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DixonChibanda_2017W-_我为什么要训练阿嬷来治疗忧郁症？_
On a warm August morning in Harare, 八月,在哈拉雷,一個溫暖的早晨,
Farai, a 24-year-old mother of two, walks towards a park bench. 法拉艾, 二十四歲,兩個孩子的母親, 走向公園的長椅。
She looks miserable and dejected . 她看起來很悲慘、很沮喪。
miserable:adj.悲惨的;痛苦的;卑鄙的; dejected:adj.沮丧的,灰心的;
Now, on the park bench sits an 82-year-old woman, better known to the community as Grandmother Jack. 公園長椅上坐著一位 八十二歲的老女人, 社區的人都叫她傑克阿嬤。
community:n.社区;[生态]群落;共同体;团体;
Farai hands Grandmother Jack an envelope from the clinic nurse. 法拉艾交給傑克阿嬤 一個診所護士給她的信封。
envelope:n.信封,封皮;包膜;[天]包层;包迹; clinic:n.诊所;临床实习;(医院的)门诊部;门诊时间;
Grandmother Jack invites Farai to sit down as she opens the envelope and reads. 傑克阿嬤邀請法拉艾坐下, 她打開信封,閱讀內容。
There's silence for three minutes or so as she reads. 阿嬤讀信時,沉默持續了大約三分鐘。
And after a long pause, Grandmother Jack takes a deep breath, looks at Farai and says, "I'm here for you. 停頓了很長的一段時間之後, 傑克祖母深深吸了一口氣, 看著法拉艾,說: 「我在這裡陪你。
Would you like to share your story with me?" 你願意和我分享你的故事嗎？」
Farai begins, her eyes swelling with tears. 法拉艾開始說, 她的眼睛泛著淚光。
swelling:n.膨胀;肿胀;肿胀处;v.膨胀;肿胀;(使)鼓出;(使)增加;(swell的现在分词)
She says, "Grandmother Jack, 她說:「傑克阿嬤,
I'm HIV-positive. 我的愛滋病毒檢測是陽性。
I've been living with HIV for the past four years. 我有愛滋病毒已經四年了。
HIV:n.艾滋病病毒;
My husband left me a year ago. 我丈夫一年前離開了我。
I have two kids under the age of five. 我有兩個孩子, 都不到五歲。
under the age of:在年龄之下;16岁以下;
I'm unemployed . 我沒有工作。
unemployed:adj.失业的;下岗的;n.(集合词)失业者;
I can hardly take care of my children." 我幾乎無法照顧我的孩子。」
Tears are now flowing down her face. 眼淚沿著她的臉頰落下。
And in response , Grandmother Jack moves closer, puts her hand on Farai, and says, "Farai, it's OK to cry. 傑克阿嬤的回應是 先向她靠近了一些, 把她的手放在法拉艾身上, 說:「法拉艾,哭吧,沒有關係。
response:n.响应;反应;回答;
You've been through a lot. 你吃了很多苦。
Would you like to share more with me?" 你願意和我多講一點嗎？」
And Farai continues. 法拉艾繼續說:
'"In the last three weeks, 「在過去三週,
I have had recurrent thoughts of killing myself, taking my two children with me. 我一直有想要自殺的念頭, 帶兩個孩子一起走。
recurrent:adj.复发的;周期性的,经常发生的;
I can't take it anymore. 我無法再承受了。
The clinic nurse sent me to see you." 診所護士要我來找你。」
There's an exchange between the two, which lasts about 30 minutes. 兩人之間交流了大約三十分鐘。
exchange:n.交换;交流;交易所;兑换;v.交换;交易;兑换;
And finally , Grandmother Jack says, "Farai, it seems to me that you have all the symptoms of kufungisisa." 最後,傑克阿嬤說: 「法拉艾, 在我看來,你似乎有 kufungisisa 的症狀。」
finally:adv.终于;最终;(用于列举)最后;彻底地; symptoms:n.症状;征候;征兆;(symptom的复数)
The word "kufungisisa" opens up a floodgate of tears. 「kufungisisa」這個詞 打開了眼淚的防洪閘門。
floodgate:n.水闸;水门;防潮水闸;制约(怒气);
So, kufungisisa is the local equivalent of depression in my country. 在我國家,「kufungisisa」一詞 等同於憂鬱。
equivalent:adj.等价的,相等的;同意义的;n.等价物,相等物; depression:n.沮丧;洼地;不景气;忧愁;
It literally means "thinking too much." 字面上的意思是 「想太多」。
literally:adv.按字面:字面上:确实地:
