Sonia Shah: 3 reasons we still haven't gotten rid of malaria

185,057 views ・ 2013-09-12

TED


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翻译人员: Guangqiu Shen 校对人员: Tingting Zhao
00:12
So over the long course of human history,
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在漫长的人类历史中,
00:16
the infectious disease that's killed more humans
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疟疾是
00:18
than any other is malaria.
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致死率最高的传染性疾病。
00:21
It's carried in the bites of infected mosquitos,
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它由受感染的蚊子叮咬传播,
00:24
and it's probably our oldest scourge.
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可能是人类最古老的灾难了。
00:26
We may have had malaria since we evolved from the apes.
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从人猿时代起疟疾可能就已经存在了。
00:30
And to this day, malaria takes a huge toll on our species.
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直至今天,疟疾已经夺去了许多许多人的生命。
00:33
We've got 300 million cases a year
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每年有3亿人疟疾患者,
00:36
and over half a million deaths.
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其中有超过50万人死亡,
00:39
Now this really makes no sense.
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这真让人匪夷所思。
00:42
We've known how to cure malaria
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自17世纪起,
00:44
since the 1600s.
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我们就已经知道如何治疗疟疾。
00:46
That's when Jesuit missionaries in Peru
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耶稣会传教士在秘鲁
00:48
discovered the bark of the cinchona tree,
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发现金鸡纳树的树皮。
00:51
and inside that bark was quinine,
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金鸡纳树树皮中的奎宁可以治疗疟疾,
00:53
still an effective cure for malaria to this day.
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这种方法至今有效。
00:56
So we've known how to cure malaria for centuries.
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所以,我们知道如何治疗疟疾已经有几个世纪的时间了。
00:59
We've known how to prevent malaria since 1897.
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从1897年开始,我们就知道如何预防疟疾。
01:02
That's when the British army surgeon Ronald Ross
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那时英国军队外科医生罗纳德-罗斯
01:05
discovered that it was mosquitos that carried malaria,
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发现了是蚊子传染疟疾,
01:08
not bad air or miasmas, as was previously thought.
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而不是之前认为的空气质量或雾霾问题
01:12
So malaria should be a relatively simple disease to solve,
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所以,疟疾应该是一种容易攻克的疾病,
01:18
and yet to this day, hundreds of thousands of people
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但直到今天,仍然有成千上万的人
01:22
are going to die from the bite of a mosquito.
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因为被一只蚊子叮咬而丧命。
01:25
Why is that?
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为什么呢?
01:26
This is a question that's
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这是一个很长时间以来
01:28
personally intrigued me for a long time.
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一直在困惑我的一个问题。
01:30
I grew up as the daughter of Indian immigrants
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我来自一个印度移民家庭,
01:33
visiting my cousins in India every summer,
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每年夏天,我会去印度看望我的表兄弟姐妹们,
01:35
and because I had no immunity to the local malarias,
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因为我对当地的疟疾没有免疫力,
01:38
I was made to sleep under this hot, sweaty mosquito net every night
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每晚我不得不睡在那种非常闷热的蚊帐里,
01:42
while my cousins, they were allowed to sleep
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但我的表兄弟姐妹们却可以被允许
01:44
out on the terrace and have
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在露台上睡觉,
01:45
this nice, cool night breeze wafting over them.
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享受从他们身上吹佛而过的舒爽夜风。
01:48
And I really hated the mosquitos for that.
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因为这个,我特别痛恨蚊子。
01:52
But at the same time, I come from a Jain family,
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但与此同时,我也是来自一个耆那教的家庭,
01:55
and Jainism is a religion that espouses
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耆那教是一个极其信奉
01:57
a very extreme form of nonviolence.
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非暴力形式的宗教。
02:00
So Jains are not supposed to eat meat.
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所以,耆那教徒不吃肉。
02:04
We're not supposed to walk on grass,
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不能在草地上走,
02:06
because you could, you know,
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因为那样的话
02:07
inadvertently kill some insects when you walk on grass.
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你无意中会杀死一些昆虫。
02:09
We're certainly not supposed to swat mosquitos.
