Ernest Madu: Bringing world-class health care to the poorest

譯者: Harvey Hao Liu 審譯者: Shelley Krishna Tsang

It is interesting that in the United States,

在美國，有趣的是:

the most significant health-care budget

最重要的醫療預算

goes to cardiovascular disease care, whether it's private or public.

無論是私人援助或是政府資助，常常都給心血管疾病醫療。

There's no comparison at all.

其他疾病得到的資助無法與其比擬。

In Africa -- where it is a major killer -- it is totally ignored.

在非洲，心血管疾病是一個主要的致命疾病，但人們徹底無視了它。

And that situation cannot be right. We must do something about it.

這種情況不是合理的。我們必須針對這情況採取一些行動。

A health status of a nation parallels development of that nation.

一個國家的醫療狀況應與其國家發展並駕齊驅。

17 million people die every year from heart disease.

每年有1千7百萬病人得心臟疾病而去世。

32 million heart attacks and strokes occur.

心臟病發作和中風的病例出現3千2百萬例。

Most of this is in developing countries, and the majority is in Africa.

這些病人主要是在發展中國家，大多數是在非洲。

85 percent of global disease burden for cardiovascular disease

全世界的心血管疾病85%发生在發展中國家，

is in developing countries -- not in the West --

而不是在西方國家--

and yet 90 percent of the resources are in the West.

然而90%的醫療資源卻集中在西方國家。

Who is at risk? People like you.

哪些人屬於高危？像你們一樣的人。

It's not just the Africans that should be concerned about that.

不僅僅是非洲人民需要關注這個狀況。

All friends of Africa, that will have reason to be in Africa at some point in time,

所有非洲的朋友們，或者未來有理由來非洲的朋友，

should be very concerned about this deplorable situation.

都應該非常關注這個糟糕的狀況。

Has anyone here wondered what will happen

在座的各位有沒有想過

if you go back to your room at night,

假若你夜晚回到你的房間

and you start getting chest pains, shortness of breath, sweating?

開始胸痛、氣短並且不停流汗，會發生什麼事？

You're having a heart attack. What are you going to do?

你這是心臟病發作。你們會怎麼處理？

Will you fly back to the U.S., Germany, Europe?

你會飛回美國、德國、歐洲嗎？

No, you will die. 50 percent will die within 24 hours, if not treated.

不，你會死。在沒有醫治的情況下，50%的病人將會在24小時內死去。

This is what's going on.

這就是事實。

In a look at the map of the U.S. -- the graph here,

看看美國地圖，這幅圖，

10 million people here, 10 million here.

最開始的時候美國和尼日利亞同樣都有1千萬人口。

By the time you get to 50, it's almost no one left in Nigeria --

等你們50歲的時候，尼日利亞已幾乎沒人剩下了 --

life expectancy is 47.

他們的預期壽命只有47歲。

It's not because some people don't survive childhood illnesses --

不是因為一些人不能倖免于兒童疾病 --

they do -- but they do not survive after the time that they reach

他們倖免于兒童疾病了，但是他們不能存活到

about 45 years old and 50 years old.

45歲至50歲左右。

And those are the times they're most productive.

這個年齡是他們最年富力強的時候，

Those are the times that they should be contributing

這個年齡應該是他們為非洲發展做出貢獻的時候。

to Africa's development. But they're not there.

但是他們去世了。

The best way to spiral into a cycle of poverty is to kill the parents.

家長的過世是貧困循環急速上升的主要原因。

If you cannot secure the parents,

如果不能保障非洲家長的生命，

you cannot guarantee the security of the African child.

那麼非洲兒童保障也岌岌可危。

What are the risk factors?

心臟病的危險因素有哪些？

It's very well known. I'm not going to spend a lot of time on those.

這是從所周知的，所以我不會花太多時間在這個上面。

These are just for information:

大概就是這些因素：

hypertension, diabetes, obesity, lack of exercise. The usual suspects.

