Gail Reed: Where to train the world's doctors? Cuba.

82,344 views ・ 2014-10-01

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翻译人员: Yumeng Guo 校对人员: Eric Chiang
00:12
I want to tell you
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我想为你们讲述
00:14
how 20,000 remarkable young people
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来自超过100个国家的
20,000个杰出的年轻人,
00:18
from over 100 countries
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如何在古巴相聚,
00:20
ended up in Cuba
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00:22
and are transforming health in their communities.
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并改变他们所在社区的医疗状况。
00:26
Ninety percent of them would never
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他们中,
如果不是因为有去古巴学医的奖学金,
00:28
have left home at all
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00:29
if it weren't for a scholarship to study medicine in Cuba
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90%的人原来根本不会离开家。
00:33
and a commitment to go back
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他们这么做也是想今后献身于
00:35
to places like the ones they'd come from —
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他们走出来的地方,
00:38
remote farmlands, mountains, ghettos —
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偏远农村、山区,以及贫民窟,
00:42
to become doctors for people like themselves,
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成为医生去帮助那些像他们一样的人,
00:45
to walk the walk.
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将梦想「付诸行动」。
00:47
Havana's Latin American Medical School:
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哈瓦那的拉丁美洲医学院,
00:50
It's the largest medical school in the world,
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是世界上最大的医学院。
00:53
graduating 23,000 young doctors
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自2005年第一班毕业生以来,
00:56
since its first class of 2005,
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已培养了23,000名年轻的医生,
00:59
with nearly 10,000 more in the pipeline.
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另有近10,000名正在就读中。
01:02
Its mission, to train physicians for the people
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其使命是,
为那些最需要医生的人们培养医生:
01:06
who need them the most:
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01:08
the over one billion
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那些超过10亿的
01:10
who have never seen a doctor,
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从没见过医生的人们。
01:12
the people who live and die
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这些人从出生到死亡,
01:16
under every poverty line ever invented.
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一辈子生活在各种贫困线之下。
01:20
Its students defy all norms.
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这些学生不同寻常,
01:22
They're the school's biggest risk
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他们既是学校最大的风险所在,
01:24
and also its best bet.
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也是学校的一张王牌。
01:26
They're recruited from the poorest,
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他们来自地球上最贫穷、
01:29
most broken places on our planet
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最破败的地区,
01:32
by a school that believes they can become
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被一所相信他们可以成为
01:34
not just the good
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不仅优秀的,
01:35
but the excellent physicians
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更是卓越的医生的学校录取,
01:37
their communities desperately need,
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而卓越的医生正是他们的社区亟需的。
01:40
that they will practice where most doctors don't,
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他们将在大多数医生不愿意去的地方行医,
01:44
in places not only poor
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那些地方不仅贫穷,
01:46
but oftentimes dangerous,
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还时常危险,
01:49
carrying venom antidotes in their backpacks
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他们的背包里要常备解毒药,
01:52
or navigating neighborhoods
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或游走于
01:54
riddled by drugs, gangs and bullets,
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充满毒品、帮派、炮火的邻里乡间,
这就是他们的家乡。
01:58
their home ground.
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02:00
The hope is that they will help
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学校寄予学生的希望是,
02:02
transform access to care,
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使当地人能够获取便捷的医疗服务,
02:04
the health picture in impoverished areas,
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改变贫穷地区的医疗状况,
02:07
and even the way medicine itself
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甚至学医和行医本身的
02:09
is learned and practiced,
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践行方式。
02:11
and that they will become pioneers in our global reach
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并且,
他们将成为先锋,
把医疗服务推向世界的各个角落,
02:16
for universal health coverage,
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02:18
surely a tall order.
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这诚然是个艰巨的任务。
02:21
Two big storms and this notion of "walk the walk"
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两场大风暴和「付诸行动」的理念,
02:25
prompted creation of ELAM back in 1998.
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促成了拉丁美洲医学院在1998年的建校。
02:29
The Hurricanes Georges and Mitch
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乔治飓风和米契飓风
02:32
had ripped through the Caribbean
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肆虐加勒比海和中美洲,
02:34
and Central America,
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02:36
leaving 30,000 dead
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造成了30,000人死亡,
02:38
and two and a half million homeless.
