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

翻译人员: Yumeng Guo 校对人员: Eric Chiang

I want to tell you

我想为你们讲述

how 20,000 remarkable young people

来自超过100个国家的

20,000个杰出的年轻人，

from over 100 countries

如何在古巴相聚，

ended up in Cuba

and are transforming health in their communities.

并改变他们所在社区的医疗状况。

Ninety percent of them would never

他们中，

如果不是因为有去古巴学医的奖学金，

have left home at all

if it weren't for a scholarship to study medicine in Cuba

90%的人原来根本不会离开家。

and a commitment to go back

他们这么做也是想今后献身于

to places like the ones they'd come from —

他们走出来的地方，

remote farmlands, mountains, ghettos —

偏远农村、山区，以及贫民窟，

to become doctors for people like themselves,

成为医生去帮助那些像他们一样的人，

to walk the walk.

将梦想「付诸行动」。

Havana's Latin American Medical School:

哈瓦那的拉丁美洲医学院，

It's the largest medical school in the world,

是世界上最大的医学院。

graduating 23,000 young doctors

自2005年第一班毕业生以来，

since its first class of 2005,

已培养了23,000名年轻的医生，

with nearly 10,000 more in the pipeline.

另有近10,000名正在就读中。

Its mission, to train physicians for the people

其使命是，

为那些最需要医生的人们培养医生：

who need them the most:

the over one billion

那些超过10亿的

who have never seen a doctor,

从没见过医生的人们。

the people who live and die

这些人从出生到死亡，

under every poverty line ever invented.

一辈子生活在各种贫困线之下。

Its students defy all norms.

这些学生不同寻常，

They're the school's biggest risk

他们既是学校最大的风险所在，

and also its best bet.

也是学校的一张王牌。

They're recruited from the poorest,

他们来自地球上最贫穷、

most broken places on our planet

最破败的地区，

by a school that believes they can become

被一所相信他们可以成为

not just the good

不仅优秀的，

but the excellent physicians

更是卓越的医生的学校录取，

their communities desperately need,

而卓越的医生正是他们的社区亟需的。

that they will practice where most doctors don't,

他们将在大多数医生不愿意去的地方行医，

in places not only poor

那些地方不仅贫穷，

but oftentimes dangerous,

还时常危险，

carrying venom antidotes in their backpacks

他们的背包里要常备解毒药，

or navigating neighborhoods

或游走于

riddled by drugs, gangs and bullets,

充满毒品、帮派、炮火的邻里乡间，

这就是他们的家乡。

their home ground.

The hope is that they will help

学校寄予学生的希望是，

transform access to care,

使当地人能够获取便捷的医疗服务，

the health picture in impoverished areas,

改变贫穷地区的医疗状况，

and even the way medicine itself

甚至学医和行医本身的

is learned and practiced,

践行方式。

and that they will become pioneers in our global reach

并且，

他们将成为先锋，

把医疗服务推向世界的各个角落，

for universal health coverage,

surely a tall order.

这诚然是个艰巨的任务。

Two big storms and this notion of "walk the walk"

两场大风暴和「付诸行动」的理念，

prompted creation of ELAM back in 1998.

促成了拉丁美洲医学院在1998年的建校。

The Hurricanes Georges and Mitch

乔治飓风和米契飓风

had ripped through the Caribbean

肆虐加勒比海和中美洲，

and Central America,

leaving 30,000 dead

造成了30,000人死亡，

and two and a half million homeless.

二百五十万人无家可归。

Hundreds of Cuban doctors volunteered for disaster response,

数以百计的古巴医生自愿为灾区服务，

but when they got there,

但当他们到达灾区，

they found a bigger disaster:

他们发现了更大的灾难：

whole communities with no healthcare,

整个社区都没有医疗服务，

doors bolted shut on rural hospitals

乡村医院因缺少医护人员

for lack of staff,

而门窗紧锁，

and just too many babies dying

太多的孩子

before their first birthday.