常見的誘因有，高血壓，糖尿病， 肥胖症，缺少鍛煉。

Right here in Tanzania, 30 percent of individuals have hypertension.

在坦桑尼亞，30%的人有高血壓。

20 percent are getting treated.

20%病人得到了醫治。

Only less than one percent are adequately treated.

但不到1%的病人得到了足夠的醫治。

If we can treat hypertension alone in Africa,

假若我們在非洲僅僅醫治高血壓，

we'll save 250,000 lives a year. That's quite significant!

每年就能挽救25萬生命。這個數目是相當可觀的！

Easy to treat. Look at the situation in Mauritius.

高血壓容易醫治，看看毛里求斯的情況，

In eight short years -- we're here talking about HIV, malaria,

短短八年間，我們這裡談論的艾滋病、瘧疾，

which is all good.

都沒有造成重大影響。

We cannot make the mistakes we've made with malaria and HIV.

我們不能再重蹈我們對待愛滋病和瘧疾的覆轍。

In eight short years, non-communicable diseases

短短八年中，非傳染的疾病

will become the leading causes of death in Africa.

將變成非洲的主要致命疾病。

That is something to keep in mind. We can't deal with it with situations like this.

這一點我們要銘記在心。我們不能這樣對待這些情況。

This is a typical African hospital. We can't depend on the elites --

這是一所典型的非洲醫院。我們不能依靠那些精英 --

they go to USA, Germany, U.K. for treatment. Unbelievable.

他們都去美國，德國，英國接受醫療。難以想像。

You can't depend on foreign aid alone.

不能僅僅依靠外國援助。

Here is the situation: countries are turning inwards.

情況是這樣的：各國都開始自顧不暇。

Post-9/11, [the] United States has had a lot of trouble

911恐怖襲擊之後，美國在處理

to deal with, their own internal issues.

其國內事務遇上了眾多麻煩。

So, they spend their money trying to fix those problems.

所以他們將錢投到解決這些問題上面。

You can't rightly -- it's not their responsibility,

理由充分 -- 幫助非洲不是他們的責任，

it is my responsibility. I have to take care of my own problems.

這是我的責任。我需要去處理我自己的問題。

If they help, that's good! But that is not my expectation.

如果他們幫手，那當然不錯！但是這不能成為我們的期盼。

These worsening indices of health care or health studies in Africa

在非洲，越來越糟糕的醫療保健指數和醫療研究狀況

demand a new look. We cannot keep on doing things

要求我們需要用新的視角來看待它。我們不能繼續用

the way we've always done them.

以往的方式來進行醫療保健。

If they have not worked, we have to look for alternative solutions.

如果以往的方法不奏效，我們要尋找替代方案。

I'm here to talk to you about solutions.

我在這裡就是要和大家談一談解決方案。

This has been -- what has been a difficult sign to some of us.

對我們一部分人而言，這是很難想像的。

Several years ago, we started thinking about it.

幾年前，我們開始思考這個問題。

Everyone knows the problem. No one knows what the solutions are.

每個人都知道問題的所在。但沒有人知道怎麼去解決它。

We decided that we needed to put our money where our mouth is.

我們決定要把錢花在刀刃上。

Everyone is ready to throw in money,

每個人都準備投錢進去

in terms of free money aid to developing countries.

幫助發展中國家，我這裡談的是免費。

Talk about sustainable investment, no one is interested.

談持續投資！沒人感興趣。

You can't raise money.

那麼就籌不到錢。

I have done businesses in healthcare in the United States --

我在美國有做過醫療保健業務 --

I live in Nashville, Tennessee, health care capital of America.

我住在田納西的首府納什維爾，美國醫療保健之都。

[It's] very easy to raise money for health-care ventures.

在那裡為醫療保健企業籌錢是很容易的事情。

But start telling them, you know,

但是一旦告訴投資商，

we're going to try to do it in Nigeria -- everyone runs away.

我們將在尼日利亞嘗試醫療保健業務。 他們都離開了。

That is totally wrong. Those of you in the audience here,

這是完全錯誤的。現場的觀眾，

if you want to help Africa, invest money in sustainable development.