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当然,我们也不能打蚊子。
02:12
So the fearsome power of this little insect
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所以,这小小的昆虫所拥有的如此可怕的力量,
02:15
was apparent to me from a very young age,
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在我很小时候就令我印象深刻,
02:17
and it's one reason why I spent five years as a journalist
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而这也是为什么我作为一名记者
02:20
trying to understand, why has malaria
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花了五年时间去尝试了解
02:23
been such a horrible scourge for all of us for so very long?
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为什么疟疾会成为人类持续的灾难。
02:28
And I think there's three main reasons why.
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我认为主要有三个原因,
02:30
Those three reasons add up to the fourth reason,
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这三个原因共同导致第四个原因,
02:33
which is probably the biggest reason of all.
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而这第四个可能就是其中的主导因素。
02:36
The first reason is certainly scientific.
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第一个原因是科学相关的。
02:39
This little parasite that causes malaria,
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这种引起疟疾的小小的病原寄生虫,
02:41
it's probably one of the most complex
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可能是人类已知的最复杂
02:43
and wily pathogens known to humankind.
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最狡猾的病原体之一。
02:45
It lives half its life inside the cold-blooded mosquito
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它生命的一半时间生活在冷血动物――蚊子体内,
02:49
and half its life inside the warm-blooded human.
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另一半生命则生活在恒温动物――人类体内。
02:53
These two environments are totally different,
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这是两种完全不同的环境,
02:56
but not only that, they're both utterly hostile.
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而且它们在两种环境下都是有害的。
02:59
So the insect is continually trying to fight off the parasite,
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因此,昆虫不断试图击退寄生虫,
03:03
and so is the human body continually trying to fight it off.
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人类的身体也不断地尝试抵抗它。
03:06
This little creature survives under siege like that,
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这种小小的生物体正是在这种围困下生存下来,
03:10
but not only does it survive, it has thrived.
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而且还在蓬勃发展。
03:13
It has spread. It has more ways to evade attack than we know.
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它拥有超过我们想象的更多方法来逃避攻击,继而传播蔓延。
03:17
It's a shape-shifter, for one thing.
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就某一方面而言,这是一种蜕变。
03:19
Just as a caterpillar turns into a butterfly,
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就像一条毛毛虫变成一只蝴蝶,
03:23
the malaria parasite transforms itself like that
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疟疾寄生虫在其生命中有7次
03:25
seven times in its life cycle.
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这样的蜕变。
03:28
And each of those life stages not only looks totally different from each other,
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各个生命阶段不只形态迥异,
03:33
they have totally different physiology.
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而且都有完全不同的生理状态。
03:36
So say you came up with some great drug
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所以,当你找到一种很强大的药物
03:38
that worked against one stage of the parasite's life cycle.
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来对抗这种疟疾寄生虫生命周期的某一个阶段,
03:41
It might do nothing at all to any of the other stages.
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但对其他生命阶段可能完全无效。
03:44
It can hide in our bodies, undetected,
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它隐藏在我们的体内,不被发现,
03:47
unbeknownst to us, for days, for weeks,
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瞒着我们,几天、几个星期、
03:49
for months, for years, in some cases even decades.
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几个月、几年,有时甚至是几十年。
03:53
So the parasite is a very big scientific challenge to tackle,
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所以这种疟疾寄生虫对科学研究而言形成巨大挑战,
03:58
but so is the mosquito that carries the parasite.
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携带疟疾寄生虫的蚊子也如此。
04:01
Only about 12 species of mosquitos
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只有大约12种的蚊子
04:03
carry most of the world's malaria,
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携带了世界上大部分的疟疾,
04:05
and we know quite a bit about the kinds of
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我们知道
04:07
watery habitats that they specialize in.
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它们擅长生活在有水的栖息地。
04:10
So you might think, then, well, why don't we just
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所以,你可能会认为,
04:13
avoid the places where the killer mosquitos live? Right?
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我们可以避开蚊子滋生的地方,对吧?
04:16
We could avoid the places where the killer grizzly bears live
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我们可以不接近凶猛灰熊的住地
04:18
and we avoid the places where the killer crocodiles live.
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也可以远离凶悍鳄鱼的活动区域。
04:21
But say you live in the tropics
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但如果你生活在热带地区
04:24
and you walk outside your hut one day
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某天你在自家的房屋外面走
04:27
and you leave some footprints in the soft dirt
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脚印留在了
04:29
around your home.