在第一个生日来临前死亡。

What would happen when these Cuban doctors left?

这些古巴医生离开后，会是怎样的情境？

New doctors were needed to make care sustainable,

需要有新的医生来持续提供医疗服务，

but where would they come from?

但他们从哪里来呢？

Where would they train?

他们在哪接受培训呢？

In Havana, the campus of a former naval academy

在哈瓦那，一座海军学院的旧校园，

was turned over to the Cuban Health Ministry

被古巴卫生部接管，

to become the Latin American Medical School,

后来变为拉丁美洲医学院，

ELAM.

也就是 ELAM。

Tuition, room and board, and a small stipend

学校提供学费、食宿、小额津贴

were offered to hundreds of students

给那些数以百计的

from the countries hardest hit by the storms.

来自受风暴影响最严重国家的学生。

As a journalist in Havana,

作为一个在哈瓦那的记者，

I watched the first 97 Nicaraguans arrive

我在1999年3月

看到第一批来自尼加拉瓜的97位学生，

in March 1999,

settling into dorms barely refurbished

入住进刚刚翻修过的宿舍里，

and helping their professors not only sweep out the classrooms

不仅帮助教授们清扫教室，

but move in the desks and the chairs and the microscopes.

还帮助他们搬入桌椅、显微镜。

Over the next few years,

几年后，

governments throughout the Americas

美洲的诸多政府

requested scholarships for their own students,

为本国的学生争取奖学金名额，

and the Congressional Black Caucus

美国国会黑人同盟

asked for and received hundreds of scholarships

为美国的年轻人

申请并获得了数以百计的奖学金名额。

for young people from the USA.

Today, among the 23,000

如今，

这些23,000名已毕业的医生，

are graduates from 83 countries

分别来自于美洲、非洲、亚洲的83个国家，

in the Americas, Africa and Asia,

and enrollment has grown to 123 nations.

而入学学生的生源国已增长到123个国家。

More than half the students are young women.

学生中超过半数是年轻女性，

They come from 100 ethnic groups,

她们来自100个民族，

speak 50 different languages.

说着50种不同的语言。

WHO Director Margaret Chan said,

世界卫生组织总干事陈冯富珍说：

"For once, if you are poor, female,

「一旦你出身贫困、身为女性、

or from an indigenous population,

或来自当地族群，

you have a distinct advantage,

你就拥有了一种独特的优势，

an ethic that makes this medical school unique."

这套办学观念使这座医学院显得独一无二。」

Luther Castillo comes from San Pedro de Tocamacho

卢瑟•卡斯蒂略来自洪都拉斯大西洋沿岸的

on the Atlantic coast of Honduras.

圣佩德罗 图卡玛奇市。

There's no running water,

那里没有自来水，

no electricity there,

没有电，

and to reach the village, you have to walk for hours

你需要步行数小时才能到达那里的村庄，

or take your chances in a pickup truck like I did

或像我一样，靠运气搭上一辆卡车，

skirting the waves of the Atlantic.

在大西洋沿岸破浪前行。

Luther was one of 40 Tocamacho children

卢瑟是来自图卡玛奇市

40个的上过小学的孩子中的一员。

who started grammar school,

the sons and daughters of a black indigenous people

他们是的当地黑人原住民的孩子，

known as the Garífuna,

这些黑人被称为加利福纳人，

20 percent of the Honduran population.

占洪都拉斯人口数量的20%左右。

The nearest healthcare was fatal miles away.

最近的医疗服务竟有数英里远。

Luther had to walk three hours every day

卢瑟需要每天步行3小时

才能到中学。

to middle school.

Only 17 made that trip.

那40个人中只有17人上了中学，

Only five went on to high school,

只有5人上了高中，

and only one to university:

只有1人上了大学：

Luther, to ELAM,

他就是卢瑟，来到了拉丁美洲医学院，

among the first crop of Garífuna graduates.

