A new way to fund health care for the most vulnerable | Andrew Bastawrous

譯者: Lilian Chiu 審譯者: Yanyan Hong

These two Kenyan ladies were best friends

這兩位肯亞女子是最要好的朋友，

from neighboring villages,

住在相鄰的村落中，

but they'd stopped seeing each other, literally, for 10 years,

但她們不再跟彼此見面了， 真的是十年都不「見」，

because both had gone blind from a curable condition called cataracts.

因為兩人都因為一種可治癒的 疾病失明了，就是白内障。

They hadn't been aware they'd been sat together for over an hour

當我們提議讓她們 在最近的醫院進行手術時，

when we offered them surgery at the nearest hospital.

過了一個小時，她們都沒有發現 好朋友就坐在自己身邊。

Mama Jane, on the right, told me

珍媽媽，也就是 右邊的這一位，告訴我

her biggest fear was that she would poison her grandson,

她最大的恐懼就是她會毒死

她從來沒看過的孫子，

whom she'd never seen,

because she couldn't see what she was cooking for him.

因為她看不見她在為他燒什麼菜。

Her arms were covered in burns from cooking on a charcoal stove,

她的手臂都是用碳爐 燒菜造成的燙傷，

and she despaired that she was robbing her six-year-old grandson of his childhood

且她感到絕望，覺得自己 奪走了六歲孫子的童年，

because he was effectively her eyes.

因為他實際上就是她的眼睛。

The effect of her blindness was going through the generations.

她的失明影響到不只一個世代。

He wasn't able to go to school or break the cycle of poverty.

他無法去上學或是打破貧窮的循環。

All of this, despite cost-effective solutions existing.

儘管具有成本效益的解決方案， 卻仍然發生這種事。

Cataract surgery can be done in under 10 minutes

白內障手術不用十分鐘就能完成，

for just a hundred dollars.

價格只要一百美金。

Four in every five people who are blind don't need to be;

五個失明的人當中， 有四個其實不該失明；

curative or preventive treatments already exist.

治癒性和或預防性的療法 都已經存在了。

Fortunately for Mama Jane and her friend,

珍媽媽和她的朋友很幸運，

a donor had provided treatment

一位捐贈者提供了治療，

so that we could take them to the nearest hospital

讓我們能帶她們到最近的醫院，

three hours away.

只要三小時的路程。

But in that very same clinic,

但就在同一間診所中，

I met Theresa,

我遇見了泰瑞莎，

a shy young woman who couldn't look me in the eyes,

她是位害羞的年輕女子， 無法看我的眼睛，

not because she couldn't see,

不是因為她看不見，

but the appearance of the growth on her eyes called pterygium

而是因為她的眼睛長出了翼狀贅片，

meant she'd lost her confidence,

意思就是她失去了她的信心，

and with it, her place in her community.

隨著信心，也失去了 她在社區中的地位。

She had no prospects for marriage or children

她完全不指望能結婚生子，

and had been completely ostracized.

且完全被排斥在外。

I knew how to treat her condition; it was pretty straightforward.

我知道如何治療她的狀況； 方法相當直接。

But we had strict instructions that the funds we had

但我們能取得的基金 有嚴格的指示，

were for people with cataracts.

只能用於白內障的人。

What was I supposed to do?

我能怎麼做？

Ignore her?

忽視她？

My wife and I managed to raise the funds to cover her treatment,

我太太和我想辦法 為她的治療募款，

but situations like Theresa were common every day,

但像泰瑞莎這樣的情況 天天都在發生，

where people had the wrong diseases.

這些人得了錯的病。

And by the "wrong diseases,"

我所謂的「錯的病」

I mean conditions for which funding hadn't been earmarked.

指的就是不包含在 資金撥款用途中的那些病。

Earmarking may seem like smart business or smart philanthropy on paper,

理論上，撥專款似乎是種 聰明的生意或聰明的慈善，

but it doesn't make any sense when you're looking the person in the eye.

但當你看著病人的眼睛時， 這樣的做法是不合理的。

Yet, this is how we deliver health care to millions of people the world over.

然而，我們就這樣將健康照護 提供給世界各地的數百萬人。

I've been thinking about this problem for a very long time.

長年以來， 我一直在思考這個問題。

Things happened to me at the age of 12 that completely transformed my life.

我十二歲的時候發生了一件事， 改變了我的人生。

My teachers insisted that I would go for an eye test.

