Mitchell Besser: Mothers helping mothers fight HIV

18,380 views ・ 2010-09-23

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譯者: Adrienne Lin 審譯者: Geoff Chen
00:16
I want you to take a trip with me.
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請各位與我一起
00:18
Picture yourself driving
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想像你們開著車
00:20
down a small road in Africa,
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開在非洲的一條小路上
00:22
and as you drive along, you look off to the side,
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邊開邊注意到路邊的景象
00:25
and this is what you see:
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你會發現到的是這個
00:27
you see a field of graves.
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一片墓地
00:29
And you stop, and you get out of your car and you take a picture.
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然後你會停下來,下車,拍下照片
00:31
And you go into the town,
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繼續往城鎮開
00:33
and you inquire, "What's going on here?"
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然後你會問:「這裡發生了什麼事?」
00:35
and people are initially reluctant to tell you.
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居民一開始會不願意回答你
00:37
And then someone says,
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之後有人會向你坦白
00:39
"These are the recent AIDS deaths in our community."
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「這些是我們社區,最近因愛滋而死亡的人」
00:43
HIV isn't like other medical conditions;
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愛滋不像其他醫療疾病
00:45
it's stigmatizing.
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得愛滋是種恥辱
00:47
People are reluctant to talk about it --
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人們不願意多談
00:50
there's a fear associated with it.
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提到愛滋就一陣惶恐
00:52
And I'm going to talk about HIV today,
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我今天要談的是,關於愛滋、
00:54
about the deaths,
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關於死亡、
00:56
about the stigma.
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關於恥辱的故事
00:58
It's a medical story, but more than that, it's a social story.
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這是關於醫療的故事,但更重要的,是關於人們的故事
01:03
This map depicts the global distribution of HIV.
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這張地圖是全球愛滋分布圖
01:06
And as you can see,
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各位可以看到
01:08
Africa has a disproportionate share of the infection.
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非洲的愛滋感染分佈極不相稱
01:10
There are 33 million people
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現今有3300萬人
01:12
living with HIV in the world today.
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感染愛滋病
01:14
Of these, two-thirds, 22 million
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這當中有三分之二的人
01:17
are living in sub-Saharan Africa.
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2200萬人住在次撒哈拉非洲地區
01:20
There are 1.4 million pregnant women
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現在有140萬個愛滋媽媽
01:23
in low- and middle-income countries living with HIV
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來自於中低所得國家
01:26
and of these, 90 percent
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其中有九成
01:28
are in sub-Saharan Africa.
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就住在次撒哈拉非洲地區
01:32
We talk about things in relative terms.
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我們用相對的例子說明
01:34
And I'm going to talk about annual pregnancies
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我要談的是每年的懷孕率
01:36
and HIV-positive mothers.
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與愛滋媽媽
01:38
The United States -- a large country --
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美國這麼大一個國家
01:40
each year, 7,000 mothers with HIV
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每年有七千個愛滋媽媽
01:43
who give birth to a child.
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產下子女
01:46
But you go to Rwanda -- a very small country --
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但你看到盧安達,相對而言很小的國家
01:49
8,000 mothers with HIV who are pregnant.
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有8000個懷孕的愛滋媽媽
01:53
And then you go to Baragwanath Hospital,
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當你到巴拉瓜納醫院
01:56
outside of Johannesburg in South Africa,
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就在(南非)約翰尼斯堡附近
01:59
and 8,000 HIV-positive pregnant women
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醫院裡有約八千名懷孕的愛滋媽媽
02:01
giving birth --
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等著生產
02:03
a hospital the same as a country.
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光一家醫院的數量就如此龐大
02:06
And to realize that this is just the tip of an iceberg
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所以請了解,這只是冰山一角
02:09
that when you compare
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和南非相比
02:11
everything here to South Africa, it just pales,
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南非的情形可是一片慘澹
02:13
because in South Africa,
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因為在南非
02:16
each year 300,000 mothers with HIV
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每年有30萬個愛滋媽媽
02:19
give birth to children.
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懷孕生子
02:23
So we talk about PMTCT,
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所以我要談PMTCT
02:25
and we refer to PMTCT, prevention of mother to child transmission.