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门口的泥土上。
04:31
Or say your cow does, or say your pig does,
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又或是你的牛或猪在土中留下了一些蹄印,
04:35
and then, say, it rains,
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然后,下雨了,
04:37
and that footprint fills up with a little bit of water.
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那些印记里积满了水。
04:39
That's it. You've created the perfect
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就这样,你已经为那些疟疾蚊子
04:41
malarial mosquito habitat that's right outside your door.
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在你家门口打造了完美的栖息地。
04:45
So it's not easy for us to extricate ourselves from these insects.
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所以说,我们要摆脱这些昆虫并不容易。
04:48
We kind of create places that they love to live
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我们生活,
04:50
just by living our own lives.
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其实也在为它们创建合适的生活环境。
04:52
So there's a huge scientific challenge,
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所以,这对科学来说是个巨大挑战,
04:54
but there's a huge economic challenge too.
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对于经济来说,也同样是一个巨大挑战。
04:56
Malaria occurs in some of the poorest
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疟疾发生在地球上那些最贫穷的
04:58
and most remote places on Earth,
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和最偏僻的地方,
05:00
and there's a reason for that.
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这是有原因的。
05:02
If you're poor, you're more likely to get malaria.
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如果你很穷,你更有可能患上疟疾。
05:04
If you're poor, you're more likely to live
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因为你的贫穷使你更可能生活
05:06
in rudimentary housing on marginal land that's poorly drained.
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在贫瘠偏远地区简陋的房屋中,那里的排水往往不好,
05:10
These are places where mosquitos breed.
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也正是是滋生蚊子的好地方。
05:13
You're less likely to have door screens or window screens.
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你不太可能有门或窗户的屏障。
05:17
You're less likely to have electricity
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你不太可能有电
05:19
and all the indoor activities that electricity makes possible,
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所有通过电力所产生的室内活动都不太可能有,
05:22
so you're outside more.
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所以你会更多在户外待着,
05:23
You're getting bitten by mosquitos more.
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更多地被蚊子叮咬。
05:25
So poverty causes malaria,
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所以说贫穷导致疟疾。
05:27
but what we also know now is that malaria itself
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但我们也知道
05:30
causes poverty.
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疟疾本身也会导致贫困。
05:31
For one thing, it strikes hardest during harvest season,
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一方面,疟疾爆发最严重的时间是在收获季节,
05:34
so exactly when farmers need to be out in the fields
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说以正当农民要在田地里收割庄稼的季节
05:37
collecting their crops, they're home sick with a fever.
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他们经常会发烧生病在家。
05:41
But it also predisposes people to death
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当然这也容易引起其它疾病
05:44
from all other causes.
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最终导致死亡。
05:45
So this has happened historically.
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所以,过去我们已经有能力
05:47
We've been able to take malaria out of a society.
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将疟疾从人类社会中铲除。
05:50
Everything else stays the same,
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但其他一切却仍保持不变,
05:52
so we still have bad food, bad water, bad sanitation,
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我们的食品安全、饮用水安全以及公共卫生都没有改善
05:54
all the things that make people sick.
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所有这些都会让人生病。
05:56
But just if you take malaria out,
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但是,只要你清除了疟疾,
05:58
deaths from everything else go down.
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其它因素致死的情况也会减少。
06:02
And the economist Jeff Sachs has actually quantified
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经济学家杰夫-萨克斯对这一问题导致的社会影响
06:05
what this means for a society.
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进行过量化分析
06:07
What it means is, if you have malaria in your society,
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这意味着,如果有疟疾存在,
06:10
your economic growth is depressed
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社会经济增长
06:12
by 1.3 percent every year,
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会因为这一种疾病
06:16
year after year after year, just this one disease alone.
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每年减少1.3%,
06:20
So this poses a huge economic challenge,
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这必然带来巨大的经济挑战。
06:22
because say you do come up with your great drug
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因为即便你有好的药品
06:25
or your great vaccine -- how do you deliver it
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或者强大的疫苗
06:27
in a place where there's no roads,
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但对于一个车都不通
06:29
there's no infrastructure,
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没有基础设施
06:31
there's no electricity for refrigeration to keep things cold,
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没有电力制冷来低温保存物品
06:34
there's no clinics, there's no clinicians
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没有诊所,也没有临床医生的地方,
06:37
to deliver these things where they're needed?
