Gary Slutkin: Let's treat violence like a contagious disease

Prevodilac: Mile Živković Lektor: Dejan Vicai

I'm a physician trained in infectious diseases,

Ja sam doktor, specijalista za infektivne bolesti

and following my training,

i nakon svog usavršavanja

I moved to Somalia

preselio sam se u Somaliju

from San Francisco.

iz San Franciska.

And my goodbye greeting

Oproštajna poruka koju sam dobio

from the chief of infectious diseases

od načelnika infektivnog odeljenja

at San Francisco General was,

u San Francisku, glasila je:

"Gary, this is the biggest mistake you'll ever make."

"Gari, ovo je najveća greška koju ćeš ikada napraviti."

But I landed in a refugee situation

Ali sam sleteo u izbeglički kamp,

that had a million refugees in 40 camps,

gde je bilo milion izbeglica smešteno u 40 kampova,

and there were six of us doctors.

i nas šest doktora.

There were many epidemics there.

Bilo je dosta epidemija tamo.

My responsibilities were largely related to

Ja sam uglavnom bio zadužen

tuberculosis,

za tuberkulozu,

and then we got struck by an epidemic of cholera.

nakon čega je udarila epidemija kolere.

So it was the spread of tuberculosis

Dakle, dalje širenje tuberkuloze

and the spread of cholera

i širenje kolere

that I was responsible for inhibiting.

sam imao za zadatak da sprečim.

And in order to do this work, we, of course,

I da bi se ovo obavilo, naravno,

because of the limitation in health workers,

zbog ograničenja u broju zdravstvenih radnika,

had to recruit refugees to be a specialized

morali smo da regrutujemo izbeglice za specijalizovanu

new category of health worker.

novu kategoriju zdravstvenih radnika.

Following three years of work in Somalia,

Naredne tri godine rada u Somaliji,

I got picked up by the World Health Organization,

izabran sam od strane Svetske zdravstvene organizacije,

and got assigned to the epidemics of AIDS.

koja mi je dodelila novi zadatak, epidemiju AIDS-a.

My primary responsibility was Uganda,

Moja primarna odgovornost bila je Uganda,

but also I worked in Rwanda and Burundi

ali takođe i Ruanda i Burundi,

and Zaire, now Congo,

Zair, sada Kongo,

Tanzania, Malawi, and several other countries.

Tanzanija, Malavi i još nekoliko drugih zemalja.

And my last assignment there was to run a unit

Moj poslednji zadatak tamo bio je da vodim jedinicu

called intervention development,

zvanu Razvoj intervencija,

which was responsible for designing interventions.

koja je bila odgovorna za dizajniranje intervencija.

After 10 years of working overseas,

Posle 10 godina rada u inostranstvu,

I was exhausted.

bio sam iscrpljen.

I really had very little left.

Jako malo stvari mi je ostalo.

I had been traveling to one country after another.

Putovao sam iz jedne zemlje u drugu

I was emotionally feeling very isolated.

i osećao sam se emocionalno izolovanim od svega.

I wanted to come home.

Želeo sam da se vratim kući.

I'd seen a lot of death,

Video sam dosta smrti,

in particular epidemic death,

naročito smrti kao posledice epidemije

and epidemic death has a different feel to it.

a epidemijska smrt je drugačija.

It's full of panic and fear,

Prepuna je panike i straha

and I'd heard the women wailing and crying

i čuo sam žene kako tuguju i plaču

in the desert.

u pustinji.

And I wanted to come home and take a break

Želeo sam da se vratim kući i odmorim

and maybe start over.

i možda počnem od početka.

I was not aware of any epidemic problems

Nisam bio svestan bilo kojih problema epidemije

in America.

u Americi.

In fact, I wasn't aware of any problems in America.

Zapravo, nisam bio svestan ikakvih problema u Americi.

In fact -- seriously.

Zaista.

