A personal health coach for those living with chronic diseases | Priscilla Pemu

翻译人员: Wanting Zhong 校对人员: Jessie Zhang

When I first became a doctor

三十多年以前，

in Benin City, Nigeria,

我刚成为尼日利亚贝宁城

some 30-odd years ago,

的一名医生的时候，

I was drawn to help people live full lives.

深深着迷于 帮助人们过上完好的生活。

But often, I found myself feeling impotent.

但我常常感到无力。

Here I was, a brand-new doctor with all these skills,

我这个初出茅庐的医生 掌握了各种技能，

but I couldn't cure my patients who had chronic diseases --

却无法治愈被慢性病—— 诸如心脏病、哮喘、

illnesses like heart disease, asthma, diabetes --

糖尿病之类的疾病—— 折磨的病人们，

and needed more than just handing them a prescription

想要把他们治好， 需要的不仅仅是一纸处方，

or providing grief counseling in the office to get the job done.

或者在办公室内 给他们做心理辅导。

Fast-forward 15 years later:

将时间快进到十五年后：

I'm in Atlanta, Georgia;

我身处佐治亚州亚特兰大；

it's a different world,

这是个截然不同的世界，

but it was déjà vu all over again.

却有似曾相识的既视感。

As doctors, we see our patients who have chronic illnesses

作为医生，我们目睹 慢性病患者

in an episodic way.

周期性地发病。

In between,

在病情恶化与好转之间，

the patients have to learn how to make a lot of decisions for themselves.

病人们不得不学会 如何自己做出很多决定。

I'll give you examples.

让我给各位举几个例子。

If you have medications you're supposed to take every day,

如果你有每天需要服用的药物，

在患病时你该怎么办？

what do you do when you're sick?

Are you still supposed to take it?

你还应该继续吃药吗？

How do you recognize a complication when it happens?

你该如何识别并发症？

How do you recognize a side effect when it happens?

你该如何识别副作用？

What do you do with it?

该如何应对这些状况？

In addition to all of this,

除此之外，

they're dealing with the inevitable loneliness, isolation and anxiety

他们还必须面对 慢性病患者无可避免地

that people who have chronic illnesses deal with.

要面对的孤独感、孤立感和焦虑。

In the US alone, six in 10 adults have a chronic illness.

仅在美国，十个成年人中 就有六个患有慢性疾病，

That's 125 million people.

加起来就是 1.25 亿人。

A recent report from the Robert Wood Johnson Foundation

罗伯特·伍德·约翰逊基金会 (Rober Wood Johnson Foundation)

showed that health habits account for 50 percent

一项最近的报告显示， 健康习惯能决定

of the health outcomes that people experience,

人们健康结果的 50%，

while medical care only accounts for 20 percent.

而医疗护理只能决定 20%。

In fact, the Centers for Disease Control

事实上，疾病防控中心表示，

says that if we could eliminate smoking,

如果我们能根除吸烟、

physical inactivity and poor nutrition,

缺乏锻炼和营养不良，

that we can prevent 80 percent of heart disease,

那么我们就能预防 80% 的心脏病，

80 percent of type 2 diabetes

80% 的 2 型糖尿病，

and 40 percent of cancer.

和 40% 的癌症。

But we also know

但我们也知道，

that changing health behaviors is very difficult.

健康习惯是很难改变的。

So we asked the question:

因此我们提出了这个问题：

What if we could create a resource

如果我们能创建一个

that could motivate people to change health behavior?

可以鼓励人们 改变健康习惯的办法呢？

The truth is, there are a lot of these resources out there

事实是，市面上已经有 很多这样的办法，

that help people acquire these so-called self-management skills.

来帮助人们获取 所谓的自我管理技能。

But many a time, they're not easily accessible or relatable,

但很多时候，这些资源难以获得 或者和个人情况不相符，

particularly to individuals within minority and underserved communities,

尤其是对于身处少数族裔 和服务水平低下的社区的人，

who face bias in addition to barriers like language and culture

他们要面对的不仅是偏见， 还要面对诸如语言和文化的障碍

and inadequate health insurance coverage.

以及医疗保险范围的不足。

And so in the last 12 years,

因此在过去的十二年里，

my colleagues and I at Morehouse School of Medicine

我和莫尔豪斯（Morehouse） 医学院的同事们

have created a technology-based application

制作了一个基于科技的应用，

to assist with chronic illness care.

用于协助慢性疾病的护理。

It's freely available on the web

它有网页版和应用软件版，

and as an app.

均可免费获取。

And what we do is get people to track variables --

我们让人们追踪

blood pressure, blood sugar --

像血压、血糖等数据，

and then report it back to them in a color-coded format.

并将这些数值用颜色 标注后反馈给他们。

So green would indicate a healthy range,

比如绿色代表在健康范围内，

and red would indicate a problem that needs something done about it.

红色代表存在健康问题， 需要采取行动来解决。

We link these stats to a curriculum.

我们将这些数据 和设计的课程相链接。

The curriculum helps the individual learn about their health condition,

课程可以帮助个人 增进对自己健康状况的了解，

whatever the chronic illness is.

不论他们患上的是哪种慢性疾病，

They also work with a health coach

还有健康教练辅导他们

to learn self-management skills,

学习自我管理的技能，

skills that'll help them prevent complications of their illness.

帮助他们预防疾病的并发症。

In order for the coach to be successful,

健康教练想要有所成效，

they have to be able to gain the trust

必须能够获得

of the individual that they're working with.

他们辅导的个人的信任。

We tested this application

我们在诊所测试了这个应用，

in clinics, where the health coaches were medical assistants,

由医学助理们担任健康教练；

and in a large urban church,

也在一座大型城市教会 进行了测试，

where the health coaches were volunteers from the health ministry.

