It is interesting that in the United States, the most significant health-care budget goes to cardiovascular disease care, whether it's private or public. There's no comparison at all. In Africa -- where it is a major killer -- it is totally ignored.
Este interesant ca in Statele Unite, cel mai semnificativ buget pentru asistenta medicala se acorda in cazul bolilor cardiovasculare, indiferent de sectorul privat sau cel public. Nici nu se poate compara. In Africa, unde produc enorm de multe decese, sunt ignorate in totalitate.
And that situation cannot be right. We must do something about it. A health status of a nation parallels development of that nation. 17 million people die every year from heart disease. 32 million heart attacks and strokes occur. Most of this is in developing countries, and the majority is in Africa. 85 percent of global disease burden for cardiovascular disease is in developing countries -- not in the West -- and yet 90 percent of the resources are in the West.
Aceasta situatie nu poate fi corecta. Trebuie sa facem ceva in privinta asta. Starea sanatatii unei natiuni reflecta nivelul de dezvoltare al acesteia. 17 milioane de oameni mor anual din cauza afectiunilor cardiace. Se inregistreaza 32 milioane de cazuri de infarct si accidente vasculare. Toate au loc in tarile in dezvoltare, majoritatea in Africa. 85% din cazurile raportate la nivel mondial de boli cardiovasculare sunt raportate in tarile in dezvoltare, nu in cele vestice, si totusi 90% din resursele alocate pentru aceasta sunt in tarile vestice.
Who is at risk? People like you. It's not just the Africans that should be concerned about that. All friends of Africa, that will have reason to be in Africa at some point in time, should be very concerned about this deplorable situation. Has anyone here wondered what will happen if you go back to your room at night, and you start getting chest pains, shortness of breath, sweating? You're having a heart attack. What are you going to do? Will you fly back to the U.S., Germany, Europe? No, you will die. 50 percent will die within 24 hours, if not treated.
Cine se afla in risc? Oamenii ca voi. Nu doar africanii trebuie sa fie preocupati de asta. Orice prieten al Africii, care ar avea un motiv sa se afle in Africa la un moment dat, ar trebui sa se gandeasca bine la aceasta situatie deplorabila. Si-a pus cineva intrebarea ce se va intampla daca te intorci in camera ta noaptea si incepi sa acuzi dureri de piept, respiratie greoaie, transpiratii? Inseamna ca faci infarct. Ce optiuni ai? Sa zbori inapoi in SUA, Germania, Europa? Nu, vei muri. 50% din persoane mor in 24 de ore daca nu primesc ingrijiri.
This is what's going on. In a look at the map of the U.S. -- the graph here, 10 million people here, 10 million here. By the time you get to 50, it's almost no one left in Nigeria -- life expectancy is 47. It's not because some people don't survive childhood illnesses -- they do -- but they do not survive after the time that they reach about 45 years old and 50 years old. And those are the times they're most productive. Those are the times that they should be contributing to Africa's development. But they're not there. The best way to spiral into a cycle of poverty is to kill the parents. If you cannot secure the parents, you cannot guarantee the security of the African child.
Asta se intampla. Sa privim harta Statelor Unite -- din graficul acesta 10 milioane de oameni aici, 10 milioane dincoace. Cand ajungi la varsta de 50 de ani, nu mai ramane aproape nimeni in Nigeria -- speranta de viata e de 47 de ani. Si nu e fiindca unele persoane nu supravietuiesc unor boli din copilarie -- ei supravietuiesc - insa nu supravietuiesc dupa ce ajung la varsta de 45 sau 50 de ani. Si asta e varsta la care oamenii sunt cei mai productivi. E varsta cand ar trebui sa contribuie la dezvoltarea Africii. Dar ei lipsesc. Cea mai buna metoda de a cadea intr-un ciclu al saraciei e sa ucizi categoria parintilor. Daca parintii nu sunt salvati nu poti garanta securitatea copilului african.
What are the risk factors? It's very well known. I'm not going to spend a lot of time on those. These are just for information: hypertension, diabetes, obesity, lack of exercise. The usual suspects. Right here in Tanzania, 30 percent of individuals have hypertension. 20 percent are getting treated. Only less than one percent are adequately treated. If we can treat hypertension alone in Africa, we'll save 250,000 lives a year. That's quite significant!