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PMTCT代表:母子垂直感染的預防計畫
02:28
I think there's an assumption amongst most people in the public
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大家對於愛滋的普遍看法是
02:31
that if a mother is HIV-positive,
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當一名母親感染愛滋
02:33
she's going to infect her child.
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她的孩子也會受感染
02:35
The reality is really, very different.
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但事實並非如此
02:38
In resource-rich countries,
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在資源豐富的國家
02:40
with all the tests and treatment we currently have,
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我們已經有許多的測試與療法
02:42
less than two percent of babies are born HIV-positive --
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愛滋寶寶機率只有不到2%
02:45
98 percent of babies are born HIV-negative.
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98%的寶寶愛滋病毒會呈現陰性反應
02:49
And yet, the reality in resource-poor countries,
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然而在資源短缺國家
02:51
in the absence of tests and treatment,
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因為測試與治療的缺乏
02:53
40 percent -- 40 percent of children are infected --
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愛滋寶寶的機率高達40%
02:56
40 percent versus two percent --
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40%與2%的差距
02:58
an enormous difference.
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是非常驚人的
03:00
So these programs --
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所以這些計畫
03:02
and I'm going to refer to PMTCT though my talk --
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我接下來演講裡所說的PMTCT
03:04
these prevention programs,
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這些預防計畫
03:06
simply, they're the tests and the drugs that we give to mothers
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簡單說,母親能接受檢查與藥物治療
03:09
to prevent them from infecting their babies,
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來預防垂直感染
03:12
and also the medicines we give to mothers
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同時也必須服用藥物
03:14
to keep them healthy and alive to raise their children.
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讓母親們身體健康到能養育嬰兒
03:16
So it's the test a mother gets when she comes in.
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所以一開始的檢查很重要
03:18
It's the drugs she receives
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她要服用的藥很重要
03:20
to protect the baby that's inside the uterus and during delivery.
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能讓肚裡的寶寶能健康發育到出生
03:23
It's the guidance she gets around infant feeding
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嬰兒餵養的指導很重要
03:25
and safer sex.
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安全性行為也很重要
03:27
It's an entire package of services,
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這是關於完善的服務
03:30
and it works.
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而且是有效的
03:32
So in the United States,
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在美國
03:34
since the advent of treatment in the middle of the 1990s,
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1990年代中期,愛滋的治療出現後
03:37
there's been an 80-percent decline
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在愛滋寶寶的數量上
03:39
in the number of HIV-infected children.
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已經降低80%
03:41
Less than 100 babies are born with HIV
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美國每年的愛滋寶寶數量
03:43
each year in the United States
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不到100個
03:45
and yet, still,
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然而世界上
03:47
over 400,000 children
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每年還是有超過40萬名兒童
03:50
are born every year in the world today with HIV.
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一出生就感染愛滋
03:54
What does that mean?
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這代表了什麼?
03:56
It means 1,100 children infected each day --
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這代表每天就有1100個孩子受感染
03:59
1,100 children each day, infected with HIV.
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每天有1100個孩子感染愛滋
04:02
And where do they come from?
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這些寶寶從哪來?
04:04
Well, less than one comes from the United States.
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不到一個是來自美國
04:08
One, on average, comes from Europe.
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平均歐洲有一個
04:12
100 come from Asia and the Pacific.
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剩下有一百個來自亞洲、太平洋地區
04:16
And each day,
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然而每一天
04:18
a thousand babies -- a thousand babies
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有一千個寶寶,一千個愛滋寶寶
04:21
are born each day with HIV in Africa.
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在非洲出生
04:26
So again, I look at the globe here
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所以我們看看全球情況
04:28
and the disproportionate share of HIV in Africa.
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在非洲,愛滋分布不均的情況
04:31
And let's look at another map.
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我們來看另一個地圖
04:33
And here, again, we see
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可以再次看到
04:35
Africa has a disproportionate share of the numbers of doctors.
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在非洲,醫生數量也是分佈不均
04:38
That thin sliver you see here, that's Africa.
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圖中那條銀色細線,就是非洲
04:41
And it's the same with nurses.
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護士也一樣
04:44
The truth is sub-Saharan Africa
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事實上,次撒哈拉非洲地區
04:46
has 24 percent
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包含了24%的
04:48
of the global disease burden
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世界疾病數量
04:50
and yet only three percent of the world's health care workers.
