Seyi Oyesola: Health care off the grid

譯者: Marie Wu 審譯者: Adrienne Lin

Just to put everything in context,

我想先做一下背景介紹，

and to kind of give you a background to where I'm coming from,

讓各位瞭解我來自何方，

so that a lot of the things I'm going to say,

因為我待會兒要說的事、

and the things I'm going to do --

我待會兒要做的事、

or things I'm going to tell you I've done --

或是我待會兒要告訴你們我做了什麼事，

you will understand exactly why and how I got motivated to be where I am.

都是為了讓各位瞭解我的動機，為什麼我要做這些事。

I graduated high school in Cleveland, Ohio, 1975.

我於1975年自俄亥俄州克利夫蘭的高中畢業，

And just like my parents did when they finished studying abroad, we went back home.

就像我父母在海外求學之後會回國一樣，我也回到家鄉，

Finished university education, got a medical degree, 1986.

在1986年取得我的大學醫學學位。

And by the time I was an intern house officer,

那時，我是住院實習醫生，

I could barely afford to maintain my mother's 13-year-old car --

薪水只勉強供得起我母親那輛13年的老爺車，

and I was a paid doctor.

而且我還是個領薪水的醫生。

This brings us to why a lot of us, who are professionals,

這就是為什麼我們這些專業人員

are now, as they say, in diaspora.

大多都待在海外不回去的原因，

Now, are we going to make that a permanent thing,

大家都在想，要一直這樣下去嗎？

where we all get trained, and we leave, and we don't go back?

大家都在畢業後就離開，不回去了嗎？

Perhaps not, I should certainly hope not --

也不一定，我希望答案是否定的，

because that is not my vision.

因為我心中不是這樣想的。

All right, for good measure, that's where Nigeria is on the African map,

為了讓大家更清楚瞭解，這是非洲地圖，奈及利亞在這裡，

and just there is the Delta region that I'm sure everybody's heard of.

我相信大家都知道這附近的三角洲區域，

People getting kidnapped, where the oil comes from,

那裡不斷有人被綁架，因為那裡盛產石油，

the oil that sometimes I think has driven us all crazy in Nigeria.

有時我覺得石油讓奈及利亞所有人都喪失理智，

But, critical poverty: this slide is from a presentation I gave

但奈及利亞卻仍極度貧困，這張投影片是我為前不久的一次演講所準備的。

not that long ago. Gapminder.org tells the story of the gap

Gapminder.org(網站)說明非洲與世界其他國家

between Africa and the rest of the world in terms of health care.

在醫療照護上的嚴重差距，

Very interesting.

很有趣。

How many people do you think are on that taxi?

你們猜有多少人在車上？

And believe it or not, that is a taxi in Nigeria.

不管你相不相信，那確實是一輛奈及利亞的計程車。

And the capital -- well, what used to be the capital of Nigeria -- Lagos,

首都--曾經是奈及利亞首都的拉哥斯，

that's a taxi, and you have police on them.

警察就坐在計程車上，

So, tell me, how many policemen do you think are on this taxi? And now? Three.

你們猜這輛計程車裡有幾個警察？三個。

So, when these kind of people -- and, believe me, it's not just the police

看看這些人，請相信在拉哥斯，不只有警察會搭乘這種計程車，

that use these taxis in Lagos. We all do. I've been on one of these,

每個市民都會搭乘，我也曾經搭過，

and I didn't have a helmet, either.

我也沒有戴安全帽。

And it just reminds me of the thought of what happens when one of us

我想到萬一有一天有人從這種計程車上掉下來了，

on a taxi like this falls off, has an accident and needs a hospital.

勢必會受傷，得送到醫院去治療。

Believe it or not, some of us do survive.

有些人的確在車禍後活了下來，

Some of us do survive malaria; we do survive AIDS.

有些人也在感染瘧疾後活了下來，有些人也躲過愛滋病，

And like I tell my family, and my wife reminds me every time,

但就像我對家人說的，或是我太太總是這麼提醒我：

"You're risking your life, you know, every time you go to that country."

這是在冒生命危險，每次你去奈及利亞都是在冒險。

And she's right. Every time you go there,

她是對的。每次你到奈及利亞，

you know that if you actually need critical care --

一旦你需要緊急醫療照護，

critical care of any sort -- if you have an accident --

不管是什麼樣的緊急醫療照護，像是出了車禍或意外什麼的，

of which there are many, there are accidents everywhere --

反正那裡到處都有可能發生意外，

where do they go?

