heart Institute

Vom construi Institutul Inimii al Africii de Vest

in Port Harcourt, Nigeria. That project will be starting

in Port Harcourt din Nigeria. Acest proiect va incepe

within the next few months. We hope to open in 2008-09.

in urmatoarele luni. Speram sa il deschidem in 2008-09.

And we will do other centers.

Si vom face si alte centre.

This model can be adapted to every disease process.

Acest model poate fi adaptat pentru orice alta boala.

All the units, all the centers, are linked

Toate unitatile si centrele sunt legate

through a switched hub to a central server,

la un hub al unui server central

and all the images are populated to review stations.

si toate imaginile sunt prezentate prin statii care au rolul de a supraveghea.

And we designed this telemedicine solution. It's proprietary to us,

Noi am realizat aceasta solutie de telemedicina. Ne apartine

and we are happy to share what we have learned with anyone

si suntem fericiti sa o impartasim cu oricine

who is interested in doing it. You can still be profitable.

e interesat sa faca acelasi lucru. Si tot este profitabil.

We make sure that the telemedicine platform gives access

Ne asiguram ca aceasta platforma de telemedicina ofera acces

to expert medical specialists anywhere in the world,

expertilor in medicina oriunde in lume,

just by a click of the button.

doar printr-o apasare de buton.

I'll lead you through, to see how this happens.

O sa va explic cum se intampla asta.

This is at the Heart Institute. The doctors from anywhere can log in.

Acesta este Instatutul Inimii. Doctori de oriunde se pot loga aici.

I can call you in Switzerland and say, "Listen, go into our system.

Pot sa va sun in Elvetia si sa va spun: "Intrati in sistemul nostru.

Look at Mrs. Jones. Look at the study, tell me what you think."

Uitati-va la cazul doamnei Jones si spuneti-mi ce credeti."

They'll give me that information,

Ei imi vor da acea informatie,

and we'll make the care of the patient better.

iar noi vom imbunatati asistenta pentru pacientul respectiv.

The patient doesn't have to travel.

Pacientul nu are nevoie sa calatoreasca.

He doesn't have to experience the anxiety of not knowing

Nu trebuie sa se ingrijoreze ca medicii nu au destule informatii

because of limited expertise.

din cauza unei expertize limitate.

We also use [an] electronic medical record system.

Totodata folosim si un sistem electronic pentru inregistrarea fiselor medicale.

I'm happy to say that the things we have implemented --

Ma bucur sa va pot spune ca lucrurile pe care le-am implementat --

80 percent of U.S. practices do not have them, and yet the technology is there.

80 % din cabinetele din Statele Unite nu au acest sistem desii tehnologia este disponibila.

But you know, they have that luxury.

Insa ei isi permit acest lux.

Because if you can't get it in Nashville, you can travel to Birmingham,

Pentru ca daca nu exista in Nashville, poti merge la Birmingham,

two hours away, and you'll get it. If you can't get it in Cleveland,

la doua ore distanta, si acolo o primesti. Daca nu o gasesti in Cleveland,

you can go to Cincinnati. We don't have that luxury,

poti merge in Cincinnati. Noi nu avem acest lux,

so we have to make it happen.

deci trebuie sa il realizam.

When we do it, we will put the cost of care down.

Cand facem asta, reducem costurile necesare asistentei medicale.

And we'll extend it to the rural centers and make it affordable.

Si o extindem si in centrele rurale si o facem astefel incat oamenii sa si-o permita.

And everyone will get the care they deserve.

Toata lumea va primi asistenta bine-meritata.

It cannot just be technology, we recognize that.

Tehnologia nu e totul, ne dam seama de asta.

Prevention must be part of the solution -- we emphasize that.

Prevenirea trebuie sa fie o parte din solutie, asta vrem sa subliniem.

But, you know, you have to tell people what can be done.

Dar trebuie sa fii in stare sa spui oamenilor ca se poate face.

It's not possible to tell people to do what is going to be expensive,

Nu poti spune oamenilor sa faca ceva costisitor

and they go home and can't do it.

si ei merg acasa si nu au cu ce.

They need to be alive, they need to feed.

Ei trebuie sa traiasca, sa se hraneasca.

We recommend exercise as the most effective, simple, easy thing to do.

Noi recomandam exercitiul ca cel mai eficient, simplu si usor lucru pe care il pot face.

We have had walks every year -- every March, April.

Organizam marsuri in fiecare an, in fiecare luna de martie, aprilie.

We form people into groups and make them go into challenges.

Noi organizam oamenii in grupuri si ii incurajam sa participe la provocari.