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但醫療人員數量卻只有全世界的3%
04:53
That means doctors and nurses
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這表示,這裡的醫生護士
04:55
simply don't have the time to take care of patients.
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根本沒有時間照顧好每個病人
04:58
A nurse in a busy clinic
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較忙的診所裡,每天
05:00
will see 50 to 100 patients in a day,
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每位護士要照看50到100位病人
05:02
which leaves her just minutes per patient --
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一個病人只有幾分鐘時間
05:04
minutes per patient.
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短短幾分鐘
05:06
And so when we look at these PMTCT programs, what does it mean?
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當我們看看這些PMTCT計畫,代表了什麼?
05:09
Well, back in 2001,
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我們先回到2001年
05:11
when there was just a simple test
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當時要做的檢查很簡單
05:13
and a single dose of a drug,
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藥也只有一顆
05:15
a nurse, in the course of her few minutes with a patient,
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一位護士可以在幾分鐘內
05:18
would have to counsel for the HIV test, perform the HIV test,
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提供病人愛滋病諮詢、檢查、
05:21
explain the results, dispense a single dose of the drug, Nevirapine,
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解釋檢查結果、發藥(因為只有一顆:Nevirapine)、
05:24
explain how to take it, discuss infant feeding options, reinforce infant feeding,
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解釋服藥方式、討論嬰兒的服藥選擇、加強嬰兒餵食、
05:27
and test the baby -- in minutes.
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替嬰兒檢查,幾分鐘內就要完成
05:30
Well, fortunately since 2001,
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幸運的是,從2001以後
05:32
we've got new treatments, new tests,
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我們有了新治療、新測試
05:34
and we're far more successful,
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能更加成功地對抗愛滋了
05:36
but we don't have any more nurses.
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但護士還是不夠多
05:38
And so these are the tests
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這些測試是
05:41
a nurse now has to do
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現在的護士
05:43
in those same few minutes.
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短短幾分鐘內就要完成的
05:45
It's not possible --
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這根本不可能
05:47
it doesn't work.
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根本辦不到
05:49
And so we need to find
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所以我們需要的是
05:51
better ways of providing care.
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提供更好的醫療照顧
05:56
This is a picture of a maternal health clinic in Africa --
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這照片是非洲一家婦產科診所
05:59
mothers coming, pregnant and with their babies.
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許多的母親來到這,有懷孕的、帶著孩子的
06:02
These women are here for care,
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這些婦女來這裡接受照顧
06:04
but we know that just doing a test,
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我們都知道只做測試
06:06
just giving someone a drug,
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給他們藥物吃
06:08
it's not enough.
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是不夠的
06:11
Meds don't equal medical care.
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藥品不等於醫療照顧
06:14
Doctors and nurses, frankly,
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老實說,醫生護士們
06:16
don't have the time or skills
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根本沒有時間、能力
06:18
to tell people what to do in ways they understand.
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去好好解釋給病人聽
06:20
I'm a doctor -- I tell people things to do,
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我是個醫生,我給病人指示
06:23
and I expect them to follow my guidance --
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希望他們能照我說的去做
06:25
because I'm a doctor; I went to Harvard --
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因為我是個醫生,我哈佛畢業的
06:27
but the reality is,
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但事實上
06:29
if I tell a patient, "You should have safer sex.
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如果跟病人說:「你要有安全的性行為」
06:31
You should always use a condom,"
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「一定要用保險套」
06:33
and yet, in her relationship, she's not empowered --
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但他們的社會裡,女人沒有權利
06:36
what's going to happen?
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會發生什麼事?
06:38
If I tell her to take her medicines every day
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如果我告訴她,每天按時服藥
06:41
and yet, no one in the household knows about her illness, so
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但她家裡沒人知道她生病了又有什麼用
06:44
it's just not going to work.
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這是行不通的
06:47
And so we need to do more,
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所以我們必須做更多
06:49
we need to do it differently,
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必須換種方式
06:51
we need to do it in ways that are affordable
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這方式要我們能夠負擔
06:54
and accessible and can be taken to scale,
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能夠接觸到更多人
06:56
which means it can be done everywhere.
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所以一定要到處都可行
06:59
So, I want to tell you a story --
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我分享一個故事給各位
07:02
I want to take you on a little trip.