如果你希望幫助非洲：就要在可持續發展的事業上投資。

Let me lead you through a day in the life of the Heart Institute,

讓我帶你們看看心臟研究所一天的運作

so you get a glimpse of what we do,

讓你們瞭解我們所做的，

and I'll talk a little bit more about it.

然後我將多談點與其有關的東西。

What we have done is to show that high-quality health care,

這一切我們所做是為證明在發展中國家

comparable to the best anywhere in the world,

是能建立一所與世界最高水平醫療中心相媲美的

can be done in a developing country environment.

高質量的醫療中心。

We have 25 positions right now -- all of them trained,

這醫療中心現在擁有25個職位，所有醫務人員都

board certified in the USA, Canada or Britain.

在美國，加拿大或者英國經過培訓，取得證書。

We have every modality that can be done in Vanderbilt,

我們擁有范德比爾特，

Cleveland Clinic -- everywhere in the U.S. --

克里夫蘭診所 -- 美國其他所有醫院所能完成的醫療方法 --

and we do it for about 10 percent of the cost

我們只收取在美國同等醫治費用

that you will need to do those things in the United States.

的十分之一。

(Applause)

（掌聲）

Additionally, we have a policy

另外，我們還有一個政策

that no one is ever turned away because of ability to pay.

不能以支付能力為由將人拒之門外。

We take care of everyone.

我們醫治每一個人。

(Applause)

（掌聲）

Whether you have one dollar, two dollars -- it doesn't matter.

無論你只有1美圓或是2美圓，都沒關係。

And I will tell you how we're able to do it.

讓我告訴你們這一切是如何做到的。

We make sure that we select our equipment properly.

我們確保選擇合適的儀器。

We go for modular units. Units that have multi-modality functions

我們選擇模組化元件，那些具備多種醫治功能的

have modular components. Easy to repair, and because of that,

模組化組件。這樣易於修理，因為這樣，

we do not take things that are not durable and cannot last.

我們不會選擇不耐用和不能長期使用的儀器。

We emphasize training,

我們強調培訓，

and we make sure that this process is regenerative.

確保培訓這一環節是不不斷傳承下去。

Very soon we will all be dead and gone, but the problems will stay,

不久的將來，我們這一批醫務人員將會老去死去，但是

unless we have people taking over from where we stopped.

除非我們培養繼承者接任我們的工作，否則問題依然存在。

We made sure that we produced some things ourselves.

我們確保自產自用。

We do not buy unit doses of radiopharmaceuticals.

不是從別處購買放射性藥物。

We get the generators from the companies.

而是買來生產機器。

We manufacture them in-house, ourselves. That keeps the costs down.

我們進行內部生產，這樣將成本降低。

So, for a radiopharmaceutical in the U.S. --

因此在美國要花費 --

that you'll get a unit dose for 250 dollars --

250美圓才買到一支放射性藥物 --

when we're finished manufacturing it in-house,

我們內部生產的同樣藥物，

we come at a price of about two dollars.

只要花費2美圓。

(Applause)

（掌聲）

We recognize that the only way to bridge the gap

我們認識到縮小

between the rich and poor countries

富裕國家與貧窮國家的唯一方法

is through education and technology.

是教育和科技。

All these problems we're talking about --

如果我們發展教育和科技，

if we bring development, they will all disappear.

所有這些剛剛談到的問題都會迎刃而解。

Technology is a great equalizer. How do we make it work?

科技相當於一個重要的天枰，我們又應該如何利用它？

It's been proved: self-care is cost-effective.

事實證明：自我保健具有成本效益。

It extends opportunity to the rural centers,

這樣有機會拓展農村市場，

and we can use expertise in a very smart way.

通過巧妙地運用自我保健專業知識。

This is the way our centers are set up.

這是我們建立自己的醫療中心的方法。

We currently have three locations in the Caribbean,

目前我們在加勒比海已有三家醫療中心，

and we're planning a fourth one.

