Bill Clinton: TED Prize wish: Let's build a health care system in Rwanda

翻译人员: Zachary Lin Zhao 校对人员: Yvonne Fu

I thought in getting up to my TED wish

在我正式阐述我的TED愿望之前，

I would try to begin by putting in perspective what I try to do

我希望可以解释一下我的追求，

and how it fits with what they try to do.

并点明我的追求是如何和这些人的追求联系在一起的。

We live in a world that everyone knows is interdependent,

众所周知，我们生活在一个息息相关彼此依存的世界，

but insufficient in three major ways.

但却在三个主要的方面存在欠缺。

It is, first of all, profoundly unequal:

首先，我们的世界是极其不平等的。

half the world's people still living on less than two dollars a day;

世界上一半人口的日均生活费用低于两美元，

a billion people with no access to clean water;

十亿人无法获取洁净的用水，

two and a half billion no access to sanitation;

二十五亿人没有基本的卫生系统，

a billion going to bed hungry every night;

十亿人每晚挨着饿睡觉。

one in four deaths every year from AIDS, TB, malaria

每四例死亡中，就有一例是因为艾滋病、肺结核、疟疾

and the variety of infections associated with dirty water --

以及其它脏水疾病所造成的疾病──

80 percent of them under five years of age.

这其中百分之八十是不满五岁的孩子。

Even in wealthy countries it is common now to see inequality growing.

即使是在富裕的国家，与日俱增的贫富差距也是变得日渐明显。

In the United States, since 2001 we've had five years of economic growth,

在美国，从2001年起，我们经历了连续五年的经济增长，

five years of productivity growth in the workplace,

五年的生产力增长，

but median wages are stagnant and the percentage of working families

但工资中位数却是停滞不前，贫困线以下的工薪家庭

dropping below the poverty line is up by four percent.

的比例上升了百分之四。

The percentage of working families without health care up by four percent.

没有医疗保险的工薪家庭比例上升了百分之四。

So this interdependent world which has been pretty good to most of us --

现今这个彼此依存的世界对我们大多数人来讲都有好处，

which is why we're all here in Northern California doing what we do

这也就是为什么我们今晚可以齐聚北加州，享受生活，

for a living, enjoying this evening -- is profoundly unequal.

但事实上，它极不平等。

It is also unstable.

与此同时，它又极不稳定。

Unstable because of the threats of terror,

不稳定的原因是多样的：恐怖袭击的威胁、

weapons of mass destruction, the spread of global disease

大规模杀伤性武器、全球范围内的疾病扩散、

and a sense that we are vulnerable to it in a way that we weren't not so many years ago.

以及一种史无前例的脆弱感。

And perhaps most important of all, it is unsustainable

但最重要的是，这个世界是不可持续的──

because of climate change, resource depletion and species destruction.

环境变化、资源匮竭、物种灭绝。

When I think about the world I would like to leave to my daughter

每当我想到我的子孙后代

and the grandchildren I hope to have,

以及我想要留给他们的世界时，

it is a world that moves away from unequal, unstable, unsustainable

我所想到的是一个从不平等、不稳定、不可持续的彼此依存

interdependence to integrated communities -- locally, nationally and globally --

迈向地区、国家、全球间互相协调的世界，

that share the characteristics of all successful communities:

一个拥有所有成功社会的特质的世界。

a broadly shared, accessible set of opportunities,

充满了面向所有人的机遇，

a shared sense of responsibility for the success of the common enterprise

以及为了人类的共同美好而努力的责任感，

and a genuine sense of belonging.

还有真正意义上的归属感。

All easier said than done.

但这一切都是说起来容易做起来难。

When the terrorist incidents occurred in the United Kingdom a couple of years ago,

当英国几年前遭受恐怖袭击的时候，

I think even though they didn't claim as many lives as we lost in the United States on 9/11,

我意识到虽然他们当时丧失的生命并没有美国9-11袭击中的那么多，

I think the thing that troubled the British most

但真正让英国人揪心担忧的是

was that the perpetrators were not invaders, but homegrown citizens

当时的那些犯案者并不是外来的侵略者，而是本土的公民。

whose religious and political identities were more important to them

对这些人来说，他们的宗教信仰和政治理念

than the people they grew up with, went to school with,

要比那些跟他们共同长大、一同吃饭、一起过周末的同学同事们

worked with, shared weekends with, shared meals with.