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你如何把它们发送到那里去?
06:39
So there's a huge economic challenge in taming malaria.
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所以,在制服疟疾时我们面临巨大的经济挑战。
06:43
But along with the scientific challenge and the economic challenge,
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在面临科学和经济挑战时,
06:46
there's also a cultural challenge,
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我们还面临文化方面的挑战,
06:48
and this is probably the part about malaria
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这大概是疟疾
06:51
that people don't like to talk about.
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让人们常常讳莫如深的那个方面。
06:54
And it's the paradox that the people
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悖论在于:世界上疟疾最多的地方,
06:56
who have the most malaria in the world
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也是疟疾最不受重视
06:58
tend to care about it the least.
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最不被在乎的地方。
07:01
This has been the finding of medical anthropologists again and again.
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医学人类学家的发现已经一次次的证明过这一点。
07:04
They ask people in malarious parts of the world,
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他们问世界上疟疾流行地区的人们,
07:07
"What do you think about malaria?"
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"你怎么看疟疾这件事?"
07:09
And they don't say, "It's a killer disease. We're scared of it."
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他们不会说,"它是一种致命的疾病。我们害怕它。”
07:13
They say, "Malaria is a normal problem of life."
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他们说,"疟疾是一个正常的生活问题"。
07:18
And that was certainly my personal experience.
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那的确也是我的亲身经历。
07:20
When I told my relatives in India
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当我告诉我在印度的亲人们
07:22
that I was writing a book about malaria,
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我正在写一本关于疟疾的书
07:24
they kind of looked at me like
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他们看我的眼神,
07:26
I told them I was writing a book about warts or something.
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好像我写的是一本关于瘊子之类的书。
07:28
Like, why would you write about something so boring,
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仿佛在问,那么无聊的话题,你也写啊!?
07:31
so ordinary? You know?
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这太平常了,知道吗?
07:33
And it's simple risk perception, really.
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它真是一个简单的风险认知。
07:36
A child in Malawi, for example,
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比如,有一个来自马拉维的小孩,
07:38
she might have 12 episodes of malaria before the age of two,
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两岁之前就已经得过12次疟疾,
07:43
but if she survives,
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但是,如果她活下来了,
07:45
she'll continue to get malaria throughout her life,
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她的一生都将不停地患上疟疾,
07:48
but she's much less likely to die of it.
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但因此致死的可能性会越来越小。
07:50
And so in her lived experience,
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所以在她的生活里,
07:52
malaria is something that comes and goes.
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疟疾不过是为来来去去的访客。
07:56
And that's actually true for most of the world's malaria.
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对于世界上大部分的疟疾来说的确是这样的。
07:58
Most of the world's malaria comes and goes on its own.
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世界上大部分的疟疾都是自己来自己去。
08:01
It's just, there's so much malaria
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只是,疟疾病例如此之多
08:04
that this tiny fraction of cases that end in death
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一起起致死的病例加起来,
08:08
add up to this big, huge number.
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也就累积成巨大的数字。
08:11
So I think people in malarious parts of the world
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所以,我认为在世界上疟疾流行地区的人们
08:13
must think of malaria the way
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看待疟疾的态度
08:15
those of us who live in the temperate world
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就和我们这些生活在温带地区的人们看待
08:16
think of cold and flu. Right?
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感冒和流感一样。对吧?
08:18
Cold and flu have a huge burden on our societies
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感冒和流感对我们的社会和我们的生活
08:22
and on our own lives,
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造成了巨大的负担,
08:24
but we don't really even take
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但我们并不会
08:25
the most rudimentary precautions against it because
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考虑采取一些哪怕是最基本的防范措施,
08:27
we consider it normal to get cold and flu
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因为我们认为它们只不过是普通的疾病,
08:30
during cold and flu season.