The World Health Organization estimates that more than 300 million people globally, today, suffer from depression, or what in my country we call kufungisisa. 世界衛生組織估計, 現今全球有超過三億人 受到憂鬱症的折磨, 或是在我的國家,稱為 kufungisisa。
Organization:n.组织;机构;体制;团体; estimates:n.估计;估价;估计的成本;v.估价;估算(estimate的第三人称单数和复数)
And the World Health Organization also tells us that every 40 seconds, someone somewhere in the world commits suicide because they are unhappy, largely due to depression or kufungisisa. 世界衛生組織也告訴我們, 每四十秒, 世界上某處就有人自殺, 因為不快樂, 主要是出於憂鬱症或 kufungisisa。
commits:vt.犯罪,做错事;把...交托给;指派…作战;使…承担义务; suicide:n.自杀;自杀行为;自杀者;adj.自杀的;v.自杀;vi.自杀; largely:adv.主要地;大部分;大量地;
And most of these deaths are occurring in low- and middle-income countries. 這些死亡案例多半發生 在中低收入的國家。
occurring:n.事件;事故;事变; middle-income:adj.中等收入的;
In fact, the World Health Organization goes as far as to say that when you look at the age group between 15 to 29, a leading cause of death now is actually suicide. 事實上, 世界衛生組織甚至還說, 對於 15~29 歲的年齡層而言, 自殺是這個年齡層的主要死因之一。
as far as:至于…; age group:n.年龄组;年龄段;
But there are wider events that lead to depression and in some cases, suicide, such as abuse , conflict , violence , isolation, loneliness -- the list is endless . 但有更多、更廣的事件會導致憂鬱, 有些情況會導致自殺, 這些事件包括虐待、 衝突、暴力、 孤立、寂寞── 還有許多其他的。
abuse:n.滥用;虐待;辱骂;弊端;恶习,陋习;v.滥用;虐待;辱骂; conflict:n.冲突;矛盾;争执;抵触;v.抵触; violence:n.暴力;侵犯;激烈;歪曲; endless:adj.无止境的;连续的;环状的;漫无目的的;
But one thing that we do know is that depression can be treated and suicides averted . 但我們的確知道一件事, 憂鬱是可以治療的, 自殺是可以避免的。
treated:v.以…态度对待;把…看作;(treat的过去分词和过去式) suicides:n.自杀;自毁;自杀者;(suicide的复数) averted:v.防止,避免;转移目光;背过脸;(avert的过去分词和过去式)
But the problem is we just don't have enough psychiatrists or psychologists in the world to do the job. 但,問題是, 世界上沒有足夠的 精神病醫生或心理醫生 來做這件事。
psychiatrists:n.精神病学家;精神科医生;(psychiatrist的复数) psychologists:n.[心理]心理学家(psychologist的复数形式);
In most low- and middle-income countries, for instance , the ratio of psychiatrists to the population is something like one for every one and a half million people, 比如,在大部分中低入的國家, 精神病醫生佔總人口的比例 大約是一百五十萬比一,
instance:n.实例;情况;建议;v.举...为例; ratio:n.比率;比例;v.用比例方式表达;求出…的比值;使…成比例;
which literally means that 90 percent of the people needing mental health services will not get it. 那表示,需要心理健康服務的人 當中就有九成 無法取得服務。
mental:adj.精神的;脑力的;疯的;n.精神病患者;
In my country, there are 12 psychiatrists, and I'm one of them, for a population of approximately 14 million. 在我的國家, 有十二名精神病醫生, 我是其中之一, 全國人口有近一千四百萬人。
approximately:adv.大约,近似地;近于;
Now, let me just put that into context . 讓我用一個情境來說明。
context:n.环境;上下文;来龙去脉;
One evening while I was at home, 有一晚,我在家的時候,
I get a call from the ER, or the emergency room , from a city which is some 200 kilometers away from where I live. 我接到 ER 打來的電話, 也就是急診室, 它在我家兩百公里外的 一個城市。
emergency room:n.急诊室;
And the ER doctor says, "One of your patients , someone you treated four months ago, has just taken an overdose , and they are in the ER department. 急診室醫生說: 「我們有一位病人 是你在四個月前治療過的, 剛剛用藥過量, 他們現在在急診室。