更加重要。

In other words, they thought their differences

换言之，他们认为人类彼此间的不同

were more important than their common humanity.

要比我们共有的人性更加重要。

It is the central psychological plague of humankind in the 21st century.

这就是21世纪我们人类所面临的最主要的心理瘟疫。

Into this mix, people like us, who are not in public office,

在这种状况下，我们这些不为公家工作的人

have more power to do good than at any time in history,

起到了史无前例的作用，

because more than half the world's people

因为世界上一半以上的人口

live under governments they voted in and can vote out.

可以民主地选举或是罢免他们的政府。

And even non-democratic governments are more sensitive to public opinion.

即使是那些非民主的政府，也开始更加注重民意。

Because primarily of the power of the Internet,

再有，随着互联网的日趋强大，

people of modest means can band together and amass vast sums of money

手无寸铁的人们只要志同道合，便可以聚集起来

that can change the world for some public good if they all agree.

筹集大笔的善款改变世界、播撒善行。

When the tsunami hit South Asia, the United States contributed 1.2 billion dollars.

当大海啸袭击东南亚时，美国捐赠了十二亿美元。

30 percent of our households gave.

百分之三十的家庭参与了募捐。

Half of them gave over the Internet.

其中一半是通过互联网捐赠的。

The median contribution was somewhere around 57 dollars.

捐款的中位数是在57美元左右。

And thirdly, because of the rise of non-governmental organizations.

第三个原因则是因为非政府性组织的崛起。

They, businesses, other citizens' groups, have enormous power

他们──企业家、其他公民团体，拥有着巨大的力量

to affect the lives of our fellow human beings.

来改变人们的生活。

When I became president in 1993,

当我在1993年刚当上总统的时候，

there were none of these organizations in Russia.

俄罗斯没有一个这样的组织机构。

There are now a couple of hundred thousand.

现在却有十几万个。

None in India. There are now at least a half a million active.

印度当时一个都没有。现在却至少有五十万个。

None in China. There are now 250,000 registered with the government,

中国当时一个都没有。现在却有二十五万个已经在政府注册，

probably twice again that many who are not registered for political reasons.

如果我们算上那些因为政治原因没有在政府注册的机构，这个数字可能要翻倍。

When I organized my foundation, and I thought about the world as it is

当我刚成立我的基金会的时候，我想到了我们现今的世界

and the world that I hope to leave to the next generation,

以及我希望留给下一代的世界，

and I tried to be realistic about what I had cared about all my life

我尽可能地做到切合实际，追求我生命中真正关心

that I could still have an impact on.

并且依靠我的微薄之力可以产生一些影响的事业。

I wanted to focus on activities

我希望可以卯足力气专门鼓舞如下的几项活动──

that would help to alleviate poverty, fight disease, combat climate change,

缓解贫穷、铲除疾病、阻止气候变化、

bridge the religious, racial and other divides that torment the world,

化解宗教、种族以及其他种种折磨世界的隔阂。

but to do it in a way that would either use

而开展这些活动的方式则是通过将我们已有的各项技能

whatever particular skills we could put together in our group

运用到我们的团队中

to change the way some public good function was performed

来改变一些公益活动运行的方式

so that it would sweep across the world more.

以求惠及世界的每个角落。

You saw one reference to that in what we were able to do with AIDS drugs.

其中的一个例子就是我们对艾滋药物所做的改变。

And I want to say that the head of our AIDS effort,

在这里，我想提到我们艾滋病团队的领导者

and the person who also is primarily active in the wish I'll make tonight,

并且对我今晚所要许下的愿景起着关键作用的Ira Magaziner

Ira Magaziner, is here with me and I want to thank him for everything he's done.

就在现场。我要感谢他所做的一切。

He's over there.

他就坐在那边。

(Applause)

（掌声）

When I got out of office and was asked to work, first in the Caribbean,

当我刚刚离职时，被邀请到加勒比海

to try to help deal with the AIDS crisis,

去帮忙解决当地的艾滋危机。

generic drugs were available for about 500 dollars a person a year.

当时那里治疗艾滋病的非名牌药物的价钱大概是每人每年500美元。

If you bought them in vast bulks,

如果你大量购买的话，

you could get them at a little under 400 dollars.

