Aparna Hegde: The life-saving tech helping mothers make healthy decisions | TED Fellows

譯者: 婉郡 吳 審譯者: Helen Chang

[SHAPE YOUR FUTURE]

形塑您的未來

Anita died in my presence while giving birth to life.

安妮塔在我面前難產死亡

She bled to death and lost her child.

她出血過多而死，並且失去了她的孩子

The irony was that she had access to care.

諷刺的是她生前得到了照顧

In the first trimester of pregnancy,

在懷孕前三個月

she had visited the antenatal clinic of the hospital in Mumbai

她曾到孟買的產前診所看診

where I was doing residency.

也就是我住院實習的地方

But over four hours of waiting in the hot, sweaty,

但四個多小時在炎熱、冒汗

dingy, overcrowded clinic

陰暗、擁擠的診所等待

just to get a minute with me,

只和我待了一會兒

a harried, overworked resident doctor,

我是一個匆忙、過度勞累的住院醫生

meant that she never came back,

也就是說，她不再回診了

only to die in labor months later.

在數月後的生產過程中死了

I was wracked with guilt.

我充滿了罪惡感

If only I had counseled her about the danger signs,

要是我忠告她危險的跡象

why she needed to access regular care.

忠告她為什麼需要定期接受照護

Would she and her child have survived?

她和她的孩子會活下來嗎？

She did not die due to a terminal condition.

她並不是死於絕症

She died because of underlying anemia,

她是死於貧血

an easily treatable, preventable condition.

一種容易治療及預防的疾病

I saw these stories daily.

我每天都看到這些事

Systemic, preventable problems resulting in mothers and children dying

系統性的、可預防的問題

在最不公平的情況下 導致母親及孩子的死去

in the most unjust of circumstances.

In the next one hour,

在接下來的一個小時裡

three women will die while giving birth somewhere in India.

在印度某處就會有 三個女人將會難產死去

Two children under age five die every minute in India.

在印度，每分鐘就有 兩個五歲以下的兒童夭折

I am a practicing urogynecologist,

我是實習泌尿科醫生

but very early in my medical training,

但在我早期的醫學訓練裡

I realized that hospital-based solutions were not enough.

我意識到醫院基本的解決方式並不足夠

And given the sheer scale of India's problems,

考慮到龐大規模的印度問題

any solution that made a difference had to be scalable,

任何有意義的解決方案 必須是可擴展的

accessible to the last woman and child directly in their homes,

婦女和小孩可在家中直接取得的

and yet cost-effective and resource-light.

並且是成本效益高、輕資源的

And then the mobile phone came to India

然後，手機傳到了印度

and within a few years everyone had a mobile phone.

在幾年後，人手一機

There are currently more mobile phones in India than toilets.

現在在印度，手機比廁所還多

The idea then struck me.

我突然想到這個主意

Why not use a simple technological tool like a mobile phone,

為什麼不用像是手機那樣 簡單的科技工具

which is available in almost every Indian household

幾乎每個印度家庭都有手機

to bridge the yawning systemic gaps in health care?

用它來彌補健康照護上的 巨大系統性鴻溝?

Maybe we could have simply called Anita weekly

或許我們本可以每週 就打給安妮塔一通電話

with critical lifesaving information.

給她關鍵的救命資訊

On the other hand,

另一方面

maybe we could have provided mobile-phone-based training

或許我們本可以提供 以手機為基礎的訓練

to the health worker who could have diagnosed Anita's anemia

讓健康人員可以診斷安妮塔的貧血

in the community itself.

在社區自行進行

Thus was born my NGO ARMMAN.

因此，我的非營利組織— 阿爾曼 [ARMMAN] 就成立了

Our programs, mMitra and Kilkari,

我們的計畫，免費語音通話 [mMitra] 和手機健康教育服務 [Kikari]

are free, weekly voice call services.