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二百五十万人无家可归。
02:41
Hundreds of Cuban doctors volunteered for disaster response,
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数以百计的古巴医生自愿为灾区服务,
02:45
but when they got there,
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但当他们到达灾区,
02:47
they found a bigger disaster:
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他们发现了更大的灾难:
02:49
whole communities with no healthcare,
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整个社区都没有医疗服务,
02:52
doors bolted shut on rural hospitals
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乡村医院因缺少医护人员
02:54
for lack of staff,
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而门窗紧锁,
02:56
and just too many babies dying
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太多的孩子
02:59
before their first birthday.
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在第一个生日来临前死亡。
03:02
What would happen when these Cuban doctors left?
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这些古巴医生离开后,会是怎样的情境?
03:06
New doctors were needed to make care sustainable,
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需要有新的医生来持续提供医疗服务,
03:08
but where would they come from?
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但他们从哪里来呢?
03:10
Where would they train?
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他们在哪接受培训呢?
03:12
In Havana, the campus of a former naval academy
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在哈瓦那,一座海军学院的旧校园,
03:17
was turned over to the Cuban Health Ministry
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被古巴卫生部接管,
03:20
to become the Latin American Medical School,
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后来变为拉丁美洲医学院,
03:23
ELAM.
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也就是 ELAM。
03:25
Tuition, room and board, and a small stipend
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学校提供学费、食宿、小额津贴
03:28
were offered to hundreds of students
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给那些数以百计的
03:30
from the countries hardest hit by the storms.
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来自受风暴影响最严重国家的学生。
03:33
As a journalist in Havana,
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作为一个在哈瓦那的记者,
03:35
I watched the first 97 Nicaraguans arrive
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我在1999年3月
看到第一批来自尼加拉瓜的97位学生,
03:38
in March 1999,
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03:40
settling into dorms barely refurbished
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入住进刚刚翻修过的宿舍里,
03:43
and helping their professors not only sweep out the classrooms
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不仅帮助教授们清扫教室,
03:46
but move in the desks and the chairs and the microscopes.
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还帮助他们搬入桌椅、显微镜。
03:51
Over the next few years,
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几年后,
03:53
governments throughout the Americas
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美洲的诸多政府
03:55
requested scholarships for their own students,
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为本国的学生争取奖学金名额,
03:58
and the Congressional Black Caucus
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美国国会黑人同盟
04:00
asked for and received hundreds of scholarships
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为美国的年轻人
申请并获得了数以百计的奖学金名额。
04:03
for young people from the USA.
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04:07
Today, among the 23,000
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如今,
这些23,000名已毕业的医生,
04:10
are graduates from 83 countries
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分别来自于美洲、非洲、亚洲的83个国家,
04:13
in the Americas, Africa and Asia,
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04:16
and enrollment has grown to 123 nations.
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而入学学生的生源国已增长到123个国家。
04:22
More than half the students are young women.
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学生中超过半数是年轻女性,
04:24
They come from 100 ethnic groups,
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她们来自100个民族,
04:26
speak 50 different languages.
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说着50种不同的语言。
04:28
WHO Director Margaret Chan said,
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世界卫生组织总干事陈冯富珍说:
04:31
"For once, if you are poor, female,
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「一旦你出身贫困、身为女性、
04:35
or from an indigenous population,
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或来自当地族群,
04:37
you have a distinct advantage,
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你就拥有了一种独特的优势,
04:39
an ethic that makes this medical school unique."
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这套办学观念使这座医学院显得独一无二。」
04:43
Luther Castillo comes from San Pedro de Tocamacho
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卢瑟•卡斯蒂略来自洪都拉斯大西洋沿岸的
04:48
on the Atlantic coast of Honduras.
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圣佩德罗 图卡玛奇市。
04:50
There's no running water,
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那里没有自来水,
04:52
no electricity there,
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没有电,
04:54
and to reach the village, you have to walk for hours
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你需要步行数小时才能到达那里的村庄,
04:58
or take your chances in a pickup truck like I did
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或像我一样,靠运气搭上一辆卡车,
05:01
skirting the waves of the Atlantic.
