Why I train grandmothers to treat depression | Dixon Chibanda

翻译人员: Qikai Guo 校对人员: Eddy Chan

On a warm August morning in Harare,

在哈拉雷（津巴布韦首都） 8 月的一个温暖的早晨，

Farai,

范蕾，

a 24-year-old mother of two,

一位有两个孩子的 24 岁母亲

walks towards a park bench.

走向了公园的长凳。

She looks miserable and dejected.

她看起来痛苦又沮丧。

Now, on the park bench sits an 82-year-old woman,

那条长凳上还坐着 一位 82 岁的老妇人，

better known to the community as Grandmother Jack.

社区的人都亲切的叫她 杰克奶奶。

Farai hands Grandmother Jack an envelope from the clinic nurse.

范蕾递给杰克奶奶一个 从诊所护士那拿到的信封。

Grandmother Jack invites Farai to sit down

杰克奶奶请范蕾坐下，

as she opens the envelope and reads.

在她打开信封并阅读时，

There's silence for three minutes or so as she reads.

有大概三分钟，两人都默不作声。

And after a long pause, Grandmother Jack takes a deep breath,

过了一会儿，杰克奶奶深吸了一口气，

looks at Farai and says,

看着范蕾说，

"I'm here for you.

“有我在呢。

Would you like to share your story with me?"

想和我说说你的故事吗？”

Farai begins,

范蕾开始了讲述，

her eyes swelling with tears.

她的眼睛满含泪水。

She says, "Grandmother Jack,

她说，“杰克奶奶，

I'm HIV-positive.

我的艾滋病检测结果呈阳性。

I've been living with HIV for the past four years.

过去四年来， 我一直是艾滋病毒携带者。

My husband left me a year ago.

我的丈夫一年前离开我了。

I have two kids

我有两个孩子，

under the age of five.

他们都还不到五岁。

I'm unemployed.

我还失业了，

I can hardly take care of my children."

我几乎无力抚养我的孩子。

Tears are now flowing down her face.

这时眼泪不停地从她脸颊流下。

And in response, Grandmother Jack moves closer,

作为回应，杰克奶奶坐近了一些，

puts her hand on Farai,

并且轻轻抚摸范雷，

and says, "Farai, it's OK to cry.

她说，“范雷，哭吧，没关系的。

You've been through a lot.

你经历了很多。

Would you like to share more with me?"

你想和我再说说吗？”

And Farai continues.

接下来，范雷继续了讲述。

"In the last three weeks,

“在过去的三周里，

I have had recurrent thoughts of killing myself,

我经常想到自杀，

taking my two children with me.

带着我的两个孩子一起。

I can't take it anymore.

我真的无法承受了。

The clinic nurse sent me to see you."

是诊所护士让我来见你的。”

There's an exchange between the two, which lasts about 30 minutes.

在接下来的三十分钟里， 她们互诉衷肠。

And finally, Grandmother Jack says,

最后，杰克奶奶说，

"Farai,

“范雷。

it seems to me that you have all the symptoms of kufungisisa."

在我看来，你有 kufungisisa 的所有症状。”

The word "kufungisisa" opens up a floodgate of tears.

kufungisisa 这个词 让范蕾再也止不住泪水。

So, kufungisisa is the local equivalent of depression

事实上，在我的国家，kufungisisa

in my country.

就相当于抑郁症。

It literally means

它的字面意思是

"thinking too much."

“想的太多”。

The World Health Organization estimates

根据世界卫生组织的估计，

that more than 300 million people globally, today, suffer from depression,

目前全球有 3 亿多人患有抑郁症，

or what in my country we call kufungisisa.

或者用我国的叫法， 患上了 Kufungisisa。

And the World Health Organization also tells us

世界卫生组织也告诉我们，

that every 40 seconds,

每 40 秒钟。

someone somewhere in the world commits suicide

世界的某个角落就会有人自杀，

because they are unhappy,

因为他们活得不快乐，

largely due to depression or kufungisisa.

主要是由于患有 抑郁症或 kufungisisa。

And most of these deaths are occurring in low- and middle-income countries.

大部分的自杀行为 都发生于中低收入的国家。

In fact,

事实上，

the World Health Organization goes as far as to say

世界卫生组织甚至表明，

that when you look at the age group between 15 to 29,

年龄在 15 岁到 29 岁之间的群体中，

a leading cause of death now is actually suicide.

目前主要的死因就是自杀。

But there are wider events that lead to depression

但导致抑郁症甚至自杀的原因

and in some cases, suicide,

其实有很多，

such as abuse,

比如虐待，

conflict, violence,

冲突，暴力，

isolation, loneliness --

孤立，寂寞，

the list is endless.

等等。

But one thing that we do know

但我们知道的是，

is that depression can be treated and suicides averted.

抑郁症是可治疗的， 自杀也是可避免的。

But the problem is

但问题是，

we just don't have enough psychiatrists or psychologists in the world

世界上没有足够的 精神病学家或心理学家

to do the job.