我的老師堅持我要去做視力檢查。

I resisted it for as many years as I could

多年來我一直很抗拒，能閃則閃，

because as the only brown boy in the school,

身為學校中唯一褐色皮膚的男孩，

I already felt like a chocolate chip in rice pudding,

我已經覺得自己像是 米布丁中的巧克力片了，

and the idea of looking more different was not particularly appealing.

我實在沒什麼興趣再去 找出我和別人的不同。

You see, I'd associated an eye test with wearing glasses

我會把視力檢查聯想到要戴眼鏡

and looking different,

及看起來與眾不同，

not with seeing differently.

而不是聯想到看更清楚。

When eventually I was persuaded to go,

最終，我被說服要去檢查時，

the optometrist fitted me with the trial lenses

驗光師讓我配上試鏡片，

and was shocked at just how poor my sight was.

我很驚訝我的視力原來這麼差。

He sent me outside to report what I could see.

他要我走出去， 告訴他我能看到什麼。

I remember looking up and seeing trees had leaves on them.

我還記得我向上看， 看到樹木上面有樹葉。

I had never known this.

我以前從來不知道這一點。

Later that week, for the first time, I saw stars in the night sky.

同一週沒多久之後， 我第一次看見了夜空的星星。

It was breathtaking.

那景象讓我摒息。

In fact, the entire trajectory of my life changed.

事實上，我人生的整個軌道改變了。

I went from a failing child at school who was constantly told I was lazy

我以前在學校裡被認為是懶惰、

注意力不集中的魯蛇小孩，

and not paying attention

to suddenly being a child with opportunity and potential.

突然變成了有機會、有潛能的小孩。

But I soon realized that this opportunity was not universal.

但我很快就發現， 這個機會並不是大家都有的。

That same summer, in Egypt,

同年夏天，在埃及，

the home where my parents are originally from,

也就是我父母原本的家鄉，

I was with children that looked a lot more like me

我和外表跟我很像的 孩子們在一起，

but couldn't have been more different.

但我又他們非常不同。

What separated us was opportunity.

我們之間的差別在於機會。

How is it that I had this life and they had theirs?

為什麼我能有這種生活， 他們的生活卻是那樣？

It still makes no sense to me.

我仍然覺得不合理。

How is it we've --

為什麼我們——

in a world where glasses, that completely changed my life

完全改變了我人生的眼鏡，

have been around for 700 years,

在世界上其實已經存在七百年了，

yet two and a half billion people still can't access them.

為什麼仍然有二十五億人 無法取得眼鏡？

This deep sense of injustice drove me to become a doctor,

這種很深刻的不公平感， 驅使我變成了醫生，

eventually an eye surgeon,

最終成了眼科外科醫生，

and in 2012, my wife and I packed our bags and moved to Kenya

2012 年，我和我太太 打包搬到肯亞，

to try and give something back.

試著以某種方式回饋。

We started by setting up a hundred eye clinics

我們一開始在東非大裂谷設立了

across the Great Rift Valley,

一百間眼科診所，

where we met people like Mama Jane and Theresa.

在那裡，我們遇到 像是珍媽媽和泰瑞莎的人。

We founded a new organization called Peek Vision,

我們成立了一個新組織， 叫 Peek Vision，

a social enterprise where we built smartphone technology

是一間社會企業， 我們開發智慧手機技術，

that makes it possible for people in the community

讓社區中的人能夠

to find people in their homes,

在他們的家中找到人，

the most vulnerable groups who are being missed,

最弱勢、被忽視的族群，

and created new tools that made it easier to diagnose them

我們還會創造新工具， 更容易為他們做診斷，

and connect them to services.

將他們與服務連結。

Inspired by the challenges I'd had as a child,

靈感是來自我小時候遇到的困難，

we equipped teachers, 25 of them, with smartphones

所以我們找了二十五位老師， 提供他們智慧手機，

to screen children in schools.

在學校篩檢兒童。

Our first program resulted in 21,000 children

我們的第一個專案結果，

being screened in just nine days.

是在九天內篩檢完 兩萬一千名兒童。

That same program was replicated to reach 200,000 children,

同樣的專案繼續複製執行， 觸及了二十萬名兒童，

covering the entire district.

也就是整區的所有兒童。

Soon we were able to repeat this in six new programs

我們很快會在 不同國家的六個新專案中

in different countries.

重覆使用這種做法。

But now, I was faced with the very same problems I had with Theresa

但現在，我面臨的問題 就類似泰瑞莎案例中的

of earmarked funds,

資金撥款用途問題，

but now as an organization.

但現在換成是一個組織。

People wanted to fund specific projects

大家會想要資助特定的專案計畫

or particular diseases

或是特定的疾病，

or subsets of the population.