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帶你們來趟旅行
07:04
Imagine yourself, if you can,
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想想你們自己
07:06
you're a young woman in Africa, you're going to the hospital or clinic.
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是非洲的一名年輕女性,來到醫院或診所
07:09
You go in for a test
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你來做檢查
07:11
and you find out that you're pregnant, and you're delighted.
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你發現你懷孕了,很開心
07:13
And then they give you another test
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但他們要你做另一項檢查
07:15
and they tell you you're HIV-positive, and you're devastated.
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告訴你患有愛滋,你感到很絕望
07:18
And the nurse takes you into a room,
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然後護士帶你到另一個房間
07:20
and she tells you about the tests
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她告訴你一些檢查方式、
07:22
and HIV and the medicines you can take
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和需要服用的愛滋藥物
07:24
and how to take care of yourself and your baby,
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教你如何照顧自己和寶寶
07:26
and you hear none of it.
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你完全聽不進去啊
07:28
All you're hearing is, "I'm going to die,
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你聽到的只有「我快死了」
07:30
and my baby is going to die."
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「我的寶寶也會死」
07:32
And then you're out on the street, and you don't know where to go.
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然後你走出診所,沒有目標地晃
07:34
And you don't know who you can talk to,
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你不知道能向誰傾訴
07:36
because the truth is, HIV is so stigmatizing
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因為事實上,染上愛滋是很恥辱的事
07:39
that if you partner, your family, anyone in your home,
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你的伴侶、家人知道後
07:42
you're likely to be thrown out
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很可能把你趕出家門
07:44
without any means of support.
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不給你任何支柱
07:46
And this -- this is the face and story
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這就是非洲今日
07:48
of HIV in Africa today.
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對於愛滋病的樣貌
07:51
But we're here to talk about possible solutions
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今天要談的是可能的解決方式
07:54
and some good news.
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和一些好消息
07:56
And I want to change the story a little bit.
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我想要換個故事說
07:59
Take the same mother, and the nurse, after she gives her her test,
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一樣的母親、護士,在她做完檢查後
08:02
takes her to a room.
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護士帶她到另一個房間
08:04
The door opens and there's a room full of mothers, mothers with babies,
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門一打開,裡面全是媽媽們,與她們的孩子
08:07
and they're sitting, and they're talking, they're listening.
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他們坐著聊天,彼此傾聽
08:09
They're drinking tea, they're having sandwiches.
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他們喝著茶,吃著三明治
08:12
And she goes inside, and woman comes up to her and says,
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她走進去,這些女人們走向她,並說
08:14
"Welcome to mothers2mothers.
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「歡迎來到媽媽天地」
08:16
Have a seat. You're safe here.
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「請坐下吧,你很安全」
08:19
We're all HIV-positive.
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「我們都有愛滋」
08:21
You're going to be okay. You're going to live.
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「但我們都會沒事的,你不會死」
08:24
Your baby is going to be HIV-negative."
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「妳的寶寶不會得愛滋的」
08:29
We view mothers
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我們將母親視為
08:31
as a community's single greatest resource.
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社群裡最有力量的來源
08:33
Mothers take care of the children, take care of the home.
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母親們照顧幼小,照顧家園
08:36
So often the men are gone.
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男人常常不在家
08:38
They're working, or they're not part of the household.
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因為他們需要工作,不管家裡的事
08:41
Our organization, mothers2mothers,
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我們的組織「媽媽天地(mothers2mothers)」
08:43
enlists women with HIV
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讓那些愛滋媽媽
08:45
as care providers.
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成為照護人員
08:47
We bring mothers who have HIV,
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我們請那些有愛滋的母親們來
08:49
who've been through these PMTCT programs
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因為她們也經歷過PMTCT計畫
08:51
in the very facilities,
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熟悉設備
08:53
to come back and work side by side with doctors and nurses
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讓她們回來,與醫生護士們一起工作
08:56
as part of the health care team.
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就像醫療團隊的一份子
08:58
These mothers, we call them mentor mothers,
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我們稱這些母親為心靈媽媽
09:01
are able to engage women
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她們能夠接觸其他女性
09:03
who, just like themselves, pregnant with babies,
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因為這些女人就像以前的她們一樣,身懷六甲
09:05
have found out about being HIV-positive,
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因為這些女人剛知道自己得了愛滋
09:07
who need support and education.
