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

翻译人员: elyse lin 校对人员: Tony Yet

It is interesting that in the United States,

在美国有个蛮有意思的现象

the most significant health-care budget

最重要的医疗预算

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

无论是私人捐助还是政府提供，都是拨给心血管疾病的

There's no comparison at all.

其他的疾病根本无法比拟

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

而在非洲，心血管疾病是致死率最高的一种疾病，却被彻底忽略了

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

这种情况不应该存在，我们必须改变它

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

一个国家的健康状况与发展水平是成正比的

17 million people die every year from heart disease.

每年有1700万人死于心脏病

32 million heart attacks and strokes occur.

3200万人死于突发心脏病和中风

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

这其中绝大多数生活在发展中国家，而且以非洲最多

85 percent of global disease burden for cardiovascular disease

在发展中国家，85%的全球性疾病会加重心血管疾病

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

而西方国家没有这种情况

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

然而90%的医疗资源却集中在西方国家

Who is at risk? People like you.

哪些人属于危险人群？你们都是

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

不仅仅非洲人民需要关注

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

所有要在非洲驻扎一段时间的人

should be very concerned about this deplorable situation.

都应该关注这个糟糕的状况

Has anyone here wondered what will happen

你们是否有想过

if you go back to your room at night,

如果某天晚上回卧室时

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

突然觉得胸闷气短、不停出汗，要怎么办

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

这可是心脏病突发，你们会怎么处理

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

飞回美国，德国，欧洲？

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

不能这样，这样会死人的。50%的人在病发后24小时内未经治疗就会死亡

This is what's going on.

这就是事实

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

看看这幅图

10 million people here, 10 million here.

最开始的时候美国和尼日利亚同样都有1000万人口

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

等你们50岁的时候，尼日利亚估计已经变成空城，人都死了

life expectancy is 47.

他们的预期寿命只有47岁

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

不是因为小时候得病死了

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

而是因为当他们

about 45 years old and 50 years old.

到45岁至50岁这期间时撑不下去了

And those are the times they're most productive.

但这才是他们产能最大的时期

Those are the times that they should be contributing

他们本应该能

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

为非洲的发展贡献力量，可人却已经不在了

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

父母去世是导致贫穷的最快方式

If you cannot secure the parents,

如果不能保证父母的生命

you cannot guarantee the security of the African child.

那么孩子的生命也岌岌可危

What are the risk factors?

心脏病的诱因有哪些

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

众所周知，所以我就不多说了

These are just for information:

大概就是这些：

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

高血压，糖尿病，肥胖症，缺乏锻炼，这些都是最常见的诱因

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

在坦桑尼亚，30%的人有高血压

20 percent are getting treated.

其中20%在治疗中

Only less than one percent are adequately treated.

但只有不到1%的人经历过完整、彻底的治疗

If we can treat hypertension alone in Africa,

如果仅治疗非洲人的高血压

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

每年就能挽回25万人的生命，这个数字很可观

Easy to treat. Look at the situation in Mauritius.

高血压其实蛮好治疗的。看看毛里求斯人民的处境

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

在未来短短的8年内，艾滋病和疟疾

which is all good.

都不会造成什么重大影响

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

请不要再重蹈我们对待艾滋病和疟疾的覆辙

In eight short years, non-communicable diseases

在未来短短的8年内，非传染性疾病

will become the leading causes of death in Africa.

将会成为非洲大陆上的主要致死疾病

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

我们必须牢记这一点，我们不能像这样对待病人

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

这是一所典型的非洲医院。我们不能指望那些精英

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

他们都离开非洲，前往美国，德国或者英国

You can't depend on foreign aid alone.

也不能就指望他国援助

Here is the situation: countries are turning inwards.

现在的各个国家都自顾不暇

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

就拿9/11来说，美国国内一片慌乱，

to deal with, their own internal issues.

自然把精力都集中在国内事务上

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

以妥善解决这些问题

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

帮助非洲并不是他们的责任

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

但是我的责任，我要努力处理好这些问题

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

如果他们能够提供帮助，那当然好，但这并不能达到我的期望

These worsening indices of health care or health studies in Africa

非洲越来越低的医疗保健指数和越来越少人关注的医疗研究状况

demand a new look. We cannot keep on doing things

必须改变，我们不能一直

the way we've always done them.

