Rebecca Onie: What if our healthcare system kept us healthy?

Translator: Timothy Covell Reviewer: Morton Bast

譯者: Gina Wang 審譯者: Anny Chung

So my freshman year of college

我大一的時候

I signed up for an internship in the housing unit

申請成為大波士頓法律援助處的實習生

at Greater Boston Legal Services.

在住宅部門

Showed up the first day

第一天上工時

ready to make coffee and photocopies,

我準備好要幫大家煮咖啡、影印

but was paired with this righteous, deeply inspired attorney

卻被分配與一位充滿正義感與啟發性的律師共事

named Jeff Purcell,

他是Jeff Purcell

who thrust me onto the front lines

他在我實習的第一天

from the very first day.

便將我丟到工作前線

And over the course of nine months

而在之後的九個月中

I had the chance

我有機會

to have dozens of conversations

跟許多波士頓低收入的家庭

with low-income families in Boston

有許多會談

who would come in presenting with housing issues,

他們來我們這裡，通常是因為許多關於居住的問題

but always had an underlying health issue.

但潛藏其中，總有與健康相關的問題

So I had a client who came in,

我有一個客戶

about to be evicted because he hasn't paid his rent.

他因長期沒付房租，即將被逐出房屋

But he hasn't paid his rent, of course,

但他一直沒付房租

because he's paying for his HIV medication

是因為他必須支付愛滋病的醫藥費

and just can't afford both.

所以無法負荷兩者加起來的支出

We had moms who would come in,

也有許多母親來我們這裡

daughter has asthma,

女兒有氣喘病

wakes up covered in cockroaches every morning.

卻每天早晨在蟑螂堆中起床

And one of our litigation strategies

我們訴訟的策略之一

was actually to send me into the home of these clients

是派我去這些客戶的家裡

with these large glass bottles.

用大玻璃瓶

And I would collect the cockroaches,

蒐集這些蟑螂

hot glue-gun them to this poster board

用熱熔膠把蟑螂黏在海報板上

that we'd bring to court for our cases.

再帶到法庭打官司

And we always won

而我們總能贏得這些案件

because the judges were just so grossed out.

因為法官看了這些都覺得很噁心

Far more effective, I have to say,

這方法，我必須承認

than anything I later learned in law school.

比我日後在法學院所學的都還要有效

But over the course of these nine months,

但是在這九個月中

I grew frustrated with feeling

我越來越感到挫敗

like we were intervening too far downstream

因為在客戶的生活中

in the lives of our clients --

我們出手相助的時機總是太晚

that by the time they came to us,

當他們來尋求幫助時

they were already in crisis.

他們的生活早已陷入危機

And at the end of my freshman year of college,

當我大一那年即將結束時

I read an article about the work

我讀到一篇文章

that Dr. Barry Zuckerman was doing

是有關Barry Zuckerman博士的工作

as Chair of Pediatrics

他是小兒科主任

at Boston Medical Center.

在波士頓醫療中心工作

And his first hire was a legal services attorney

而他的第一份工作是當律師

to represent the patients.

為病患辯護

So I called Barry,

我打電話給Barry

and with his blessing, in October 1995

並在他的幫助之下，於1995年10月

walked into the waiting room

走進波士頓醫療中心

of the pediatrics clinic at Boston Medical Center.

小兒科的候診室

I'll never forget,

我永遠不會忘記

the TVs played this endless reel of cartoons.

他們的電視上不斷播放卡通

And the exhaustion of mothers

而那些筋疲力竭的母親們

who had taken two, three, sometimes four buses

有些已經轉了2、3次，甚至是4次的公車

to bring their child to the doctor

才能帶她的小孩來看醫生

was just palpable.

她們的疲憊真實的如可觸見

The doctors, it seemed,

那些醫生

never really had enough time for all the patients,

看似永遠沒有足夠時間來看所有的病患

try as they might.

儘管他們很努力

And over the course of six months,

而接下來的六個月

I would corner them in the hallway

我常在走廊上攔下這些醫生

and ask them a sort of naive but fundamental question:

問他們一個看似天真但卻很基本的問題：

"If you had unlimited resources,

「如果你有無限的資源

what's the one thing you would give your patients?"

你會給你的病患什麼？」

And I heard the same story again and again,

同樣的回答一次又一次的出現

a story we've heard hundreds of times since then.