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就像在感冒和流感季节中常见的感冒和流感一样。
08:32
And so this poses a huge cultural challenge in taming malaria,
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所以,这对驯服疟疾带来了巨大的文化挑战。
08:37
because if people think it's normal to have malaria,
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因为,如果人们认为患上疟疾是正常的,
08:41
then how do you get them to run to the doctor
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那么,你怎么能让他们跑到医生那里
08:44
to get diagnosed, to pick up their prescription,
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去治疗,开处方
08:47
to get it filled, to take the drugs,
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拿药
08:49
to put on the repellents, to tuck in the bed nets?
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用上驱蚊用品,躺到蚊帐中去呢?
08:52
This is a huge cultural challenge in taming this disease.
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这的的确确是一个巨大的文化挑战。
08:57
So take all that together.
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所以把这些因素都凑在一起,
08:58
We've got a disease. It's scientifically complicated,
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我们可以说,
09:03
it's economically challenging to deal with,
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疟疾在医学上很复杂,在经济上的挑战也不好处理,
09:05
and it's one for which the people who stand
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那些最该关注此疾病的人们
09:07
to benefit the most care about it the least.
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却对它不加重视
09:09
And that adds up to the biggest problem of all,
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这所有一切加总起来,就导致了最大问题,
09:11
which, of course, is the political problem.
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当然,就是政治问题。
09:14
How do you get a political leader to do anything
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政治领导人要怎样
09:17
about a problem like this?
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才能为这类问题做一些什么呢?
09:19
And the answer is, historically, you don't.
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答案是,从历史上看,不能。
09:24
Most malarious societies throughout history
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在整个历史上,大部分疟疾流行的社会
09:26
have simply lived with the disease.
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就是简单地和这种疾病共存。
09:28
So the main attacks on malaria have come
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所以疟疾面对的主要攻击来源于
09:30
from outside of malarious societies,
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外部社会因素,
09:33
from people who aren't constrained
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来自于那些
09:34
by these rather paralyzing politics.
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不受制于此类瘫痪政治的人们。
09:37
But this, I think, introduces a whole host of other kinds of difficulties.
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但我觉得这一点必然会导致一系列各式各样的问题。
09:41
The first concerted attack against malaria
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第一次针对疟疾的协力防治
09:43
started in the 1950s.
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开始于20世纪50年代,
09:45
It was the brainchild of the U.S. State Department.
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耗费了美国国务院不少心血,
09:48
And this effort well understood the economic challenge.
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在此期间也充分考虑了经济面临的挑战。
09:51
They knew they had to focus on cheap, easy-to-use tools,
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他们知道必须着眼于便宜、 便捷的工具,
09:54
and they focused on DDT.
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所以着力使用了滴滴涕(译者注:DDT,一种杀虫剂)。
09:56
They understood the cultural challenge.
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他们也理解了文化面临的挑战。
09:58
In fact, their rather patronizing view was that
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事实上,当时的观点十分照顾病人,人们认为
10:01
people at risk of malaria shouldn't be asked to do anything at all.
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不能向处于感染疟疾风险之中的人们提什么要求,
10:04
Everything should be done to them and for them.
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只要为他们采取一切可能采取的措施就行了。
10:07
But they greatly underestimated the scientific challenge.
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但他们大大低估了科学所面临的挑战。
10:10
They had so much faith in their tools
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他们对他们的工具如此有信心
10:13
that they stopped doing malaria research.
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以至于他们停止了对疟疾的研究,
10:16
And so when those tools started to fail,
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因此,当这些工具失败的时候,
10:18
and public opinion started to turn against those tools,
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公众的舆论开始反对,
10:21
they had no scientific expertise to figure out what to do.
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而他们没有专业的科学知识可以应对这些。
10:25
The whole campaign crashed, malaria resurged back,
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整个运动残败,疟疾又死灰复燃、卷土重来了,
10:29
but now it was even worse than before
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而且甚至比先前更猛烈
10:30
because it was corralled into the hardest-to-reach places
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因为它已经以最难控制的形式,
10:33
in the most difficult-to-control forms.
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抢占了我们最难接触到的地方。
10:36
One WHO official at the time actually called that whole campaign
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那时一位世界卫生组织的官员称那整个运动是
10:40
"one of the greatest mistakes ever made in public health."
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"在公共卫生领域所做犯过的最大错误之一"。
10:45
The latest effort to tame malaria started in the late 1990s.