停滞不前

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

如果办法不奏效，我们必须找到其他有用的办法替代

I'm here to talk to you about solutions.

我要说的是解决方法，如何改善当前这个局面

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

这是令我们头疼的问题

Several years ago, we started thinking about it.

几年前，我们就开始研究这方面的问题

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

每个人都知道症结所在，但没人知道对症下药

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

我们决定要把钱花在刀刃上

Everyone is ready to throw in money,

当有人免费援助发展中国家的时候

in terms of free money aid to developing countries.

每个人都兴奋不已

Talk about sustainable investment, no one is interested.

.但说到持续投资，却没人回应

You can't raise money.

这样是筹不到钱的

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

我在美国有从事医疗保健方面的业务

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

我住在田纳西州的纳什维尔，那里是美国医疗保健的中心

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

在那从事医疗保健的企业筹款是件是件很容易的事

But start telling them, you know,

但如果告诉投资者

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

我们打算在尼日利亚开展这项业务，没人予以理睬

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

其实这种想法是完全错误的，现场的观众，

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

如果你们想要帮助非洲，就要持续投资

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

我来带你们看看心脏研究所一天的运作情况

so you get a glimpse of what we do,

让你们了解我们所做的

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

然后我再说点有关这个

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

我们在发展中国家建立了一所

comparable to the best anywhere in the world,

足以媲美世界上顶级医疗保健中心的

can be done in a developing country environment.

高质量的医疗中心

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

这个中心现在设有25个岗位，每个上岗人员

board certified in the USA, Canada or Britain.

都在美国、加拿大活英国经过培训，并取得证书

We have every modality that can be done in Vanderbilt,

我们拥有范德毕特大学,

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

克利夫兰诊所，甚至是美国其他所有的地方都能做的模态分析系统

and we do it for about 10 percent of the cost

但我们的收费只有

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

美国的十分之一

(Applause)

（掌声）

Additionally, we have a policy

另外，我们还有一个规定，

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

不能以支付能力为由将人拒之门外

We take care of everyone.

我们帮助所有需要帮助的人

(Applause)

（掌声）

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

你只有1美元或2美元，都没关系

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

让我告诉你们这一切是如何办到的

We make sure that we select our equipment properly.

确保选择正确的仪器

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

选择具有模块化单元的仪器。各个单元都能实现多模融合（不同成像方式的图像融合）,

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

含有模块化组件。易于修理，因此

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

我们选择的仪器都是耐用的

We emphasize training,

在我们这里，培训是重点

and we make sure that this process is regenerative.

我们确保培训这一环节能够不断地传承下去，

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

不久的将来，我们这一任将会老死离去，但除非

unless we have people taking over from where we stopped.

我们找到继任者，将我们的志愿继承发扬，否则问题依然存在

We made sure that we produced some things ourselves.

我们确保自产自用

We do not buy unit doses of radiopharmaceuticals.

不是从别处购买单位计量的放射性药物

We get the generators from the companies.

而是买来生产机器

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

进行内部生产，这样就降低了成本

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

因此，在美国要花

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

250美元才能买到单位计量的放射性药物

when we're finished manufacturing it in-house,

在我们这边内部生产的

we come at a price of about two dollars.

只要花2美元

(Applause)

（掌声）

We recognize that the only way to bridge the gap

我们意识到要缩短

between the rich and poor countries

富国和穷国的差距

is through education and technology.

必须通过教育和科技

All these problems we're talking about --

如果能够取得发展，

if we bring development, they will all disappear.

所有这些刚刚说到的问题都会迎刃而解

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

科技起的作用举足轻重，我们又是如何利用科技的？

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

事实证明：自我保健具有成本效益

It extends opportunity to the rural centers,

能够拓展农村市场的机会

and we can use expertise in a very smart way.

通过巧妙地运用自我保健专业知识

This is the way our centers are set up.

我们建立了自己的医疗中心

We currently have three locations in the Caribbean,

目前我们在加勒比海有三家医疗中心

and we're planning a fourth one.

第四家的开业正在筹备中

And we have now decided to go into Africa.