And in fact I would visit friends of mine,

I zaista, kada bih posetio svoje prijatelje,

and I noticed that they had water

primetio bih da imaju vodu

that came right into their homes.

koja dolazi direktno do njihovih kuća.

How many of you have such a situation?

Koliko vas ima sličnu situaciju?

(Laughter)

(Smeh)

And some of them, many of them actually,

I neki od njih, zapravo mnogi,

had water that came into more than one room.

su imali vodu koja dolazi do nekoliko soba

And I noticed that they would move

I primećivao sam da bi pomerili

this little thermoregulatory device

taj mali uređaj za termoregulaciju

to change the temperature in their home

kako bi promenili temperaturu u svojim domovima

by one degree or two degrees.

za stepen ili dva.

And now I do that.

I sada i ja to radim.

And I really didn't know what I would do,

I zaista nisam znao šta bih učinio po tom pitanju,

but friends of mine began telling me

ali moji prijatelji su počeli da mi pričaju

about children shooting other children with guns.

o tome kako deca pucaju na drugu decu oružjem.

And I asked the question,

Pitao sam ih:

what are you doing about it?

"Šta radite u vezi toga?

What are you in America doing about it?

Šta vi u Americi radite povodom toga?"

And there were two essential explanations

Izdvojila su se dva esencijalna objašnjenja,

or ideas that were prevalent.

ili ideje koje su prevagnule.

And one was punishment.

Jedna je bila kazna.

And this I had heard about before.

O tome sam već čuo ranije.

We who had worked in behavior

Mi koji imamo iskustva sa ljudskim ponašanjem

knew that punishment was something that was discussed

znamo da se kazne primenjuju,

but also that it was highly overvalued.

ali i da su jako precenjene.

It was not a main driver of behavior,

One nisu glavni pokretač ponašanja,

nor was it a main driver of behavior change.

pa samim tim ni glavni uzrok promena u ponašanju.

And besides that, it reminded me

To me je podsetilo

of ancient epidemics

na stare epidemije

that were previously completely misunderstood

koje su u početku potpuno pogrešno shvaćene,

because the science hadn't been there before,

jer nauka nije bila razvijena,

epidemics of plague

epidemije kuge,

or typhus or leprosy,

tifusa ili lepre,

where the prevalent ideas were that there were

gde su prevladavajuće ideje bile

bad people or bad humors or bad air,

da se dešavaju zbog loših ljudi, loše volje ili lošeg vazduha

and widows were dragged around the moat,

i udovice su vučene po rovovima,

and dungeons were part of the solution.

a tamnice su bile deo rešenja.

The other explanation or, in a way,

Drugo objašnjenje, ili na neki način rešenje

the solution suggested,

koje je predlagalo

is please fix all of these things:

prvenstveno rešavanje sledećih problema:

the schools, the community, the homes, the families,

školstva, društva, domova, porodica,

everything.

svega.

And I'd heard this before as well.

I za ovo sam već bio čuo ranije.

I'd called this the "everything" theory,

Zvao sam ga "teorija svega".

or EOE: Everything On Earth.

ili TSNS - teorija svega na svetu.

But we'd also realized

Ali shvatili smo,

in treating other processes and problems

prilikom rešavanja drugih procesa i problema,

that sometimes you don't need to treat everything.

da nekad nije potrebno rešavati sve.

And so the sense that I had

Zato sam imao utisak

was there was a giant gap here.

da tu postoji veliki propust.

The problem of violence was stuck,

Problem nasilja je zastao sa svojim rešavanjem

and this has historically been the case

i to je u prošlosti bio slučaj i sa mnogim

in many other issues.

drugim problemima.

Diarrheal diseases had been stuck.

Sa oboljenjem creva.

Malaria had been stuck.

Malarijom. Posle nekog vremena,

Frequently, a strategy has to be rethought.

strategija je morala da se ponovo osmisli.