我們正在計畫開第四家。

And we have now decided to go into Africa.

同時我們計畫將醫療中心發展到非洲。

We will be doing the West African Heart Institute

我們將在尼日利亞的哈科特港建立西非心臟研究所

in Port Harcourt, Nigeria. That project will be starting

這個項目將在未來幾個月中啟動

within the next few months. We hope to open in 2008-09.

我們希望在2008年9月開業。

And we will do other centers.

我們還將籌劃更多其他中心。

This model can be adapted to every disease process.

這個模式適用於每個疾病治療的過程。

All the units, all the centers, are linked

所有的單元，所有的研究中心都有聯繫，

through a switched hub to a central server,

通過交換式集線器連接到一個中央服務器，

and all the images are populated to review stations.

所有的醫療影像被輸入到審查站。

And we designed this telemedicine solution. It's proprietary to us,

我們設計了這個遠程醫療方案。這是我們的專利，

and we are happy to share what we have learned with anyone

我們願意將我們掌握的技術與任何感興趣的人分享。

who is interested in doing it. You can still be profitable.

還可以有盈利。

We make sure that the telemedicine platform gives access

我們要確定這個遠程系統

to expert medical specialists anywhere in the world,

一點擊就可以連接上

just by a click of the button.

世界各地的醫學專家。

I'll lead you through, to see how this happens.

現在我們看看這整套流程。

This is at the Heart Institute. The doctors from anywhere can log in.

這是心臟研究所。世界各地的醫生都能登入。

I can call you in Switzerland and say, "Listen, go into our system.

我可以在瑞士打電話給你：『請登入我們的系統。

Look at Mrs. Jones. Look at the study, tell me what you think."

看看Jone夫人的診斷報告，告訴我們你的看法。』

They'll give me that information,

醫生們會反饋一些訊息，

and we'll make the care of the patient better.

有了這些專家的訊息，我們將能更好的醫治病人。

The patient doesn't have to travel.

病人也不需要長途跋涉。

He doesn't have to experience the anxiety of not knowing

也不會因為缺乏專家診斷

because of limited expertise.

而焦躁不安.。

We also use [an] electronic medical record system.

我們還有一套電子病歷系統

I'm happy to say that the things we have implemented --

我很自豪地告訴大家，這些技術我們已經實現了 --

80 percent of U.S. practices do not have them, and yet the technology is there.

反觀美國，80%的醫療操作還沒有採用這些技術。

But you know, they have that luxury.

但是，美國是富有的國家。

Because if you can't get it in Nashville, you can travel to Birmingham,

因為如果納什維爾醫治不了，你可以去伯明翰，

two hours away, and you'll get it. If you can't get it in Cleveland,

兩個小時的路程而已，你就可以得到治療。如果克里夫蘭醫治不了，

you can go to Cincinnati. We don't have that luxury,

你可以去辛辛那提。我們沒有美國那麼富有，

so we have to make it happen.

因此我們只能通過科技來實現為病人醫治。

When we do it, we will put the cost of care down.

同時降低醫療成本。

And we'll extend it to the rural centers and make it affordable.

我們將把業務拓展到農村地區，並使得那裡的人可以負擔起醫治費用。

And everyone will get the care they deserve.

每個人都能得到治療。

It cannot just be technology, we recognize that.

我們意識到僅僅依靠科技是不夠的。

Prevention must be part of the solution -- we emphasize that.

我們強調預防必須是解決方案的一部分。

But, you know, you have to tell people what can be done.

不過，你需要告訴大家我們可以做些什麼。

It's not possible to tell people to do what is going to be expensive,

但是不可能叫大家做些昂貴的治療，

and they go home and can't do it.

那樣只會導致他們回家，不接受醫治。

They need to be alive, they need to feed.

他們需要生存，他們需要養家糊口。

We recommend exercise as the most effective, simple, easy thing to do.

我們推薦運動，因為運動是最有效，最簡單的預防疾病的方法。

We have had walks every year -- every March, April.

