In the opioid crisis, here's what it takes to save a life | Jan Rader

譯者: Lilian Chiu 審譯者: Yanyan Hong

For the past 24 years, I have been a firefighter

過去二十四年， 我一直都是西維吉尼亞州

in Huntington, West Virginia.

亨廷頓市的消防員。

As firefighters, my team and I are tasked with saving lives

身為消防員，我和我的隊員的

工作任務就是要拯救性命

and property

和地產，

from such disasters as car wrecks, house fires

不受到災難的威脅， 如車禍、房子失火，

and also life-threatening medical emergencies.

以及會危及性命的醫療緊急事件。

I am a woman leading a department in a male-dominated profession.

在男性主宰的行業中， 我是領導一個局的女性主管。

And 10 years ago,

十年前，

I decided to increase my medical knowledge and I received a nursing degree.

我決定要增加我的醫療知識， 我取得了一個護理學位。

That was because it became clear

那是因為，現在大家都清楚，

that the next big threat facing not only my city,

不只是我的城市， 還有全國其他城市，

but other cities around the country,

要面臨的下一個大威脅

was not the one-and-done disaster,

並不是發生了就會過去了的災難，

where you can ride in like the cavalry, as a firefighter,

對那些災難，你可以用救兵、 消防員的身分抵達，

put out the fire and leave, feeling like you have made a difference

把火滅掉後離開， 覺得你造就了不同，

and everything is OK.

且一切都沒事了。

The next big disaster in my city was and is the long, debilitating

我城市裡的下一個大災難

是很漫長、讓人衰弱，

and lethal disaster known as opioid addiction.

且致命的災難，就是大家 所知的鴉片類藥物成癮。

We now call this a health epidemic,

我們現在稱之為健康流行病，

and we have replaced the name "addiction" with "substance use disorder."

且我們把「成癮」這個字 換成了「物質使用障礙症」。

To give you some perspective

這種流行病變得多重大？

of how significant this epidemic has become,

給大家一點概念，

in 2017, in my county of 95,000 people,

2017 年，我的郡

人口是九萬五千人，

we saw 1,831 overdoses

我們發現了 1831 個 服藥過量的案例，

[and] 183 deaths from overdose.

以及 183 個因為 服藥過量致死的案例。

This is the job of my firefighters, as well as other agencies,

我們消防員以及其他 機構的工作都包括

to respond to that.

要對那些狀況做應變。

(Coughs)

（咳嗽）

Excuse me.

對不起。

So, watching this epidemic unfold for several years,

數年來，看著這種流行病漸漸出現，

I developed some insight.

我也發展出了一些洞見。

For this disaster, we need to redefine our job as a first responder.

對這種災難，我們需要重新定義

我們身為第一線應變人員的工作。

We need to be more than just the cavalry.

我們不能只當救兵。

We need to do more than just save a life.

我們要做的不只是拯救性命。

We need to find ways to rebuild that life.

我們得要找出方法來重塑那些生命。

And it's going to take a lot of people to do that.

會需要很多人才能夠做到。

And that is exactly what we are trying to do

那正是我們在西維吉尼亞州

亨廷頓市試圖去做的事。

in Huntington, West Virginia.

Now, let me give you some insight as to what we do.

讓我說明一下，我們做的是什麼事。

First, this is what happens when somebody overdoses.

首先，當有人用藥過量時， 狀況會是這樣的。

Imagine you are somebody who is suffering from the brain disorder of addiction.

想像你受到成癮的 腦部功能失調所苦。

You are fragile.

你很脆弱。

You're embarrassed, you're ashamed.

你很尷尬，你很羞恥。

And you overdose.

且你用藥過量。

Maybe a friend or a family member calls 911.

也許你的朋友或家人打了求救電話。

And then all of a sudden,

接著，突然間，

you are awakened by five or six total strangers in uniform.

你醒來就看到五六個

穿著制服的陌生人。

And they're rubbing your sternum,

他們在磨擦你的胸骨，

and they're saying, "Wake up, wake up!

他們說：「醒醒，醒醒！

You overdosed, you could've died."

你用藥過量了， 你本來可能喪命的。」

Now, would you not be defensive and angry?

你不會有防禦心或感到生氣嗎？

Because I know I would be.

因為我知道我就會。

And on top of that,

此外，

those strangers gave you a dose of naloxone,

那些陌生人還給了你一劑鈉洛酮，

which has sent you into withdrawals,

讓你進入戒斷，

or what is better known as "dope sickness."