成为第一批加利福纳人的毕业生。

Just two Garífuna doctors had preceded them

在洪都拉斯的历史上，这批学生之前，

in all of Honduran history.

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。

Now there are 69, thanks to ELAM.

Big problems need big solutions,

非常问题需要非常手段，

sparked by big ideas, imagination and audacity,

这些非常手段由伟大的理念、想象力和胆识激发，

but also solutions that work.

也由已经见效的各种办法激发。

ELAM's faculty had no handy evidence base

拉丁美洲医学院的教员们，没有现成的经验

to guide them, so they learned the hard way,

来指导如此庞大的学生，因此他们只能艰苦地摸索，

by doing and correcting course as they went.

边做边学边调整。

Even the brightest students

即便是来自贫穷地区的

from these poor communities

最聪明的学生，

weren't academically prepared

也没在学业上做好

for six years of medical training,

接受六年医疗训练的准备，

so a bridging course was set up in sciences.

因此设立了一门衔接性课程。

Then came language:

然后是语言关：

these were Mapuche, Quechuas, Guaraní, Garífuna,

这里有马普切人、克丘亚人、瓜拉尼人、加利福那人，

indigenous peoples

都是当地的原住民。

who learned Spanish as a second language,

他们以西班牙语为第二语言，

or Haitians who spoke Creole.

或是讲克里奥耳语的海地人。

So Spanish became part

因此西班牙语

of the pre-pre-med curriculum.

成了一门医学预预科的课程。

即便如此，在古巴，

Even so, in Cuba,

the music, the food, the smells,

音乐、食物、气味，

just about everything was different,

几乎一切都不一样，

so faculty became family, ELAM home.

因此教职员工就像家人一样，拉丁美洲医学院就是家乡。

Religions ranged from indigenous beliefs

宗教信仰有当地的信仰、

to Yoruba, Muslim and Christian evangelical.

约鲁巴信仰、穆斯林信仰，以及基督教福音派信仰。

Embracing diversity became a way of life.

接受多元化成为了一种生活方式。

Why have so many countries

为何有这么多的国家

asked for these scholarships?

申请拉丁美洲医学院的奖学金？

First, they just don't have enough doctors,

第一，这些国家没有足够的医生，

and where they do, their distribution

即使在那些有足够数量的医生的国家，

is skewed against the poor,

医疗资源的分布也不利于穷人就医，

because our global health crisis

医护人员的人力资源缺乏

is fed by a crisis in human resources.

造成了全球医疗危机。

We are short four to seven million health workers

要满足基本医疗需求，

just to meet basic needs,

至少短缺400至700万的医护工作者，

and the problem is everywhere.

这种短缺随处可见。

Doctors are concentrated in the cities,

医生集中在城市，

where only half the world's people live,

而世界人口只有一半住在城市，

and within cities,

并且医生多在市区，

not in the shantytowns or South L.A.

不在贫民窟或南洛杉矶。

Here in the United States,

在美国，

where we have healthcare reform,

这里正在推行医疗改革，

we don't have the professionals we need.

可专业的医护人员仍显不足。

By 2020, we will be short

到2020年，

45,000 primary care physicians.

初级护理医师缺口将达45,000人，

我们也有部分责任：

And we're also part of the problem.

The United States is the number one importer

美国是最大的

发展中国家医生输入国。

of doctors from developing countries.

The second reasons students flock to Cuba

学生们涌向古巴的第二个原因，

is the island's own health report card,

是这个岛屿上

relying on strong primary care.

依赖强大的基础医疗护理的人们的健康水平。

A commission from The Lancet

《柳叶刀》的委员会，

rates Cuba among the best performing

将古巴列为

middle-income countries in health.

中等收入国家中健康水平最好的国家之一。

Save the Children ranks Cuba

拯救儿童基金会将古巴列为

the best country in Latin America to become a mother.