It's not as if I had any idea what it would look like,

Nije da sam imao bilo kakvu ideju kako će se stvari odvijati

but there was a sense that we would have to do

ali postojao je osećaj da treba raditi nešto

something with new categories of workers

vezano za nove kategorije radnika

and something having to do with behavior change

i nešto sa promenama u ponašanju

and something having to do with public education.

i nešto sa javnim obrazovanjem.

But I began to ask questions

Počeo sam da postavljam pitanja

and search out the usual things

i istražujem standardne stvari

that I had been exploring before,

koje sam radio i ranije,

like, what do the maps look like?

kao na primer, kako izgledaju mape.

What do the graphs look like?

kako izgledaju grafici.

What does the data look like?

Kako izgledaju podaci.

And the maps of violence

I mape nasilja

in most U.S. cities

u većini gradova u SAD

looked like this.

izgledale su ovako.

There was clustering.

Pojavljivalo se grupisanje.

This reminded me of clustering that we'd seen also

To me je podsetilo na grupisanje koje bismo viđali

in infectious epidemics,

i kod infektivnih epidemija,

for example cholera.

kao što je kolera.

And then we looked at the maps,

I posmatrali smo mape,

and the maps showed this typical wave

pokazivale su nam tipičan talas

upon wave upon wave,

nakon talasa, nakon talasa,

because all epidemics

jer sve epidemije

are combinations of many epidemics.

su zapravo kombinacija više epidemija.

And it also looked like infectious epidemics.

I izgledalo je isto kao kod infektivnih epidemija.

And then we asked the question,

Zapitali smo se

well what really predicts a case of violence?

šta zaista predviđa slučaj nasilja.

And it turns out that the greatest predictor

I ispostavilo se da je najveći pokazatelj nasilja

of a case of violence is a preceding case of violence.

prethodni slučaj nasilja.

Which also sounds like, if there is a case of flu,

To je isto kao i kad postoji slučaj gripa,

someone gave someone a case of flu, or a cold,

neko je nekom preneo grip, ili prehladu,

or the greatest risk factor of tuberculosis

ili to što je najveći rizik od tuberkuloze

is having been exposed to tuberculosis.

prethodna izloženost tuberkulozi.

And so we see that violence is, in a way,

Tako vidimo da se nasilje na neki način

behaving like a contagious disease.

ponaša kao zarazna bolest.

We're aware of this anyway

Svakako smo svesni ovoga

even in our common experiences

čak i u našim zajedničkim iskustvima

or our newspaper stories

ili pričama u novinama

of the spread of violence from fights

o širenju nasilja, od tuča,

or in gang wars or in civil wars

ratova bandi ili građanskih ratova

or even in genocides.

ili čak genocida.

And so there's good news about this, though,

Ipak, ima i dobrih vesti,

because there's a way to reverse epidemics,

jer postoji način da se preokrenu epidemije

and there's really only three things that are done

i zapravo postoje samo tri stvari koje se rade

to reverse epidemics,

da bi se preokrenula epidemija,

and the first of it is interrupting transmission.

a prva je prekidanje prenosa.

In order to interrupt transmission,

Kako bi se prenos prekinuo,

you need to detect and find first cases.

morate da otkrijete i nađete prve slučajeve.

In other words, for T.B. you have to find somebody

Drugim rečima, kod tuberkuloze morate pronaći nekoga

who has active T.B. who is infecting other people.

ko ima aktivnu tuberkulozu i inficira druge ljude.

Make sense?

Ima smisla?

And there's special workers for doing that.

I za to postoje posebni radnici.

For this particular problem,

Za ovaj poseban problem,

we designed a new category of worker

smislili smo novu kategoriju radnika

who, like a SARS worker

koji, poput radnika za SARS

or someone looking for bird flu,

ili nekoga ko traži ptičji grip,

might find first cases.

možda pronađe prve slučajeve.