或是某部分的人口。

But it didn't make sense,

但這樣不合理，

because what we needed to do was build an incredible team

因為我們需要做的 是建立一個絕佳的團隊，

who could create the systems that would change the lives

這個團隊要能夠創造系統，

來改變數百萬人的生命， 不論他們的需求是什麼。

of millions of people, whatever their needs were.

But it didn't work that way.

但不是那樣運作的。

Soon, we were able to align ourselves with partners who understood,

我們很快就和能夠理解的夥伴結盟，

because I understand the challenge.

因為我知道困難挑戰在哪裡。

Ultimately, you need to trust where your money's going,

最終，你得要信任你的金錢投資，

and that trust usually manifests through the requirement

而信任的表現方式 通常是會透過需求，

to create detailed plans -- lots of paperwork.

建立細節計畫的需求， 很多文書工作。

But what happens if the dynamic needs of people

但如果人的動態需求

don't fit with the plan that you created,

不符合你所建立的計畫，

and your funding is dependent on delivering the plan?

且你的資金要仰賴 計畫的實現，怎麼辦？

You end up with a choice:

你最後要做一個選擇：

Do you serve the plan, the funder,

你是要滿足計畫，也就是出資者，

or do you serve the need?

或是要滿足需求？

This is not a choice we should have to make,

這不該是我們需要去做的選擇，

because ultimately, we can only serve one master.

因為最終，我們只能 服侍一個主人。

The measure of our humanity

人性的衡量方式，

is how we serve the most vulnerable amongst us.

就是我們如何服務 我們當中最脆弱的人。

Currently, the system is not working, and too many people are being left behind.

目前，這個系統沒有用， 太多人被拋下。

We've been fortunate to find incredible supporters and partners,

我們很幸運， 能找到很棒的支持者和夥伴，

which led to a new program in Botswana,

這就導致了在波紮那的新專案，

in which every single schoolchild is being screened and treated

這個專案要讓所有學童

在 2021 年底前都接受篩檢和治療，

by the end of 2021,

meaning an entire generation of children

也就是說，整個世代的孩童

will have the opportunity that good vision affords.

都將會有好視力帶來的機會。

But this took years of work.

但這花了很多年的工作。

It took multiple feasibility studies,

做了很多項可行性研究，

engaging different partners and stakeholders,

動用到不同的夥伴、利害關係人、

business cases, economic analyses,

商業案例、經濟分析，

to persuade the government to eventually come on board.

終於說服政府加入。

But they're now leading and funding this in their own national budget.

現在他們用自己國家的預算 在領導和資助這件事。

But we did not have the resources to do this.

但我們沒有資源來做這件事。

Our visionary funders and partners came alongside us,

我們有遠景的資助者 和夥伴來協助我們，

and the key ingredients were we were aligned on mission,

而關鍵的要素就是 我們因為使命而結盟，

on the why we were doing it.

因為做這件事的原因而結盟。

We agreed on the outcome, what had to be done.

我們對於結果、 該做什麼，都有一致看法。

But critically, they were flexible and gave us autonomy

但，重要的是， 他們有彈性，能給我們自主權

to work out how we got there,

來想辦法做到目標，

giving us the space to be creative, ambitious and take risk.

給我們空間來發揮創意、 施展野心、去冒險。

What if all health care looked like this?

如果所有的健康照護 都是這個樣子的呢？

What would it mean for all the social causes we're trying to solve?

那對於我們試圖解決的 所有社會成因，有什麼意涵？

Business knows this.

企業知道這一點。

By taking a long-term, ambitious view

採用長遠、有野心的觀點，

and giving people the autonomy to be creative

給大家自主權，發揮創意，

to solve our world's biggest challenges,

來解決我們世界上 最大的挑戰之一，

we've disrupted entire industries.

我們已經擾亂了整個產業。

Look at Amazon, Google.

看看亞馬遜、谷歌。

Surely, we need the same level of ambition

當然，我們需要同等的野心，

if we're going to serve the most vulnerable in our societies.

如果我們打算要服務 我們社會中最脆弱的人。

As a planet, we've set a target,

我們地球已經設定了一個目標，

the Sustainable Development Goals,

「永續發展目標」，

yet we're spending less than half the amount on tackling the global goals

但我們用在處理全球目標上的花費，

還不到在解決衝突上的花費的一半，

than we are on conflict resolution,

which mostly arises from the very inequalities we're not serving.

而大部分的衝突都因為那些我們 沒打算服務的不平等所產生的。

It's time for change.

該是改變的時候了。

It's not just common sense as well -- it makes business sense.