Care sunt factorii de risc? Se stie foarte bine. Nu o sa intru in detalii asupra acestora. Sunt doar pentru informarea voastra: hipertensiunea, diabetul, obezitatea, lipsa de exercitiu. Suspiciunile obisnuite. Chiar aici in Tanzania, 30% din populatie are hipertensiune. 20% primesc ingrijiri medicale. Insa mai putin de 1% sunt tratati cum trebuie. Daca am putea trata numai hipertensiunea in Africa, deja am salva 250.000 de vieti pe an. Un numar semnificativ!
Easy to treat. Look at the situation in Mauritius. In eight short years -- we're here talking about HIV, malaria, which is all good. We cannot make the mistakes we've made with malaria and HIV. In eight short years, non-communicable diseases will become the leading causes of death in Africa.
E usor de tratat. Priviti situatia din Mauritiu. Doar in 8 ani -- vorbim de HIV, malarie lucururi ok. Nu putem face aceleasi greseli ca si in cazul malariei si al HIV-ului. Doar in 8 ani, bolile netransmisibile vor deveni principala cauza a mortalitatii in Africa.
That is something to keep in mind. We can't deal with it with situations like this. This is a typical African hospital. We can't depend on the elites -- they go to USA, Germany, U.K. for treatment. Unbelievable. You can't depend on foreign aid alone. Here is the situation: countries are turning inwards. Post-9/11, [the] United States has had a lot of trouble to deal with, their own internal issues. So, they spend their money trying to fix those problems. You can't rightly -- it's not their responsibility, it is my responsibility. I have to take care of my own problems. If they help, that's good! But that is not my expectation. These worsening indices of health care or health studies in Africa demand a new look. We cannot keep on doing things the way we've always done them. If they have not worked, we have to look for alternative solutions.
Sa tinem minte asta. Nu putem face fata unor situatii de acest gen. Acesta este un spital african obisnuit. Nu putem depinde de elitele - care au plecat in State, Germania, Marea Britanie pentru a fi tratati. Incredibil. Nu te poti baza doar pe ajutorul altor tari. Asta este situatia actuala: ficare tara isi vede de problemele ei interne. Dupa 9/11, Statele Unite au avut dificultati mari in a se ocupa de problemele lor interne. Iar banii si i-au folosit incercand sa rezolve aceste probleme. Nu poti sa astepti -- nu e responsabilitatea lor, e a mea. Eu trebuie sa am grija de problemele proprii. Daca ne ajuta, e bine! Dar nu astea sunt asteptarile mele. Acesti indici din ce in ce mai gravi ai asistentei medicale sau al studiilor de sanatate in Africa trebuie priviti din nou. Nu putem sa facem lucrurile la fel ca si pana acum. Daca nu au functionat, trebuie sa cautam solutii alternative
I'm here to talk to you about solutions. This has been -- what has been a difficult sign to some of us. Several years ago, we started thinking about it. Everyone knows the problem. No one knows what the solutions are. We decided that we needed to put our money where our mouth is. Everyone is ready to throw in money, in terms of free money aid to developing countries. Talk about sustainable investment, no one is interested. You can't raise money. I have done businesses in healthcare in the United States -- I live in Nashville, Tennessee, health care capital of America. [It's] very easy to raise money for health-care ventures. But start telling them, you know, we're going to try to do it in Nigeria -- everyone runs away. That is totally wrong. Those of you in the audience here, if you want to help Africa, invest money in sustainable development.
Sunt aici sa va vorbesc despre solutii. Acesta a fost un semn dificil petru unii dintre noi. Acum cativa ani am inceput sa ne gandim la asta. Toata lumea cunoaste problema. Insa nimeni nu are solutii pentru ea. Am decis ca e necesar sa investim bani. Lumea e pregatita sa ofere ajutoare in bani pentru tarile in curs de dezvoltare. Insa cand vine vorba de o investite sustinuta, nimeni nu e interesat. Nu ai cum sa aduni bani. Am facut afaceri in domeniul asistentei medicale in Statele Unite -- Traiesc in Nashville, Tennessee, capitala asistentei medicale din America. Acolo e foarte usor sa aduni bani pentru cooperari in domeniul asistentei medicale Cand incerci sa le zic, stiti, o sa incercam sa facem asta in Nigeria -- toata lumea dispare. Asta este in totalitate gresit. Voi, cei din audienta, daca vreti sa ajutati Africa: investiti bani pentru o dezvoltare sustinuta.