来完成这项工作。

In most low- and middle-income countries, for instance,

比如在大多数中低收入的国家，

the ratio of psychiatrists to the population

精神科医生与总人口的比例

is something like one for every one and a half million people,

是 1 比 150 万。

which literally means that 90 percent of the people

这个数字意味着 90％ 需要

needing mental health services

心理健康服务的人群

will not get it.

无法得到应有的服务。

In my country,

在我的祖国，

there are 12 psychiatrists,

共有 12 位精神科医生，

and I'm one of them,

我就是其中之一，

for a population of approximately 14 million.

要为约 1400 万人口服务。

Now, let me just put that into context.

现在，我给大家讲个实际的例子。

One evening while I was at home,

一天晚上，我在家休息，

I get a call from the ER,

接到了一个 ER，也就是急诊室的

or the emergency room,

电话，

from a city which is some 200 kilometers away

那个城市和我住的地方

from where I live.

相距 200 公里。

And the ER doctor says,

急诊室医生说，

"One of your patients,

“你的一个病人，

someone you treated four months ago,

就是四个月前接受治疗的那个，

has just taken an overdose,

现在服药过量，

and they are in the ER department.

正在一个急诊科里。

Hemodynamically, they seem to be OK,

从血流动力上看没什么问题，

but they will need neuropsychiatric evaluation."

但需要进行神经精神病方面的评估。”

Now, I obviously can't get into my car in the middle of the night

但我当时显然不会在半夜驱车

and drive 200 kilometers.

200 公里到达现场。

So as best as we could,

所以我当时能做的

over the phone with the ER doctor,

就是和电话那头急诊室医生

we come up with an assessment.

进行了一个评估。

We ensure that suicidal observations are in place.

我们确认自杀监管到位。

We ensure that we start reviewing the antidepressants

我们确认我们检查了那个病人

that this patient has been taking,

一直服用的抗抑郁药物，

and we finally conclude

最后我们得出结论，

that as soon as Erica -- that was her name, 26-year-old --

26 岁的爱瑞卡——那是她的名字——

as soon as Erica is ready to be released from the ER,

一旦爱瑞卡可以从急诊室出院，

she should come directly to me with her mother,

她应该和她母亲直接来我这里，

and I will evaluate

然后我会评估她的精神状况，

and establish what can be done.

也会尽我所能来帮助她。

And we assumed that that would take about a week.

我们估计那要花大概一周。

A week passes.

一周过去了，

Three weeks pass.

三周过去了，

No Erica.

爱瑞卡没有来。

And one day I get a call from Erica's mother,

一天我接到了爱瑞卡母亲的电话，

and she says,

她说，

"Erica committed suicide three days ago.

“爱瑞卡三天前自杀了。

She hanged herself from the mango tree

她在自家院子里的

in the family garden."

芒果树上上吊了。”

Now, almost like a knee-jerk reaction,

那时候，就像膝跳反射一样，

I couldn't help but ask,

我忍不住问道，

"But why didn't you come to Harare, where I live?

“但是你们为什么没来 我在哈拉雷的住处？

We had agreed that as soon as you're released from the ER,

我们都说好了，一旦爱瑞卡出院，

you will come to me."

你们就会过来。”

Her response was brief.

她的答案很简短，

"We didn't have the 15 dollars bus fare

“我们付不起十五美元的巴士钱，

to come to Harare."

去不了哈拉雷。”

Now, suicide is not an unusual event

在精神健康领域，

in the world of mental health.

自杀很常见。

But there was something about Erica's death

但是爱瑞卡的死

that struck me at the core of my very being.

却深深地震撼了我。

That statement from Erica's mother:

爱瑞卡母亲的话：

"We didn't have 15 dollars bus fare to come to you,"

“我们付不起十五美元的 巴士钱去找你，”

made me realize

让我明白了，

that it just wasn't going to work,

让病人来找我，

me expecting people to come to me.

根本就行不通。

And I got into this state of soul-searching,

我开始进行深刻的反思，

trying to really discover my role

想要探寻我作为非洲的

as a psychiatrist in Africa.

一名精神病学家的角色。

And after considerable consultation and soul-searching,

在经过一系列咨询和自我反思，

talking to colleagues, friends and family,

以及和同事、朋友和家人的交流后，

it suddenly dawned on me

我突然之间明白了，

that actually, one the most reliable resources we have in Africa

实际上，在非洲，我们最可靠的资源

are grandmothers.

就是我们的奶奶们。

Yes, grandmothers.

没错，奶奶们。

And I thought,

我认为，

grandmothers are in every community.

奶奶们无处不在。

There are hundreds of them.

数量众多，

And --

而且——

(Laughter)

（笑声）

And they don't leave their communities in search of greener pastures.

而且也不会抛下我们 去追求更好的生活。

(Laughter)

（笑声）

See, the only time they leave

她们唯一离开的时候，

is when they go to a greener pasture called heaven.