更為人所知的說法是 「毒品戒斷不適」。

Dope sickness makes you feel absolutely horrible.

毒品戒斷不適會讓你感覺非常糟糕。

Some say it's like the flu, times ten.

有人說就像是流感再乘以十倍。

Nausea, vomiting, diarrhea, body aches.

噁心、嘔吐、腹瀉、身體疼痛。

So not only did we, as strangers, wake you up,

所以，我們這些陌生人 不僅是把你喚醒，

but we also made you feel really sick.

我們還讓你感覺非常不舒服。

So in turn, you, the patient, are not going to be very kind to us.

所以，相對的，身為病人， 你對我們不會太仁慈。

And you're going to refuse further medical treatment.

你將會拒絕接受進一步的醫療治療。

OK, well, then that's going to frustrate the heck out of us,

那會讓我們非常有受挫感，

and we're going to be mad,

我們會被惹毛，

because you're ungrateful that we just saved your life.

因為你不知感激， 我們剛救了你一命呢。

This is not a good dynamic here.

這並不是很好的互動關係。

What we are dealing with is a brain disorder

我們在處理的是大腦功能失調，

that changes your thinking.

會改變你的思想。

It convinces you that you don't have a problem.

它會說服你說你沒有問題。

So, this might have been not only the first time you've overdosed,

所以，這可能不是你 頭一次用藥過量，

it might have been the third, fourth or fifth time

可能是我們第三次、第四次，

that we, personally, have revived you.

或第五次，親手把你救回來。

This is not a good situation.

這並不是很好的狀況。

Second,

再者，

first responders do not receive much education

第一線應變人員並沒有受過很多

關於物質使用失調的相關教育，

on what substance use disorder is.

Neither does the medical community.

連醫療界也是一樣。

We're not trained how to deal with those suffering from substance use disorder.

我們沒有受過如何處理 物質使用失調患者的訓練。

I am trained to put out many different types of fires.

我受過撲滅各種火災的訓練。

I am trained to save a life in the moment.

我受過當下拯救人命的訓練。

But I am not trained to deal with the intricate interaction

但我受過的所有訓練 都沒有教我處理第一線應變人員、

between first responders, the health care community,

健康照護圈、社工服務， 和更廣大的群體之間複雜的互動，

social services

and the wider community that is necessary to save a life long-term.

但要長期拯救生命這是必需學會的。

Thirdly,

第三，

and this hits home.

這點正中要害。

As a first responder, I consider myself the cavalry.

身為第一線應變人員， 我認為我自己是救兵。

We're knights in shining armor.

我們是穿著閃亮盔甲的騎士。

We want to swoop in, do our job and leave feeling satisfied

我們想要衝到現場，

做我們的工作，帶著滿足感離開，

that we've made a difference in somebody's life.

認為我們為別人的生命帶來了不同。

But that just doesn't happen

但當我們在處理物質 使用失調患者時，

when we're dealing with somebody with substance use disorder.

就不是這樣的狀況。

We leave feeling frustrated and useless.

我們帶著挫折感和無用感離開。

We deal with the same people over and over again,

我們不斷處理同樣的人，

with no positive outcome.

沒有任何正面的結果。

And you know what?

你們知道嗎？ 在某個時點，我了解到，

At some point, I realized that it is up to us as first responders

我們要以第一線應變人員 以及一個團體的身分，

and as a community

to solve this problem,

來解決這個問題，

to find better ways to deal with those that are suffering.

來找到更好的方式， 處理那些受苦的人。

So what I did is I started observing more on overdoses.

所以，我便開始 對用藥過量做更多的觀察。

I started talking and listening to my patients.

我開始和我的病人交談，傾聽他們。

I wanted to know what led them to where they are.

我想要知道是什麼原因 導致他們變成現在這樣。

What exactly are they experiencing?

他們到底經歷了什麼？

What makes their situation worse?

什麼會讓他們的狀況更糟？

What makes their situation better?

什麼會讓他們的狀況變好？

I began experimenting with my words

我開始用我的話語來做實驗，

and paying attention to my own actions

並對我自己的行為多加留心，

and how it affected those of my patients.

看我的行為會如何影響我的病人。

The education that I have received

我在亨廷頓市街頭

and continue to receive on a street level in Huntington

曾經受到／持續受到的教育，

has been both eye-opening and life-changing for me.