那麼受傷的人要去哪裡？

Where do they go when they need help for this kind of stuff?

當他們需要醫療照護時，他們會去什麼地方？

I'm not saying instead of, I'm saying as well as,

我不是說除了這些疾病以外就沒有別的疾病了，

AIDS, TB, malaria, typhoid -- the list goes on.

愛滋病、結核病、瘧疾、傷寒...還有很多疾病，

I'm saying, where do they go when they're like me?

我是說當他們生病時他們會上哪裡求診？

When I go back home -- and I do all kinds of things,

當我回到奈及利亞，我會做很多事，

I teach, I train -- but I catch one of these things,

我會教書、訓練醫護人員，但如果我染上這其中一種病，

or I'm chronically ill with one of those, where do they go?

或是我得了慢性病，他們該怎麼辦？

What's the economic impact when one of them dies or becomes disabled?

如果他們死了或是殘廢了，會有什麼經濟上的影響？

I think it's quite significant. This is where they go.

我認為影響很嚴重。這是他們會去的地方，

These are not old pictures and these are not from some downtrodden --

這不是一張過時的照片，也不是從哪個落後的地方拍來的，

this is a major hospital. In fact, it's from a major teaching hospital in Nigeria.

這是一家大型醫院，一家在奈及利亞的大型教學醫院。

Now that is less than a year old, in an operating room.

這張照片是在不到一年以前拍的，這是手術室，

That's sterilizing equipment in Nigeria.

這是在奈及利亞的消毒設備，

You remember all that oil?

還記得我剛才說的石油的事嗎？

Yes, I'm sorry if it upsets some of you, but

如果我讓各位感到不舒服，我很抱歉，

I think you need to see this. That's the floor, OK?

但我覺得各位一定得看看這個，這是地板，好嗎？

You can say some of this is education.

你可以說這是教育的問題，

You can say it's hygiene. I'm not pleading poverty.

你也可以說是衛生的問題，但我不是以貧窮為藉口，

I'm saying we need more than just, you know, vaccination,

我只是覺得我們需要的不只是對抗天花、瘧疾和愛滋病的藥物，

malaria, AIDS, because I want to be treated

我只是希望在我發生意外的時候，

in a proper hospital if something happens to me out there.

能到一個像樣的醫院裡求診。

In fact, when I start running around saying,

事實上，當我四處奔走宣傳說：

"Hey, boys and girls, you're cardiologists in the U.S.,

「嘿，各位，你們是在美國的心臟科醫生，

can you come home with me and do a mission?"

可不可以回來和我一起為大家服務？」

I want them to think, "Well there's some hope."

我希望他們覺得：「好像還有一點希望。」

Now, have a look at that. That's the anesthesiology machine.

現在，看看這個，這是麻醉的機器，

And that's my specialty, right?

那可是我的專長，對吧？

Anesthesiology and critical care -- look at that bag.

我的專長是麻醉和緊急醫療，看看這個袋子，

It's been taped with tape that we even stopped using in the U.K.

這個袋子讓人用膠帶固定住了，我們甚至在英國都已經不用這個東西了，

And believe me, these are current pictures.

相信我，這是最近才照的照片。

Now, if something like this, which has happened in the U.K.,

如果這種情況發生在英國，

that's where they go. This is the intensive care unit in which I work.

病人會到這裡來，也就是我工作的加護病房。

All right, this is a slide from a talk I gave

這一張投影片是我上次在談

about intensive care units in Nigeria,

奈及利亞的加護病房時準備的，

and jokingly we refer to it as "Expensive Scare."

我們把加護病房戲稱為「加錢病惶」，

Because it's scary and it's expensive, but we need to have it, OK?

因為又貴又嚇人，但我們還是得用，

So, these are the problems.

所以就有幾個問題，

There are no prizes for telling us what the problems are, are there?

是哪些問題回答了沒獎品，因為太簡單了對吧？

I think we all know. And several speakers before

我想大家應該都已經知道是什麼問題，

and speakers after me are going to tell us even more problems.

在我之前或之後的講者都提到這許多問題，

These are a few of them. So, what did I do?