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需要支持與教育
09:10
And they support them around the diagnosis
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心靈媽媽能給病患們連續的扶持
09:12
and educate them about how to take their medicines,
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並教導他們如何服藥
09:14
how to take care of themselves,
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如何照顧自己
09:16
how to take care of their babies.
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如何照顧孩子
09:19
Consider: if you needed surgery,
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想想:如果你需要開刀
09:22
you would want the best possible technical surgeon, right?
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你會找最好的外科醫生,對吧
09:26
But if you wanted to understand
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但如果你想了解
09:28
what that surgery would do to your life,
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手術將造成的影響
09:30
you'd like to engage someone,
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你想找的會是
09:32
someone who's had the procedure.
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有過同樣手術的病人
09:34
Patients are experts on their own experience,
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病人他們自己疾病的專家
09:37
and they can share that experience with others.
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他們可以分享自己的經驗
09:41
This is the medical care that goes beyond just medicines.
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這才是所謂藥品以外的醫療照顧
09:45
So the mothers who work for us,
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這些替我們工作的母親們
09:47
they come from the communities in which they work.
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都來自於自己的社區
09:49
They're hired -- they're paid as professional members of the health care teams,
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我們雇用她們,支付與專業醫療人員般的薪水
09:52
just like doctors and nurses.
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就像醫生、護士
09:54
And we open bank accounts for them
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我們替他們開銀行帳戶
09:56
and they're paid directly into the accounts,
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薪水直接匯入銀行
09:58
because their money's protected;
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如此一來,能保護他們的所得
10:00
the men can't take it away from them.
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讓家中的男人拿不到
10:03
They go through two to three weeks
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他們必須接受二到三週的
10:05
of rigorous curriculum-based education, training.
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非常密集教育訓練
10:08
Now, doctors and nurses -- they too get trained.
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醫生護士們也接受訓練
10:11
But so often, they only get trained once,
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但通常只有一次而已
10:13
so they're not aware of new medicines,
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所以對於新藥品、
10:15
new guidelines as they come out.
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新的指導原則都不了解
10:17
Our mentor mothers get trained every single year
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但心靈媽媽每年接受訓練
10:19
and retrained.
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重新培訓
10:21
And so doctors and nurses --
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所以醫生護士們
10:23
they look up to them as experts.
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都把他們當成專家看待
10:26
Imagine that: a woman, a former patient,
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想像一下,過去也是病人的婦女
10:29
being able to educate her doctor for the first time
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竟能夠教育她的醫生
10:31
and educate the other patients
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教育其他病人
10:33
that she's taking care of.
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照顧其他病人
10:36
Our organization has three goals.
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我們的機構有三個目標
10:38
The first, to prevent mother-to-child transmission.
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第一:預防母子垂直感染
10:42
The second: keep mothers healthy, keep mothers alive,
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第二:照顧母親的身體健康,讓媽媽們活下去
10:45
keep the children alive --
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讓孩子們活下去
10:47
no more orphans.
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不再有孤兒
10:49
And the third, and maybe the most grand,
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第三點,也是最重要的一點
10:52
is to find ways to empower women,
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就是找到能賦予女性們力量的方法
10:56
enable them to fight the stigma
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讓她們能打破既有的印象
10:58
and to live positive and productive lives with HIV.
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雖患愛滋,但也能過著正向、有生產力的人生
11:02
So how do we do it?
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我們怎麼做的?
11:04
Well, maybe the most important engagement
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我想,最重要的就是"參與"
11:06
is the one-to-one,
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就是一對一
11:08
seeing patients one-to-one, educating them, supporting them,
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一對一的醫療諮詢及照顧
11:11
explaining how they can take care of themselves.
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教導他們如何照顧自己
11:14
We go beyond that;
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我們所做的不只如此
11:16
we try to bring in the husbands, the partners.
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我們找來她們的丈夫、伴侶
11:19
In Africa, it's very, very hard to engage men.
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在非洲,要男性們一起參與是很困難的
11:22
Men are not frequently part of pregnancy care.