In this case, it's someone who's very angry

U ovom slučaju, to je neko ko je veoma besan

because someone looked at his girlfriend

jer je neko pogledao njegovu devojku

or owes him money,

ili mu duguje novac,

and you can find workers and train them

i možete pronaći radnike i obučiti ih

into these specialized categories.

za ove posebne kategorije.

And the second thing to do, of course,

Druga stvar je naravno,

is to prevent further spread,

sprečavanje daljeg širenja,

that means to find who else has been exposed,

to znači pronalazak drugih koji su bili izloženi,

but may not be spreading so much right now

ali kod koga se to ne širi toliko,

like someone with a smaller case of T.B.,

poput nekoga sa blažom tuberkulozom

or someone who is just hanging out in the neighborhoods,

ili nekoga ko samo visi po komšiluku,

but in the same group,

ali unutar iste grupe,

and then they need to be, in a way,

i na neki način, i oni moraju

managed as well,

da budu procesuirani,

particular to the specific disease process.

po procesu za određenu zarazu.

And then the third part, the shifting the norms,

Treći deo je pomeranje normi,

and that means a whole bunch of community activities,

a to podrazumeva puno aktivnosti u zajednici,

remodeling, public education,

ponovnog modeliranja, javnog obrazovanja,

and then you've got what you might call

i onda dobijate nešto što bi se moglo nazvati

group immunity.

grupnim imunitetom.

And that combination of factors

Tom kombinacijom faktora

is how the AIDS epidemic in Uganda

je epidemija AIDS-a u Ugandi

was very successfully reversed.

bila uspešno preokrenuta.

And so what we decided to do in the year 2000

U godini 2000. smo odlučili

is kind of put this together in a way

da ovo sklopimo na neki način

by hiring in new categories of workers,

zapošljavanjem nove kategorije radnika,

the first being violence interruptors.

gde su prvi zaustavljači nasilja.

And then we would put all of this into place

Onda bismo sve ovo stavili na jedno mesto

in one neighborhood

u jedan komšiluk,

in what was the worst police district

u najgori policijski distrikt

in the United States at the time.

u SAD u to vreme.

So violence interruptors hired from the same group,

Zaustavljači nasilja zapošljeni su iz jedne iste grupe,

credibility, trust, access,

naspram kredibiliteta, poverenja, pristupa,

just like the health workers in Somalia,

isto kao zdravstveni radnici u Somaliji,

but designed for a different category,

ali s namerom za drugu kategoriju

and trained in persuasion,

i obučeni su da ubeđuju,

cooling people down, buying time, reframing.

smire ljude, kupe sebi vreme, stvore novi okvir.

And then another category of worker,

Tu je i druga kategorija radnika,

the outreach workers, to keep people

radnici za povezivanje, koji ljude drže

in a way on therapy for six to 24 months.

na terapiji od 6 do 24 meseca na neki način.

Just like T.B., but the object is behavior change.

Kao kod tuberkuloze, ali cilj je promena ponašanja.

And then a bunch of community activities

A tu je i hrpa aktivnosti za zajednicu

for changing norms.

za menjanje normi.

Now our first experiment of this

Naš prvi eksperiment s ovim

resulted in a 67-percent drop

za posledicu je imao pad od 67%

in shootings and killings

u pucnjavama i ubistvima

in the West Garfield neighborhood of Chicago.

u oblasti Vest Garfild u Čikagu.

(Applause)

(Aplauz)

And this was a beautiful thing

Ovo je za sam komšiluk

for the neighborhood itself,

bila divna stvar,

first 50 or 60 days, then 90 days,

prvih 50 ili 60 dana, onda 90 dana,

and then there was unfortunately another shooting

i onda se nažalost desila još jedna pucnjava

in another 90 days,

za drugih 90 dana

and the moms were hanging out in the afternoon.

i majke su se družile popodne.

They were using parks they weren't using before.

Koristile su parkove koje nisu nikada pre.

The sun was out. Everybody was happy.