要花400美元不到。

The first country we went to work in, the Bahamas,

我们当时去的第一个国家，巴哈马群岛

was paying 3,500 dollars for these drugs.

那里的药物价格高达三千五百美元。

The market was so terribly disorganized

当地的药物市场极其混乱，

that they were buying this medicine through two agents

病人不得不经过两层的代理商才能买到药物，

who were gigging them sevenfold.

药物的价格因此被哄抬七倍。

So the very first week we were working,

而在我们开始工作的第一个星期，

we got the price down to 500 dollars.

就成功地把药物的价格降低到了五百美元。

And all of a sudden, they could save seven times as many lives

突然间，他们可以利用同样的财力资源

for the same amount of money.

来拯救七倍的生命。

Then we went to work with the manufacturers of AIDS medicines,

随后我们又开始和艾滋药物的制造商合作，

one of whom was cited in the film,

影片中提到了其中的一位。

and negotiated a whole different change in business strategy,

我们和他们协调磋商，希望可以发展一套全新的商业策略。

because even at 500 dollars, these drugs

因为即使是在500美元的价格，这些药物的销售仍旧是

were being sold on a high-margin, low-volume, uncertain-payment basis.

高利润、低销量，外加上不稳定的付款。

So we worked on improving the productivity of the operations

所以我们加强提高了他们营销和供应的生产力，

and the supply chain, and went to a low-margin, high-volume,

构建了一个薄利多销、付款稳定的

absolutely certain-payment business.

商业模式。

I joked that the main contribution we made

我曾开玩笑的说道，我们对于这场艾滋战役

to the battle against AIDS was to get the manufacturers

所做出的最重要的贡献，就是说服药物厂商放弃珠宝店的经营模式，

to change from a jewelry store to a grocery store strategy.

转而投靠杂货店的商业策路。

But the price went to 140 dollars from 500.

但药物价钱则是从500美元降低到140美元，

And pretty soon, the average price was 192 dollars.

不久后，平均价钱稳定在192美元。

Now we can get it for about 100 dollars.

现在我们只需大概100美元便可得到这些药物。

Children's medicine was 600 dollars,

儿童药物当时的价钱是600美元，

because nobody could afford to buy any of it.

因为没有人可以承担得起。

We negotiated it down to 190.

我们通过协商，将价钱降到190美元。

Then, the French imposed their brilliantly conceived airline tax

法国人还颁布了他们别具匠心的航空税，

to create a something called UNITAID,

创办了UNITAID，

got a bunch of other countries to help.

说服了一些其他的国家共同参与帮助。

That children's medicine is now 60 dollars a person a year.

现在儿童药物的人均价钱是每年60美元。

The only thing that is keeping us from basically saving the lives

而我们拯救生命、将药物传递给那些需要的人的梦想

of everybody who needs the medicine to stay alive

只剩下最后的一个阻隔，

are the absence of systems necessary to diagnose, treat and care

那就是体制的欠缺。我们缺少一个可以诊察、治疗、运送药物

for people and deliver this medicine.

的体制。

We started a childhood obesity initiative with the Heart Association in America.

我们曾和美国心脏协会合作，提出了一项减少儿童肥胖的倡议。

We tried to do the same thing by negotiating industry-right deals

我们也尝试将同样的理念传达给那些饮料、零食的厂商，

with the soft drink and the snack food industry to cut the caloric

通过协调磋商，来降低学校食物中

and other dangerous content of food going to our children in the schools.

卡路里的含量以及其他不健康的物质。

We just reorganized the markets.

我们因此重新整顿了市场。

And it occurred to me that in this whole non-governmental world,

我也意识到，在现今这个非政府性的世界里，

somebody needs to be thinking about organizing public goods markets.

我们需要一些人，来想办法打开公共产品的市场。

And that is now what we're trying to do,

而这正是我们当下所要做的事情。

and working with this large cities group to fight climate change,

通过和大城市中各组织的合作，来共同阻止气候变化，

to negotiate huge, big, volume deals that will enable cities

开展谈判，敦促这些

which generate 75 percent of the world's greenhouse gases,

排放世界上百分之七十五温室气体的大城市

to drastically and quickly reduce greenhouse gas emissions

采取极端快速的手段，以一种从经济学的角度来看行得通的方式，

in a way that is good economics.