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在大西洋沿岸破浪前行。
05:04
Luther was one of 40 Tocamacho children
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卢瑟是来自图卡玛奇市
40个的上过小学的孩子中的一员。
05:09
who started grammar school,
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05:11
the sons and daughters of a black indigenous people
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他们是的当地黑人原住民的孩子,
05:13
known as the Garífuna,
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这些黑人被称为加利福纳人,
05:15
20 percent of the Honduran population.
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占洪都拉斯人口数量的20%左右。
05:19
The nearest healthcare was fatal miles away.
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最近的医疗服务竟有数英里远。
05:24
Luther had to walk three hours every day
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卢瑟需要每天步行3小时
才能到中学。
05:27
to middle school.
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05:29
Only 17 made that trip.
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那40个人中只有17人上了中学,
05:31
Only five went on to high school,
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只有5人上了高中,
05:33
and only one to university:
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只有1人上了大学:
05:36
Luther, to ELAM,
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他就是卢瑟,来到了拉丁美洲医学院,
05:38
among the first crop of Garífuna graduates.
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成为第一批加利福纳人的毕业生。
05:42
Just two Garífuna doctors had preceded them
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在洪都拉斯的历史上,这批学生之前,
05:45
in all of Honduran history.
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只产生过两名加利福纳人医生。
仰赖于拉丁美洲医学院的培养,如今已有69名了。
05:48
Now there are 69, thanks to ELAM.
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05:53
Big problems need big solutions,
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非常问题需要非常手段,
05:57
sparked by big ideas, imagination and audacity,
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这些非常手段由伟大的理念、想象力和胆识激发,
06:00
but also solutions that work.
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也由已经见效的各种办法激发。
06:03
ELAM's faculty had no handy evidence base
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拉丁美洲医学院的教员们,没有现成的经验
06:07
to guide them, so they learned the hard way,
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来指导如此庞大的学生,因此他们只能艰苦地摸索,
06:10
by doing and correcting course as they went.
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边做边学边调整。
06:14
Even the brightest students
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即便是来自贫穷地区的
06:16
from these poor communities
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最聪明的学生,
06:18
weren't academically prepared
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也没在学业上做好
06:20
for six years of medical training,
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接受六年医疗训练的准备,
06:23
so a bridging course was set up in sciences.
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因此设立了一门衔接性课程。
06:26
Then came language:
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然后是语言关:
06:28
these were Mapuche, Quechuas, Guaraní, Garífuna,
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这里有马普切人、克丘亚人、瓜拉尼人、加利福那人,
06:31
indigenous peoples
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都是当地的原住民。
06:33
who learned Spanish as a second language,
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他们以西班牙语为第二语言,
06:35
or Haitians who spoke Creole.
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或是讲克里奥耳语的海地人。
06:38
So Spanish became part
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因此西班牙语
06:40
of the pre-pre-med curriculum.
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成了一门医学预预科的课程。
即便如此,在古巴,
06:44
Even so, in Cuba,
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06:47
the music, the food, the smells,
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音乐、食物、气味,
06:50
just about everything was different,
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几乎一切都不一样,
06:53
so faculty became family, ELAM home.
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因此教职员工就像家人一样,拉丁美洲医学院就是家乡。
06:58
Religions ranged from indigenous beliefs
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宗教信仰有当地的信仰、
07:00
to Yoruba, Muslim and Christian evangelical.
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约鲁巴信仰、穆斯林信仰,以及基督教福音派信仰。
07:05
Embracing diversity became a way of life.
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接受多元化成为了一种生活方式。
07:09
Why have so many countries
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为何有这么多的国家
07:11
asked for these scholarships?
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申请拉丁美洲医学院的奖学金?
07:13
First, they just don't have enough doctors,
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第一,这些国家没有足够的医生,
07:17
and where they do, their distribution
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即使在那些有足够数量的医生的国家,
07:18
is skewed against the poor,
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医疗资源的分布也不利于穷人就医,
07:21
because our global health crisis
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医护人员的人力资源缺乏
07:23
is fed by a crisis in human resources.
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造成了全球医疗危机。
07:26
We are short four to seven million health workers
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要满足基本医疗需求,
07:30
just to meet basic needs,
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至少短缺400至700万的医护工作者,
07:33
and the problem is everywhere.