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1990年代后期,新一轮驯服疟疾的运动启动了,
10:47
It's similarly directed and financed primarily
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它的指导和经济支持
10:51
from outside of malarious societies.
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仍然来源于疾病肆掠的社会之外。
10:53
Now this effort well understands the scientific challenge.
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这次努力很好的理解了科学所面临的挑战,
10:56
They are doing tons of malaria research.
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他们做了无数的疟疾研究。
10:58
And they understand the economic challenge too.
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他们也很了解经济面临的挑战,
11:00
They're focusing on very cheap, very easy-to-use tools.
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主要集中在便宜、易用的工具上。
11:04
But now, I think, the dilemma is the cultural challenge.
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但是却遇上了文化方面的困境。
11:08
The centerpiece of the current effort is the bed net.
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目前主要的努力是利用蚊帐,
11:11
It's treated with insecticides.
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它是用杀虫剂处理过的。
11:13
This thing has been distributed across the malarious world
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这个蚊帐已在疟疾流行地区
11:15
by the millions.
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发放了数百万件。
11:17
And when you think about the bed net,
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当你想到蚊帐时,
11:19
it's sort of a surgical intervention.
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它就像某种外科手术。
11:22
You know, it doesn't really have any value
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你知道,除了有助于防止疟疾外,
11:24
to a family with malaria except that it helps prevent malaria.
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它对一个已经患上疟疾的家庭来说真的没有任何意义。
11:27
And yet we're asking people to use these nets every night.
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我们还会要求人们
11:31
They have to sleep under them every night.
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每晚都必须睡在蚊帐当中,
11:33
That's the only way they are effective.
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这是唯一有效的途径。
11:35
And they have to do that
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他们不得不这样做
11:36
even if the net blocks the breeze,
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即便这些蚊帐挡住了风,
11:39
even if they might have to get up in the middle of the night
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他们有可能不得不
11:42
and relieve themselves,
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在深夜起床透透气,
11:44
even if they might have to move all their furnishings
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他们可能需要移动他们所有的家具
11:46
to put this thing up,
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来把这东西挂起来,
11:48
even if, you know, they might live in a round hut
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而他们很可能住在一个圆形的小屋
11:50
in which it's difficult to string up a square net.
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很难挂起一个方形的蚊帐……
11:54
Now that's no big deal if you're fighting a killer disease.
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但所有这些麻烦,对于要与一种致命疾病抗争来说
11:59
I mean, these are minor inconveniences.
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我觉得都微不足道。
12:01
But that's not how people with malaria think of malaria.
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而患上疟疾的人们也许不这样认为
12:05
So for them, the calculus must be quite different.
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他们有着完全不同的逻辑。
12:10
Imagine, for example, if a bunch of well-meaning Kenyans
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想象一下,如果有一群好心的肯尼亚人
12:14
came up to those of us in the temperate world and said,
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来到我们这些在温带世界生活的人面前,告诉我们说
12:16
"You know, you people have a lot of cold and flu.
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2822
"你知道,你们有很多的感冒和流感。
12:19
We've designed this great, easy-to-use, cheap tool,
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我们设计出了这个伟大的、便利的、廉价的工具,
12:22
we're going to give it to you for free.
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并愿意无偿送给你们。
12:23
It's called a face mask,
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它叫口罩,
12:25
and all you need to do is
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你们只需要
12:29
wear it every day during cold and flu season
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在感冒和流感季节来临时,
12:31
when you go to school and when you go to work."
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上班上学都戴着它。"
12:34
Would we do that?
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我们会这样做吗?
12:36
And I wonder if that's how people
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我猜想那些生活在疟疾泛滥地区的人们
12:38
in the malarious world thought of those nets
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第一次收到蚊帐的时候,
12:40
when they first received them?
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就是这么看待那些蚊帐的吧?
12:42
Indeed, we know from studies
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事实上,根据我们的调查
12:45
that only 20 percent of the bed nets
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我们第一次派发的蚊帐中只有20%
12:48
that were first distributed were actually used.
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被实际使用了,
12:51
And even that's probably an overestimate,
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甚至连这个数字也是高估的,
12:52
because the same people who distributed the nets
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因为分发蚊帐的那人回访时
12:55
went back and asked the recipients,
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问那些受助人
12:56
"Oh, did you use that net I gave you?"