Let me lead you through a day in the life of the Heart Institute, so you get a glimpse of what we do, and I'll talk a little bit more about it. What we have done is to show that high-quality health care, comparable to the best anywhere in the world, can be done in a developing country environment. We have 25 positions right now -- all of them trained, board certified in the USA, Canada or Britain. We have every modality that can be done in Vanderbilt, Cleveland Clinic -- everywhere in the U.S. -- and we do it for about 10 percent of the cost that you will need to do those things in the United States. (Applause)
Lasati-ma sa va descriu o zi din viata Institutului Inimii ca sa intelegeti ceea ce facem noi si sa va spun putin mai multe despre asta. Am aratat ca o asistenta medicala la nivel inalt, comparabila cu cele mai bune din lume, poate fi oferita intr-o tara in dezvoltare. Avem 25 de posturi -- toate cu educatie si acreditate in SUA, Canada sau Marea Britanie. Exista toate procedurile care pot fi facute, spre exemplu, in Vanderbilt, Clinica din Cleveland -- sau oriunde in Statele Unite -- si noi le facem petru doar 10% din cat ar costa aceste proceduri in Statele Unite. (Aplauze)
Additionally, we have a policy that no one is ever turned away because of ability to pay. We take care of everyone. (Applause) Whether you have one dollar, two dollars -- it doesn't matter. And I will tell you how we're able to do it.
Mai mult decat atat, avem o politica prin care nimeni nu este refuzat daca nu poate plati. Avem grija de toata lumea. (Aplauze) Daca ai un dolar sau doi -- nu conteaza. Si o sa va explic cum reusim sa facem asta.
We make sure that we select our equipment properly. We go for modular units. Units that have multi-modality functions have modular components. Easy to repair, and because of that, we do not take things that are not durable and cannot last. We emphasize training, and we make sure that this process is regenerative. Very soon we will all be dead and gone, but the problems will stay, unless we have people taking over from where we stopped.
Ne alegem echipamentul cu grija. Alegem unitati modulare. Unitati care sa fie multi-functionale si sa aiba componente modulare. Sunt usor de reparat, si de aceea, nu achizitionam lucruri care nu sunt rezistente si durabile. Punem accentul pe training si ne asiguram ca acest proces este regenerativ. Foarte curand o sa fim una cu pamantul, dar problemele vor ramane daca nu avem oameni pregatiti sa preia stafeta.
We made sure that we produced some things ourselves. We do not buy unit doses of radiopharmaceuticals. We get the generators from the companies. We manufacture them in-house, ourselves. That keeps the costs down. So, for a radiopharmaceutical in the U.S. -- that you'll get a unit dose for 250 dollars -- when we're finished manufacturing it in-house, we come at a price of about two dollars. (Applause)
Ne-am asigurat ca unele lucruri sunt produse de noi insine. Nu cumparam unitati de radiofarmaceutice. Luam generatoarele de la companii. Producem dozele la noi. Asta mentine costurile scazute. Deci, pentru o unitate de radiofarmaceutice pe care in Statele Unite o poti lua la 250 de dolari, in momentul in care am finalizat procesul de productie la noi ajungem la un pret de aproximativ 2 dolari. (Aplauze)
We recognize that the only way to bridge the gap between the rich and poor countries is through education and technology. All these problems we're talking about -- if we bring development, they will all disappear. Technology is a great equalizer. How do we make it work? It's been proved: self-care is cost-effective. It extends opportunity to the rural centers, and we can use expertise in a very smart way.
Ne dam seama ca singura modalitate de a traversa prapastia dintre tarile bogate si cele sarace este prin educatie si tehnologie. Toate aceste probleme cu care ne confruntam vor disparea daca investim in dezvoltare. Tehnologia este un important egalizator. Cum o facem sa functioneze? Este dovedit: asistenta prin masuri proprii reduce costurile. Oportunitatile se extind catre centre rurale, iar noi putem folosi expertiza intr-un mod inteligent.
This is the way our centers are set up. We currently have three locations in the Caribbean, and we're planning a fourth one. And we have now decided to go into Africa. We will be doing the West African Heart Institute in Port Harcourt, Nigeria. That project will be starting within the next few months. We hope to open in 2008-09. And we will do other centers. This model can be adapted to every disease process. All the units, all the centers, are linked through a switched hub to a central server, and all the images are populated to review stations. And we designed this telemedicine solution. It's proprietary to us, and we are happy to share what we have learned with anyone who is interested in doing it. You can still be profitable.