我們大概聽了一百遍這樣的故事

They said, "Every day we have patients that come into the clinic --

他們說："我們每天有許多病患來求診

child has an ear infection,

像耳朵感染的小孩

I prescribe antibiotics.

我會開抗生素

But the real issue is there's no food at home.

但是最大的問題是他們家中沒有食物

The real issue

真正的問題

is that child is living with 12 other people

是這小孩與其他12個人一起

in a two-bedroom apartment.

住在一間只有兩個臥房的公寓

And I don't even ask about those issues

而我對於這樣的事卻不願多問

because there's nothing I can do.

因為我也束手無策

I have 13 minutes with each patient.

我與每位病患有13分鐘的診療時間

Patients are piling up in the clinic waiting room.

候診室塞滿病人

I have no idea where the nearest food pantry is.

我不曉得最近的救濟中心在哪

And I don't even have any help."

也沒有人能幫我。"

In that clinic, even today,

即便今日，在那間醫療中心

there are two social workers

只有2位社工

for 24,000 pediatric patients,

卻要處理2萬4千位小兒科病人

which is better than a lot of the clinics out there.

但這狀況已經比其他的醫療中心好了

So Health Leads was born of these conversations --

「導向健康組織(Heath Leads)」從這些會談中誕生

a simple model

運用簡單的模式

where doctors and nurses

讓醫生和護士

can prescribe nutritious food,

能開營養的食物

heat in the winter

冬天的暖氣

and other basic resources for their patients

和其他基本的生活資源給病患

the same way they prescribe medication.

就像他們開其他藥方一樣

Patients then take their prescriptions

病患拿著這些處方籤

to our desk in the clinic waiting room

來我們位於候診室的櫃台

where we have a core of well-trained college student advocates

在這我們有一群訓練優良的大學生

who work side by side with these families

可以從旁協助這些家庭

to connect them out

幫他們向外聯繫

to the existing landscape of community resources.

取得社區現有的資源

So we began with a card table in the clinic waiting room --

一開始我們在診療室設立了一個簡單的櫃台

totally lemonade stand style.

就像賣檸檬汁的攤販那樣

But today we have a thousand college student advocates

但如今我們已有1千名支持這項行動的大學生

who are working to connect nearly 9,000 patients and their families

他們幫忙9千個病患和其家庭

with the resources that they need to be healthy.

幫忙取得他們維持健康所需的資源

So 18 months ago

18個月前

I got this email that changed my life.

我收到一封改變我人生的電郵

And the email was from Dr. Jack Geiger,

是Jack Geiger博士寄給我的

who had written to congratulate me on Health Leads

他寫來恭賀我和導向健康組織

and to share, as he said,

並且分享，如同他說的

a bit of historical context.

一些歷史脈絡

In 1965 Dr. Geiger founded

1965年，Geiger博士創立

one of the first two community health centers in this country,

那時全國唯二社區健康中心的其中一個

in a brutally poor area in the Mississippi Delta.

位於密西西比三角洲，是極為貧窮的地區

And so many of his patients came in

博士有許多前來求診的病患

presenting with malnutrition

呈現營養不良的問題

that be began prescribing food for them.

於是他開始開食物給病患當藥方

And they would take these prescriptions to the local supermarket,

病人將這些處方籤拿去當地超市

which would fill them

取得他們所需的食物

and then charge the pharmacy budget of the clinic.

超市則向診所支取這些費用

And when the Office of Economic Opportunity in Washington, D.C. --

當華府的職業訓練部

which was funding Geiger's clinic --

--他們當時資助Geiger的診所--

found out about this,

發現這件事後

they were furious.

他們十分不高興

And they sent this bureaucrat down

派官員告訴Geiger

to tell Geiger that he was expected to use their dollars

他們期待將這些資助的費用

for medical care --

花在醫療保健上

to which Geiger famously and logically responded,

Geiger的回應出名且有邏輯：

"The last time I checked my textbooks,

"上回我查課本的時候

the specific therapy for malnutrition was food."

針對改善營養不良，最好的解藥就是食物。"

(Laughter)

(笑聲)

So when I got this email from Dr. Geiger,

因此當我收到Geiger博士的這封電郵

I knew I was supposed to be proud

我知道我身為這段歷史的一份子

to be part of this history.

