[SHAPE YOUR FUTURE]
形塑您的未來
Anita died in my presence while giving birth to life. She bled to death and lost her child. The irony was that she had access to care. In the first trimester of pregnancy, she had visited the antenatal clinic of the hospital in Mumbai where I was doing residency. But over four hours of waiting in the hot, sweaty, dingy, overcrowded clinic just to get a minute with me, a harried, overworked resident doctor, meant that she never came back, only to die in labor months later. I was wracked with guilt. If only I had counseled her about the danger signs, why she needed to access regular care. Would she and her child have survived? She did not die due to a terminal condition. She died because of underlying anemia, an easily treatable, preventable condition.
安妮塔在我面前難產死亡 她出血過多而死,並且失去了她的孩子 諷刺的是她生前得到了照顧 在懷孕前三個月 她曾到孟買的產前診所看診 也就是我住院實習的地方 但四個多小時在炎熱、冒汗 陰暗、擁擠的診所等待 只和我待了一會兒 我是一個匆忙、過度勞累的住院醫生 也就是說,她不再回診了 在數月後的生產過程中死了 我充滿了罪惡感 要是我忠告她危險的跡象 忠告她為什麼需要定期接受照護 她和她的孩子會活下來嗎? 她並不是死於絕症 她是死於貧血 一種容易治療及預防的疾病
I saw these stories daily. Systemic, preventable problems resulting in mothers and children dying in the most unjust of circumstances. In the next one hour, three women will die while giving birth somewhere in India. Two children under age five die every minute in India.
我每天都看到這些事 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 在接下來的一個小時裡 在印度某處就會有 三個女人將會難產死去 在印度,每分鐘就有 兩個五歲以下的兒童夭折
I am a practicing urogynecologist, but very early in my medical training, I realized that hospital-based solutions were not enough. And given the sheer scale of India's problems, any solution that made a difference had to be scalable, accessible to the last woman and child directly in their homes, and yet cost-effective and resource-light.
我是實習泌尿科醫生 但在我早期的醫學訓練裡 我意識到醫院基本的解決方式並不足夠 考慮到龐大規模的印度問題 任何有意義的解決方案 必須是可擴展的 婦女和小孩可在家中直接取得的 並且是成本效益高、輕資源的
And then the mobile phone came to India and within a few years everyone had a mobile phone. There are currently more mobile phones in India than toilets. The idea then struck me. Why not use a simple technological tool like a mobile phone, which is available in almost every Indian household to bridge the yawning systemic gaps in health care? Maybe we could have simply called Anita weekly with critical lifesaving information. On the other hand, maybe we could have provided mobile-phone-based training to the health worker who could have diagnosed Anita's anemia in the community itself.
然後,手機傳到了印度 在幾年後,人手一機 現在在印度,手機比廁所還多 我突然想到這個主意 為什麼不用像是手機那樣 簡單的科技工具 幾乎每個印度家庭都有手機 用它來彌補健康照護上的 巨大系統性鴻溝? 或許我們本可以每週 就打給安妮塔一通電話 給她關鍵的救命資訊 另一方面 或許我們本可以提供 以手機為基礎的訓練 讓健康人員可以診斷安妮塔的貧血 在社區自行進行
Thus was born my NGO ARMMAN. Our programs, mMitra and Kilkari, are free, weekly voice call services. They provide preventive information directly to women through pregnancy and infancy in their chosen time slot and language. There are multiple tries for every message, a missed-call system, and mMitra also has a call center.
因此,我的非營利組織— 阿爾曼 [ARMMAN] 就成立了 我們的計畫,免費語音通話 [mMitra] 和手機健康教育服務 [Kikari] 是每週免費的語音通話服務 計畫直接提供婦女預防性訊息 涵蓋整個懷孕期及嬰兒期 由他們選擇時間段及語言 提供預防性訊息 每封訊息都會多次嘗試發送 有一個未接來電系統 免費語音通話 [mMitra] 同樣也有一個客服中心
If only Anita had received this service. In the second month of pregnancy itself, it would have told her about the need to take an iron pill daily from the third month of pregnancy. When the third month arrived, it would have sent her a reminder and counseled her on how to take the iron pills. For example, the need to avoid tea, coffee to improve the absorption of iron and stress on why it is so necessary to prevent anemia. Two weeks later, it would have spoken about how to tackle the adverse effects of iron pills, like constipation. If she had any query, she could have reached out to our call center staff.
要是安妮塔收到這個服務 在她懷孕的第二個月 就會通知她每天需要吃鐵藥丸 從懷孕第三個月開始 第三個月到的時候 系統也會給她發送一封提醒 並且建議她如何來服用鐵藥丸 例如,必須要避免喝茶、咖啡 以利鐵的吸收 並且強調預防貧血的必要性 兩週後 系統會告訴她如何應對鐵藥丸的副作用 像是便祕 若她有任何的疑問 她可以和我們的客服中心員工溝通
These are simple voice calls. As a typical doctor, I expected them to just inform and hopefully lead to better health behaviors. However, the one unexpected transformational benefit that has completely blown my mind is this: Information is empowerment. Armed with this information, women like Anita are upending patriarchal family dynamics, challenging entrenched mores and demanding care. Karnam, the wife of a deeply conservative preacher, convinced her husband to adopt family planning because mMitra told her that spacing between pregnancies is necessary. And the change is intergenerational. Punita, form a deeply conservative family, sent her daughter to an English medium school. In addition to the big pictured messages, the most underprivileged of women want to know when their child will understand color, how to ensure psychosocial stimulation of the child, when their child will develop fingers in their womb and so on. Like any woman would. Our services respect that.