Sunce je izašlo. Svi su bili srećni.

But of course, the funders said, "Wait a second,

Ali naravno, investitori su rekli: "Stani malo,

do it again."

uradite to opet."

And so we had to then, fortunately,

Onda smo na sreću

get the funds to repeat this experience,

opet morali da dobijemo sredstva da ponovimo ovo iskustvo,

and this is one of the next four neighborhoods

i ovo je jedan od sledeća 4 komšiluka

that had a 45-percent drop in shootings and killings.

koji su imali pad od 45% u ubistvima i pucnjavama.

And since that time, this has been replicated

Od tada, ovo je ponovljeno

20 times.

20 puta.

There have been independent evaluations

Radile su se nezavisne procene

supported by the Justice Department

koje je podržalo Ministarstvo pravde

and by the CDC and performed by Johns Hopkins

i Centar za kontrolu i prevenciju zaraza i koje je vršio Džon Hopkins,

that have shown 30-to-50-percent and 40-to-70-percent

koje su pokazale smanjenja od 30-50% i 40-70%

reductions in shootings and killings

u pucnjavama i ubistvima

using this new method.

koristeći ovaj novi metod.

In fact, there have been three independent

Zapravo, urađene su

evaluations of this now.

tri nezavisne procene do sada.

Now we've gotten a lot of attention as a result of this,

Kao posledica ovoga, dobili smo dosta pažnje,

including being featured on

uključujući i to što smo bili

The New York Times' Sunday magazine cover story.

glavna priča u nedeljnom magazinu Njujork Tajms.

The Economist in 2009

2009. Ekonomist je rekao

said this is "the approach that will come to prominence."

da je ovo "pristup koji će doći do izražaja".

And even a movie was made around our work.

Na osnovu našeg rada je čak napravljen i film.

[The Interrupters]

[Zaustavljivači]

However, not so fast,

Ipak, ne tako brzo,

because a lot of people did not agree

jer se dosta ljudi nije slagalo

with this way of going about it.

sa načinom na koji se ovo radilo.

We got a lot of criticism,

Dobili smo dosta kritika,

a lot of opposition,

dosta protivljenja

and a lot of opponents.

i dosta protivnika.

In other words, what do you mean, health problem?

Drugim rečima, kako to misliš, zdravstveni problem?

What do you mean, epidemic?

Kako to misliš, epidemija?

What do you mean, no bad guys?

Kako to misliš, nema negativaca?

And there's whole industries designed

A postoje čitave industrije osmišljene

for managing bad people.

za baratanje negativcima.

What do you mean, hiring people

Kako to misliš, zapošljavanje ljudi

who have backgrounds?

koji imaju pozadinu?

My business friends said,

Moji prijatelji iz sveta posla su mi rekli:

"Gary, you're being criticized tremendously.

"Gari, izuzetno snažno te kritikuju.

You must be doing something right."

Mora da radiš nešto kako treba."

(Laughter)

(Smeh)

My musician friends added the word "dude."

Moji prijatelji iz sveta muzike dodali su reč "brate".

So anyway, additionally,

Kako god bilo, pored svega

there was still this problem,

još uvek je postojao ovaj problem,

and we were getting highly criticized as well

i takođe su nas žestoko kritikovali

for not dealing with all of these other problems.

jer ne rešavamo sve ove druge probleme.

Yet we were able to manage malaria

Ipak, uspeli smo da se izborimo s malarijom

and reduce HIV and reduce diarrheal diseases

i smanjimo HIV i bolesti izazvane dijarejom

in places with awful economies

na mestima sa užasnim standardima

without healing the economy.

bez popravljanja ekonomije.

So what's actually happened is,

Zapravo se desilo to,

although there is still some opposition,

da iako još ima neke opozicije,

the movement is clearly growing.

pokret očigledno raste.