應該感到驕傲

But the truth is

但事實上

I was devastated.

我卻感到挫敗

Here we are,

我們現在

45 years after Geiger has prescribed food for his patients,

離Geiger開食物給他的病人當藥方已經45年

and I have doctors telling me,

卻仍有醫生告訴我

"On those issues, we practice a 'don't ask, don't tell' policy."

"面對這些問題 我們奉行「不問、不說」的原則"

Forty-five years after Geiger,

在Geiger開始這項行動的45年後

Health Leads has to reinvent

導向健康組織必須重新創造

the prescription for basic resources.

給予病人基本生活資源的的藥方

So I have spent hours upon hours

我花了好多時間

trying to make sense of this weird Groundhog Day.

試圖了解這個怪異的迴圈

How is it that if for decades

為什麼這幾十年來

we had a pretty straightforward tool for keeping patients,

我們一直有非常直接的方法讓病患健康

and especially low-income patients, healthy,

特別是低收入戶的患者

that we didn't use it?

我們卻從不使用？

If we know what it takes to have a healthcare system

如果我們知道要如何成立「健保」系統

rather than a sick-care system,

而不是「病保」系統

why don't we just do it?

為什麼我們不做呢？

These questions, in my mind,

在我心中，這些問題

are not hard because the answers are complicated,

並不因為答案很複雜而困難

they are hard because they require that we be honest with ourselves.

它們是如此困難， 是因為它需要我們誠實的面對自己

My belief is that it's almost too painful

我認為這是一件極為痛苦的事

to articulate our aspirations for our healthcare system,

以致我們無法表達對健保制度的期望

or even admit that we have any at all.

或甚至承認有任何期待

Because if we did,

因為如果我們這麼做

they would be so removed

它們將看似遙不可及

from our current reality.

不可能存在現實生活中

But that doesn't change my belief

但這並不能改變我的信念

that all of us, deep inside,

我認為每個人在心深處

here in this room and across this country,

在這間大廳和整個國家

share a similar set of desires.

都有相同的渴望

That if we are honest with ourselves

如果我們能誠實的面對自己

and listen quietly,

並安靜的傾聽

that we all harbor

我們便能懷抱

one fiercely held aspiration for our healthcare:

對健保制度的熱切期望：

that it keep us healthy.

它幫我們保持健康

This aspiration that our healthcare keep us healthy

認為健保制度能讓人們健康的期待

is an enormously powerful one.

是非常強大有影響力的

And the way I think about this

我是這麼認為:

is that healthcare is like any other system.

健保制度跟其它制度一樣

It's just a set of choices that people make.

它只是一系列人們的選擇

What if we decided

如果我們決定

to make a different set of choices?

做出不同的選擇，將會如何?

What if we decided to take all the parts of healthcare

如果我們決定不讓健保制度

that have drifted away from us

拿走對我們有助益的部分

and stand firm and say, "No.

並且堅決的說："不

These things are ours.

這些都是屬於我們的

They will be used for our purposes.

它們會幫助我們達成目標

They will be used to realize

它們會被使用並實現

our aspiration"?

我們的期望"

What if everything we needed

所有能讓我們實現

to realize our aspiration for healthcare

對健保制度期望的要件

was right there in front of us

會不會就在我們面前

just waiting to be claimed?

等待被使用？

So that's where Health Leads began.

這就是導向健康組織的開端

We started with the prescription pad --

我們從處方籤著手

a very ordinary piece of paper --

一張非常平凡的紙

and we asked, not what do patients need to get healthy --

我們不問病患要怎麼做才能健康

antibiotics, an inhaler, medication --

不是抗生素、吸入劑、藥物治療

but what do patients need to be healthy,

而是問病患需要什麼才能保持健康

to not get sick in the first place?

讓他們一開始就不會生病

And we chose to use the prescription

而我們選擇使用的藥方

for that purpose.

專為這個目的

So just a few miles from here

離這裡幾哩遠的地方

at Children's National Medical Center,

在國家兒童醫療中心

when patients come into the doctor's office,

當病人來到醫生辦公室

they're asked a few questions.

他們會被問幾個問題

They're asked, "Are you running out of food at the end of the month?

"你的食物夠不夠每月所需？

Do you have safe housing?"