并且我们决定要进军非洲

We will be doing the West African Heart Institute

在尼日利亚的哈科特港

in Port Harcourt, Nigeria. That project will be starting

我们要建立西非心脏研究所，这个项目将在

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

接下来的几个月内启动，我们希望2008-09年就能正式投入运营

And we will do other centers.

我们还会继续筹划更多的研究中心

This model can be adapted to every disease process.

这个模式适用于每个疾病治疗流程

All the units, all the centers, are linked

所有的环节，所有的研究中心，

through a switched hub to a central server,

通过交换式集线器连接到一个中央服务器上

and all the images are populated to review stations.

所有的图像都能在视图站中看到

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

我们设计了这个远程医疗方案，这是我们的专利

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

我们愿意跟其他人分享这一切

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

并同时使他们保持盈利

We make sure that the telemedicine platform gives access

只需点击鼠标

to expert medical specialists anywhere in the world,

远程医疗系统就能

just by a click of the button.

连接上世界各地的医学专家

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

现在我们看看这整套流程

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

这是心脏研究所，世界各地的医生都能登录

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

我可以在瑞士打电话给你，“请登录我们的系统，

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

看看琼斯太太的诊断图，告诉我们你的建议。”

They'll give me that information,

医生们就会据此给出一些讯息

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

有了这些专家的讯息，病人的治疗就更有保障

The patient doesn't have to travel.

病人们不需要长途跋涉

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

不会因为缺乏专家意见

because of limited expertise.

而焦躁不安

We also use [an] electronic medical record system.

我们还有一套电子病历系统

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

我很自豪地告诉你们，在美国，80%的医疗手段中还没能采取

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

这些应用在研究中心的技术

But you know, they have that luxury.

但是美国人有条件

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

如果纳什维尔治不了，可以去伯明翰

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

只有两小时的路程而已；如果克利夫兰治不了，

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

可以去辛辛那提，但非洲人民没有这种条件

so we have to make it happen.

因此我们只能通过科技来改变这种状况

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

同时降低看病的成本

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

我们要把业务拓展到农村地区，并且使当地人都能负担得起

And everyone will get the care they deserve.

每个人都能得到治疗

It cannot just be technology, we recognize that.

但我们意识到仅仅依靠科技是不够的

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

预防也是我们所强调的解决方案

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

但一定要是切合实际的

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

你可以跟病人说将要进行的治疗花费高昂

and they go home and can't do it.

可这么说只能导致他们回家，因为负担不起

They need to be alive, they need to feed.

他们需要活命，需要养家糊口

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

我们推荐运动，因为运动是最有效、最简单的预防疾病的方法

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

每年的三月和四月是“行走月”

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

我们将病人分组，让他们互相竞赛

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

减重最多的那组将得到奖励

Which groups record more walking distance by pedometer,

通过计步器计算出的行走最多的那组

we give them prizes. We do this constantly.

也会得到奖励，我们一直支持这项活动

We encourage them to bring children.

同时我们也鼓励病人带上孩子一起运动

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

从小就给孩子灌输

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

锻炼身体预防疾病的观念，一旦孩子们有了这种观念

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

他们就会坚持锻炼。通过开展这项活动

at least 100 skilled jobs in Jamaica alone,

仅在牙买加，我们就创造了至少100个技术类工作

and these are physicians with expertise and special training.

这些医师经过特别培训，具有专业的医学知识

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

我们挽回了1000多个十分贫困的病人的生命

including four free pacemakers in patients

包括为四个患有完全性心传导阻滞的病人

with complete heart block. For those that understand cardiology,

免费提供心脏起搏器。对于了解心脏病学的人来说

complete heart block means certain death.

完全性心传导阻滞意味着濒临死亡

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

如果没有心脏起搏器，病人将会死亡

So we are pleased with that.

能帮助病人我们觉得很欣慰

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

因为病人们无需飞到迈阿密活亚特兰大看病

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

我们间接替牙买加政府省了500万美元

And we've hopefully saved a lot of lives.

而且我们有能力挽救很多生命

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

到今年末，我们在贫困病人的治疗上

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

已经投入了100多万美元。前四个月投入34万美元

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

平均下来每月8万5。政府就没法给予这么大力度的支持

because they have competing needs.