我把他們列出來。那麼我做了什麼？

There we go -- we're going on a mission.

看看，這是我們這一趟義診，

We're going to do some open-heart surgery. I was the only Brit,

我們打算執行幾個開心手術，我是裡頭唯一的英國人，

on a team of about nine American cardiac surgeons,

其他九個都是來自美國的心臟手術醫生、

cardiac nurse, intensive care nurse.

心臟科護士和加護病房護士。

We all went out and did a mission and we've done three of them so far.

我們在那裡義診，目前已完成了三趟義診。

Just so you know, I do believe in missions, I do believe in aid

因此，我相信義診，我相信援助，

and I do believe in charity. They have their place,

我也相信慈善的力量，每一個都有其功能，

but where do they go for those things we talked about earlier?

但這三者對我先前所談到的事情又有何助益？

Because it's not everyone that's going to benefit from a mission.

不是每一個人都能從我們的義診中獲益，

Health is wealth, in the words of Hans Rosling.

但套句漢斯．羅斯林的話說，健康就是財富，

You get wealthier faster if you are healthy first.

有健康才能迅速致富。

So, here we are, mission. Big trouble.

我們來做義診：很困難。

Open-heart surgery in Nigeria -- big trouble.

在奈及利亞執行開心手術：很困難。

That's Mike, Mike comes out from Mississippi.

這是麥克，他來自密西西比，

Does he look like he's happy?

他看起來高興嗎？

It took us two days just to organize the place, but hey,

我們花了二天的時間來佈置這個地方，

you know, we worked on it. Does he look happy?

但你看，這個地方可以用了！他高不高興？

Yes, that's the medical advice the committee chairman says,

對，這就是醫療諮詢委員會主席說的：

"Yes, I told you, you weren't going to be able to,

「對，我告訴你，你不能，

you can't do this, I just know it."

你做不到，我就知道！」

Look, that's the technician we had. So yes, you go on, all right?

看看，這是我們的技師，好吧，你說對了，可以吧？

(Laughter)

(笑聲)

I got him to come with me -- anesthesia tech -- come with me from the U.K.

我把他帶來，他是個麻醉技師，我把他從英國帶來，

Yes, let's just go work this thing out.

對，我們要一起讓這個機器動起來。

See, that's one of the problems we have in Nigeria and in Africa generally.

看看，這是我們在奈及利亞和非洲常會碰到的問題之一，

We get a lot of donated equipment.

我們會收到很多捐贈的儀器，

Equipment that's obsolete, equipment that doesn't quite work,

有些是已經過時的機器，有些則是不太能運作的機器，

or it works and you can't fix it. And there's nothing wrong with that,

或是你根本無法維修的機器。但他們都是一片好心，

so long as we use it and we move on.

所以我們就將就著用了。

But we had problems with it. We had severe problems there.

但我們還有其他的問題，還有其他更嚴重的問題，

He had to get on the phone. This guy was always on the phone.

他要講電話，這傢伙老是電話講個不停，

So what we going to do now?

該怎麼辦呢？

It looks like all these Americans are here and

看起來這些美國人就待在這裡，

yes, one Brit, and he's not going to do anything --

哦，還有一個英國人，他好像什麼事都不用做，

he thinks he's British actually, and he's actually Nigerian,

他認為他自己是英國人，也是奈及利亞人，

I just thought about that.

我就是這麼想的。

We eventually got it working, is the truth,

我們終於讓那台機器動了起來，是真的，

but it was one of these. Even older than the one you saw.

但那只是其中的一台而已，還有比你看到的那台還老的。

The reason I have this picture here, this X-ray,

我給各位看這張X光片的原因是，

it's just to tell you where and how we were viewing X-rays.

我要讓各位知道我們是在哪裡、怎麼看X光片的。

Do you figure where that is? It was on a window.

猜到這是什麼地方了嗎？是個窗戶，

I mean, what's an X-ray viewing box? Please.

我是說，幹嘛要用燈箱啊？拜託哦！

Well, nowadays everything's on PAX anyway.

嗯，現在很多東西都是用電子交換了，

You look at your X-rays on a screen and you do stuff with them,

你可以在電腦上看你的X光片，你還可以做些處理，

you email them. But we were still using X-rays,

像是用電子郵件寄出去。但我們還是在用X光，

but we didn't even have a viewing box!