是每週免費的語音通話服務

They provide preventive information directly to women

計畫直接提供婦女預防性訊息

through pregnancy and infancy

涵蓋整個懷孕期及嬰兒期

in their chosen time slot and language.

由他們選擇時間段及語言 提供預防性訊息

There are multiple tries for every message,

每封訊息都會多次嘗試發送

a missed-call system,

有一個未接來電系統

and mMitra also has a call center.

免費語音通話 [mMitra] 同樣也有一個客服中心

If only Anita had received this service.

要是安妮塔收到這個服務

In the second month of pregnancy itself,

在她懷孕的第二個月

it would have told her about the need to take an iron pill daily

就會通知她每天需要吃鐵藥丸

from the third month of pregnancy.

從懷孕第三個月開始

When the third month arrived,

第三個月到的時候

it would have sent her a reminder

系統也會給她發送一封提醒

and counseled her on how to take the iron pills.

並且建議她如何來服用鐵藥丸

For example, the need to avoid tea, coffee to improve the absorption of iron

例如，必須要避免喝茶、咖啡 以利鐵的吸收

and stress on why it is so necessary to prevent anemia.

並且強調預防貧血的必要性

Two weeks later,

兩週後

it would have spoken about how to tackle the adverse effects of iron pills,

系統會告訴她如何應對鐵藥丸的副作用

like constipation.

像是便祕

If she had any query,

若她有任何的疑問

she could have reached out to our call center staff.

她可以和我們的客服中心員工溝通

These are simple voice calls.

這就是簡單的語音通話

As a typical doctor,

身為一個典型的醫生

I expected them to just inform

我期望只是送通知

and hopefully lead to better health behaviors.

就會導引成健康的好行為

However, the one unexpected transformational benefit

然而，有一個非預期轉變的優勢

that has completely blown my mind is this:

讓我感到興奮，那就是

Information is empowerment.

資訊就是力量

Armed with this information,

裝備這個資訊

women like Anita are upending patriarchal family dynamics,

像安妮塔那樣的婦女 是顛覆父權家庭的動力

challenging entrenched mores

挑戰根深蒂固的風俗習慣

and demanding care.

要求被照護

Karnam, the wife of a deeply conservative preacher,

卡爾南，是一位非常保守的佈道的太太

convinced her husband to adopt family planning

說服她先生接納家庭計畫

because mMitra told her

因為免費語音通話 [mMitra] 告訴她

that spacing between pregnancies is necessary.

兩次懷孕間的空檔是必要的

And the change is intergenerational.

這個改變是跨世代的

Punita, form a deeply conservative family,

出身非常保守家庭的蒲妮塔

sent her daughter to an English medium school.

讓她的女兒去英語授課的學校

In addition to the big pictured messages,

除了大型圖的訊息

the most underprivileged of women want to know

大多的貧困的婦女想要知道

when their child will understand color,

她們的孩子什麼時候會知道什麼是顏色

how to ensure psychosocial stimulation of the child,

如何確定小孩的心理社會刺激

when their child will develop fingers in their womb and so on.

她們的孩子在子宮時 什麼時候會長出手指頭等等

Like any woman would.

就像每個婦女都想要的

Our services respect that.

我們的服務尊重這些

Over 20 million women in over 16 states in India

在印度超過 16 個州 超過兩千萬的婦女

have enrolled for these services since 2014.

自 2014 年以來 已經註冊了這些服務

This is testament to how easily scalable and replicable these solutions are

這個是對在世界的每個角落 如何快速擴展

anywhere in the world.

並且複製這些解決方法的見證

Similarly, our mHealth-based refresher training program

同樣地，我們以行動醫療照護 為基礎的進修訓練課程

for government frontline health workers called Mobile Academy

給政府前線的健康工作人員的 叫做行動學院

has trained over 130,000 health workers in 13 states in India.

行動學院已經在印度 13 個州 培訓超過 13 萬個健康工作者

Both Kilkari and Mobile Academy, in collaboration with the government,

手機健康教育服務 [Kikari] 和行動學院都和政府合作

will extend through the country in the next three to five years.