来减少温室气体的排放。

And this whole discussion as if it's some sort of economic burden,

而人们为什么会把这一切当做是某种经济负担

is a mystery to me.

对我来讲是个不解的谜团。

I think it's a bird's nest on the ground.

我觉得减少温室气体将会产生巨大的利益。

When Al Gore won his well-deserved Oscar

当Al Gore（戈尔，克林期的美国副总统）的影片《难以忽视的真相》

for the "Inconvenient Truth" movie, I was thrilled,

众望所归地夺得奥斯卡时，我是无比兴奋的。

but I had urged him to make a second movie quickly.

但我也督促他抓紧时间来拍摄另一部电影。

For those of you who saw "An Inconvenient Truth,"

如果你看过《难以忽视的真相》，你应该知道

the most important slide in the Gore lecture is the last one,

戈尔的整个演讲中最重要的一张幻灯片是最后一张，

which shows here's where greenhouse gases are going

它展示了如果我们什么都不做的话，温室气体排放的走向（上升）

if we don't do anything, here's where they could go.

以及温室气体排放应该达到的走向（下降）。

And then there are six different categories

我们一共可以做六项事情

of things we can do to change the trajectory.

来改变温室气体排放的走向。

We need a movie on those six categories.

我们需要一部电影来详解这六项事情。

And all of you need to have it embedded in your brains

而你们所有人都应该将其铭记于心，

and to organize yourselves around it.

并依据它组织管理自己。

So we're trying to do that.

所以这就是我们当前正在努力做的事情之一──

So organizing these markets is one thing we try to do.

建立这些公益市场。

Now we have taken on a second thing, and this gets to my wish.

而我们正在做的另一件事情是和我的愿望相关的。

It has been my experience in working in developing countries

根据我以往在发展中国家工作的经验，

that while the headlines may all be -- the pessimistic headlines may say,

虽然报纸头条，至少那些悲观的报纸头条，总是说

well, we can't do this, that or the other thing because of corruption --

我们无法做这个、不能做那个，因为腐败泛滥，

I think incapacity is a far bigger problem in poor countries than corruption,

但我却觉得在贫穷国家，比腐败更严重的问题是无能，

and feeds corruption.

无能滋养着腐败。

We now have the money, given these low prices, to distribute

我们现在有足够的财力资源，将这些低价位的艾滋药物

AIDS drugs all over the world to people we cannot presently reach.

分给世界上那些我们现今还无法接触到的人们。

Today these low prices are available in the 25 countries where we work,

现如今，这些低价位药品可以在62个国家买到，

and in a total of 62 countries,

其中25个是我们工作的国家。

and about 550,000 people are getting the benefits of them.

大概有五十五万人因此而收益。

But the money is there to reach others.

但就算我们有这些财力来帮助人们，

The systems are not there to reach the people.

却没有相应的体制将这些利益传递给他们。

So what we have been trying to do,

对此，我们所做的尝试是──

working first in Rwanda and then in Malawi and other places --

先在卢旺达，随后在马拉维和其他地区工作，

but I want to talk about Rwanda tonight --

但我今晚主要想谈谈卢旺达──

is to develop a model for rural health care in a very poor area

我们正尝试着发展一个在贫困地区可行的乡村医疗模型，

that can be used to deal with AIDS, TB, malaria, other infectious diseases,

用来解决艾滋、肺结核、疟疾、其他传染性疾病、

maternal and child health, and a whole range of health issues

母子健康、以及其他一系列发展中国家的贫困人口

poor people are grappling with in the developing world,

正努力应付的医疗问题。

that can first be scaled for the whole nation of Rwanda,

我们希望这个模式可以首先普及到卢旺达全国，

and then will be a model that could literally

随后可以推广到

be implemented in any other poor country in the world.

世界上每一个贫困的国家。

And the test is: one, will it do the job?

而其所面临的考验则是：首先，这个模式能履行它的职责吗？

Will it provide high quality care?

能发展提供高质量的医疗保健吗？

And two, will it do it at a price

其次，这一切可以在一个低价的前提下完成吗？

that will enable the country to sustain a health care system

可以帮助贫困国家在五至十年后脱离国际援助，

without foreign donors after five to 10 years?