只是我們甚至連個燈箱都沒有！

And we were doing open-heart surgery.

我們都做過開心手術了耶！

OK, I know it's not AIDS, I know it's not malaria,

好，我知道這不是愛滋病，也不是瘧疾，

but we still need this stuff. Oh yeah, echo --

但我們還是需要燈箱！

this was just to get the children ready and the adults ready.

讓大人小孩都能安心。

People still believe in Voodoo. Heart disease,

這裡的人還是相信巫毒，但還是會有心臟病、

VSD, hole in the heart, tetralogies.

心室中隔缺損、心膜缺損、四合症(四種心臟異常症狀)等，

You still get people who believe in it and they came.

所以還是有人相信現代醫學，來到這裡。

At 67 percent oxygen saturation, the normal is about 97.

她的血氧飽合度只有67%，正常值是97%，

Her condition, open-heart surgery that as she required,

她需要動開心手術，

would have been treated when she was a child.

早在她還是小孩時就該做了。

We had to do these for adults. So, we did succeed and we still do.

我們必須為幾個成人動開心手術，而且還很成功，

We've done three. We're planning another one in July

我們已經做了三趟義診了，我們計畫在今年七月再進行一趟，

in the north of the country. So, we certainly still do open-heart,

地點會在奈及利亞北部。我們當然還會繼續做開心手術，

but you can see the contrast between everything that was shipped in --

但你來看看我們進口的每樣東西，

we ship everything, instruments. We had explosions

我們幾乎什麼都要進口，各種設備都有，還有幾次小爆炸，

because the kit was designed and installed by people who weren't used to it.

因為安裝這些器材的人並不熟悉設備的運作方式，

The oxygen tanks didn't quite work right.

氧氣瓶沒有裝對位置。

But how many did we do the first one? 12.

猜猜我們第一趟義診做了幾個開心手術？12個，

We did 12 open-heart surgical patients successfully.

我們成功地為12個病人進心開心手術，

Here is our very first patient, out of intensive care,

這是我們第一位病人，他在加護病房外面，

and just watch that chair, all right?

看看那張椅子，好嗎？

This is what I mean about appropriate technology.

這就是我所說的適合的科技，

That's what he was doing, propping up the bed because the bed simply didn't work.

我們用椅子撐起那張床，因為那張床上升的裝置壞了，

Have you seen one of those before?

你以前看過這種情形嗎？

No? Yes? Doesn't matter, it worked.

有？沒有？沒關係，反正能用就好。

I'm sure you've all seen or heard this before:

我相信你們以前一定看過或聽過這句話，

"We, the willing, have been doing so much with so little for so long --

我們的意志可以在這麼簡陋的情況下完成這麼多的事...

(Applause)

(掌聲)

-- we are now qualified to do anything with nothing."

我們現在就算什麼都沒有也可以做出一些事來。

(Applause)

(掌聲)

Thank you. Sustainable Solutions -- this was my first company.

謝謝！「長久之計」，這是我的第一家公司，

This one's sole aim is to provide the very things that I think are missing.

這家公司成立的唯一目的就是提供我認為缺乏的東西，

So, we put my hand in my pocket and say, "Guys, let's just buy stuff.

我會把手伸進口袋裡，說：「各位，我們來買點東西。」

Let's go set up a company that teaches people, educates them,

我們來成立一家公司，用來教導群眾，

gives them the tools they need to keep going."

給他們維持生計所需要的工具，

And that's a perfect example of one.

這就是一個很棒的例子。

Usually when you buy a ventilator in a hospital,

通常在你為醫院採買呼吸器時，

you buy a different one for children,

你會為孩童買一個不一樣的，

you buy a different one for transport. This one will do everything,

買一個可以方便運送的；這個則有全方位功能，

and it will do it at half the price and doesn't need compressed air.

價格只有一半，還不需要壓縮空氣。

If you're in America and you don't know about this one, we do,

如果你在美國，你一定不知道這些，但我們知道，

because we make it our duty to find out

因為我們必須盡全力找到這種東西，

what's appropriate technology for Africa -- what's appropriately priced,

也就是對非洲來說最適合的科技，有最適合的價格，

does the job, and we move on. Anesthesia machine:

會運作就行了。麻醉機、

multi-parameter monitor, operating lights, suction.