Centrele noastre sunt astfel gandite. Momentan avem trei locatii in Caraibe si planuim sa deschidem o a patra. Si am luat decizia sa intram in Africa. Vom construi Institutul Inimii al Africii de Vest in Port Harcourt din Nigeria. Acest proiect va incepe in urmatoarele luni. Speram sa il deschidem in 2008-09. Si vom face si alte centre. Acest model poate fi adaptat pentru orice alta boala. Toate unitatile si centrele sunt legate la un hub al unui server central si toate imaginile sunt prezentate prin statii care au rolul de a supraveghea. Noi am realizat aceasta solutie de telemedicina. Ne apartine si suntem fericiti sa o impartasim cu oricine e interesat sa faca acelasi lucru. Si tot este profitabil.
We make sure that the telemedicine platform gives access to expert medical specialists anywhere in the world, just by a click of the button. I'll lead you through, to see how this happens. This is at the Heart Institute. The doctors from anywhere can log in. I can call you in Switzerland and say, "Listen, go into our system. Look at Mrs. Jones. Look at the study, tell me what you think." They'll give me that information, and we'll make the care of the patient better. The patient doesn't have to travel. He doesn't have to experience the anxiety of not knowing because of limited expertise.
Ne asiguram ca aceasta platforma de telemedicina ofera acces expertilor in medicina oriunde in lume, doar printr-o apasare de buton. O sa va explic cum se intampla asta. Acesta este Instatutul Inimii. Doctori de oriunde se pot loga aici. Pot sa va sun in Elvetia si sa va spun: "Intrati in sistemul nostru. Uitati-va la cazul doamnei Jones si spuneti-mi ce credeti." Ei imi vor da acea informatie, iar noi vom imbunatati asistenta pentru pacientul respectiv. Pacientul nu are nevoie sa calatoreasca. Nu trebuie sa se ingrijoreze ca medicii nu au destule informatii din cauza unei expertize limitate.
We also use [an] electronic medical record system. I'm happy to say that the things we have implemented -- 80 percent of U.S. practices do not have them, and yet the technology is there. But you know, they have that luxury. Because if you can't get it in Nashville, you can travel to Birmingham, two hours away, and you'll get it. If you can't get it in Cleveland, you can go to Cincinnati. We don't have that luxury, so we have to make it happen. When we do it, we will put the cost of care down. And we'll extend it to the rural centers and make it affordable. And everyone will get the care they deserve.
Totodata folosim si un sistem electronic pentru inregistrarea fiselor medicale. Ma bucur sa va pot spune ca lucrurile pe care le-am implementat -- 80 % din cabinetele din Statele Unite nu au acest sistem desii tehnologia este disponibila. Insa ei isi permit acest lux. Pentru ca daca nu exista in Nashville, poti merge la Birmingham, la doua ore distanta, si acolo o primesti. Daca nu o gasesti in Cleveland, poti merge in Cincinnati. Noi nu avem acest lux, deci trebuie sa il realizam. Cand facem asta, reducem costurile necesare asistentei medicale. Si o extindem si in centrele rurale si o facem astefel incat oamenii sa si-o permita. Toata lumea va primi asistenta bine-meritata.
It cannot just be technology, we recognize that. Prevention must be part of the solution -- we emphasize that. But, you know, you have to tell people what can be done. It's not possible to tell people to do what is going to be expensive, and they go home and can't do it. They need to be alive, they need to feed. We recommend exercise as the most effective, simple, easy thing to do. We have had walks every year -- every March, April. We form people into groups and make them go into challenges. Which group loses the most weight, we give them prizes. Which groups record more walking distance by pedometer, we give them prizes. We do this constantly. We encourage them to bring children. That way we start exposing the children from very early on, on what these issues are. Because once they learn it,
Tehnologia nu e totul, ne dam seama de asta. Prevenirea trebuie sa fie o parte din solutie, asta vrem sa subliniem. Dar trebuie sa fii in stare sa spui oamenilor ca se poate face. Nu poti spune oamenilor sa faca ceva costisitor si ei merg acasa si nu au cu ce. Ei trebuie sa traiasca, sa se hraneasca. Noi recomandam exercitiul ca cel mai eficient, simplu si usor lucru pe care il pot face. Organizam marsuri in fiecare an, in fiecare luna de martie, aprilie. Noi organizam oamenii in grupuri si ii incurajam sa participe la provocari. Grupul care pierde cel mai mult din greutate, castiga premii. Grupul care inregistreaza cea mai mare distanta parcursa folosind un pedometru, primeste premii. Facem asta in mod constant. Ii incurajam sa-si aduca si copiii. In felul acesta ii invatam pe copii chiar de la inceput care sunt problemele posibile. O data ce invata,
they will stay with it. In doing this we have created at least 100 skilled jobs in Jamaica alone, and these are physicians with expertise and special training. We have taken care of over 1,000 indigent patients that could have died, including four free pacemakers in patients with complete heart block. For those that understand cardiology, complete heart block means certain death. If you don't get this pacemaker, you will be dead. So we are pleased with that.