每年的三月和四月，我們都舉辦行走活動。

We form people into groups and make them go into challenges.

我們將人們分組，讓他們互相競賽。

Which group loses the most weight, we give them prizes.

減重最多的小組將得到獎品。

Which groups record more walking distance by pedometer,

通過計步器算出行走最多的小組，

we give them prizes. We do this constantly.

也將得到獎品。我們一直支持這項活動。

We encourage them to bring children.

我們鼓勵他們帶上小孩一起參加活動。

That way we start exposing the children from very early on,

從小給孩子灌輸鍛煉身體預防疾病的觀念，

on what these issues are. Because once they learn it,

一旦孩子們有了這種觀念，

they will stay with it. In doing this we have created

他們就會一直保持下去。

at least 100 skilled jobs in Jamaica alone,

通過這個活動，僅在牙買加我們就創造了至少一百的技術類工作崗位，

and these are physicians with expertise and special training.

這些醫生通過特殊培訓，具有專業的醫學知識。

We have taken care of over 1,000 indigent patients that could have died,

我們挽救了一千多個可能已經病死的病人，

including four free pacemakers in patients

還免費給四個完全性心臟傳導阻滯的病人

with complete heart block. For those that understand cardiology,

安裝了心臟起搏器。對於瞭解心臟病學的人來說，

complete heart block means certain death.

完全性心臟傳導阻滯就意味著瀕臨死亡。

If you don't get this pacemaker, you will be dead.

病人不能得到心臟起搏器，他就將會死去。

So we are pleased with that.

因此我們為所做的事業而感到自豪。

Indirectly, we have saved the government of Jamaica five million dollars

我們間接為牙買加政府節約了5百萬美圓

from people that would have gone to Miami or Atlanta for care.

因為病人們無需飛到邁阿密或者亞特蘭大去看病。

And we've hopefully saved a lot of lives.

我們已經挽救了很多生命。

By the end of this year, we would have contributed over one million dollars

到今年末，我們將在醫治貧困病人方面投入1百萬美圓

in indigent care. In the first four months, it's been 340,000 dollars,

前四個月投入34萬美圓，

averaging 85,000 dollars a month. The government will not do that,

平均每月8.5萬美圓。政府做不到，

because they have competing needs.

因為他們面對多種需求。

They need to put resources elsewhere. But we can still do it.

他們需要將資源投入到其他方面。但我們仍然能夠做到。

People say, "How can you do that?" This is how we can do that.

人們說：『你們是如何做到的』。就是這樣做到的。

At least 4,000 rich Jamaicans that were heading to Miami for treatment

至少4千個打算前往邁阿密看病的牙買加有錢人

have self-confessed that they did not go to Miami

承認他們沒有去邁阿密，

because of the Heart Institute of the Caribbean.

就是因為加勒比海心臟研究所的存在。

And, if they went to Miami, they will spend significantly more --

如果他們去邁阿密接受治療需要的花費將是在這裡醫治的

eight to 10 times more. And they feel happy spending it at home,

8至10倍之多。同時他們很高興將錢花在本國，

getting the same quality of care.

並能得到同等水平的醫治。

And for that money -- for every one patient that has the money to pay,

能支付起醫治費用的每一個病人所花費的錢

it gives us an opportunity to take care of at least four people

將被我們用去治療

that do not have the resources to pay.

至少4個付不起醫治費用的病人。

(Applause)

（掌聲）

For this to work, this progress must be sustainable.

但關鍵是，我們必須持之以恆地支持這個事業。

So, we emphasize training. Training is critical.

因此，我們強調的是培訓，培訓是關鍵。

We have gone further: we have formed a relationship

我們已做了進一步工作：我們與

with the University of Technology, Jamaica,

牙買加的理工大學建立了合作關係。

where I now have an appointment.

在那裡我們有一個約定。

And we are starting a biomedical engineering program,

我們正在開展一個生物醫學工程項目，

so that we will train people locally, who can repair that equipment.

這樣我們將培訓當地人，讓他們學會修理儀器。

That way we're not going to deal with obsolescence and all those kinds of issues.