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这种短缺随处可见。
07:35
Doctors are concentrated in the cities,
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医生集中在城市,
07:37
where only half the world's people live,
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而世界人口只有一半住在城市,
07:40
and within cities,
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并且医生多在市区,
07:41
not in the shantytowns or South L.A.
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不在贫民窟或南洛杉矶。
07:46
Here in the United States,
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在美国,
07:47
where we have healthcare reform,
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这里正在推行医疗改革,
07:50
we don't have the professionals we need.
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可专业的医护人员仍显不足。
07:52
By 2020, we will be short
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到2020年,
07:55
45,000 primary care physicians.
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初级护理医师缺口将达45,000人,
我们也有部分责任:
07:59
And we're also part of the problem.
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08:01
The United States is the number one importer
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美国是最大的
发展中国家医生输入国。
08:04
of doctors from developing countries.
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08:08
The second reasons students flock to Cuba
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学生们涌向古巴的第二个原因,
08:11
is the island's own health report card,
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是这个岛屿上
08:13
relying on strong primary care.
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依赖强大的基础医疗护理的人们的健康水平。
08:16
A commission from The Lancet
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《柳叶刀》的委员会,
08:18
rates Cuba among the best performing
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将古巴列为
08:20
middle-income countries in health.
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中等收入国家中健康水平最好的国家之一。
08:23
Save the Children ranks Cuba
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拯救儿童基金会将古巴列为
08:25
the best country in Latin America to become a mother.
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拉丁美洲最适合做母亲的国家。
08:30
Cuba has similar life expectancy
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古巴居民预期寿命跟美国基本持平,
08:33
and lower infant mortality than the United States,
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婴儿死亡率要比美国更低,
08:36
with fewer disparities,
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不平等的地方更少,
08:38
while spending per person
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而古巴人均医疗费用
08:40
one 20th of what we do on health
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只是
08:43
here in the USA.
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美国的二十分之一。
08:45
Academically, ELAM is tough,
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拉丁美洲医学院对学业要求很严格,
08:48
but 80 percent of its students graduate.
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但毕业率达到80%。
08:52
The subjects are familiar —
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所学科目(跟别处相比)基本一样
08:53
basic and clinical sciences —
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——基础和临床医学——
08:56
but there are major differences.
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但也有很大的不同。
08:58
First, training has moved out of the ivory tower
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第一,医护培训走出了象牙塔,
09:02
and into clinic classrooms and neighborhoods,
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学生们可在临床教室和周边社区实践,
09:05
the kinds of places most of these grads will practice.
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大部分毕业生都会在这样的地方锻炼。
09:08
Sure, they have lectures and hospital rotations too,
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当然,他们也会听讲座,也会在医院轮班,
09:12
but community-based learning starts on day one.
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但基于社区的医疗实习从第一天就开始了。
09:17
Second, students treat the whole patient,
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第二,学生全方位的诊疗病人,
09:21
mind and body,
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09:23
in the context of their families, their communities
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结合他们的家庭、社区、
09:25
and their culture.
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文化背景,
给予他们身体和心理上的照料。
09:27
Third, they learn public health:
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第三,他们学习公共卫生,
09:30
to assess their patients' drinking water, housing,
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评估病人的饮用水、住房、
09:33
social and economic conditions.
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社会和经济状况。
第四,他们已经懂得,
09:37
Fourth, they are taught
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09:39
that a good patient interview
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良好的问诊
09:42
and a thorough clinical exam
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和细致的临床检查,
09:44
provide most of the clues for diagnosis,
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已经能为诊断提供大部分线索,
09:47
saving costly technology for confirmation.
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从而不需要使用昂贵的技术进行确诊。
09:51
And finally, they're taught over and over again
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最后,他们被反复教导
09:54
the importance of prevention,
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预防的重要性,
09:57
especially as chronic diseases
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尤其是慢性疾病来说更是如此,
09:59
cripple health systems worldwide.
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慢性疾病已经使世界各地的医疗系统不堪重负。
10:03
Such an in-service learning
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这样的服务性学习,
10:06
also comes with a team approach,
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团队合作的方式,
10:09
as much how to work in teams
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使他们学会了如何以一种谦逊的态度
10:12
as how to lead them,
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与别人协作,
10:14
with a dose of humility.