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"哦,你使用我给你的蚊帐了吗?"
12:59
Which is like your Aunt Jane asking you,
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这就像你的姑妈Jane在问你,
13:01
"Oh, did you use that vase I gave you for Christmas?"
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"嘿,我圣诞节送你的礼物用了没有?"
13:04
So it's probably an overestimate.
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所以它很可能是被高估了。
13:06
But that's not an insurmountable problem.
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但这不是一个不能克服的问题。
13:10
We can do more education,
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我们可以多做教育工作,
13:11
we can try to convince these people to use the nets.
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试着说服这些人使用蚊帐,
13:14
And that's what happening now.
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而我们现在就正在这么做。
13:15
We're throwing a lot more time and money
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我们花费了更多的时间和金钱
13:17
into workshops and trainings and musicals and plays
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进行讲习和培训,还通过音乐剧和戏剧,
13:22
and school meetings,
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通过学校会议,
13:24
all these things to convince people
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所有这些努力都是为了说服人们
13:26
to use the nets we gave you.
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去使用我们送的蚊帐,
13:29
And that might work.
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这也许可能奏效。
13:31
But it takes time. It takes money.
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只是需要时间和花钱,
13:34
It takes resources. It takes infrastructure.
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需要资源和基础设施。
13:36
It takes all the things that that cheap,
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为了这便宜又简便的蚊帐
13:39
easy-to-use bed net was not supposed to be.
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我们必须大费周折。
13:42
So it's difficult to attack malaria from inside malarious societies,
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所以,在疟疾流行的社会,与疟疾的斗争很困难。
13:45
but it's equally tricky when we try to attack it
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但其实当我们试图从这些社会外部去攻击疟疾时,
13:48
from outside of those societies.
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也会遇到相同的阻碍。
13:51
We end up imposing our own priorities
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最终,我们把关注的焦点
13:52
on the people of the malarious world.
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放在了世界上疟疾流行地区的人们身上。
13:54
That's exactly what we did in the 1950s,
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这正是我们在1950年代所做的,
13:57
and that effort backfired.
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1878
而结果却是事与愿违。
13:59
I would argue today,
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今天,我想说的是,
14:00
when we are distributing tools that we've designed
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我们分发我们设计的那些
14:04
and that don't necessarily make sense in people's lives,
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3753
不一定会有意义的工具时,
14:08
we run the risk of making the same mistake again.
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我们其实在再次冒风险犯同样的错误。
14:12
That's not to say that malaria is unconquerable,
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这并不是说疟疾是不可战胜的,
14:14
because I think it is,
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我觉得它可以攻克,
14:15
but what if we attacked this disease
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只是在疾病攻关时
14:17
according to the priorities of the people who lived with it?
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我们是不是应该优先考虑那些受疟疾困扰的人们?
14:21
Take the example of England and the United States.
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举个英国和美国的例子。
14:23
We had malaria in those countries for hundreds of years,
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数百年来,在这些国家中都有疟疾,
14:26
and we got rid of it completely,
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我们已经完全摆脱了它,
14:29
not because we attacked malaria. We didn't.
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但不是因为我们攻克了疟疾,我们没有。
14:32
We attacked bad roads and bad houses
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我们攻克的其实是破旧的道路和鄙陋的住房
14:36
and bad drainage and lack of electricity and rural poverty.
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不良的排水系统,不足的电力供应和贫困的农村经济,
14:41
We attacked the malarious way of life,
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易感染疟疾的生活方式是我们攻击的目标。
14:44
and by doing that, we slowly built malaria out.
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通过这样做,我们慢慢地将疟疾驱赶出去。
14:50
Now attacking the malarious way of life,
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攻击与疟疾为伴的生活方式
14:51
this is something -- these are things people care about today.
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才是今天人们所关心的。
14:55
And attacking the malarious way of life,
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攻击与疟疾为伴的生活方式
14:57
it's not fast, it's not cheap, it's not easy,
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不是一种可以迅速见效、廉价或者容易的办法,
15:02
but I think it's the only lasting way forward.
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但却是可持续走下去的唯一选择。
15:05
Thank you so much.
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非常感谢。
15:06
(Applause)
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(掌声)
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