是要去一个更好的地方，天堂。

(Laughter)

（笑声）

So I thought, how about training grandmothers

所以我想，何不训练一下奶奶们，

in evidence-based talk therapy,

让她们进行循证型的谈话治疗，

which they can deliver on a bench?

在长凳上就能进行？

Empower them with the skills to listen,

让她们可以通过倾听他人

to show empathy,

来表达同情心。

all of that rooted in cognitive behavioral therapy;

这些都源于认知行为疗法；

empower them with the skills to provide behavior activation,

可以让奶奶们提供行为激活，

activity scheduling;

安排活动日程，

and support them using digital technology.

并且让她们运用数码科技，

You know, mobile phone technology.

就是移动电话技术。

Pretty much everyone in Africa has a mobile phone today.

毕竟在非洲， 现在几乎每个人都有手机。

So in 2006,

所以在 2006 年，

I started my first group

我开创了我的第一个

of grandmothers.

奶奶团。

(Applause)

（掌声）

Thank you.

谢谢。

(Applause)

（掌声）

Today, there are hundreds of grandmothers

现在，已经有数百位奶奶们

who are working in more than 70 communities.

在超过 70 个社区中工作。

And in the last year alone,

仅在去年，

more than 30,000 people received treatment

就有超过三万人

on the Friendship Bench

在友情长凳上

from a grandmother in a community in Zimbabwe.

接受了津巴布韦 某个社区的奶奶的治疗。

(Applause)

（掌声）

And recently, we published this work that is done by these grandmothers

最近，我们将 这些奶奶们完成的工作

in the Journal of the American Medical Association.

发布在了美国医学会的期刊上。

And --

不仅如此——

(Applause)

（掌声）

And our results show that six months after receiving treatment

我们的数据表明， 在经过一位奶奶

from a grandmother,

六个月的治疗后，

people were still symptom-free:

人们的病症纷纷消失了：

no depression,

也不再抑郁，

suicidal ideation completely reduced.

自杀想法大大降低。

In fact, our results -- this was a clinical trial --

实际上我们的结果—— 这是个临床试验——

in fact, this clinical trial showed

这个临床试验表明，

that grandmothers were more effective at treating depression

我们的奶奶们相比医生

than doctors and --

要有效得多。

(Laughter)

（笑声）

(Applause)

（掌声）

And so,

所以，

we're now working towards expanding this program.

我们现在正在致力于 扩大这个项目。

There are more than 600 million people currently aged above 65 in the world.

全世界目前有 6 亿 65 岁以上的人。

And by the year 2050,

到了 2050 年，

there will be 1.5 billion people aged 65 and above.

这个人数会增加到 15 亿。

Imagine if we could create a global network of grandmothers

想像一下，如果我们 在全世界的所有主要城市

in every major city in the world,

创造一个奶奶们的关系网络，

who are trained in evidence-based talk therapy,

她们都受过循证谈话治疗的训练，

supported through digital platforms,

并由电子平台支持，

networked.

通过网络工作。

And they will make a difference in communities.

她们会在社区中起到显著的作用，

They will reduce the treatment gap

减少精神，神经

for mental, neurological and substance-use disorders.

和药物使用障碍方面的治疗缺口。

Finally,

最后，

this is a file photograph of Grandmother Jack.

这是杰克奶奶的一张照片。

So, Farai had six sessions on the bench with Grandmother Jack.

范蕾在这张长凳上和杰克奶奶 进行了六个疗程的治疗。

Today, Farai is employed.

现在，范蕾有了工作，

She has her two children at school.

两个孩子也在上学。

And as for Grandmother Jack,

至于杰克奶奶，

one morning in February, we expected her to see her 257th client on the bench.

二月的一天早晨，我们以为 她会在长凳上治疗第 257 名病人，

She didn't show up.

但她并没有出现。

She had gone to a greener pasture called heaven.

因为她去了一个更好的地方，天堂。

But I believe that Grandmother Jack,

但我相信杰克奶奶

from up there,

一直以来都在天堂

she's cheering on all the other grandmothers --

鼓舞着其他的奶奶们——

the increasing number of grandmothers who are making a difference

帮助着许多人的，

in the lives of thousands of people.

队伍不断壮大的奶奶们。

And I'm sure she's in awe

我也相信，

when she realizes that something that she helped to pioneer

当她知道她所倡导的精神

is now spreading to other countries,

正在其他国家不断传播，

like Malawi,

比如马拉维，

the island of Zanzibar

桑给巴尔岛，

and coming closer to home here in the Unites States

同时也将马上 影响到美国，就在纽约，

in the city of New York.

我相信她一定会感到敬畏。

May her soul rest in peace.

愿她的灵魂安息。

Thank you.

谢谢。

(Applause)

（掌声）

(Cheering)

（欢呼）

(Applause)

（掌声）