對我來說，既讓我開了眼界， 也改變了我的人生。

So, in Huntington, West Virginia, we have come together as a community,

在西維吉尼亞的亨廷頓市， 我們結合成了一個群體，

and we are changing the way that we treat

對於那些受到這種 可怕疾病所苦的人，

those that suffer from this horrible disease.

我們正在改變對待他們的方式。

We have started many programs, and it's making a difference.

我們開始了許多方案， 創造了很多不同。

I'll tell you about just a few of those.

我會告訴各位其中幾項。

Last year, we started a Quick Response Team,

去年，我們成立了快速反應小隊，

QRT for short.

縮寫是 QRT。

The team consists of a paramedic,

小隊成員有一位醫務人員、

a police officer,

一位警官、

somebody in the recovery community and somebody in the faith community.

一名來自康復界的人， 及一名來自宗教信仰界的人。

As a team, they go out and visit people who have overdosed

在一個人用藥過量被救回來 之後的七十二小時內，

within 72 hours of that resuscitation.

整個小隊會一起去造訪他。

They talk.

他們會交談。他們會傾聽。

They listen.

They build a rapport with that patient,

他們會和那名病人建立友好關係，

and they offer them treatment options.

且他們會提供病人一些治療選擇。

Right now, about 30 percent or up to 30 percent

目前，

在快速應變小隊接觸過的人當中，

of those that the Quick Response Team have reached out to

大約有 30% 或高達 30%

have accepted some form of help.

都接受了某種形式的協助。

And the wonderful thing about this

很棒的一點是，

is the first responders who are involved in this team,

參與這種小隊的第一線應變人員，

they actually feel like they can make a difference.

他們真的有感覺到 他們能夠創造不同。

Positive change where there wasn't any.

這些正面改變是以前無法做到的。

This year --

今年——

(Applause)

（掌聲）

This year, we opened a free-standing specialty clinic, called PROACT,

今年，我們成立了一間 自立專科診所，

簡稱 PROACT，

for those suffering from substance use disorder.

服務對象是受物質 使用失調之苦的人。

It's a one-stop shop, if you will.

可以說它是一站購齊式的商店。

A patient comes in,

病人進來之後，

they're immediately assessed by somebody who's an addiction specialist.

馬上有成癮的專家為他做評估。

They work with them to provide treatment options

他們會根據病人自己個別的需求，

based on their own needs, individual needs.

來提供相關的治療選擇。

This does several things for us.

這對我們也會有些影響。

It gives first responders a place to either take or refer our patients

第一線應變人員就可以接受或轉介

who are no longer in a life-threatening situation,

已經沒有生命危險

that have refused to go to the hospital.

且已經拒絕去醫院的病人到這裡來。

And it also clears up

它也能幫已經爆滿的

the overwhelmed emergency rooms in hospitals that we have.

醫院急診室分擔一些病人。

The third thing that I want to tell you about

我想要談的第三點，

is very dear to me and very important to my team.

我個人非常有感， 且對我的團隊也非常重要。

We recently started a first responders self-care program.

最近，我們開始了一項 第一線應變人員的自我照顧方案。

More and more ...

越來越多的……

first responders are experiencing compassion fatigue and PTSD.

第一線應變人員經歷到 同情心疲勞和創傷後壓力症候群。

It is not uncommon for the average firefighter in Huntington

對亨廷頓市的一般消防員來說，

to deal with or see up to five young deaths per month.

每個月要處理或看見五個 年輕人死亡是家常便飯。

These are their friends, these are their classmates.

這些人是他們的朋友、他們的同學。

So this much-needed program will not only recognize their hard work,

所以這個很被需要的方案，

不僅是肯定他們的辛苦努力， 也會讓他們的可以發聲。

it's going to give them a voice.

It's going to provide them with training

這個計畫會提供他們訓練，

that will help deal with the stress that they are under.

協助他們處理他們所受的壓力。

And it will give them more mental-health options

這個計畫也會給予他們 更多心理健康的選擇，

that they desperately need.

這些是他們迫切需要的。

We now have yoga classes in fire stations.

現在在消防局裡還有瑜伽課。

(Laughter)

（笑聲）

(Applause)

（掌聲）

We've also provided on-duty massages, which is fabulous.

我們還在執勤時段提供按摩，

這真的很棒。

(Laughter)

（笑聲）

And we have some off-duty programs that we've started,

我們也開始有一些不當班時的方案，

like cooking classes for first responders and their significant other

比如烹飪課，對象是第一線應變 人員以及他們的重要另一半，

and pottery classes.