你有安全的住處嗎？"

And when the doctor begins the visit,

因此當醫生診療時

she knows height, weight, is there food at home,

他知道病人的身高、體重、家裡存糧的狀況

is the family living in a shelter.

他的家庭是否住在安全的地方

And that not only leads to a better set of clinical choices,

這些問題不只讓診療結果更好

but the doctor can also prescribe those resources for the patient,

醫生也能開給病患他們所需的資源

using Health Leads like any other sub-specialty referral.

藉由導向健康或其他組織的幫助

The problem is,

問題是

once you get a taste of what it's like

當你嚐到

to realize your aspiration for healthcare,

實現對健保制度的期望的滋味

you want more.

你會想要更多

So we thought,

因此我們想:

if we can get individual doctors

如果我們可以讓每位醫生

to prescribe these basic resources for their patients,

開基本的生活資源給患者

could we get an entire healthcare system

我們是否能讓整個健保制度

to shift its presumption?

改變它先入為主的態度?

And we gave it a shot.

所以我們決定一試

So now at Harlem Hospital Center

現在，哈林醫學中心

when patients come in with an elevated body mass index,

當前來的病患測出有過高身體質量指數(BMI)時

the electronic medical record

電子醫療記錄

automatically generates a prescription for Health Leads.

自動產生處方給導向健康組織

And our volunteers can then work with them

而我們的志工即可協助

to connect patients to healthy food and excercise programs

讓病患取得他們的社區中

in their communities.

健康飲食與運動計畫

We've created a presumption

我們創造出這個假設:

that if you're a patient at that hospital

如果你去醫院

with an elevated BMI,

身體質量指數很高

the four walls of the doctor's office

在醫院裡

probably aren't going to give you everything

你可能無法得到你需要的

you need to be healthy.

你需要健康

You need more.

你需要更多

So on the one hand,

所以一方面

this is just a basic recoding

這只是基本重新設計

of the electronic medical record.

電子醫療的記錄程式

And on the other hand,

另一方面

it's a radical transformation

這是大規模的改變

of the electronic medical record

對電子醫療記錄而言

from a static repository of diagnostic information

從靜態儲存診斷記錄

to a health promotion tool.

變成推廣健康的工具

In the private sector,

在私營部門

when you squeeze that kind of additional value

當你從固定成本的投資中

out of a fixed-cost investment,

找出這樣的附加價值

it's called a billion-dollar company.

這被稱做高盈利公司

But in my world,

但在我的世界裡

it's called reduced obesity and diabetes.

這被稱做減少肥胖和糖尿病

It's called healthcare --

這就是健保

a system where doctors can prescribe solutions

讓醫生能開好處方的系統

to improve health,

讓病人改善健康

not just manage disease.

不只是控制病情

Same thing in the clinic waiting room.

在醫院的候診室也是如此

So every day in this country

在這個國家裡，每一天

three million patients

3百萬名病人

pass through about 150,000 clinic waiting rooms in this country.

會先待在15萬的候診室

And what do they do when they're there?

他們在那裡要做什麼呢？

They sit, they watch the goldfish in the fish tank,

他們坐著，看水族箱裡的金魚

they read extremely old copies

他們讀好久以前的

of Good Housekeeping magazine.

居家生活雜誌

But mostly we all just sit there forever, waiting.

但我們大多就在那永無止盡的等待

How did we get here

我們怎麼會這樣

where we devote hundreds of acres and thousands of hours

致力花了很多空間與時間

to waiting?

只為了等待？

What if we had a waiting room

如果我們可以有一個候診室

where you don't just sit when you're sick,

不只是生病時去那坐著

but where you go to get healthy.

而是去那裡恢復健康

If airports can become shopping malls

如果機場可以變成購物中心

and McDonald's can become playgrounds,

麥當勞變成遊樂場

surely we can reinvent the clinic waiting room.

我們也可以重新設計候診室

And that's what Health Leads has tried to do,

而這就是導向健康組織試圖做的事

to reclaim that real estate and that time

重新審視空間與時間

and to use it as a gateway

將之利用成為一種

to connect patients

幫助病人的途徑

to the resources they need to be healthy.

讓他們得到能恢復健康的物資

So it's a brutal winter in the Northeast,

今年美國東北的冬天很冷

your kid has asthma, your heat just got turned off,

你的孩子有氣喘，你沒有暖氣

and of course you're in the waiting room of the ER,

你當然前往急診室的候診室

because the cold air triggered your child's asthma.