建立一个自给自足的医疗体系吗？

Because the longer I deal with these problems,

我和这些问题打交道的时间越长，

the more convinced I am that we have to --

就越坚信：我们必须──

whether it's economics, health, education, whatever --

不管是经济、医疗、教育还是其他的方面──

we have to build systems.

我们都必须建立好的体制。

And the absence of systems that function

而体制的欠缺

break the connection which got you all in this seat tonight.

足以摧毁让你们今晚得以坐在这里的联系。

You think about whatever your life has been,

回头想想你的人生

however many obstacles you have faced in your life,

以及你人生中所面临的种种挑战，

at critical junctures you always knew

在人生中关键的分叉口，你总是知道

there was a predictable connection between the effort you exerted

你的付出与你的收获之间

and the result you achieved.

有着一种可以预知的联系。

In a world with no systems, with chaos,

而在一个没有系统的混乱世界里，

everything becomes a guerilla struggle,

一切都将变成游击队般的挣扎，

and this predictability is not there.

所谓的预知性也自然是不复存在了。

And it becomes almost impossible to save lives,

而拯救生命、教育儿童、发展经济

educate kids, develop economies, whatever.

等等梦想都将因此而变得不可能。

The person, in my view,

在我看来，

who has done the best job of this in the health care area,

在为贫困地区建造医疗保健这一领域

of building a system in a very poor area, is Dr. Paul Farmer,

最为成功的人士就是 Paul Farmer （保罗·法默医师）。

who, many of you know, has worked for now 20 years with his group,

你们中的很多人可能听说过他。在过往二十年里，

Partners in Health, primarily in Haiti where he started,

他和他的团队Partners in Health（健康伙伴）主要是在海地工作。

but they've also worked in Russia, in Peru

但他们也曾在其他地方工作过，

and other places around the world.

比如俄罗斯和秘鲁。

As poor as Haiti is, in the area where Farmer's clinic is active --

尽管海地是一贫如洗——而且法默医师的诊所

and they serve a catchment area far greater

所覆盖的治疗区域

than the medical professionals they have would indicate they could serve --

要远远超过他们的医疗队伍所能承受的范围——

since 1988, they have not lost one person to tuberculosis, not one.

尽管如此，自从1988年起，他们手下的病患中，没有一个人死于肺结核。没有一个人。

And they've achieved a lot of other amazing health results.

除此之外，他们也取得了很多其他了不起的医疗成就。

So when we decided to work in Rwanda

因此，当我们决定在卢旺达工作，

on trying to dramatically increase the income of the country and fight the AIDS problem,

打算大幅度地增加这个国家的收入并且抗击艾滋所带来的问题时，

we wanted to build a healthcare network,

我们想到的是建立一个医疗保健体系，

because it had been totally destroyed during the genocide in 1994,

因为卢旺达的医疗体系在1994年的种族屠杀中被彻底摧毁，

and the per capita income was still under a dollar a day.

人均收入仍旧是每天不足一美元。

So I rang up, asked Paul Farmer if he would help.

所以我打电话给保罗·法默医师，问他是否可以帮助我。

Because it seemed to me if we could prove there was a model in Haiti

因为当时在我看来，如果我们可以证实有这样的一个体系

and a model in Rwanda that we could then take all over the country,

既可以在海地落实也可以在卢旺达全国性地落实，

number one, it would be a wonderful thing for a country

那么我们就可以， 其一，为这个在过往15年里遭遇了难以想象的磨难的国家

that has suffered as much as any on Earth in the last 15 years,

做一件善事，

and number two, we would have something that could then be adapted

其二，我们将拥有一套可以应用在

to any other poor country anywhere in the world.

世界上任何一个贫困国家的体系。

And so we have set about doing that.

这就是我们想达到的效果。

Now, we started working together 18 months ago.

我们在18个月前开始合作。

And we're working in an area called Southern Kayonza,

现在的工作重心是在Southern Kayonza，

which is one of the poorest areas in Rwanda,

卢旺达最贫困的地区之一，

with a group that originally includes about 400,000 people.