patients:n.接受治疗者,病人;(patient的复数) overdose:n.(一次用药)过量;v.一次用药过量;
Hemodynamically , they seem to be OK, but they will need neuropsychiatric evaluation ." 血液的流動似乎沒問題, 但會需要神經精神評估。」
Hemodynamically:adv.在血流动力学上; neuropsychiatric:神经精神系统;神经精神病学的;神经精神性; evaluation:n.评价;[审计]评估;估价;求值;
Now, I obviously can't get into my car in the middle of the night and drive 200 kilometers. 很顯然,我不可能大半夜跳進車裡, 開兩百公里過去。
So as best as we could, over the phone with the ER doctor, we come up with an assessment . 所以我們最好的做法, 就是和急診室醫生透過電話, 做出一項評估。
come up with:提出;想出;赶上; assessment:n.评定;估价;
We ensure that suicidal observations are in place. 我們確保有做好自殺觀察。
ensure:vt.保证,确保;使安全; suicidal:adj.自杀的,自杀性的;自我毁灭的;自取灭亡的; observations:n.观察,观察值;观察结果;(observation的复数形式);
We ensure that we start reviewing the antidepressants that this patient has been taking, and we finally conclude that as soon as Erica -- that was her name, 26-year-old -- 我們確保我們會開始檢視這個病人 服用的抗抑鬱劑, 我們最後的結論是, 等艾瑞卡──
reviewing:v.复查;重新考虑;反思;评论;(review的现在分词) antidepressants:n.[药]抗抑郁药(antidepressant的复数形式);抗忧郁剂; conclude:v.断定:得出结论:终止:达成:缔结(协定) as soon as:一…就; Erica:n.石南科灌木;
as soon as Erica is ready to be released from the ER, she should come directly to me with her mother, and I will evaluate and establish what can be done. 等艾瑞卡準備好可以離開急診室了, 她應該要和母親立刻直接來找我, 我就會做評估 與確認哪些事是可以做的。
released:v.释放;使免除;已发布;(release的过去分词和过去式) directly:adv.直接地;立即;马上;正好地;坦率地;conj.一…就; evaluate:v.评价;评估;估计; establish:v.创立;设立;建立;确立;使立足;查实;
And we assumed that that would take about a week. 我們假設這大概會需要一週的時間。
assumed:adj.假定的;假设的;v.假定;假设;认为;承担;(assume的过去分词和过去式)
A week passes. 一週過去了。
Three weeks pass. 三週過去了。
No Erica. 沒有艾瑞卡。
And one day I get a call from Erica's mother, and she says, "Erica committed suicide three days ago. 有一天,艾瑞卡的媽媽打電話給我, 她說: 「艾瑞卡在三天前自殺了。
committed:adj.坚信的; v.做出错事; (commit的过去分词和过去式)
She hanged herself from the mango tree in the family garden." 她在芒果樹上上吊, 在我們家的院子裡。」
hanged:v.悬挂;吊;垂下;垂落;(hang的过去分词和过去式) mango:n.芒果;
Now, almost like a knee-jerk reaction , 幾乎就像膝反射一樣,
knee-jerk:n.下意识,自动反应;膝反射;adj.下意识的,自动反应的;膝反射的; reaction:n.反应,感应;反动,复古;反作用;
I couldn't help but ask, "But why didn't you come to Harare, where I live? 我忍不住問: 「為什麼你們不來哈拉雷, 來我住的地方？
We had agreed that as soon as you're released from the ER, you will come to me." 我們先前就達成同意, 一旦你們離開了急診室, 就要來找我。」
Her response was brief. 她的回應很簡短。
'"We didn't have the 15 dollars bus fare to come to Harare." 「我們沒有十五元的公車錢 可以去哈拉雷。」
fare:n.车费;饭菜;船费;飞机票价;v.成功(或不成功、更好等);
Now, suicide is not an unusual event in the world of mental health. 在心理健康的世界裡, 自殺並非不尋常的事件。
But there was something about Erica's death that struck me at the core of my very being. 不知為什麼,艾瑞卡的死 卻一直在我腦中揮之不去。
core:n.核心;要点;果心;[计]磁心;vt.挖...的核;
That statement from Erica's mother: "We didn't have 15 dollars bus fare to come to you," 艾瑞卡母親的那句話: 「我們沒有十五元的 公車錢去找你。」