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男人們通常不參與懷孕保健
11:26
But in Rwanda, in one country,
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但在盧安達這地方
11:28
they've got a policy
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他們有個政策就是
11:30
that a woman can't come for care
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婦女不能單獨尋求醫療照顧
11:32
unless she brings the father of the baby with her --
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一定要孩子的父親陪伴才行
11:34
that's the rule.
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這就是規定
11:36
And so the father and the mother, together,
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所以爸媽兩人會一起
11:38
go through the counseling and the testing.
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接受檢查與諮詢
11:41
The father and the mother, together, they get the results.
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爸媽兩人一起等待檢查報告
11:43
And this is so important in breaking through the stigma.
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這是打破原始印象很重要的一件事
11:47
Disclosure is so central to prevention.
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公開對於預防是很重要的
11:50
How do you have safer sex, how do you use a condom regularly
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要怎麼進行安全性行為?要怎麼定期使用保險套?
11:53
if there hasn't been disclosure?
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這些都是透過公開做到的
11:55
Disclosure is so important to treatment,
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公開對於治療也很重要
11:58
because again, people need the support of family members and friends
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因為,病人們需要家人朋友的支持
12:01
to take their medicines regularly.
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才能乖乖按時服藥
12:04
We also work in groups.
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我們也是以團體進行
12:06
Now the groups, it's not like me lecturing,
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在團體裡,講課的不是我
12:08
but what happens is women, they come together --
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而是這些女人們,聚在一起
12:11
under the support and guidance of our mentor mothers --
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在心靈媽媽的協助及輔導下
12:13
they come together, and they share their personal experiences.
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她們來到這裡,分享彼此的經驗
12:16
And it's through the sharing
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透過分享
12:18
that people get tactics of how to take care of themselves,
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病患們學會怎麼照顧自己
12:20
how to disclose how to take medicines.
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怎麼對他人坦白、如何服藥
12:24
And then there's the community outreach,
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接下來還要擴展到整個社區
12:26
engaging women in their communities.
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讓社區內的女人都一同參與
12:29
If we can change the way
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如果我們能改變一個家戶
12:31
households believe and think,
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的想法與信念
12:33
we can change the way communities believe and think.
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我們就能改變整個社群的想法信念
12:36
And if we can change enough communities,
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如果我們能改變整個社群
12:38
we can change national attitudes.
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我們就能改變整個國家態度
12:40
We can change national attitudes to women
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就能改變整個國家對女人的態度
12:42
and national attitudes to HIV.
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對愛滋病的態度
12:45
The hardest barrier really is around stigma reduction.
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最難的隔閡就是既有印象的破除
12:47
We have the medicines, we have the tests,
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我們有藥物,也有醫療檢查
12:49
but how do you reduce the stigma?
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但要如何破除既有印象?
12:52
And it's important about disclosure.
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這又回到公開的重要性了
12:54
So, a couple years ago, one of the mentor mothers came back,
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幾年前,有位心靈媽媽回來後
12:56
and she told me a story.
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告訴我個故事
12:58
She had been asked by one of the clients
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她有個病人,要求她
13:00
to go to the home of the client,
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陪她一起回家
13:02
because the client wanted to tell the mother and her brothers and sisters
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因為那病人想告訴自己的家人
13:05
about her HIV status,
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她患有愛滋
13:07
and she was afraid to go by herself.
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但她不敢一個人面對
13:09
And so the mentor mother went along with.
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所以心靈媽媽陪她一起去
13:11
And the patient walked into the house
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那病人走近家中
13:13
and said to her mother and siblings,
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對她的母親與手足說:
13:16
"I have something to tell you. I'm HIV-positive."
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「我要告訴你們一件事,我有愛滋」
13:19
And everybody was quiet.
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每個人都噤聲
13:21
And then her oldest brother stood up and said,
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然後他的大哥站起來說
13:23
"I too have something to tell you.
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「我也要告訴你們一件事」
13:25
I'm HIV-positive.
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「我也有愛滋」
13:27
I've been afraid to tell everybody."
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「我一直不敢跟你們說」
13:30
And then this older sister stood up and said,
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然後她姐姐也站起來說
13:32
"I too am living with the virus,
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「我也有愛滋」
13:35
and I've been ashamed."
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「一直怕丟臉不敢說」
13:37
And then her younger brother stood up and said,
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同樣的,她弟弟也站起來說
13:40
"I'm also positive.