多功能監視器、手術燈、抽吸器等。

This little unit here -- remember your little 12-volt plug in the car,

這個小東西--你還記得車子上有一個12伏特的小插座嗎？

that charges your, whatever, Game Boy, telephone?

可以幫你的遊戲機、電話這一類的充電？

That's exactly how the outlets are designed.

這個東西用汽車插座就能充電，

Yes, it will take a solar panel. Yes a solar panel will charge it.

也可以連接到太陽能板上，一片太陽能板就能幫它充電，

But if you've got mains as well, it will charge the batteries in there.

如果有電源的話，還可以幫裡頭的電池充電。

And guess what? We have a little pedal charger too, just in case.

猜猜還有什麼？我們還有一個小型的腳踏式充電器，以防萬一。

And guess what, if it all fails,

如果先前講的充電方式都不管用，

if you can find a car that's still got a live battery

只要找輛汽車，車上有汽車電池，

and you stick it in, it will still work. Then you can customize it.

插上就可以用了。你還可以依客戶需要來修改，

Is it dental surgery you want? General surgery you want?

你要做牙科手術嗎？還是一般的手術？

Decide which instruments, stock it up with consumables.

先決定你要用什麼儀器，再把零件找齊。

And currently we're working on oxygen -- oxygen delivery on-site.

現在我們在研究的是氧氣，我們想現場供輸氧氣。

The technology for oxygen delivery is not new.

供輸氧氣的科技不是什麼新科技，

Oxygen concentrators are very old technology. What is new,

氧氣濃縮技術很早就有了，

and what we will have in a few months, I hope,

我們想在未來幾個月達成的是一種新的技術，

is that ability to use this same renewable energy system

我們想用這種再生能源系統

to provide and produce oxygen on site. Zeolite -- it's not new --

現場製造並供輸氧氣。沸石也不是什麼新東西，

zeolite removes nitrogen from air and nitrogen is 78 percent of air.

它可以移除空氣中的氮氣，氮氣佔了空氣的78%。

If you take nitrogen out, what's left? Oxygen, pretty much.

如果我們把氮氣排除，還剩下什麼？大部分會是氧氣，

So that's not new. What we're doing is applying this technology to it.

所以這不是什麼新技術，我們只是要運用這項技術，

These are the basic features of my device, or our device.

這是我們的儀器的基本功能，

This is what makes it so special.

也正因這些功能而使這儀器異常特別。

Apart from the awards it's won,

先不提這個儀器所獲頒的獎項，

it's portable and it's certified. It's registered, the MHRA --

這個儀器是經過認證的，可以攜帶，已取得藥品管制局登記，

and the CE mark, for those who don't know, for Europe, is the equivalent

也通過歐洲CE標準認證，相當於美國的

of the FDA in the U.S.

食品藥物管理局。

If you compare it with what's on the market, price-wise,

將它與市面上其他產品相比，不管是價錢、

size-wise, ease of use, complexity ...

大小、使用簡便性或複雜程度等。

This picture was taken last year.

這張照片是去年拍的，

These are members of my graduating class, 1986.

是我1986年畢業的同班同學，

It was in this gentleman's house in the Potomac,

我們在這位男士位於波多馬克的家中拍攝的，

for those of you who are familiar with Maryland.

熟悉馬里蘭州的人應該知道波多馬克這個地方。

There are too many of us outside and everybody,

有很多人擠不進照片裡，

just to borrow a bit from Hans -- Hans Rosling, he's my guy --

套用我的偶像漢斯．羅斯林的一句話：

if the size of the text represents what gets the most attention,

如果字體的大小能抓住讀者的注意力，

it's the problems. But what we really need are African solutions

那就用來呈現問題吧！我們需要的是非洲式的方案，

that are appropriate for Africa -- looking at the culture,

要適合非洲的風土民情。看看那裡的文化，

looking at the people, looking at how much money they've got.

看看那裡的群眾，看看他們有多少錢。

African people, because they will do it with a passion, I hope.

我希望非洲人民會以滿腔熱血來執行這些方案，

And lots and lots of that little bit down there, sacrifice.

不管要犠牲什麼代價。

You have to do it. Africans have to do it,

各位必須投入心血，非洲人也是一樣，

in conjunction with everyone else.

大家一起來共同完成吧！

Thank you.

謝謝！

(Applause)

(掌聲)