人口大概是四十万。

We're essentially implementing what Paul Farmer did in Haiti:

我们基本上是把保罗·法默在海地的模式应用到了这里。

he develops and trains paid community health workers

在海地，保罗发展训练了一批全职的社区医疗员工，

who are able to identify health problems,

帮助寻找健康问题、

ensure that people who have AIDS or TB are properly diagnosed

确保艾滋和肺结核患者能及时确诊

and take their medicine regularly,

并且按时服药。

who work on bringing about health education, clean water and sanitation,

同时他们也带去了医疗教育、洁净用水和卫生设备，

providing nutritional supplements and moving people up the chain of health care

提供了营养补品，并帮助那些有严重问题的患者

if they have problems of the severity that require it.

寻求更专业的治疗。

The procedures that make this work have been perfected,

这一过程，就如我之前所提到的，已经被保罗和他的队伍

as I said, by Paul Farmer and his team

通过过去20年在海地乡间工作的经验

in their work in rural Haiti over the last 20 years.

完善，并日趋完美。

Recently we did an evaluation of the first 18 months of our efforts in Rwanda.

最近，我们刚刚对过去18个月在卢旺达的努力工作进行了评估。

And the results were so good that the Rwandan government

评估的结果是如此的令人满意，以至于卢旺达的政府

has now agreed to adopt the model for the entire country,

已经同意在全国范围内实施这一体系，

and has strongly supported and put the full resources of the government behind it.

并且会提供采用政府现有的全部资源，来提供必要的支持。

I'll tell you a little bit about our team because it's indicative of what we do.

为了能让你们更好地了解我们的工作，我打算向你们更详尽地介绍我们的团队。

We have about 500 people around the world

我们在全球范围内共有500名员工

working in our AIDS program, some of them for nothing --

为我们的艾滋方案工作。他们中的一些人完全是无偿服务，

just for transportation, room and board.

只收取通勤和居住的费用。

And then we have others working in these other related programs.

除此之外，我们还有为其他相关项目工作的人员。

Our business plan in Rwanda

我们在卢旺达的工作计划

was put together under the leadership of Diana Noble,

是在Diana Noble的领导下完成的。

who is an unusually gifted woman,

她是一位不寻常的女士，

but not unusual in the type of people who have been willing to do this kind of work.

但对于做这份工作的人来讲，她又显得是那么寻常。

She was the youngest partner at Schroder Ventures in London in her 20s.

在她20岁的时候她已经是伦敦Schroder Ventures投资公司最年轻的合伙人，

She was CEO of a successful e-venture --

她也是一项非常成功的电子商业的执行总裁——

she started and built Reed Elsevier Ventures --

Reed Elsevier Ventures就是由她创办的。

and at 45 she decided she wanted to do something different with her life.

但是在她45岁的时候，她决定要做一些不一样的事情。

So she now works full-time on this for very little pay.

现如今，她为我们全职工作，却拿很少的薪水。

She and her team of former business people have created a business plan

她和她之前的商业伙伴为我们创建了一个业务计划，

that will enable us to scale this health system up for the whole country.

帮助我们把整个医疗体系发展到全国。

And it would be worthy of the kind of private equity work

而她为此所付出的努力，若放到当初，

she used to do when she was making a lot more money for it.

完全可以为她赚到一大笔钱。

When we came to this rural area, 45 percent of the children under the age of five

当我们刚刚来到这个地区的时候，五岁以下的儿童有45%

had stunted growth due to malnutrition.

因为营养不良而发育不健全。

23 percent of them died before they reached the age of five.

23%在五岁之前夭折。

Mortality at birth was over two-and-a-half percent.

初生婴儿的死亡率超过2.5%。

Over 15 percent of the deaths among adults and children occurred

超过15%的成人和儿童死亡是

because of intestinal parasites and diarrhea from dirty water and inadequate sanitation --

脏水和不完善卫生设备引发的肠道寄生以及腹泻所造成的——

all entirely preventable and treatable.

完全可以预防和治愈。

Over 13 percent of the deaths were from respiratory illnesses --

13%的死亡是呼吸疾病造成的——

again, all preventable and treatable.

同样是可以预防和治愈的。

And not a single soul in this area was being treated for AIDS or tuberculosis.

在这个地区内，没有一个艾滋或者肺结核患者得到应有的治疗。

Within the first 18 months, the following things happened:

而在我们开始的最初18个月里，如下的事情发生了：

we went from zero to about 2,000 people being treated for AIDS.