拉丁美洲最适合做母亲的国家。

Cuba has similar life expectancy

古巴居民预期寿命跟美国基本持平，

and lower infant mortality than the United States,

婴儿死亡率要比美国更低，

with fewer disparities,

不平等的地方更少，

while spending per person

而古巴人均医疗费用

one 20th of what we do on health

只是

here in the USA.

美国的二十分之一。

Academically, ELAM is tough,

拉丁美洲医学院对学业要求很严格，

but 80 percent of its students graduate.

但毕业率达到80%。

The subjects are familiar —

所学科目（跟别处相比）基本一样

basic and clinical sciences —

——基础和临床医学——

but there are major differences.

但也有很大的不同。

First, training has moved out of the ivory tower

第一，医护培训走出了象牙塔，

and into clinic classrooms and neighborhoods,

学生们可在临床教室和周边社区实践，

the kinds of places most of these grads will practice.

大部分毕业生都会在这样的地方锻炼。

Sure, they have lectures and hospital rotations too,

当然，他们也会听讲座，也会在医院轮班，

but community-based learning starts on day one.

但基于社区的医疗实习从第一天就开始了。

Second, students treat the whole patient,

第二，学生全方位的诊疗病人，

mind and body,

in the context of their families, their communities

结合他们的家庭、社区、

and their culture.

文化背景，

给予他们身体和心理上的照料。

Third, they learn public health:

第三，他们学习公共卫生，

to assess their patients' drinking water, housing,

评估病人的饮用水、住房、

social and economic conditions.

社会和经济状况。

第四，他们已经懂得，

Fourth, they are taught

that a good patient interview

良好的问诊

and a thorough clinical exam

和细致的临床检查，

provide most of the clues for diagnosis,

已经能为诊断提供大部分线索，

saving costly technology for confirmation.

从而不需要使用昂贵的技术进行确诊。

And finally, they're taught over and over again

最后，他们被反复教导

the importance of prevention,

预防的重要性，

especially as chronic diseases

尤其是慢性疾病来说更是如此，

cripple health systems worldwide.

慢性疾病已经使世界各地的医疗系统不堪重负。

Such an in-service learning

这样的服务性学习，

also comes with a team approach,

团队合作的方式，

as much how to work in teams

使他们学会了如何以一种谦逊的态度

as how to lead them,

与别人协作，

with a dose of humility.

以及如何领导团队。

Upon graduation, these doctors share

毕业时，这些医生将自己的知识和经验

their knowledge with nurse's aids, midwives,

与护士、助产士、

community health workers,

社区医疗工作者分享，

to help them become better at what they do,

来帮助他们，而非要替代他们，

not to replace them,

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。

to work with shamans and traditional healers.

ELAM's graduates:

拉丁美洲医学院的毕业生：

Are they proving this audacious experiment right?

他们的实际行动证明了这项大胆的试验是正确的吗？

Dozens of projects give us an inkling

通过数十个项目的成效，

of what they're capable of doing.

我们可对他们的能力略窥一二。

以加利福纳毕业生为例，

Take the Garífuna grads.

They not only went to work back home,

他们不仅回到家乡工作，

but they organized their communities to build

还联合当地社区，

Honduras' first indigenous hospital.

创办了洪都拉斯第一家本土医院。

受一位建筑师之助，

With an architect's help,

residents literally raised it from the ground up.

毫不夸张的说，人们从无到有地建立了这座医院。

The first patients walked through the doors

第一批病人

in December 2007,

在2007年12月步入医院大门，

and since then, the hospital has received

nearly one million patient visits.

从那时起，

医院接待了近100万人次病人求诊。

And government is paying attention,

政府对此也更加关注，

upholding the hospital as a model

将这所医院树立为

洪都拉斯农村公共医疗的典范。

of rural public health for Honduras.

拉丁美洲医学院的毕业生不但聪慧、

ELAM's graduates are smart,

strong and also dedicated.