statement:n.声明;陈述,叙述;报表,清单;
made me realize that it just wasn't going to work, me expecting people to come to me. 讓我了解到, 這樣不行的。 我不能期望人們來找我。
And I got into this state of soul-searching , trying to really discover my role as a psychiatrist in Africa. 我開始沈思與反省, 試圖找到,在非洲, 身為精神科醫生的自己, 我的角色到底是什麼,
soul-searching:n.深思;真挚的自我反省;
And after considerable consultation and soul-searching, talking to colleagues , friends and family, it suddenly dawned on me that actually, one the most reliable resources we have in Africa are grandmothers. 經過大量的諮詢和深思探索, 和同事、朋友、家人的交談, 我突然開始理解, 其實,非洲最可靠的資源之一, 就是阿嬤們。
considerable:adj.相当大的;重要的,值得考虑的; consultation:n.咨询;磋商;[临床]会诊;讨论会; colleagues:n.同事;同行(colleague的复数); dawned:n.天亮了;v.破晓(dawn的过去分词); reliable:adj.可信赖的;可依靠的;真实可信的;可靠的; resources:n.[计][环境]资源; v.向…提供资金(resource的第三人称单数);
Yes, grandmothers. 是的,阿嬤們。
And I thought, grandmothers are in every community. 我心想, 每個社區都有阿嬤。
There are hundreds of them. 有成百上千個阿嬤。
And -- 且──
(Laughter) （笑聲）
And they don't leave their communities in search of greener pastures . 她們不會離開她們的社區 去找更好的生存環境。
communities:n.社区;社会;团体;共有(community的复数) pastures:n.牧场;牧草地;工作条件;v.放牧;(pasture的第三人称单数和复数)
(Laughter) （笑聲）
See, the only time they leave is when they go to a greener pasture called heaven. 只有一種情況下,她們會離開, 去更好的地方,那就是去天堂。
(Laughter) （笑聲）
So I thought, how about training grandmothers in evidence-based talk therapy , which they can deliver on a bench? 所以,我心想, 來訓練這些阿嬤,會如何？ 教她們以證據為基礎的談話治療, 她們在長椅上就能進行。
evidence-based:adj.基于证据的; therapy:n.治疗,疗法;
Empower them with the skills to listen, to show empathy , all of that rooted in cognitive behavioral therapy; empower them with the skills to provide behavior activation , activity scheduling; and support them using digital tech nology . 教導她們傾聽的技巧、 展現同理心, 這些都是來自認知行為治療; 讓她們運用這些技巧, 提供行為活化治療、 計畫活動、 並用數字科技協助她們。
Empower:vt.授权,允许;使能够; empathy:n.神入;移情作用;执着; cognitive:adj.认知的,认识的; behavioral:adj.行为的; activation:n.[电子][物]激活;活化作用;
You know, mobile phone technology. 你們知道的,行動電話科技。
mobile phone:移动电话
Pretty much everyone in Africa has a mobile phone today. 現在非洲幾乎人人都有手機了。
So in 2006, 在 2006 年,
I started my first group of grandmothers. 我開始了我的第一個 阿嬤團隊。
(Applause) （掌聲）
Thank you. 謝謝。
(Applause) （掌聲）
Today, there are hundreds of grandmothers who are working in more than 70 communities. 現在,有數百名阿嬤, 在超過七十個社區工作。
And in the last year alone, more than 30,000 people received treatment on the Friendship Bench from a grandmother in a community in Zimbabwe . 單單在去年, 就有超過三萬人接受治療, 在「友誼長椅」上, 由在辛巴威社區的阿嬤所提供。
treatment:n.治疗;疗法;对待;处理;讨论; Zimbabwe:n.津巴布韦(国家名,位于非洲);
(Applause) （掌聲）
And recently , we published this work that is done by these grandmothers in the Journal of the American Medical Association . 最近,我們發表了 這項由阿嬤完成的工作, 在美國醫學會雜誌上。
recently:adv.最近;新近; Journal:n.杂志;日记;日志;(用于报纸名)…报; Association:n.协会;关联;联想;交往;
And -- 且──
(Applause) （掌聲）