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以及如何领导团队。
10:16
Upon graduation, these doctors share
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毕业时,这些医生将自己的知识和经验
10:19
their knowledge with nurse's aids, midwives,
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与护士、助产士、
10:21
community health workers,
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社区医疗工作者分享,
10:23
to help them become better at what they do,
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来帮助他们,而非要替代他们,
10:26
not to replace them,
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让他们的工作更加优秀,
以及与萨满和传统疗法的医护者协作。
10:28
to work with shamans and traditional healers.
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10:33
ELAM's graduates:
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拉丁美洲医学院的毕业生:
10:35
Are they proving this audacious experiment right?
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他们的实际行动证明了这项大胆的试验是正确的吗?
10:40
Dozens of projects give us an inkling
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通过数十个项目的成效,
10:42
of what they're capable of doing.
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我们可对他们的能力略窥一二。
以加利福纳毕业生为例,
10:45
Take the Garífuna grads.
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10:47
They not only went to work back home,
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他们不仅回到家乡工作,
10:49
but they organized their communities to build
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2407
还联合当地社区,
10:51
Honduras' first indigenous hospital.
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创办了洪都拉斯第一家本土医院。
受一位建筑师之助,
10:55
With an architect's help,
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10:57
residents literally raised it from the ground up.
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毫不夸张的说,人们从无到有地建立了这座医院。
11:01
The first patients walked through the doors
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第一批病人
11:03
in December 2007,
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在2007年12月步入医院大门,
11:06
and since then, the hospital has received
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11:08
nearly one million patient visits.
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从那时起,
医院接待了近100万人次病人求诊。
11:11
And government is paying attention,
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政府对此也更加关注,
11:14
upholding the hospital as a model
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将这所医院树立为
洪都拉斯农村公共医疗的典范。
11:16
of rural public health for Honduras.
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5179
拉丁美洲医学院的毕业生不但聪慧、
11:21
ELAM's graduates are smart,
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11:25
strong and also dedicated.
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3453
坚强,而且极富使命感。
11:28
Haiti, January 2010.
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4354
海地,2010年1月,
11:33
The pain.
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1835
永远的伤痛。
11:35
People buried under 30 million tons of rubble.
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人们被埋在3000万吨碎石下。
11:39
Overwhelming.
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太让人难以接受了。
11:41
Three hundred forty Cuban doctors
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340名古巴医生已就绪,
11:43
were already on the ground long term.
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开展长期服务,
11:45
More were on their way. Many more were needed.
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更多的人在前去的路上,但还需要更多。
11:47
At ELAM, students worked round the clock
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在拉丁美洲医学院,
学生们昼夜不停地联系2000名毕业生,
11:51
to contact 2,000 graduates.
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3218
11:54
As a result, hundreds arrived in Haiti,
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3184
结果,数以百计的毕业生来到海地,
11:57
27 countries' worth, from Mali in the Sahara
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4297
他们从撒哈拉的马里共和国,
到圣卢西亚、玻利维亚、智利和美国等27个国家而来。
12:01
to St. Lucia, Bolivia, Chile and the USA.
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12:06
They spoke easily to each other in Spanish
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他们之间用西班牙语自如的沟通,
12:09
and listened to their patients in Creole
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由于有古巴拉丁美洲医学院的
12:12
thanks to Haitian medical students
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海地籍学生加入救援,
12:14
flown in from ELAM in Cuba.
253
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2227
他们得以与伤者用克里奥耳语交流。
12:16
Many stayed for months,
254
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1688
很多人在此停留了数月,
12:18
even through the cholera epidemic.
255
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2778
即使霍乱蔓延的情况下也是如此。
12:21
Hundreds of Haitian graduates
256
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2340
数以百计的海地毕业生
12:23
had to pick up the pieces,
257
743558
2722
不得不收拾残局,
暂搁自己的悲伤,
12:26
overcome their own heartbreak,
258
746280
2014
12:28
and then pick up the burden
259
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扛起为海地建立
12:30
of building a new public health system for Haiti.
260
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新的公共医疗系统的重担。
12:33
Today, with aid of organizations and governments
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如今,
在挪威、古巴、巴西的政府和各类组织的帮助下,
12:36
from Norway to Cuba to Brazil,
262
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2553
12:38
dozens of new health centers have been built,
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数十个医疗中心已建立起来,医护人员也配备到位,
12:41
staffed, and in 35 cases, headed
264
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其中35个医疗中心,
由拉丁美洲医学院的毕业生主持工作。
12:44
by ELAM graduates.