這就是簡單的語音通話 身為一個典型的醫生 我期望只是送通知 就會導引成健康的好行為 然而,有一個非預期轉變的優勢 讓我感到興奮,那就是 資訊就是力量 裝備這個資訊 像安妮塔那樣的婦女 是顛覆父權家庭的動力 挑戰根深蒂固的風俗習慣 要求被照護 卡爾南,是一位非常保守的佈道的太太 說服她先生接納家庭計畫 因為免費語音通話 [mMitra] 告訴她 兩次懷孕間的空檔是必要的 這個改變是跨世代的 出身非常保守家庭的蒲妮塔 讓她的女兒去英語授課的學校 除了大型圖的訊息 大多的貧困的婦女想要知道 她們的孩子什麼時候會知道什麼是顏色 如何確定小孩的心理社會刺激 她們的孩子在子宮時 什麼時候會長出手指頭等等 就像每個婦女都想要的 我們的服務尊重這些
Over 20 million women in over 16 states in India have enrolled for these services since 2014. This is testament to how easily scalable and replicable these solutions are anywhere in the world. Similarly, our mHealth-based refresher training program for government frontline health workers called Mobile Academy has trained over 130,000 health workers in 13 states in India. Both Kilkari and Mobile Academy, in collaboration with the government, will extend through the country in the next three to five years. Our goal is to be able to reach over 15 million women and their children every year, and that would mean over half of the mothers and children born every year have the information they need. And this massive scale is only possible because so many of our partners, be it NGOs, hospitals and the government, recognize the value of this approach and provided the scaffold on which we grew. Our quest in the next five years is to adopt multimedia approaches, and given the massive amounts of data we have, use the power of AI and predictive analytics to better serve our mothers and children.
在印度超過 16 個州 超過兩千萬的婦女 自 2014 年以來 已經註冊了這些服務 這個是對在世界的每個角落 如何快速擴展 並且複製這些解決方法的見證 同樣地,我們以行動醫療照護 為基礎的進修訓練課程 給政府前線的健康工作人員的 叫做行動學院 行動學院已經在印度 13 個州 培訓超過 13 萬個健康工作者 手機健康教育服務 [Kikari] 和行動學院都和政府合作 會在未來的三到五年擴展到全國 我們的目標是可以達到 每年超過一千五百萬名婦女 及她們的孩子 這也意味著 每年有半數的母親及新生兒 獲得他們需要的資訊 這個龐大規模之所以成為可能 是因為我們許多的合作夥伴 無論是非營利組織、醫院或是政府 都認識到這個途徑的價值 並且提供了我們成長的支架 我們在未來五年的尋求是 採用多媒體途徑 考慮我們有的大量資訊 使用人工智慧的力量,預測分析 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. When COVID-19 struck, lockdown was announced overnight. Among the worst affected were the underprivileged women and children in the slums of Mumbai and Delhi, which were declared as containment zones. However, pregnancy and infancy can't wait for a lockdown. When there's an emergency like bleeding, care is needed immediately. And we were right there and ready. We repurposed our tech platform within a matter of days. We created a virtual clinic for antenatal pediatric care manned by qualified doctors. Our call-center staff arranged logistic support, like ambulances. We also sent COVID-specific information covering pregnancy and infancy to over 300,000 pregnant women and mothers through voice calls.
而我們建立的科技平台及網路是靈敏的 當新冠病毒突然來襲 一夜間宣布封城 孟買及德里貧民窟中 窮困的婦女與孩童之間 受到最嚴重的影響 那裡被認定為感染區 然而,懷孕及新生兒期沒辦法等到解封 當有緊急事件像出血發生時 需要即刻的照護 而我們就在那裏準備好了 在幾天內,我們利用我們的科技平台 我們為產前小兒科學照護 創建了一個虛擬診所 配置了合格的醫師群 我們的客服中心人員安排合適的支持 例如,救護車 我們也會傳送涵蓋懷孕 及新生兒新冠病毒的特定資訊 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? The pandemic has made us confront this most implacable of truths. A robust primary health care system is an absolute pillar of a functioning and efficient society. Improvement in maternal and child health leads to horizontal development of health systems and improved primary health care. A village that can look after its mothers and children well can look after all other conditions by ripple effect. And pregnancy is not a disease. Childhood is not an ailment. Dying due to natural life event is not acceptable, and we know why our mothers and children die. Yet we invest so little in preventing their deaths. There can be no global progress until all our mothers and children do well. I implore you to add your voices to ours. To amplify this message loud and clear. That maternal and child health is a human right.
您為什麼要關心我們的母親及孩童呢? 疫情讓我們面對這個最無法改變的事實 堅固的基礎健康照護系統無庸置疑是 運作及效率社會的支柱 改善母親及孩童的健康 使健康系統平行發展 改善基礎健康照護 一個可以好好照顧母親及孩童的村落 藉由連鎖反應 可以照顧所有其他的狀況 懷孕不是一種疾病 孩童不是一種毛病 因為自然生命事件而死去 是令人無法接受的 儘管我們知道為什麼 母親和小孩會死亡 卻很少投資在 預防她們死亡的事上 只有我們所有的母親和兒童都過得好 全球才能取得進展 我懇求您為我們發聲 大聲且清楚的放大這個訊息 母親及孩童健康是一種人權
Thank you.
謝謝