se vor tine de program. Prin asta am creat numai in Jamaica cel putin 100 de locuri de munca iar acestia sunt doctori cu experienta si pregatire speciala. Am tratat peste 1.000 de pacienti indigeni care au fi putut muri, inclusiv patru pacienti care au avut nevoie de pacemaker pentru ca aveau inima complet blocata. Pentru cei ce inteleg cardiologia, blocajul total la nivelul inimii inseamna moarte sigura. Daca nu primesti acest pacemaker, esti mort. Suntem multumiti cu aceste rezultate.
Indirectly, we have saved the government of Jamaica five million dollars from people that would have gone to Miami or Atlanta for care. And we've hopefully saved a lot of lives. By the end of this year, we would have contributed over one million dollars in indigent care. In the first four months, it's been 340,000 dollars, averaging 85,000 dollars a month. The government will not do that, because they have competing needs. They need to put resources elsewhere. But we can still do it. People say, "How can you do that?" This is how we can do that. At least 4,000 rich Jamaicans that were heading to Miami for treatment have self-confessed that they did not go to Miami because of the Heart Institute of the Caribbean. And, if they went to Miami, they will spend significantly more -- eight to 10 times more. And they feel happy spending it at home, getting the same quality of care. And for that money -- for every one patient that has the money to pay, it gives us an opportunity to take care of at least four people that do not have the resources to pay. (Applause)
Indirect, am scutit guvernul din Jamaica cu 5 milioane de dolari pentru pacientii care ar fi trebuit sa mearga la Miami sau Atlanta pentru asistenta. Si speram ca am salvat si numeroase vieti. Pana la sfarsitul anului acesta vom fi contribuit cu peste un milion de dolari in asistenta pentru indigeni. In primele 4 luni au fost 340.000 de dolari, in medie 85.000 pe luna. Guvernul nu ar da atatia bani fiindca pentru ei exista si alte nevoi. Trebuie sa investeasca resursele in altceva. Dar noi putem face asta. Oamenii ne intreaba: "Cum reusiti?". Iata cum reusim. Cel putin 4.000 de jamaicani bogati care trebuiau sa ajunga la Miami pentru tratament au recunoscut singuri ca nu au mers la Miami, fiindca exista Institutul Inimii din Caraibe. Si daca ar fi mers in Miami ar fi cheltuit cu mult mai multi bani -- de 8 pana la 10 ori mai multi. Si sunt multumiti ca ii pot cheltui acasa, si primesc acelasi nivel de ingrijire. Si pentru acei bani -- pentru fiecare pacient care are bani sa plateasca -- noi avem posibilitatea sa ne ingrijim de cel putin 4 oameni care nu isi permit sa plateasca. (Aplauze)
For this to work, this progress must be sustainable. So, we emphasize training. Training is critical. We have gone further: we have formed a relationship with the University of Technology, Jamaica, where I now have an appointment. And we are starting a biomedical engineering program, so that we will train people locally, who can repair that equipment. That way we're not going to deal with obsolescence and all those kinds of issues. We're also starting ancillary health-care technology training programs -- training people in echocardiography, cardiac ultrasound, those kinds of things. Now, with that kind of training, it gives people motivation. Because now they will get a bachelors degree in medical imaging and all that kind of stuff. In the process, I want you to just hear from the trainees themselves what it has meant for them.