這樣我們就不用處理儀器老化的問題。

We're also starting ancillary health-care technology training programs --

我們也在開展輔助醫療技術培訓項目 --

training people in echocardiography, cardiac ultrasound,

培訓人們使用回聲心動圖儀器，心臟超聲儀器，

those kinds of things. Now, with that kind of training,

等這樣的儀器。目前這種培訓項目，

it gives people motivation.

激勵著當地人們。

Because now they will get a bachelors degree in medical imaging

因為他們將獲得醫學成像的學士學位

and all that kind of stuff. In the process, I want you to just hear

等相關學位。現在我想讓你們聽聽

from the trainees themselves what it has meant for them.

我們的培訓生是怎麼說的。

(Video) Dr. Jason Topping: My name is Jason Topping.

（視頻）Jason Topping醫生：我是Jason Topping，

I'm a senior resident in anesthesia in intensive care

我是一名重症監護科方面的高級麻醉醫師

at the University Hospital of the West Indies.

來自西印度大學醫院。

I came to the Heart Institute in 2006,

我是2006年到來這個心臟研究所

as part of my elective in my anesthesia and intensive care program.

我選修了麻醉學和重症監護科學。

I spent three months at the Heart Institute.

我在心臟研究所待了3個月。

There's been no doubt around my colleagues

我的同事

about the utility of the training I received here,

對我在這裡所受到的培訓給與肯定，

and I think there's been an increased interest now in --

我認為回聲心動圖儀器及其

particularly in echocardiography and its use in our setting.

在我們的實際應用上的關注度日益增加

Sharon Lazarus: I am an echocardiographer at the Heart Institute of the Caribbean,

Sharon Lazarus: 我是加勒比海心臟研究所的一名回聲心動圖儀器操作員

since the past two years. I received training at this institution.

在過期的兩年中，我一直接受研究所的培訓。

I think this aspect of training in cardiology

我認為加勒比海心臟研究所在牙買加提供的

that the Heart Institute of the Caribbean has introduced in Jamaica

心臟病學培訓對於診斷心臟疾病

is very important in terms of diagnosing cardiac diseases.

起到了非常重要的作用。

Ernest Madu: The lesson in this is that it can be done, and it can be sustained,

Ernest Madu: 最關鍵的是我們的培訓是奏效的並且能持續下去

and you can make it possible for everyone.

並且能為每一個病人提供醫療。

Who are we to decide that poor people cannot get the best care?

誰說窮人就不能享受最好的治療？

When have you been appointed to play God?

什麼時候你已扮演成上帝？

It is not my decision. My job is to make sure that every person,

我做不了決定，但是我的任務是確保每個人，

no matter what fate has assigned to you, will have the opportunity

無論貧富貴賤，都能享有同等機會

to get the best quality health care in life.

接受最好的治療。

Next stop is West African Heart Institute,

我們下一步計畫是

that we are going to be doing in Port Harcourt, Nigeria,

在尼日利亞哈科特港建立西非心臟研究所，

as I said before. We will do other centers across West Africa.

當然也會在西非建立其他的醫療研究中心。

We will extend the same system into other areas,

我們將在其他地區部署相同的系統，

like dialysis treatment.

比如透析治療。

And anyone who is interested in doing it in any health care situation,

對醫療保健方面感興趣的人們，

we will be happy to assist you and tell you how we've done it,

我將很高興幫助你們，並分享我們的經驗

and how you can do it. If we do this,

教導你們如何達成目標。如果大家共同致力於這方面，

we can change the face of health care in Africa.

我們就能改變非洲的醫療保健格局。

Africa has been good to us; it is time for us to give back to Africa.

非洲養育了我們，是時候輪到我們回報它。

I am going. Those who want to come,

我投身於改善非洲的醫療保健事業。志同道合的朋友們，

I welcome you to come along with me.

歡迎你們加入我，讓我們同行。

Thank you.

謝謝。

(Applause)

（掌聲）