會在未來的三到五年擴展到全國

Our goal is to be able to reach

我們的目標是可以達到

over 15 million women and their children every year,

每年超過一千五百萬名婦女 及她們的孩子

and that would mean

這也意味著

over half of the mothers and children born every year

每年有半數的母親及新生兒

have the information they need.

獲得他們需要的資訊

And this massive scale is only possible

這個龐大規模之所以成為可能

because so many of our partners,

是因為我們許多的合作夥伴

be it NGOs, hospitals and the government,

無論是非營利組織、醫院或是政府

recognize the value of this approach

都認識到這個途徑的價值

and provided the scaffold on which we grew.

並且提供了我們成長的支架

Our quest in the next five years is to adopt multimedia approaches,

我們在未來五年的尋求是 採用多媒體途徑

and given the massive amounts of data we have,

考慮我們有的大量資訊

use the power of AI and predictive analytics

使用人工智慧的力量，預測分析

to better serve our mothers and children.

來提升我們給母親及孩童的服務

And our tech platform and the networks we build are nimble.

而我們建立的科技平台及網路是靈敏的

When COVID-19 struck,

當新冠病毒突然來襲

lockdown was announced overnight.

一夜間宣布封城

Among the worst affected were the underprivileged women and children

孟買及德里貧民窟中 窮困的婦女與孩童之間

in the slums of Mumbai and Delhi,

受到最嚴重的影響

which were declared as containment zones.

那裡被認定為感染區

However, pregnancy and infancy can't wait for a lockdown.

然而，懷孕及新生兒期沒辦法等到解封

When there's an emergency like bleeding, care is needed immediately.

當有緊急事件像出血發生時 需要即刻的照護

And we were right there and ready.

而我們就在那裏準備好了

We repurposed our tech platform within a matter of days.

在幾天內，我們利用我們的科技平台

We created a virtual clinic for antenatal pediatric care

我們為產前小兒科學照護 創建了一個虛擬診所

manned by qualified doctors.

配置了合格的醫師群

Our call-center staff arranged logistic support, like ambulances.

我們的客服中心人員安排合適的支持 例如，救護車

We also sent COVID-specific information covering pregnancy and infancy

我們也會傳送涵蓋懷孕 及新生兒新冠病毒的特定資訊

to over 300,000 pregnant women and mothers through voice calls.

傳語音訊息給三十多萬名孕婦及母親

But why should you care about our mothers and children?

您為什麼要關心我們的母親及孩童呢?

The pandemic has made us confront this most implacable of truths.

疫情讓我們面對這個最無法改變的事實

A robust primary health care system is an absolute pillar

堅固的基礎健康照護系統無庸置疑是

of a functioning and efficient society.

運作及效率社會的支柱

Improvement in maternal and child health

改善母親及孩童的健康

leads to horizontal development of health systems

使健康系統平行發展

and improved primary health care.

改善基礎健康照護

A village that can look after its mothers and children well

一個可以好好照顧母親及孩童的村落

can look after all other conditions by ripple effect.

藉由連鎖反應 可以照顧所有其他的狀況

And pregnancy is not a disease.

懷孕不是一種疾病

Childhood is not an ailment.

孩童不是一種毛病

Dying due to natural life event is not acceptable,

因為自然生命事件而死去 是令人無法接受的

and we know why our mothers and children die.

儘管我們知道為什麼 母親和小孩會死亡

Yet we invest so little in preventing their deaths.

卻很少投資在 預防她們死亡的事上

There can be no global progress

只有我們所有的母親和兒童都過得好

until all our mothers and children do well.

全球才能取得進展

I implore you to add your voices to ours.

我懇求您為我們發聲

To amplify this message loud and clear.

大聲且清楚的放大這個訊息

That maternal and child health is a human right.

母親及孩童健康是一種人權

Thank you.

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