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.
在美國,有趣的是: 最重要的醫療預算 無論是私人援助或是政府資助,常常都給心血管疾病醫療。 其他疾病得到的資助無法與其比擬。 在非洲,心血管疾病是一個主要的致命疾病,但人們徹底無視了它。
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.
這種情況不是合理的。我們必須針對這情況採取一些行動。 一個國家的醫療狀況應與其國家發展並駕齊驅。 每年有1千7百萬病人得心臟疾病而去世。 心臟病發作和中風的病例出現3千2百萬例。 這些病人主要是在發展中國家,大多數是在非洲。 全世界的心血管疾病85%发生在發展中國家, 而不是在西方國家-- 然而90%的醫療資源卻集中在西方國家。
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.
哪些人屬於高危?像你們一樣的人。 不僅僅是非洲人民需要關注這個狀況。 所有非洲的朋友們,或者未來有理由來非洲的朋友, 都應該非常關注這個糟糕的狀況。 在座的各位有沒有想過 假若你夜晚回到你的房間 開始胸痛、氣短並且不停流汗,會發生什麼事? 你這是心臟病發作。你們會怎麼處理? 你會飛回美國、德國、歐洲嗎? 不,你會死。在沒有醫治的情況下,50%的病人將會在24小時內死去。
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.
這就是事實。 看看美國地圖,這幅圖, 最開始的時候美國和尼日利亞同樣都有1千萬人口。 等你們50歲的時候,尼日利亞已幾乎沒人剩下了 -- 他們的預期壽命只有47歲。 不是因為一些人不能倖免于兒童疾病 -- 他們倖免于兒童疾病了,但是他們不能存活到 45歲至50歲左右。 這個年齡是他們最年富力強的時候, 這個年齡應該是他們為非洲發展做出貢獻的時候。 但是他們去世了。 家長的過世是貧困循環急速上升的主要原因。 如果不能保障非洲家長的生命, 那麼非洲兒童保障也岌岌可危。
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!
心臟病的危險因素有哪些? 這是從所周知的,所以我不會花太多時間在這個上面。 大概就是這些因素: 常見的誘因有,高血壓,糖尿病, 肥胖症,缺少鍛煉。 在坦桑尼亞,30%的人有高血壓。 20%病人得到了醫治。 但不到1%的病人得到了足夠的醫治。 假若我們在非洲僅僅醫治高血壓, 每年就能挽救25萬生命。這個數目是相當可觀的!
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.
高血壓容易醫治,看看毛里求斯的情況, 短短八年間,我們這裡談論的艾滋病、瘧疾, 都沒有造成重大影響。 我們不能再重蹈我們對待愛滋病和瘧疾的覆轍。 短短八年中,非傳染的疾病 將變成非洲的主要致命疾病。
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.
這一點我們要銘記在心。我們不能這樣對待這些情況。 這是一所典型的非洲醫院。我們不能依靠那些精英 -- 他們都去美國,德國,英國接受醫療。難以想像。 不能僅僅依靠外國援助。 情況是這樣的:各國都開始自顧不暇。 911恐怖襲擊之後,美國在處理 其國內事務遇上了眾多麻煩。 所以他們將錢投到解決這些問題上面。 理由充分 -- 幫助非洲不是他們的責任, 這是我的責任。我需要去處理我自己的問題。 如果他們幫手,那當然不錯!但是這不能成為我們的期盼。 在非洲,越來越糟糕的醫療保健指數和醫療研究狀況 要求我們需要用新的視角來看待它。我們不能繼續用 以往的方式來進行醫療保健。 如果以往的方法不奏效,我們要尋找替代方案。
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.