還有陶藝課。

So a couple of months ago,

幾個月前，

I walked out on the apparatus floor, where I had some firefighters.

我走到消防車車庫， 在那裡有些消防員。

And half of them had had a massage,

當中有一半的人都做過按摩，

and the other half were getting ready to have a massage.

另一半的人也準備好要做按摩了。

And I saw 10 firefighters who were bantering

我看到十名消防員以非常正面、

in a very positive, relaxed manner.

放鬆的方式在開玩笑。

And I hadn't seen that in years.

我好多年沒看到這種景象了。

And that relaxed state is trickling down to the community, to the citizens.

而那種放鬆的狀態

會向下滲到社區、到市民。

So a couple of weeks ago, I had a neighbor overdose.

幾個星期前，

我有一位鄰居用藥過量。

Twenty-two years old.

二十二歲。

So of course, I hurried down to help my firefighters and my neighbor.

當然，我趕快去協助 我的消防員和那位鄰居。

And what I witnessed was my firefighters being supportive.

我看到的是，

這些消防員的表現充滿支持。

Talking in a non-judgmental way.

他們說話的方式不帶有評斷。

I watched as one of my firefighters

我看著我的其中一位消防員

showed the father and another family member

教導這位鄰居的爸爸和另一位家人

how to provide rescue breaths, should this happen again.

如果再發生這樣的事， 要如何做人工呼吸。

And left him with a bag valve mask.

並留給他一個袋瓣呼吸面罩。

Positive change.

正面的改變。

Positive change.

正面的改變。

Did I happen to mention

我剛有沒有提到

the two things that firefighters dislike the most?

消防員最不喜歡的兩樣東西？

The way things are and change.

事物的現狀……和改變。

(Laughter)

（笑聲）

You know, I recognize that there have been drug epidemics before.

我知道以前也有毒品流行。

And I've seen what crack can do to a community.

我曾經見過古柯鹼對社區的影響。

A lot of our critics think

很多評論家認為

that this new compassionate response that we're doing in Huntington

我們在亨廷頓市做 這種新的同情式應變

is because of race.

是因為種族。

That because the overdoses are happening so much to the white community.

因為在白人社區 發生這麼多用藥過量。

And I understand that criticism,

我能了解這種批評，

because we as a country messed up.

因為我們這個國家搞砸了。

And we treated black people poorly during the crack epidemic.

在古柯鹼流行的時候， 我們對待黑人的方式很糟糕。

We can't forget that.

我們無法忘懷這件事。 我們必須要做得更好。

And we must do better.

But right now, what I know is people are dying.

但，現在，我所知道的是 有人在步向死亡。

And we in Huntington deal with people suffering from substance use disorder

在亨廷頓市， 我們每天在街頭要處理的

物質使用失調患者是 什麼膚色都有、什麼背景都有。

of every color and every background, on the streets, every day.

The job of a first responder: prevent unnecessary deaths.

第一線應變人員的工作： 預防不必要的死亡。

Period.

就這樣。

So ...

所以……

Obviously, I'm a stubborn firefighter and nurse.

很顯然，我是位 很固執的消防員和護士。

And I refuse to believe that there isn't a way around every barrier.

我拒絕相信我們 找不到路可以繞過障礙。

One of the barriers that we have

我們在處理鴉片類藥物

dealing with the opioid epidemic is stigma.

所遇到的障礙之一就是視之為羞恥。

So ...

所以……

We in Huntington, West Virginia, are showing the rest of the country

在西維吉尼亞的亨廷頓市， 我們要讓全國其他地方看到，

that change can happen.

改變是有可能發生的。

That there is hope dealing with this epidemic.

仍然有希望可以處理這種流行。

Our current overdoses are down 40 percent.

我們目前用藥過量的 狀況已經下降四成。

(Applause)

（掌聲）

Currently, our overdose deaths are down 50 percent.

目前，我們因為用藥過量 造成的死亡下降了五成。

(Applause)

（掌聲）

This epidemic is far from over.

流行離結束還很遠。

But each and every one of us has a part to play in this epidemic.

但在這場流行病當中， 我們每一個人都有角色要扮演。

Just by listening and being kind to somebody,

只要能夠傾聽他人、對他人仁慈，

you have the ability to make a difference in their lives.

你就有能力可以 在他們的生命中創造改變。

Thank you and God bless.

謝謝大家，願上帝保佑。

(Applause)

（掌聲）