艾滋病的治疗人数从0上升到了2000，

That's 80 percent of the people who need treatment in this area.

占这个地区需要治疗的人口的80%。

Listen to this: less than four-tenths of one percent of those being treated

不仅如此，少于千分之四的接受治疗的患者

stopped taking their medicine or otherwise defaulted on treatment.

因为停止服药或是其他原因而中止治疗，

That's lower than the figure in the United States.

这甚至低于美国的数据——

Less than three-tenths of one percent

千分之三不到

had to transfer to the more expensive second-line drugs.

需要转而购买更加昂贵的高级药物。

400,000 pregnant women were brought into counseling

四十万（口误：应该是四万）的怀孕妇女接受了辅导，

and will give birth for the first time within an organized healthcare system.

并将第一次在一个有组织的医疗体系下分娩。

That's about 43 percent of all the pregnancies.

大概是全部怀孕数量的43%。

About 40 percent of all the people -- I said 400,000. I meant 40,000.

大概40%——我前面说是四十万孕妇，应该是四万——

About 40 percent of all the people who need TB treatment are now getting it --

大概40%的肺结核患者正接收着治疗，

in just 18 months, up from zero when we started.

而就在18个月前，这个数字还是0。

43 percent of the children in need of an infant feeding program

43%需要婴儿哺育计划来防止营养不良和早死的儿童

to prevent malnutrition and early death

正接受他们所需要的食物补品

are now getting the food supplements they need to stay alive and to grow.

来帮助他们生存、生长。

We've started the first malaria treatment programs they've ever had there.

我们也帮助他们建立了他们的第一个疟疾医治方案。

Patients admitted to a hospital that was destroyed during the genocide

病患们被送往我们重新装修的在大屠杀中被摧毁的医院，

that we have renovated along with four other clinics,

以及新建的四个拥有太阳能发电器

complete with solar power generators, good lab technology.

和完善的实验室设备的诊所。

We now are treating 325 people a month,

我们现在一个月治疗325个病人，

despite the fact that almost 100 percent of the AIDS patients are now treated at home.

这还不算所有那些在家接受治疗的艾滋患者。

And the most important thing is

但最重要的一点是，

because we've implemented Paul Farmer's model, using community health workers,

我们采用了保罗的模式，通过社区医疗人员的努力，

we estimate that this system could be put into place for all of Rwanda

我们估算这个系统仅需要5%到6%的全国生产总值

for between five and six percent of GDP,

便可以应用到卢旺达全国的范围内。

and that the government could sustain that

卢旺达的政府也可以在五、六年后摆脱国际援助，

without depending on foreign aid after five or six years.

独立维持这一体系。

And for those of you who understand healthcare economics

你们中那些懂得医疗经济的人

you know that all wealthy countries spend between nine and 11 percent of GDP

应该都知道所有的富裕国家都在医疗保健上

on health care, except for the United States, we spend 16 --

花费9%到11%的国内生产总值。美国除外，我们花费16%——

but that's a story for another day.

不过我今天没时间来解释这个。

(Laughter)

（笑声）

We're now working with Partners in Health and the Ministry of Health in Rwanda

我们现在正和“健康伙伴”以及卢旺达的卫生部门还有我们的基金会人员合作

and our Foundation folks to scale this system up.

争取扩大这个系统。

We're also beginning to do this in Malawi and Lesotho.

我们也开始在马拉维和莱索托实施这一体制。

And we have similar projects in Tanzania, Mozambique,

我们在坦桑尼亚、莫桑比克、肯尼亚和埃塞俄比亚

Kenya and Ethiopia with other partners trying to achieve the same thing:

都有着类似计划，与其他伙伴合作，达成同样的梦想，

to save as many lives as quickly as we can,

最快速地拯救尽可能多的生命，

but to do it in a systematic way that can be implemented nationwide

但却是以一个极其系统的方式进行，以便在全国范围内

and then with a model that can be implemented in any country in the world.

甚至是全世界的范围内得以实施。

We need initial upfront investment to train doctors, nurses,

我们需要先期的投资来培训医生、护士、

health administration and community health workers throughout the country,

医疗管理人员以及全国范围内的社区保健人员，

to set up the information technology, the solar energy,

来帮忙安排信息技术、太阳能、

the water and sanitation, the transportation infrastructure.