坚强，而且极富使命感。

Haiti, January 2010.

海地，2010年1月，

The pain.

永远的伤痛。

People buried under 30 million tons of rubble.

人们被埋在3000万吨碎石下。

Overwhelming.

太让人难以接受了。

Three hundred forty Cuban doctors

340名古巴医生已就绪，

were already on the ground long term.

开展长期服务，

More were on their way. Many more were needed.

更多的人在前去的路上，但还需要更多。

At ELAM, students worked round the clock

在拉丁美洲医学院，

学生们昼夜不停地联系2000名毕业生，

to contact 2,000 graduates.

As a result, hundreds arrived in Haiti,

结果，数以百计的毕业生来到海地，

27 countries' worth, from Mali in the Sahara

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。

to St. Lucia, Bolivia, Chile and the USA.

They spoke easily to each other in Spanish

他们之间用西班牙语自如的沟通，

and listened to their patients in Creole

由于有古巴拉丁美洲医学院的

thanks to Haitian medical students

海地籍学生加入救援，

flown in from ELAM in Cuba.

他们得以与伤者用克里奥耳语交流。

Many stayed for months,

很多人在此停留了数月，

even through the cholera epidemic.

即使霍乱蔓延的情况下也是如此。

Hundreds of Haitian graduates

数以百计的海地毕业生

had to pick up the pieces,

不得不收拾残局，

暂搁自己的悲伤，

overcome their own heartbreak,

and then pick up the burden

扛起为海地建立

of building a new public health system for Haiti.

新的公共医疗系统的重担。

Today, with aid of organizations and governments

如今，

在挪威、古巴、巴西的政府和各类组织的帮助下，

from Norway to Cuba to Brazil,

dozens of new health centers have been built,

数十个医疗中心已建立起来，医护人员也配备到位，

staffed, and in 35 cases, headed

其中35个医疗中心，

由拉丁美洲医学院的毕业生主持工作。

by ELAM graduates.

Yet the Haitian story

海地的故事

also illustrates some of the bigger problems

也表明了其他诸多国家

faced in many countries.

面临的更大的问题。

Take a look:

看一下吧：

748 Haitian graduates by 2012, when cholera struck,

2012年，在霍乱爆发时，748名海地毕业生，

nearly half working in the public health sector

接近一半在公共医疗机构工作，

but one quarter unemployed,

但有四分之一没有工作，

and 110 had left Haiti altogether.

110名已离开了海地。

So in the best case scenarios,

因此，在最好的情况下，

these graduates are staffing

这些学生都会有工作，

and thus strengthening public health systems,

加强公共医疗系统的服务，

where often they're the only doctors around.

在尚未有医疗服务的地区开展工作。

In the worst cases, there are simply not enough jobs

最糟糕的情况下，

公共医疗机构并没有足够多的工作机会，

in the public health sector,

where most poor people are treated,

而公共医疗机构正是大多数穷人看病的地方，

not enough political will, not enough resources,

政治意愿不够强烈，资源匮乏，

not enough anything —

一切都是缺乏的，

just too many patients with no care.

唯一不缺泛的，就是有太多的病人得不到医疗服务。

The grads face pressure from their families too,

毕业生也面临着来自家庭的压力，

desperate to make ends meet,

他们的家庭绝望的在温饱线上挣扎，

so when there are no public sector jobs,

因此，当缺少公共部门的就业机会时，

these new MDs decamp into private practice,

这些医学博士就进入私人执业，

or go abroad to send money home.

或出国工作，把钱寄回家。

Worst of all, in some countries,

最为糟糕的是，在一些国家，

medical societies influence accreditation bodies

在医疗协会的影响下，

not to honor the ELAM degree,

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，

fearful these grads will take their jobs

or reduce their patient loads and income.

或者会减少病人的数量及他们的收入。

It's not a question of competencies.