Which group loses the most weight, we give them prizes.

Grupul care pierde cel mai mult din greutate, castiga premii.

Which groups record more walking distance by pedometer,

Grupul care inregistreaza cea mai mare distanta parcursa folosind un pedometru,

we give them prizes. We do this constantly.

primeste premii. Facem asta in mod constant.

We encourage them to bring children.

Ii incurajam sa-si aduca si copiii.

That way we start exposing the children from very early on,

In felul acesta ii invatam pe copii chiar de la inceput

on what these issues are. Because once they learn it,

care sunt problemele posibile. O data ce invata,

they will stay with it. In doing this we have created

se vor tine de program. Prin asta am creat numai in Jamaica

at least 100 skilled jobs in Jamaica alone,

cel putin 100 de locuri de munca

and these are physicians with expertise and special training.

iar acestia sunt doctori cu experienta si pregatire speciala.

We have taken care of over 1,000 indigent patients that could have died,

Am tratat peste 1.000 de pacienti indigeni care au fi putut muri,

including four free pacemakers in patients

inclusiv patru pacienti care au avut nevoie de pacemaker

with complete heart block. For those that understand cardiology,

pentru ca aveau inima complet blocata. Pentru cei ce inteleg cardiologia,

complete heart block means certain death.

blocajul total la nivelul inimii inseamna moarte sigura.

If you don't get this pacemaker, you will be dead.

Daca nu primesti acest pacemaker, esti mort.

So we are pleased with that.

Suntem multumiti cu aceste rezultate.

Indirectly, we have saved the government of Jamaica five million dollars

Indirect, am scutit guvernul din Jamaica cu 5 milioane de dolari

from people that would have gone to Miami or Atlanta for care.

pentru pacientii care ar fi trebuit sa mearga la Miami sau Atlanta pentru asistenta.

And we've hopefully saved a lot of lives.

Si speram ca am salvat si numeroase vieti.

By the end of this year, we would have contributed over one million dollars

Pana la sfarsitul anului acesta vom fi contribuit cu peste un milion de dolari

in indigent care. In the first four months, it's been 340,000 dollars,

in asistenta pentru indigeni. In primele 4 luni au fost 340.000 de dolari,

averaging 85,000 dollars a month. The government will not do that,

in medie 85.000 pe luna. Guvernul nu ar da atatia bani

because they have competing needs.

fiindca pentru ei exista si alte nevoi.

They need to put resources elsewhere. But we can still do it.

Trebuie sa investeasca resursele in altceva. Dar noi putem face asta.

People say, "How can you do that?" This is how we can do that.

Oamenii ne intreaba: "Cum reusiti?". Iata cum reusim.

At least 4,000 rich Jamaicans that were heading to Miami for treatment

Cel putin 4.000 de jamaicani bogati care trebuiau sa ajunga la Miami pentru tratament

have self-confessed that they did not go to Miami

au recunoscut singuri ca nu au mers la Miami,

because of the Heart Institute of the Caribbean.

fiindca exista Institutul Inimii din Caraibe.

And, if they went to Miami, they will spend significantly more --

Si daca ar fi mers in Miami ar fi cheltuit cu mult mai multi bani --

eight to 10 times more. And they feel happy spending it at home,

de 8 pana la 10 ori mai multi. Si sunt multumiti ca ii pot cheltui acasa,

getting the same quality of care.

si primesc acelasi nivel de ingrijire.

And for that money -- for every one patient that has the money to pay,

Si pentru acei bani -- pentru fiecare pacient care are bani sa plateasca --

it gives us an opportunity to take care of at least four people

noi avem posibilitatea sa ne ingrijim de cel putin 4 oameni

that do not have the resources to pay.

care nu isi permit sa plateasca.

(Applause)

(Aplauze)

For this to work, this progress must be sustainable.

Ca aceasta sa functioneze, acest progres trebuie sa fie sustinut.

So, we emphasize training. Training is critical.

Deci ne concentram pe training. Trainigul e critic.

We have gone further: we have formed a relationship

Am mers si mai departe si am stabilit o legatura

with the University of Technology, Jamaica,

cu Universitatea Tehnologica din Jamaica,

where I now have an appointment.

unde am acum o intalnire.

And we are starting a biomedical engineering program,

O sa incepem un program de inginerie biomedicala,

so that we will train people locally, who can repair that equipment.

astfel incat sa educam localnici sa poata repara echipamentul.

That way we're not going to deal with obsolescence and all those kinds of issues.

In felul acesta o sa eliminam problemele cu uzura echipamentelor.