And our results show that six months after receiving treatment from a grandmother, people were still symptom-free : no depression, suicidal ideation completely reduced. 且我們的結果顯示, 病人的症狀沒有復發, 沒有憂鬱, 自殺傾向完全減少。
symptom-free:adj.无症状的;解除症状; ideation:n.构思能力,思维能力;构思过程;
In fact, our results -- this was a clinical trial -- in fact, this clinical trial showed that grandmothers were more effective at treating depression than doctors and -- 事實上,我們的結果 ──這是一項臨床試驗── 事實上,這項臨床試驗顯示, 在治療憂鬱上,阿嬤的成效 比醫生還好──
clinical:adj.临床的;诊所的; effective:adj.有效的,起作用的;实际的,实在的;给人深刻印象; treating:v.以…态度对待;把…看作;处理;讨论;(treat的现在分词)
(Laughter) （笑聲）
(Applause) （掌聲）
And so, we're now working towards expanding this program. 所以, 我們現在在努力擴展這個計畫。
expanding:v.扩大,增加,增强细谈;详述;(expand的现在分词)
There are more than 600 million people currently aged above 65 in the world. 在全世界,有超過六億人的 年齡在六十五歲以上。
currently:adv.当前;一般地;
And by the year 2050, there will be 1.5 billion people aged 65 and above. 到 2050 年, 將會有十五億人的年齡 在六十五歲以上。
Imagine if we could create a global network of grandmothers in every major city in the world, who are trained in evidence-based talk therapy, supported through digital platforms , networked. 想像一下,如果我們能 創造一個全球的阿嬤網, 這些阿嬤受過實證支持療法的訓練, 由數位平台協助, 聯成網路。
global:adj.全球的;总体的;球形的; platforms:n.平台; v.把…放在台上;
And they will make a difference in communities. 她們將會為社區帶來改變。
make a difference:有影响,有关系;
They will reduce the treatment gap for mental, neurological and substance-use disorders . 她們會縮小治療的空缺, 心理、神經或藥物濫用造成的空缺。
gap:n.差距;间隙;缺口;间隔;v.使豁裂;豁开; neurological:adj.神经病学的,神经学上的; substance-use:物质使用;易有物质使用;药物滥用; disorders:n.无秩序,混乱; v.[电子]扰乱(disorder的单三形式);
Finally, this is a file photograph of Grandmother Jack. 最後, 這是傑克阿嬤的照片。
So, Farai had six sessions on the bench with Grandmother Jack. 所以,法拉艾在長椅上接受了 傑克阿嬤的六次治療。
sessions:n.会议;会期(session的复数); on the bench:坐板凳;当法官;
Today, Farai is employed. 現在,法拉艾有工作了。
She has her two children at school. 她的兩個孩子都在上學。
And as for Grandmother Jack, one morning in February, we expected her to see her 257th client on the bench. 至於傑克阿嬤, 二月的一個早晨,她應該要在 長椅上看她的第 257 個病人。
client:n.[经]客户;顾客;委托人;
She didn't show up. 她沒有出席。
She had gone to a greener pasture called heaven. 她去了更好的地方,天堂。
But I believe that Grandmother Jack, from up there, she's cheering on all the other grandmothers -- the increasing number of grandmothers who are making a difference in the lives of thousands of people. 但我相信,傑克阿嬤 就在上頭 為所有其他阿嬤加油── 有越來越多的阿嬤,
And I'm sure she's in awe when she realizes that something that she helped to pioneer is now spreading to other countries, like Malawi , the island of Zanzibar 我確信她會心存敬畏, 如果她能知道她協助開創的這個計畫 現在正在向其他國家拓展, 比如馬拉威、 溫古賈島,
awe:vt.使敬畏;使畏怯;n.敬畏; Malawi:n.马拉维(非洲国家);
and coming closer to home here in the Unites States in the city of New York. 以及美國這裡更靠近家的地方, 紐約市。
Unites:联合;合并;
May her soul rest in peace. 願她的靈魂安息。
Thank you. 謝謝。
(Applause) （掌聲）
(Cheering) （歡呼）
(Applause) （掌聲）