Ca aceasta sa functioneze, acest progres trebuie sa fie sustinut. Deci ne concentram pe training. Trainigul e critic. Am mers si mai departe si am stabilit o legatura cu Universitatea Tehnologica din Jamaica, unde am acum o intalnire. O sa incepem un program de inginerie biomedicala, astfel incat sa educam localnici sa poata repara echipamentul. In felul acesta o sa eliminam problemele cu uzura echipamentelor. De asemenea, incepem si programe auxiliare de training in tehnologia in asistenta medicala -- educarea oamenilor in ecocardiograma, examinare cardiaca cu ultrasunete, si toate aceste lucruri. Aceste tipuri de training ofera oamenilor motivatie. Pentru ca acum vor primi o diploma universitara in imagistica medicala si altele. Vreau doar sa auziti de la cei ce au urmat trainingul ce a insemnat acest proces pentru ei.
(Video) Dr. Jason Topping: My name is Jason Topping. I'm a senior resident in anesthesia in intensive care at the University Hospital of the West Indies. I came to the Heart Institute in 2006, as part of my elective in my anesthesia and intensive care program. I spent three months at the Heart Institute. There's been no doubt around my colleagues about the utility of the training I received here, and I think there's been an increased interest now in -- particularly in echocardiography and its use in our setting.
(Video) Dr. Jason Topping: Numele meu este Jason Topping, Sunt rezident senior in anestezia in terapie intensiva la Spitalul Universitar din Indiile de Vest. Am venit la Institutul Inimii in 2006 prin programul universitar de anestezie si terapie intensiva. Am petrecut 3 luni la Institutul Inimii. Nu a existat nici un dubiu printre colegii mei in privinta utilitatii acestui training pe care l-am primit aici. Si cred ca acum exista un interes crescut in special in ecocardiografie si la ceea ce foloseste aceasta.
Sharon Lazarus: I am an echocardiographer at the Heart Institute of the Caribbean, since the past two years. I received training at this institution. I think this aspect of training in cardiology that the Heart Institute of the Caribbean has introduced in Jamaica is very important in terms of diagnosing cardiac diseases.
Sharon Lazarus: Sunt specialist in ecocardiografie la Institutul Inimii din Caraibe de doi ani. Am urmat trainingul in aceasta institutie. Cred ca acest aspect al trainingului in cardiologie pe care Institutul Inimii din Caraibe l-a introdus in Jamaica este foarte important in ceea ce priveste diagnosticarea problemelor cardiace.
Ernest Madu: The lesson in this is that it can be done, and it can be sustained, and you can make it possible for everyone. Who are we to decide that poor people cannot get the best care? When have you been appointed to play God? It is not my decision. My job is to make sure that every person, no matter what fate has assigned to you, will have the opportunity to get the best quality health care in life. Next stop is West African Heart Institute, that we are going to be doing in Port Harcourt, Nigeria, as I said before. We will do other centers across West Africa. We will extend the same system into other areas, like dialysis treatment. And anyone who is interested in doing it in any health care situation, we will be happy to assist you and tell you how we've done it,
Ernest Madu: Lectia ce rezulta de aici este ca se poate face si se poate sustine, si ca poate fi posibil pentru toata lumea. Cine suntem noi sa decidem ca oamenii saraci nu pot primi cea mai buna asistenta? Cine te-a numit Dumnezeu? Nu este decizia mea. Sarcina mea este sa ma asigur ca fiecare persoana, indiferent de ce soarta ar avea, are posibilitatea sa primeasca cea mai buna asistenta medicala in timpul vietii. Urmatoarea oprire este Institutul Inimii din Africa de Vest pe care il vom construi in Port Harcourt, Nigeria, asa cum am mentionat mai devreme. Vom face si alte centre in Africa de Vest. Vom extinde acelasi sistem in alte zone, cum ar fi tratamentul prin dializa. Si oricine este interesat sa faca asta pentru orice alte scopuri in asistenta medicala, vom fi bucurosi sa ajutam si sa impartasim cum am facut noi
and how you can do it. If we do this, we can change the face of health care in Africa. Africa has been good to us; it is time for us to give back to Africa. I am going. Those who want to come, I welcome you to come along with me. Thank you. (Applause)
si cum se poate face de altii. Daca reusim asta, putem schimba fata asistentei medicale din Africa. Africa a fost buna cu noi; acum e timpul sa da si noi ceva inapoi. Eu am pornit. Cei ce vor sa ma insoteasca, sunt binevoiti. Va multumesc. (Aplauze)