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3922
12:48
Yet the Haitian story
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海地的故事
12:50
also illustrates some of the bigger problems
267
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2059
也表明了其他诸多国家
12:52
faced in many countries.
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2216
面临的更大的问题。
12:54
Take a look:
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1744
看一下吧:
12:56
748 Haitian graduates by 2012, when cholera struck,
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2012年,在霍乱爆发时,748名海地毕业生,
13:02
nearly half working in the public health sector
271
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接近一半在公共医疗机构工作,
13:05
but one quarter unemployed,
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2071
但有四分之一没有工作,
13:07
and 110 had left Haiti altogether.
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110名已离开了海地。
13:14
So in the best case scenarios,
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因此,在最好的情况下,
13:16
these graduates are staffing
275
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这些学生都会有工作,
13:18
and thus strengthening public health systems,
276
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加强公共医疗系统的服务,
13:21
where often they're the only doctors around.
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在尚未有医疗服务的地区开展工作。
13:25
In the worst cases, there are simply not enough jobs
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最糟糕的情况下,
公共医疗机构并没有足够多的工作机会,
13:27
in the public health sector,
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1642
13:29
where most poor people are treated,
280
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2566
而公共医疗机构正是大多数穷人看病的地方,
13:32
not enough political will, not enough resources,
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2799
政治意愿不够强烈,资源匮乏,
13:34
not enough anything —
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一切都是缺乏的,
13:37
just too many patients with no care.
283
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3453
唯一不缺泛的,就是有太多的病人得不到医疗服务。
13:40
The grads face pressure from their families too,
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2984
毕业生也面临着来自家庭的压力,
13:43
desperate to make ends meet,
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2303
他们的家庭绝望的在温饱线上挣扎,
13:45
so when there are no public sector jobs,
286
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2576
因此,当缺少公共部门的就业机会时,
13:48
these new MDs decamp into private practice,
287
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2621
这些医学博士就进入私人执业,
13:51
or go abroad to send money home.
288
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4015
或出国工作,把钱寄回家。
13:55
Worst of all, in some countries,
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最为糟糕的是,在一些国家,
13:58
medical societies influence accreditation bodies
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在医疗协会的影响下,
14:01
not to honor the ELAM degree,
291
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3015
认证机构不承认拉丁美洲医学院的学位,
担心这些毕业生会抢他们的饭碗,
14:04
fearful these grads will take their jobs
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2317
14:06
or reduce their patient loads and income.
293
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3555
或者会减少病人的数量及他们的收入。
14:10
It's not a question of competencies.
294
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这并非胜任力的问题。
14:13
Here in the USA, the California Medical Board
295
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2508
在美国,拉美医学院经过严格考核后,
14:15
accredited the school after rigorous inspection,
296
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3600
得到了加州医疗委员会的认证,
14:19
and the new physicians are making good
297
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2048
这些新医生不负众望,
14:21
on Cuba's big bet,
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2191
表现优异,
14:23
passing their boards and accepted
299
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1811
从纽约到芝加哥,到新墨西哥州,
14:25
into highly respected residencies
300
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2385
他们通过了审核,得到肯定,
14:27
from New York to Chicago to New Mexico.
301
867647
4091
成为受高度尊敬的新居民。
14:31
Two hundred strong, they're coming
302
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2625
200位毕业生回到美国,
14:34
back to the United States energized,
303
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2385
干劲十足,
14:36
and also dissatisfied.
304
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2587
但也有不满意的地方。
14:39
As one grad put it,
305
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1631
就像一位毕业生所说的,
14:40
in Cuba, "We are trained to provide quality care
306
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3454
在古巴,「我们学习在最有限的资源下
如何提供高质量的医疗护理,
14:44
with minimal resources,
307
884420
2002
14:46
so when I see all the resources we have here,
308
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2576
所以当我看到我们在这所拥有的全部资源,
14:48
and you tell me that's not possible,
309
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2162
你还告诉我那是不可能的,
14:51
I know it's not true.