我在這裡就是要和大家談一談解決方案。 對我們一部分人而言,這是很難想像的。 幾年前,我們開始思考這個問題。 每個人都知道問題的所在。但沒有人知道怎麼去解決它。 我們決定要把錢花在刀刃上。 每個人都準備投錢進去 幫助發展中國家,我這裡談的是免費。 談持續投資!沒人感興趣。 那麼就籌不到錢。 我在美國有做過醫療保健業務 -- 我住在田納西的首府納什維爾,美國醫療保健之都。 在那裡為醫療保健企業籌錢是很容易的事情。 但是一旦告訴投資商, 我們將在尼日利亞嘗試醫療保健業務。 他們都離開了。 這是完全錯誤的。現場的觀眾, 如果你希望幫助非洲:就要在可持續發展的事業上投資。
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)
讓我帶你們看看心臟研究所一天的運作 讓你們瞭解我們所做的, 然後我將多談點與其有關的東西。 這一切我們所做是為證明在發展中國家 是能建立一所與世界最高水平醫療中心相媲美的 高質量的醫療中心。 這醫療中心現在擁有25個職位,所有醫務人員都 在美國,加拿大或者英國經過培訓,取得證書。 我們擁有范德比爾特, 克里夫蘭診所 -- 美國其他所有醫院所能完成的醫療方法 -- 我們只收取在美國同等醫治費用 的十分之一。 (掌聲)
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.
另外,我們還有一個政策 不能以支付能力為由將人拒之門外。 我們醫治每一個人。 (掌聲) 無論你只有1美圓或是2美圓,都沒關係。 讓我告訴你們這一切是如何做到的。
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.
我們確保選擇合適的儀器。 我們選擇模組化元件,那些具備多種醫治功能的 模組化組件。這樣易於修理,因為這樣, 我們不會選擇不耐用和不能長期使用的儀器。 我們強調培訓, 確保培訓這一環節是不不斷傳承下去。 不久的將來,我們這一批醫務人員將會老去死去,但是 除非我們培養繼承者接任我們的工作,否則問題依然存在。
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)
我們確保自產自用。 不是從別處購買放射性藥物。 而是買來生產機器。 我們進行內部生產,這樣將成本降低。 因此在美國要花費 -- 250美圓才買到一支放射性藥物 -- 我們內部生產的同樣藥物, 只要花費2美圓。 (掌聲)
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.
我們認識到縮小 富裕國家與貧窮國家的唯一方法 是教育和科技。 如果我們發展教育和科技, 所有這些剛剛談到的問題都會迎刃而解。 科技相當於一個重要的天枰,我們又應該如何利用它? 事實證明:自我保健具有成本效益。 這樣有機會拓展農村市場, 通過巧妙地運用自我保健專業知識。
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.
這是我們建立自己的醫療中心的方法。 目前我們在加勒比海已有三家醫療中心, 我們正在計畫開第四家。 同時我們計畫將醫療中心發展到非洲。 我們將在尼日利亞的哈科特港建立西非心臟研究所 這個項目將在未來幾個月中啟動 我們希望在2008年9月開業。 我們還將籌劃更多其他中心。 這個模式適用於每個疾病治療的過程。 所有的單元,所有的研究中心都有聯繫, 通過交換式集線器連接到一個中央服務器, 所有的醫療影像被輸入到審查站。 我們設計了這個遠程醫療方案。這是我們的專利, 我們願意將我們掌握的技術與任何感興趣的人分享。 還可以有盈利。
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.
我們要確定這個遠程系統 一點擊就可以連接上 世界各地的醫學專家。 現在我們看看這整套流程。 這是心臟研究所。世界各地的醫生都能登入。 我可以在瑞士打電話給你:『請登入我們的系統。 看看Jone夫人的診斷報告,告訴我們你的看法。』 醫生們會反饋一些訊息, 有了這些專家的訊息,我們將能更好的醫治病人。 病人也不需要長途跋涉。 也不會因為缺乏專家診斷 而焦躁不安.。
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.
我們還有一套電子病歷系統 我很自豪地告訴大家,這些技術我們已經實現了 -- 反觀美國,80%的醫療操作還沒有採用這些技術。 但是,美國是富有的國家。 因為如果納什維爾醫治不了,你可以去伯明翰, 兩個小時的路程而已,你就可以得到治療。如果克里夫蘭醫治不了, 你可以去辛辛那提。我們沒有美國那麼富有, 因此我們只能通過科技來實現為病人醫治。 同時降低醫療成本。 我們將把業務拓展到農村地區,並使得那裡的人可以負擔起醫治費用。 每個人都能得到治療。
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,
我們意識到僅僅依靠科技是不夠的。 我們強調預防必須是解決方案的一部分。 不過,你需要告訴大家我們可以做些什麼。 但是不可能叫大家做些昂貴的治療, 那樣只會導致他們回家,不接受醫治。 他們需要生存,他們需要養家糊口。 我們推薦運動,因為運動是最有效,最簡單的預防疾病的方法。 每年的三月和四月,我們都舉辦行走活動。 我們將人們分組,讓他們互相競賽。 減重最多的小組將得到獎品。 通過計步器算出行走最多的小組, 也將得到獎品。我們一直支持這項活動。 我們鼓勵他們帶上小孩一起參加活動。 從小給孩子灌輸鍛煉身體預防疾病的觀念, 一旦孩子們有了這種觀念,
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.