需要资金的地方很多

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

政府只能拨款给其他更需要的方面。但我们就不同了，我们能够支持这方面的发展

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

人们问：”你们怎么能做到？” 我们就是做到了

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

至少4000个打算前往迈阿密看病的有钱人

have self-confessed that they did not go to Miami

承认他们实际上没去

because of the Heart Institute of the Caribbean.

因为加勒比海有一个心脏研究所

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

如果他们去迈阿密，那么花费将是

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

现在同等医疗水平的8至10倍，

getting the same quality of care.

他们很开心可以将省下来的这笔钱花在家庭开销上

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

省下的这笔钱

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

可以囊括至少4个付不起医药费的

that do not have the resources to pay.

病人的治疗费用

(Applause)

（掌声）

For this to work, this progress must be sustainable.

但关键是，我们必须持之以恒地支持这方面事业

So, we emphasize training. Training is critical.

我们强调培训，培训是十分重要的

We have gone further: we have formed a relationship

我们不满足于现状，我们与

with the University of Technology, Jamaica,

牙买加的理工大学建立了合作关系

where I now have an appointment.

现在我手头上就有一个合同

And we are starting a biomedical engineering program,

我们开展一个生物医学工程项目

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

这样就能在当地进行培训，让工作人员学会修理仪器

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

我们就不用处理机器淘汰之类的问题

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

我们还开展了辅助医疗技术培训

training people in echocardiography, cardiac ultrasound,

例如超声心动图，心脏超声检查等

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

通过这类培训

it gives people motivation.

能够鞭策员工

Because now they will get a bachelors degree in medical imaging

因为他们能够获得医学成像学士学位

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

现在我想让你们听听

from the trainees themselves what it has meant for them.

我们的培训学员是怎么说的

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

（视频）Jason Topping 医生：我是Jason Topping

I'm a senior resident in anesthesia in intensive care

来自西印度大学医院

at the University Hospital of the West Indies.

是重症监护方面的高级麻醉医师

I came to the Heart Institute in 2006,

2006年来到这个心脏研究所

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

因为我有麻醉学和重症监护方面的选修课程

I spent three months at the Heart Institute.

我在心脏研究所待了3个月

There's been no doubt around my colleagues

我的同事都

about the utility of the training I received here,

对我在这里所受的培训给予肯定

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

我认为现在

particularly in echocardiography and its use in our setting.

超声心动图及其在我们的实际应用中的关注率日益增加

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

Sharon Lazarus: 我是加勒比海心脏研究所的一名超声心动图操作员

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

在过去的两年里，我一直都在所里接受培训

I think this aspect of training in cardiology

我认为研究所在牙买加

that the Heart Institute of the Caribbean has introduced in Jamaica

引进的这方面的培训

is very important in terms of diagnosing cardiac diseases.

对诊断心脏疾病能起到非常重要的作用

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

但是最关键的是我们的培训能够进行并且持续下去

and you can make it possible for everyone.

为人们提供帮助

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

谁说穷人就不能享受最好的治疗

When have you been appointed to play God?

谁规定你就得扮演上帝，帮助他人

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

我做不了决定，但我的任务就是确保每个人

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

无论贫富贵贱，都能享有同等机会

to get the best quality health care in life.

接受最好的治疗

Next stop is West African Heart Institute,

我们下一步计划是

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

在尼日利亚哈科特港

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

开一个西非心脏研究所

We will extend the same system into other areas,

当然也会在其他地区设立同样的研究机构

like dialysis treatment.

例如透析治疗研究所

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

任何人如果对医疗保健方面感兴趣

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

我们乐于协助你们，并分享我们的经验

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

帮助你们达成。如果大家共同致力于这方面

we can change the face of health care in Africa.

非洲的医疗保健水平定将发生翻天覆地的变化

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

非洲养育了我们，是时候轮到我们回报它了

I am going. Those who want to come,

我将投身于改善非洲的医疗保健事业，志同道合的朋友们

I welcome you to come along with me.

欢迎你们加入我，让我们同行。

Thank you.

谢谢

(Applause)

（掌声）