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「我也有愛滋」
13:42
I thought you were going to throw me out of the family."
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「我怕你們知道後,會把我趕出家門」
13:44
And you see where this is going.
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你們應該猜到後續發展了
13:46
The last sister stood up and said, "I'm also positive.
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最後,妹妹站起來說「我也有愛滋」
13:48
I thought you were going to hate me."
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「我怕你們會恨我」
13:50
And there they were, all of them together for the first time
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就這樣,他們第一次面對彼此
13:52
being able to share this experience for the first time
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第一次分享這個經驗
13:55
and to support each other for the first time.
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第一次給彼此支持
13:58
(Video) Female Narrator: Women come to us,
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(影片) 許多女人來到這
14:00
and they are crying and scared.
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哭喪著臉
14:03
I tell them my story,
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我分享自己的故事
14:05
that I am HIV-positive,
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告訴她們,我也是愛滋病患
14:08
but my child is HIV-negative.
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但我的孩子很健康
14:11
I tell them, "You are going to make it,
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我告訴她們,「你們辦得到的」
14:14
and you will raise a healthy baby."
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「你可以扶養出健康的寶寶。」
14:18
I am proof that there is hope.
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我就是最好的證明
14:24
Mitchell Besser: Remember the images I showed you
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記得我今天給各位看的
14:26
of how few doctors and nurses there are in Africa.
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非洲那極少數的醫生護士數量
14:28
And it is a crisis in health care systems.
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他們醫療系統的大問題
14:31
Even as we have more tests and more drugs,
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就算我們有再多的藥品、檢查
14:33
we can't reach people; we don't have enough providers.
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我們還是沒辦法接觸到很多人,因為協助不夠多
14:35
So we talk in terms of what we call task-shifting.
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所以我們講到任務轉換
14:37
Task-shifting is traditionally
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任務轉換通常是
14:39
when you take health care services from one provider
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當你從某個提供照護者的身上,獲得服務
14:41
and have another provider do it.
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會是由另一個照護者幫助你
14:43
Typically, it's a doctor giving a job to a nurse.
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正常來講,是由醫生囑咐護士
14:45
And the issue in Africa
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但非洲的問題是
14:47
is that there are fewer nurses, really than doctors,
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護士比醫生還少
14:49
and so we need to find new paradigm for health care.
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所以健保來說,需要有新規範
14:52
How do you build a better health care system?
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要怎麼建立更好的健保制度?
14:55
We've chosen to redefine the health care system
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我選擇去重新定義健保制度
14:57
as a doctor, a nurse and a mentor mother.
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新制度包含了醫生、護士,和心靈媽媽
14:59
And so what nurses do
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所以護士們能請
15:01
is that they ask the mentor mothers to explain
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心靈媽媽們向病人解釋
15:03
how to take the drugs, the side effects.
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服藥方式、及其副作用
15:05
They delegate education about infant feeding,
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她們教育這些媽媽餵食嬰兒的方式、
15:08
family planning, safer sex,
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家庭計劃、安全性行為
15:10
actions that nurses simple just don't have time for.
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這些都是護士們沒有時間做的
15:15
So we go back to the prevention of mother to child transmission.
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我們回到最初討論的,母子垂直感染的預防
15:18
The world is increasingly seeing these programs
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有越來越多人,將這類型的計畫
15:20
as the bridge to comprehensive maternal and child health.
365
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視為母子健康的全面性橋樑
15:23
And our organization
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而我們的組織
15:25
helps women across that bridge.
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就是要幫助女性跨越橋樑
15:27
The care doesn't stop when the baby's born --
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但醫療照顧不止於孩子出生而已
15:29
we deal with the ongoing health of the mother and baby,
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我們照顧母子後續的健康
15:32
ensuring that they live healthy,
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確保他們都能
15:35
successful lives.
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健康地活下去
15:37
Our organization works on three levels.
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我們的組織有三個層面
15:40
The first, at the patient level --
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第一:病患層面
15:42
mothers and babies keeping babies from getting HIV,
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照顧母子,避免孩子傳染上愛滋病毒
15:44
keeping mothers healthy to raise them.
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讓母親能健康地撫養小孩
15:47
The second, communities --
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第二:社群層面
15:49
empowering women.