他們就會一直保持下去。 通過這個活動,僅在牙買加我們就創造了至少一百的技術類工作崗位, 這些醫生通過特殊培訓,具有專業的醫學知識。 我們挽救了一千多個可能已經病死的病人, 還免費給四個完全性心臟傳導阻滯的病人 安裝了心臟起搏器。對於瞭解心臟病學的人來說, 完全性心臟傳導阻滯就意味著瀕臨死亡。 病人不能得到心臟起搏器,他就將會死去。 因此我們為所做的事業而感到自豪。
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)
我們間接為牙買加政府節約了5百萬美圓 因為病人們無需飛到邁阿密或者亞特蘭大去看病。 我們已經挽救了很多生命。 到今年末,我們將在醫治貧困病人方面投入1百萬美圓 前四個月投入34萬美圓, 平均每月8.5萬美圓。政府做不到, 因為他們面對多種需求。 他們需要將資源投入到其他方面。但我們仍然能夠做到。 人們說:『你們是如何做到的』。就是這樣做到的。 至少4千個打算前往邁阿密看病的牙買加有錢人 承認他們沒有去邁阿密, 就是因為加勒比海心臟研究所的存在。 如果他們去邁阿密接受治療需要的花費將是在這裡醫治的 8至10倍之多。同時他們很高興將錢花在本國, 並能得到同等水平的醫治。 能支付起醫治費用的每一個病人所花費的錢 將被我們用去治療 至少4個付不起醫治費用的病人。 (掌聲)
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.
但關鍵是,我們必須持之以恆地支持這個事業。 因此,我們強調的是培訓,培訓是關鍵。 我們已做了進一步工作:我們與 牙買加的理工大學建立了合作關係。 在那裡我們有一個約定。 我們正在開展一個生物醫學工程項目, 這樣我們將培訓當地人,讓他們學會修理儀器。 這樣我們就不用處理儀器老化的問題。 我們也在開展輔助醫療技術培訓項目 -- 培訓人們使用回聲心動圖儀器,心臟超聲儀器, 等這樣的儀器。目前這種培訓項目, 激勵著當地人們。 因為他們將獲得醫學成像的學士學位 等相關學位。現在我想讓你們聽聽 我們的培訓生是怎麼說的。
(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.
(視頻)Jason Topping醫生:我是Jason Topping, 我是一名重症監護科方面的高級麻醉醫師 來自西印度大學醫院。 我是2006年到來這個心臟研究所 我選修了麻醉學和重症監護科學。 我在心臟研究所待了3個月。 我的同事 對我在這裡所受到的培訓給與肯定, 我認為回聲心動圖儀器及其 在我們的實際應用上的關注度日益增加
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: 我是加勒比海心臟研究所的一名回聲心動圖儀器操作員 在過期的兩年中,我一直接受研究所的培訓。 我認為加勒比海心臟研究所在牙買加提供的 心臟病學培訓對於診斷心臟疾病 起到了非常重要的作用。
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: 最關鍵的是我們的培訓是奏效的並且能持續下去 並且能為每一個病人提供醫療。 誰說窮人就不能享受最好的治療? 什麼時候你已扮演成上帝? 我做不了決定,但是我的任務是確保每個人, 無論貧富貴賤,都能享有同等機會 接受最好的治療。 我們下一步計畫是 在尼日利亞哈科特港建立西非心臟研究所, 當然也會在西非建立其他的醫療研究中心。 我們將在其他地區部署相同的系統, 比如透析治療。 對醫療保健方面感興趣的人們, 我將很高興幫助你們,並分享我們的經驗
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)
教導你們如何達成目標。如果大家共同致力於這方面, 我們就能改變非洲的醫療保健格局。 非洲養育了我們,是時候輪到我們回報它。 我投身於改善非洲的醫療保健事業。志同道合的朋友們, 歡迎你們加入我,讓我們同行。 謝謝。 (掌聲)