因為冷空氣導致你小孩氣喘

But what if instead of waiting for hours anxiously,

但假使與其在那花幾個小時焦急的等待

the waiting room became the place

候診室成為

where Health Leads turned your heat back on?

導向健康組織幫你讓暖氣重新運作的地方?

And of course all of this requires

當然這些都需要

a broader workforce.

更多的人力

But if we're creative, we already have that too.

但如果我們夠有創意，我們早已擁有這些

We know that our doctors and nurses

我們知道我們的醫生和護士

and even social workers

甚至社工

aren't enough,

都仍不夠

that the ticking minutes of health care

時間緊迫的健保制度

are too constraining.

設限太多

Health just takes more time.

健康需要我們花更多的時間

It requires a non-clinical army

需要非診所的團體

of community health workers and case managers

社區健康工作者和個案負責人

and many others.

還有許多其他的人力

What if a small part of that next healthcare workforce

那如果下代健保一部分人力來自

were the 11 million college students in this country?

我國1億1的大學生呢?

Unencumbered by clinical responsibilities,

不受醫療系統的限制

unwilling to take no for an answer

不願意向政府機構

from those bureaucracies

那些無法幫助病人的政策

that tend to crush patients,

低頭與妥協

and with an unparalleled ability

大學生擁有前所未有的能力

for information retrieval

能取得資料

honed through years of using Google.

因著這幾年來使用google的經驗

Now lest you think it improbable

現在，如果你覺得這不可能

that a college volunteer

一個大學志工

can make this kind of commitment,

可以委身這樣的託付

I have two words for you:

我有4個字給你：

March Madness.

三月瘋狂(美國大學籃球聯賽賽季)

The average NCAA Division I men's basketball player

美國體育協會的一級男子籃球競賽中

dedicates 39 hours a week to his sport.

籃球員每週花39小時做訓練

Now we may think that's good or bad,

不論你覺得是好是壞

but in either case it's real.

這是確實發生的事情

And Health Leads is based on the presumption

導向健康組織認為

that for too long

已經太久

we have asked too little of our college students

我們對大學生的要求太少

when it comes to real impact in vulnerable communities.

我們需要大學生對脆弱的社群發揮影響力

College sports teams say,

大學球隊會說：

"We're going to take dozens of hours

"我們要花很多小時

at some field across campus at some ungodly hour of the morning

在離校園很遠的地方，在討厭的清晨

and we're going to measure your performance, and your team's performance,

我們要考核你和你隊伍的表現

and if you don't measure up or you don't show up,

如果你表現不夠好或是你沒出現

we're going to cut you off the team.

我們會把你踢出球隊

But we'll make huge investments

但是我們會高額投資

in your training and development,

在你的訓練和發展上

and we'll give you an extraordinary community of peers."

我們也會給你優良的隊員"

And people line up out the door

而人們總是在門外大排長龍

just for the chance to be part of it.

只想要成為球隊的一份子

So our feeling is,

因此我們認為

if it's good enough for the rugby team,

如果大學生願意參加橄欖球隊

it's good enough for health and poverty.

他們也會願意幫助健康或窮困

Health Leads too recruits competitively,

導向健康的招募像球隊一樣充滿競爭性

trains intensively,

高強度訓練

coaches professionally,

並有專業指導

demands significant time,

需要花一段時間

builds a cohesive team

來建立凝聚力高的團隊

and measures results --

並驗收成效

a kind of Teach for America for healthcare.

像是「為美國而教」的健保版 (大學畢業生到偏遠、窮困地區教書)

Now in the top 10 cities in the U.S.

現在於美國

with the largest number of Medicaid patients,

十個最多的病人需要醫療補助的城市中

each of those has at least 20,000 college students.

各個至少有2萬名大學生

New York alone has half a million college students.

僅紐約就有50萬

And this isn't just a sort of short-term workforce

這不是短期的勞動力

to connect patients to basic resources,

為了幫病人取得基本資源

it's a next generation healthcare leadership pipeline

這是培養下一代健保領導者的管道

who've spent two, three, four years

他們花了2、3、4年

in the clinic waiting room

在候診室裡

talking to patients about their most basic health needs.

與病人協談有關他們最基本的保健需求

And they leave with the conviction,

而他們離開時會有信念

the ability and the efficacy

能力和功效

to realize our most basic aspirations for health care.