这并非胜任力的问题。

Here in the USA, the California Medical Board

在美国，拉美医学院经过严格考核后，

accredited the school after rigorous inspection,

得到了加州医疗委员会的认证，

and the new physicians are making good

这些新医生不负众望，

on Cuba's big bet,

表现优异，

passing their boards and accepted

从纽约到芝加哥，到新墨西哥州，

into highly respected residencies

他们通过了审核，得到肯定，

from New York to Chicago to New Mexico.

成为受高度尊敬的新居民。

Two hundred strong, they're coming

200位毕业生回到美国，

back to the United States energized,

干劲十足，

and also dissatisfied.

但也有不满意的地方。

As one grad put it,

就像一位毕业生所说的，

in Cuba, "We are trained to provide quality care

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，

with minimal resources,

so when I see all the resources we have here,

所以当我看到我们在这所拥有的全部资源，

and you tell me that's not possible,

你还告诉我那是不可能的，

I know it's not true.

我知道这不是事实。

Not only have I seen it work, I've done the work."

我不只是看到它能实现，我还亲自做成功了。」

ELAM's graduates,

拉丁美洲医学院的毕业生，

some from right here in D.C. and Baltimore,

有些就来自这儿，华盛顿特区和巴尔的摩，

have come from the poorest of the poor

有些来自最贫穷的地方，

to offer health, education

来为他们的社区提供医疗服务、教育，

and a voice to their communities.

并为社区「代言」。

They've done the heavy lifting.

他们已扛起重担。

Now we need to do our part

现在我们要做的是

to support the 23,000 and counting,

支持这23000名及后续的毕业生。

我们所有的人——

All of us —

foundations, residency directors, press,

基金会、居委会理事、媒体、

企业家、政策制定者，以及我们大家——

entrepreneurs, policymakers, people —

都需要行动起来。

need to step up.

We need to do much more globally

我们需要在全球范围内

to give these new doctors the opportunity

为这些新医生提供更多的机会，

to prove their mettle.

使他们能够施展才华。

They need to be able

to take their countries' licensing exams.

他们需要

They need jobs in the public health sector

通过所在国家的执业考试，

or in nonprofit health centers

他们需要有公共医疗机构

to put their training and commitment to work.

或非营利医疗机构的工作，

来把他们所学和使命付诸实践。

They need the chance to be

他们需要得到机会，

the doctors their patients need.

成为病人所需的医生。

为了推进医疗事业，

To move forward,

we may have to find our way back

我们或许不得不

回到一位儿科医生的道路上来。

to that pediatrician who would

在我还是个孩子的时候，

knock on my family's door

他到我们位于南芝加哥的家来拜访。

on the South Side of Chicago when I was a kid,

who made house calls,

他上门服务，

who was a public servant.

他真是一位人民公仆。

These aren't such new ideas

这些内容，对于医疗服务来说，

of what medicine should be.

没有什么新颖之处。

What's new is the scaling up

新颖的是其覆盖范围的扩大，

and the faces of the doctors themselves:

以及医生的面庞：

an ELAM graduate is more likely to be a she

拉丁美洲医学院的毕业生，

更可能是一名女性而非男性；

than a he;

In the Amazon, Peru or Guatemala,

一位在亚马逊、秘鲁或危地马拉

an indigenous doctor;

当地行医的本土医生；

in the USA, a doctor of color

在美国，很可能是一位能说流利的西班牙语的

who speaks fluent Spanish.

有色人种医生。

She is well trained, can be counted on,

她们受过良好训练，值得信赖，

and shares the face and culture of her patients,

她们与病人来自同一种族，并有文化共通感，

and she deserves our support surely,

她们理应获得我们的支持，

because whether by subway, mule, or canoe,

因为无论是坐着地铁、骑着骡子，还是乘着独木舟，

she is teaching us to walk the walk.

她们都在教我们怎样将想法「付诸行动」。

Thank you. (Applause)

谢谢。（掌声）