它不只是常識—— 它在商業上也說得通。

Our work in Botswana showed

根據我們在波紮那的研究，

for a modest investment, the economy would gain 1.3 billion dollars

針對適度的投資，

經濟會在孩子的一生中 增加十三億美金。

over the lifetime of the children.

That was 150 times return on investment.

投資利潤是一百五十倍。

But part of the problem is that value is generated in the future,

但部分問題在於 要到未來才會產生價值，

but we need the money now to deliver it.

但我們現在就需要錢來實現它。

Turns out, this is not a new problem.

結果發現，這不是個新問題。

Banks have been solving it for centuries.

數個世紀以來， 銀行都在解決這個問題。

Simply put, it's called financing.

簡單來說，它叫融資。

If you want to buy a house

如果你想要買一間房子，

but you can't afford to pay for it up front,

但你買不起，無法先付清，

the bank financiers, you see, can realize that future value now.

銀行的金融家能夠在現在 就知道未來的價值。

In other words, you can live in the house straightaway.

換言之，你可以馬上住進房子。

But what if you couldn't?

但如果你不能呢？

What if you had to wait until you'd raised all of the money to move into the house,

如果你得要籌到所有 必要的錢才能搬進房子，

為了搬進房子而存錢的過程

and you were kept homeless whilst trying to save the money

你都無家可歸，會如何？

to get there in the first place?

你會陷入一個不可能的循環中， 永遠達不到目標，

You'd end up in an impossible cycle, never able to get there,

但，我們就把自己 放入了這樣的困境中。

yet that's this very same bind we've put on ourselves.

Inspired by the change in Botswana

波紮那的改變帶給我們靈感，

and by the visionary support of our funders and partners,

加上我們的資助者 和夥伴提供很有遠見的支持，

we've come together -- two world-leading banks,

我們同心協力—— 兩間世界頂級的銀行、

for-profit and private, not-for-profit organizations,

營利和私人、非營利組織、

foundations and philanthropists --

基金會和慈善家——

to launch the Vision Catalyst Fund,

一起推出了「促進遠景基金」，

a fund which will have trust built in by design.

這個基金本身就有著信任。

It will make funding available now

它現在就能提供資金給組織，

to the organizations that can serve the need of the most vulnerable.

去滿足最脆弱的人的需求。

It will ensure that those organizations can work together in partnership,

它會確保那些組織能夠合作，

rather than competing for limited funds,

而不是為了爭取有限資金而競爭，

serving the priority needs of an entire population,

來滿足所有人的優先需求，

whatever they are,

不論所有人指的是誰，

so that ultimately the individuals affected

最終，受到影響的個人

can receive the care that they deserve.

就能夠得到他們應得的照護。

And as we've shown,

如我們先前說明的，

it doesn't make just a health and social difference,

它不只是在健康 和社會上創造不同，

it creates huge economic benefit.

它還創造了很大的經濟利益。

This benefit in itself will create sustainability

利益本身將會創造出永續性，

to perpetuate a virtuous, catalytic cycle of improvement and change.

讓改善和改變的良性 促進循環能夠永存。

Because when we do this,

因為當我們這麼做時，

the individual needs of people like myself can be met.

像我這樣的人的 個別需求就能被滿足。

And this coalition has come together this year

這個聯盟已經在今年組成，

to make a commitment with 53 heads of government,

並與五十三位政府首長立下承諾，

who have now committed to take action

他們現在承諾要採取行動，

towards achieving access to quality eye care for all.

努力朝向讓所有人都能 取得高品質眼睛照護邁進。

We've had incredible commitments

我們已經得到了些很棒的承諾，

of 200 million pairs of glasses to the fund

包括提供兩億副眼鏡給基金，

and millions of dollars,

還有數百萬美金的資金，

so that the dynamic and individual needs of people --

這麼一來，大家的 動態個別需求——

like my own issues that I had as child,

就像我小時候的問題，

and like Theresa, who just required simple surgery --

或像只需要動簡單手術的泰瑞莎——

can be met.

能被滿足。

For Theresa, it meant her place back in society,

對泰瑞莎而言的意義是 她能取回她在社會上的地位，

now with her own family and children.

現在她有自己的家人和孩子。

And for Mama Jane, it wasn't just restoring her sight,

對珍媽媽來說， 她不只恢復了視力，

it meant the opportunity to restore hope,

她也有機會能夠重獲希望、

to restore joy

重獲喜悅，

and to restore dignity.

並重獲尊嚴。

(Music)

（音樂）

Thank you.

謝謝大家。

(Applause)

（掌聲）