这里的健康教练由 卫生部的志愿者们担任。

A year later, a third of the participants

一年之后，三分之一的参与者

were able to acquire three new self-management skills

成功地学会了三项自我管理技能，

and maintain them to the extent that it was able to improve

并且一直坚持使用这些技能，

their blood pressures, their blood sugar

让自己的血压、血糖

and their exercise.

和运动量得到改善。

Now, what was simple yet fascinating to us

对于我们来说， 一个简单却奇妙的发现是，

was that the group from the church did just as well or even better

教会的那组参与者 和单纯接受医疗护理的那组相比，

than the group that were under purely medical care.

效果同样好，甚至要更好一些。

And we wanted to learn why that was.

我们想知道其中的原因。

So we looked a little further into the research --

于是我们进行了更深入的研究，

400 hours of recorded conversation --

通过挖掘 400 个小时的对话录音，

and what we learned was that the coaches from the church

我们发现，教会的健康教练们

did have more time to spend with the patients,

有更多时间和患者们相处，

they had access to the patients' families,

他们和患者的家庭有所接触，

and so they could figure out what people needed

因此能够了解人们的需求，

and provide those resources for them.

并为他们提供相应的资源。

My team and I call this "culturally congruent coaching."

我和我的团队将其称为 “文化一致的辅导”。

To illustrate this concept of culturally congruent coaching,

为了阐释这个概念，

I want to tell you about one of our patients.

我想给各位讲讲 一位患者的故事。

I'll call her Ms. Bertha.

我将她称为 伯莎女士（Ms. Bertha）。

So Ms. Bertha is an 83-year-old lady with diabetes and hypertension.

伯莎女士是一位 83 岁的女性， 患有糖尿病与高血压。

She was assigned to Anne, her health coach in the church.

她被分配给了安妮（Anne）， 即她在教会中的健康教练。

Anne also happened to be a family friend to Ms. Bertha for many years,

安妮碰巧是伯莎女士 多年的家庭好友，

and they were fellow congregants.

也是彼此的教友。

Anne observed after the first few visits

安妮在头几次辅导后发现，

that even though Ms. Bertha faithfully recorded her stats,

虽然伯莎女士忠实地 记录了自己的数据，

they were all showing up as red.

但数字全都是红色的。

So she probed a little deeper

于是安妮更深入地询问了一下，

to try to understand what was going on with Ms. Bertha,

试图了解伯莎女士的情况，

and Ms. Bertha gave her the real-real.

而伯莎女士向她 吐露了实情。

(Laughter)

（笑声）

She told her that there were times

她告诉安妮，有些时候

when her medications made her feel weird,

她的药让自己感觉怪怪的，

and she wouldn't take them the way they were prescribed,

于是她没有按照医嘱吃药，

因为她觉得不适感 是药物造成的，

because she thought it was due to the medicines

但她并没有把这个情况告诉医生。

but she didn't tell her doctor that.

She also skipped out on some doctor appointments

她还因为种种原因跳过了几次

for a variety of reasons,

和医生预约的看诊，

but one of them was she wasn't doing better

但理由之一是 她的状况没有改善，

and she didn't want to make her doctor mad,

她不想让医生发火，

所以她就干脆没去。

so she just didn't go.

So Anne talked to Ms. Bertha

和伯莎女士交谈之后，

and asked her to bring her daughter in for the next visit, which she did.

安妮请她在下次辅导时 把女儿一同带来，伯莎也照做了。

And at that visit,

在那次辅导中，

Anne was able to print out a log of all these stats

安妮打印出了

伯莎女士一直在收集的 数据的记录，

that Ms. Bertha had been collecting,

gave them to her and encouraged them to go see the doctor together,

把记录交给了她女儿， 并鼓励她们一起去看医生，

which they did.

她们也这么做了。

With that information,

根据这些信息，

the doctor was able to make changes to Ms. Bertha's treatment.

医生得以对伯莎女士 的治疗方案做出改动。

Within three months, Ms. Bertha's numbers were all in the green.

三个月之内，伯莎女士 的数字都变绿了。

No one was more excited or surprised than Ms. Bertha herself.

没有人比伯莎女士自己 更加兴奋与惊讶。

Now, Anne was successful as a health coach

安妮作为健康教练无疑是成功的，

because she cared enough to go below the surface

因为她的关切之深 让她潜入表层之下，

and probe Ms. Bertha's deep culture

探查伯莎女士深层的文化，

and was able to reach her at that level.

并在那一层面碰触到了她。

She knew how to listen,

她懂得如何聆听，

and she knew how to ask the right questions

她也懂得如何通过 问正确的问题

to get to what was needed.

找到对方的需求。

We all have deep unconscious rules

我们都有深层的无意识准则

that drive the way we make our health decisions.

驱动我们做出健康决策。

That's our culture.

这即是我们的文化。

The relationship and the conversation between Anne and Ms. Bertha

安妮和伯莎女士 的关系与对话

illustrates what's possible

向我们彰显了

when we have conversations with our patients,

当我们和我们的患者、 朋友与邻居

our friends and our neighbors

在深入的文化层面上对话时

on a deep cultural level.

所产生的可能性。

And personally, I'm beyond excited

就我个人来说，

想到这个简单的 文化一致的辅导

to think that with this simple concept of culturally congruent coaching,

we could change the lives of 125 million Americans

能让我们改变患有慢性疾病 的 1.25 亿美国人

and many others across the world

以及世界各地的许多人的生活，

that are living with chronic diseases.

我就感到无比激动。

Thank you.

谢谢大家。

(Applause)

（掌声）