310
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2170
我知道这不是事实。
14:53
Not only have I seen it work, I've done the work."
311
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5619
我不只是看到它能实现,我还亲自做成功了。」
14:58
ELAM's graduates,
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1961
拉丁美洲医学院的毕业生,
15:00
some from right here in D.C. and Baltimore,
313
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3517
有些就来自这儿,华盛顿特区和巴尔的摩,
15:04
have come from the poorest of the poor
314
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3168
有些来自最贫穷的地方,
15:07
to offer health, education
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2333
来为他们的社区提供医疗服务、教育,
15:09
and a voice to their communities.
316
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2916
并为社区「代言」。
15:12
They've done the heavy lifting.
317
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2652
他们已扛起重担。
15:15
Now we need to do our part
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915496
2014
现在我们要做的是
15:17
to support the 23,000 and counting,
319
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3617
支持这23000名及后续的毕业生。
我们所有的人——
15:21
All of us —
320
921127
1354
15:22
foundations, residency directors, press,
321
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3634
基金会、居委会理事、媒体、
企业家、政策制定者,以及我们大家——
15:26
entrepreneurs, policymakers, people —
322
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3184
都需要行动起来。
15:29
need to step up.
323
929299
2153
15:31
We need to do much more globally
324
931452
1991
我们需要在全球范围内
15:33
to give these new doctors the opportunity
325
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2939
为这些新医生提供更多的机会,
15:36
to prove their mettle.
326
936382
2393
使他们能够施展才华。
15:38
They need to be able
327
938775
1003
15:39
to take their countries' licensing exams.
328
939778
3204
他们需要
15:42
They need jobs in the public health sector
329
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2948
通过所在国家的执业考试,
15:45
or in nonprofit health centers
330
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1755
他们需要有公共医疗机构
15:47
to put their training and commitment to work.
331
947685
3847
或非营利医疗机构的工作,
来把他们所学和使命付诸实践。
15:51
They need the chance to be
332
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2283
他们需要得到机会,
15:53
the doctors their patients need.
333
953815
4859
成为病人所需的医生。
为了推进医疗事业,
15:58
To move forward,
334
958674
1857
16:00
we may have to find our way back
335
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2992
我们或许不得不
回到一位儿科医生的道路上来。
16:03
to that pediatrician who would
336
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2183
在我还是个孩子的时候,
16:05
knock on my family's door
337
965706
1687
他到我们位于南芝加哥的家来拜访。
16:07
on the South Side of Chicago when I was a kid,
338
967393
3186
16:10
who made house calls,
339
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1910
他上门服务,
16:12
who was a public servant.
340
972489
2891
他真是一位人民公仆。
16:15
These aren't such new ideas
341
975380
1823
这些内容,对于医疗服务来说,
16:17
of what medicine should be.
342
977203
2362
没有什么新颖之处。
16:19
What's new is the scaling up
343
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2725
新颖的是其覆盖范围的扩大,
16:22
and the faces of the doctors themselves:
344
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3383
以及医生的面庞:
16:25
an ELAM graduate is more likely to be a she
345
985673
3457
拉丁美洲医学院的毕业生,
更可能是一名女性而非男性;
16:29
than a he;
346
989130
1930
16:31
In the Amazon, Peru or Guatemala,
347
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2927
一位在亚马逊、秘鲁或危地马拉
16:33
an indigenous doctor;
348
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2351
当地行医的本土医生;
16:36
in the USA, a doctor of color
349
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3014
在美国,很可能是一位能说流利的西班牙语的
16:39
who speaks fluent Spanish.
350
999352
2396
有色人种医生。
16:41
She is well trained, can be counted on,
351
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3679
她们受过良好训练,值得信赖,
16:45
and shares the face and culture of her patients,
352
1005427
3644
她们与病人来自同一种族,并有文化共通感,
16:49
and she deserves our support surely,
353
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3409
她们理应获得我们的支持,
16:52
because whether by subway, mule, or canoe,
354
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4466
因为无论是坐着地铁、骑着骡子,还是乘着独木舟,
16:56
she is teaching us to walk the walk.
355
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2998
她们都在教我们怎样将想法「付诸行动」。
16:59
Thank you. (Applause)
356
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5570
谢谢。(掌声)
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