來完成我們對健保最基本的期望

And the thing is, there's thousands of these folks already out there.

事實上，我們已經有成千上萬委身此事的大學生

So Mia Lozada is Chief Resident of Internal Medicine

Mia Lozada是內科住院總醫師

at UCSF Medical Center,

在加州大學舊金山分校的醫學中心

but for three years as an undergraduate

但她還是大學生時，她花了三年

she was a Health Leads volunteer

擔任導向健康組織的志工

in the clinic waiting room at Boston Medical Center.

在波士頓醫學中心的候診室

Mia says, "When my classmates write a prescription,

Mia說："當我的醫學院同學開了處方

they think their work is done.

他們認為他們的工作已結束

When I write a prescription,

當我開處方時

I think, can the family read the prescription?

我會想，這個家庭讀得懂這個處方嗎？

Do they have transportation to the pharmacy?

他們有辦法通車到藥房嗎？

Do they have food to take with the prescription?

他們有可以搭配療程的食物嗎？

Do they have insurance to fill the prescription?

他們有保險可以支付這張藥單嗎？

Those are the questions I learned at Health Leads,

這些問題都是我在導向健康工作時學到的

not in medical school."

不是在醫學院"

Now none of these solutions --

目前這些解決方式：

the prescription pad, the electronic medical record,

處方籤、電子醫療記錄

the waiting room,

候診室

the army of college students --

或大學生志工

are perfect.

都仍不完善

But they are ours for the taking --

但只要我們願意，這些都能改善

simple examples

舉個簡單的例子

of the vast under-utilized healthcare resources

這些大量少被使用的健保資源

that, if we reclaimed and redeployed,

如果我們重新使用與配置

could realize our most basic aspiration

即可實現我們對健保

of healthcare.

最基本的渴望

So I had been at Legal Services for about nine months

當我在法律機構工作9個月後

when this idea of Health Leads started percolating in my mind.

成立導向健康組織的概念在我心中逐漸成型時

And I knew I had to tell Jeff Purcell, my attorney,

我知道我必須告訴Jeff Purcell，我的上司

that I needed to leave.

我必須離開

And I was so nervous,

我當時非常緊張

because I thought he was going to be disappointed in me

覺得他會對我感到失望

for abandoning our clients for some crazy idea.

因為我為了瘋狂的想法拋棄我們的客戶

And I sat down with him and I said,

我們倆坐下商量，我說

"Jeff, I have this idea

"Jeff，我有個想法

that we could mobilize college students

我們可以動員大學生

to address patients' most basic health needs."

讓他們向社會宣導病患最基本的健康需求"

And I'll be honest,

我誠實的告訴你

all I wanted was for him to not be angry at me.

我當時只希望上司不要對我生氣

But he said this,

但他卻這麼說

"Rebecca, when you have a vision,

"Rebecca，當你有這樣的遠見

you have an obligation to realize that vision.

你有義務去實行它

You must pursue that vision."

你必須追求這個夢想"

And I have to say, I was like "Whoa.

我得說，我當時覺得

That's a lot of pressure."

"哇！這個壓力真大"

I just wanted a blessing,

我本來只希望得到他的祝福

I didn't want some kind of mandate.

我不想被命令

But the truth is

但事實上

I've spent every waking minute nearly since then

自那時起，我花了所有的心力

chasing that vision.

追求我的目標

I believe that we all have a vision

我相信我們對這國家的健保制度

for healthcare in this country.

都有一個目標

I believe that at the end of the day

我相信，最後

when we measure our healthcare,

當我們衡量健保的重要性

it will not be by the diseases cured,

不是用治癒疾病的數量

but by the diseases prevented.

而是用避免疾病的數量

It will not be by the excellence of our technologies

也不是用科技的發達

or the sophistication of our specialists,

或是專家專精的程度

but by how rarely we needed them.

而是以我們不用倚賴他們的程度來算

And most of all,

最重要的是

I believe that when we measure healthcare,

我相信當我們估算健保的重要性時

it will be, not by what the system was,

將不會根據這個制度以往的樣子

but by what we chose it to be.

而是我們決定它成為的樣子

Thank you.

謝謝

(Applause)

(掌聲)

Thank you.

謝謝

(Applause)

(掌聲)