We're also starting ancillary health-care technology training programs --

De asemenea, incepem si programe auxiliare de training in tehnologia in asistenta medicala --

training people in echocardiography, cardiac ultrasound,

educarea oamenilor in ecocardiograma, examinare cardiaca cu ultrasunete,

those kinds of things. Now, with that kind of training,

si toate aceste lucruri. Aceste tipuri de training

it gives people motivation.

ofera oamenilor motivatie.

Because now they will get a bachelors degree in medical imaging

Pentru ca acum vor primi o diploma universitara in imagistica medicala

and all that kind of stuff. In the process, I want you to just hear

si altele. Vreau doar sa auziti de la cei ce au urmat trainingul

from the trainees themselves what it has meant for them.

ce a insemnat acest proces pentru ei.

(Video) Dr. Jason Topping: My name is Jason Topping.

(Video) Dr. Jason Topping: Numele meu este Jason Topping,

I'm a senior resident in anesthesia in intensive care

Sunt rezident senior in anestezia in terapie intensiva

at the University Hospital of the West Indies.

la Spitalul Universitar din Indiile de Vest.

I came to the Heart Institute in 2006,

Am venit la Institutul Inimii in 2006

as part of my elective in my anesthesia and intensive care program.

prin programul universitar de anestezie si terapie intensiva.

I spent three months at the Heart Institute.

Am petrecut 3 luni la Institutul Inimii.

There's been no doubt around my colleagues

Nu a existat nici un dubiu printre colegii mei

about the utility of the training I received here,

in privinta utilitatii acestui training pe care l-am primit aici.

and I think there's been an increased interest now in --

Si cred ca acum exista un interes crescut

particularly in echocardiography and its use in our setting.

in special in ecocardiografie si la ceea ce foloseste aceasta.

Sharon Lazarus: I am an echocardiographer at the Heart Institute of the Caribbean,

Sharon Lazarus: Sunt specialist in ecocardiografie la Institutul Inimii din Caraibe

since the past two years. I received training at this institution.

de doi ani. Am urmat trainingul in aceasta institutie.

I think this aspect of training in cardiology

Cred ca acest aspect al trainingului in cardiologie

that the Heart Institute of the Caribbean has introduced in Jamaica

pe care Institutul Inimii din Caraibe l-a introdus in Jamaica

is very important in terms of diagnosing cardiac diseases.

este foarte important in ceea ce priveste diagnosticarea problemelor cardiace.

Ernest Madu: The lesson in this is that it can be done, and it can be sustained,

Ernest Madu: Lectia ce rezulta de aici este ca se poate face si se poate sustine,

and you can make it possible for everyone.

si ca poate fi posibil pentru toata lumea.

Who are we to decide that poor people cannot get the best care?

Cine suntem noi sa decidem ca oamenii saraci nu pot primi cea mai buna asistenta?

When have you been appointed to play God?

Cine te-a numit Dumnezeu?

It is not my decision. My job is to make sure that every person,

Nu este decizia mea. Sarcina mea este sa ma asigur ca fiecare persoana,

no matter what fate has assigned to you, will have the opportunity

indiferent de ce soarta ar avea, are posibilitatea

to get the best quality health care in life.

sa primeasca cea mai buna asistenta medicala in timpul vietii.

Next stop is West African Heart Institute,

Urmatoarea oprire este Institutul Inimii din Africa de Vest

that we are going to be doing in Port Harcourt, Nigeria,

pe care il vom construi in Port Harcourt, Nigeria,

as I said before. We will do other centers across West Africa.

asa cum am mentionat mai devreme. Vom face si alte centre in Africa de Vest.

We will extend the same system into other areas,

Vom extinde acelasi sistem in alte zone,

like dialysis treatment.

cum ar fi tratamentul prin dializa.

And anyone who is interested in doing it in any health care situation,

Si oricine este interesat sa faca asta pentru orice alte scopuri in asistenta medicala,

we will be happy to assist you and tell you how we've done it,

vom fi bucurosi sa ajutam si sa impartasim cum am facut noi

and how you can do it. If we do this,

si cum se poate face de altii. Daca reusim asta,

we can change the face of health care in Africa.

putem schimba fata asistentei medicale din Africa.

Africa has been good to us; it is time for us to give back to Africa.

Africa a fost buna cu noi; acum e timpul sa da si noi ceva inapoi.

I am going. Those who want to come,

Eu am pornit. Cei ce vor sa ma insoteasca,

I welcome you to come along with me.

sunt binevoiti.

Thank you.

Va multumesc.

(Applause)

(Aplauze)