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賦予女性力量
15:51
They become leaders within their communities.
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讓她們成為自己社群的領導者
15:54
They change the way communities think --
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讓她們改變社群的思考方式
15:56
we need to change attitudes to HIV.
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我們必須改變大家對愛滋的態度
15:59
We need to change attitudes to women in Africa.
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我們必須改變大家對非洲女性的態度
16:01
We have to do that.
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我們必須做到這些
16:03
And then rework the level of the health care systems,
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再來努力健保系統的部份
16:06
building stronger health care systems.
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建立更強大的醫療體制
16:08
Our health care systems are broken.
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因為現有的體制已經無效
16:10
They're not going to work the way they're currently designed.
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照現在制度是不可行的
16:13
And so doctors and nurses
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所以那些醫生護士們
16:15
who need to try to change people's behaviors
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必須負責改變病人的行為
16:17
don't have the skills, don't have the time --
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不過他們沒有能力,也沒時間
16:19
our mentor mothers do.
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但心靈媽媽們有
16:21
And so in redefining the health care teams by bringing the mentor mothers in,
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藉由心靈媽媽的加入,重新組織的醫療團隊才健全
16:24
we can do that.
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這我們做得到
16:27
I started the program in Capetown, South Africa
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我們的計畫最早從(南非)開普敦開始的
16:30
back in 2001.
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2001年那時候
16:32
It was at that point, just the spark of an idea.
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當時,只是個突想的點子
16:35
Referencing Steven Johnson's very lovely speech yesterday
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依據Steven Johnson昨天的演講
16:38
on where ideas come from,
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講述新點子是從哪裡來
16:41
I was in the shower at the time --
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我當時沖著澡
16:44
I was alone.
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獨自一人
16:46
(Laughter)
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(笑聲)
16:50
The program is now working in nine countries,
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我們的計畫已在九個國家實行
16:53
we have 670 program sites,
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共有670個據點
16:56
we're seeing about 230,000
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每個月能照顧到
16:59
women every month,
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23萬名婦女
17:01
we're employing 1,600 mentor mothers,
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共僱用1600個心靈媽媽
17:04
and last year, they enrolled
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去年,我們收了
17:06
300,000 HIV-positive pregnant women and mothers.
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30萬名愛滋媽媽
17:09
That is 20 percent
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這佔了全球
17:12
of the global HIV-positive pregnant women --
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愛滋媽媽的20%
17:15
20 percent of the world.
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全世界的20%
17:17
What's extraordinary is how simple the premise is.
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這麼簡單的主張,這麼驚人的成果
17:19
Mothers with HIV caring for mothers with HIV.
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讓愛滋媽媽照顧愛滋媽媽
17:22
Past patients taking care of present patients.
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讓過去的病患照顧現在的病患
17:24
And empowerment through employment --
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讓就業賦予她們能力
17:26
reducing stigma.
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打破既有的看法
17:28
(Video) Female Narrator: There is hope,
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(影片) 希望是存在的
17:30
hope that one day
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我希望有天
17:32
we shall win this fight
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我們能贏得這場
17:34
against HIV and AIDS.
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對抗愛滋的戰爭
17:37
Each person must know
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每個人都要知道
17:39
their HIV status.
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自己的愛滋病毒情況
17:42
Those who are HIV-negative
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那些愛滋病毒成陰性反應的人
17:44
must know how to stay negative.
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要知道怎麼繼續保持陰性
17:48
Those who are HIV-infected
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已經感染愛滋病毒的人
17:51
must know how
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一定要知道
17:53
to take care of themselves.
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如何照顧自己
17:56
HIV-positive pregnant women
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感染愛滋的懷孕婦女
17:58
must get PMTCT services
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一定要加入PMTCT計畫
18:01
in order to have
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如此才能
18:03
HIV-negative babies.
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生下健康的寶寶
18:05
All of this is possible,
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這些是辦得到的
18:08
if we each contribute to this fight.
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只要每個人都盡一己之力
18:13
MB: Simple solutions to complex problems.
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這個複雜問題的簡單解答就是
18:16
Mothers caring for mothers.
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讓母親們相互照顧
18:18
It's transformational.
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這轉變是非常大的
18:20
Thank you.
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謝謝各位
18:22
(Applause)
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(掌聲)
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