Many of the major cities in the U.S.,

Mnogi veliki gradovi u SAD,

including New York City and Baltimore

uključujući Njujork, Baltimor

and Kansas City,

i Kanzas siti,

their health departments are running this now.

njihova odeljenja za zdravstvo trenutno koriste ovo.

Chicago and New Orleans, the health departments

U Čikagu i Nju Orleansu, odeljenja za zdravstvo

are having a very large role in this.

imaju veoma veliku ulogu u ovome.

This is being embraced more by law enforcement

Ovo organi reda prihvataju

than it had been years ago.

više nego pre nekoliko godina.

Trauma centers and hospitals

Domovi zdravlja i bolnice

are doing their part in stepping up.

daju svoj doprinos u poboljšavanju.

And the U.S. Conference of Mayors

Savez gradonačelnika SAD-a

has endorsed not only the approach

je podržao ne samo pristup

but the specific model.

već i specifični model.

Where there's really been uptake even faster

Najbrži napredak se zapravo vidi

is in the international environment,

u međunarodnom okruženju,

where there's a 55-percent drop

gde se desio pad od 55%

in the first neighborhood in Puerto Rico,

u prvom komšiluku u Portoriku,

where interruptions are just beginning in Honduras,

zaustavljanja tek počinju u Hondurasu,

where the strategy has been applied in Kenya

strategija je primenjena u Keniji

for the recent elections,

za skorašnje izbore,

and where there have been 500 interruptions in Iraq.

a u Iraku je bilo 500 zaustavljanja.

So violence is responding as a disease

Nasilje odgovara kao zaraza

even as it behaves as a disease.

isto kao što se i ponaša kao zaraza.

So the theory, in a way,

Tako se na neki način

is kind of being validated by the treatment.

teorija potvrđuje kroz lečenje.

And recently, the Institute of Medicine

Institut medicine je skoro objavio

came out with a workshop report

izveštaj sa radionice

which went through some of the data,

kroz koji su provučeni neki podaci,

including the neuroscience,

uključujući neurologiju,

on how this problem is really transmitted.

a radilo se o tome kako se ovaj problem zapravo prenosi.

So I think this is good news,

Mislim da su ovo dobre vesti,

because it allows us an opportunity

jer ovo pruža priliku

to come out of the Middle Ages,

da se izađe iz Srednjeg veka,

which is where I feel this field has been.

gde mislim da se nalazilo ovo polje.

It gives us an opportunity to consider the possibility

Ovo nam daje priliku da u obzir uzmemo mogućnost

of replacing some of these prisons

da se neki od ovih zatvora

with playgrounds or parks,

zamene igralištima ili parkovima

and to consider the possibility

i da se obzir uzme mogućnost

of converting our neighborhoods into neighborhoods,

preokretanja naših komšiluka u komšiluke

and to allow there to be a new strategy,

i da se dozvoli postojanje nove strategije,

a new set of methods, a new set of workers:

novog skupa metoda, skupa radnika:

science, in a way, replacing morality.

na jedan način, nauka zamenjuje moralnost.

And moving away from emotions

Najbitniji deo rešenja

is the most important part of the solution

je odmicanje od emocija,

to science as a more important part of the solution.

nauci kao bitnijem delu rešenja.

So I didn't mean to come up with this at all.

Uopšte nisam nameravao da smislim ovo.

It was a matter of,

To je bilo stvar toga

I wanted actually a break,

da mi je zaista trebala pauza

and we looked at maps, we looked at graphs,

i pogledali smo mape, grafikone,

we asked some questions

postavili neka pitanja

and tried some tools

i isprobali neke alate

that actually have been used many times before

koji su se koristili mnogo puta pre toga

for other things.

za druge stvari.

For myself, I tried to get away from

Što se mene tiče, pokušao sam da pobegnem

infectious diseases,

od infektivnih zaraza,

and I didn't.

a nisam uspeo u tome.

Thank you.

Hvala vam.

(Applause)

(Aplauz)