用水、卫生保健以及运输系统。

But over a five- to 10-year period,

但在五到十年之内的时间里，

we will take down the need for outside assistance

我们将减缓对外界援助的需求

and eventually it will be phased out.

直到彻底摆脱国际救援。

My wish is that TED assist us in our work and help us to build

我的愿景就是希望TED可以帮助我们的工作，帮我们

a high-quality rural health system in a poor country, Rwanda,

在卢旺达这样贫穷的国家建立起一个高质量的乡村医疗体系，

that can be a model for Africa,

将它当作一个全非洲

and indeed, for any poor country anywhere in the world.

甚至全世界任何贫穷国家都可以效仿的模型。

My belief is that this will help us to build a more integrated world

我相信这将有助我们建立起一个更加融合的世界，

with more partners and fewer terrorists,

更多的合作分子，更少的恐怖分子，

with more productive citizens and fewer haters,

更多的生产，更少的仇恨，

a place we'd all want our kids and our grandchildren to grow up in.

一个我们希望可以托付给我们的子孙的生长环境。

It has been an honor for me, particularly, to work in Rwanda

这是我的荣幸，尤其是可以在卢旺达工作。

where we also have a major economic development project

我们现在还在和苏格兰慈善家Sir Tom Hunter合作，

in partnership with Sir Tom Hunter, the Scottish philanthropist,

开展一个大型的经济计划。

where last year we, using the same thing with AIDS drugs,

就在去年，我们利用我们从艾滋药物那里学来的经验，

cut the cost of fertilizer and the interest rates on microcredit loans by 30 percent

将化肥的费用以及小额信贷的利率锐减了30%，

and achieved three- to four-hundred percent increases

帮助农民的农作物产量

in crop yields with the farmers.

提升了300%到400%。

These people have been through a lot and none of us, most of all me,

这些人都经历了许多，而我们——尤其是我自己——

helped them when they were on the verge of destroying each other.

却没能给予他们援助，阻止他们之间的互相残杀。

We're undoing that now, and they are so over it and so into their future.

我们现在正努力弥补这一切。而他们也已经摆脱了过去，畅想着未来。

We're doing this in an environmentally responsible way.

而我们也尽可能地以最环保的方式达成这一切。

I'm doing my best to convince them not to run the electric grid

我正尽全力的说服他们，不要将电网直接扯到那些

to the 35 percent of the people that have no access,

现在还用不上电的、35%的人口，

but to do it with clean energy. To have responsible reforestation projects,

而是应该使用洁净能源，负责任地开始重新植树造林。

the Rwandans, interestingly enough, have been quite good, Mr. Wilson,

卢旺达人对他们土壤层的保护工作

in preserving their topsoil.

其实是相当尽责的。

There's a couple of guys from southern farming families --

有一批从南部农民世家来的人——

the first thing I did when I went out to this place

我到达那个地方所做的第一件事

was to get down on my hands and knees and dig in the dirt

就是弯下腰来，挖挖当地的土壤，

and see what they'd done with it.

看看他们对其作了些什么。

We have a chance here to prove that a country

我们现在有这样的一个机会来证实

that almost slaughtered itself out of existence

就算是一个曾经几乎自我摧毁的国家

can practice reconciliation, reorganize itself, focus on tomorrow

也是可以从头再来、重新组织、聚焦未来、

and provide comprehensive, quality health care with minimal outside help.

依赖最少量的外界援助提供全面、高质量的医疗保健。

I am grateful for this prize, and I will use it to that end.

我对这个大奖感激不尽，并将充分利用它来实现我上述的梦想。

We could use some more help to do this,

我们需要大家的帮助。

but think of what it would mean if we could have a world-class health system

设想一下，这一切将意味着什么，如果我们可以将世界级的医疗体系

in Rwanda -- in a country with a less-than-one-dollar-a-day-per-capita income,

带到卢旺达这个人均收入低于每天一美元的国家，

one that could save hundreds of millions of lives

利用这个体系拯救上千万的生命，

over the next decade if applied to every similarly situated country on Earth.

并将其在未来的十年里推广到世界上每一个类似的国家。

It's worth a try and I believe it would succeed.

这值得我们的努力，而且我相信我们可以成功。

Thank you and God bless you.

谢谢你们。上帝保佑大家。

(Applause)

（掌声）