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PriscillaPemu_2019S-_慢性疾病患者的个人健康教练_-
When I first became a doctor in Benin City, Nigeria, some 30-odd years ago, 三十多年以前, 我刚成为尼日利亚贝宁城 的一名医生的时候,
I was drawn to help people live full lives. 深深着迷于 帮助人们过上完好的生活。
But often, I found myself feeling impotent . 但我常常感到无力。
impotent:adj.无力的;无效的;虚弱的;阳萎的;
Here I was, a brand-new doctor with all these skills, but I couldn't cure my patients who had chronic diseases -- illnesses like heart disease, asthma , diabetes -- 我这个初出茅庐的医生 掌握了各种技能, 却无法治愈被慢性病—— 诸如心脏病、哮喘、 糖尿病之类的疾病—— 折磨的病人们,
brand-new:adj.崭新的;最近获得的; patients:n.接受治疗者,病人;(patient的复数) chronic:adj.慢性的;长期的;习惯性的; diseases:n.[医]病(disease的复数);[医]疾病;[植保]病害;疾病种类; asthma:n.[内科][中医]哮喘,气喘; diabetes:n.糖尿病;多尿症;
and needed more than just handing them a prescription or providing grief counseling in the office to get the job done. 想要把他们治好, 需要的不仅仅是一纸处方, 或者在办公室内 给他们做心理辅导。
prescription:n.处方;药方;医生开的药;开处方; grief:n.悲痛;忧伤;不幸; counseling:n.咨询服务;v.建议;劝告;商讨;(counsel的现在分词形式)
Fast-forward 15 years later: 将时间快进到十五年后:
Fast-forward:n.快进功能;adj.进展迅速的;vi.快进;vt.使快进;
I'm in Atlanta , Georgia; it's a different world, 我身处佐治亚州亚特兰大; 这是个截然不同的世界,
Atlanta:n.亚特兰大(美国城市);
As doctors, we see our patients who have chronic illnesses in an episodic way. 作为医生,我们目睹 慢性病患者 周期性地发病。
episodic:adj.插话式的;
In between, the patients have to learn how to make a lot of decisions for themselves. 在病情恶化与好转之间, 病人们不得不学会 如何自己做出很多决定。
I'll give you examples. 让我给各位举几个例子。
If you have medications you're supposed to take every day, what do you do when you're sick? 如果你有每天需要服用的药物, 在患病时你该怎么办？
medications:n.药;药物;(medication的复数) supposed:adj.误信的;所谓的;v.认为;假设;设想;(suppose的过去分词和过去式)
Are you still supposed to take it? 你还应该继续吃药吗？
How do you recognize a complication when it happens? 你该如何识别并发症？
recognize:v.认识;认出;辨别出;承认;意识到; complication:n.并发症;复杂;复杂化;混乱;
How do you recognize a side effect when it happens? 你该如何识别副作用？
side effect:n.副作用;附带后果;
What do you do with it? 该如何应对这些状况？
In addition to all of this, they're dealing with the inevitable loneliness, isolation and anxiety that people who have chronic illnesses deal with. 除此之外, 他们还必须面对 慢性病患者无可避免地 要面对的孤独感、孤立感和焦虑。
In addition to:除…之外; inevitable:adj.必然的,不可避免的; anxiety:n.焦虑;渴望;挂念;令人焦虑的事;
In the US alone, six in 10 adults have a chronic illness. 仅在美国,十个成年人中 就有六个患有慢性疾病,
That's 125 million people. 加起来就是 1.25 亿人。
A recent report from the Robert Wood Johnson Foundation showed that health habits account for 50 percent of the health outcomes that people experience, while medical care only accounts for 20 percent. 罗伯特·伍德·约翰逊基金会 (Rober Wood Johnson Foundation) 一项最近的报告显示, 健康习惯能决定 人们健康结果的 50%, 而医疗护理只能决定 20%。
Foundation:n.基础;地基;基金会;根据;创立; account for:对…负有责任;对…做出解释;说明…的原因;导致;(比例)占; outcomes:n.结果;成果;后果;出路;(outcome的复数)
In fact, the Centers for Disease Control says that if we could eliminate smoking, physical inactivity and poor nutrition , that we can prevent 80 percent of heart disease, 80 percent of type 2 diabetes and 40 percent of cancer . 事实上,疾病防控中心表示, 如果我们能根除吸烟、 缺乏锻炼和营养不良, 那么我们就能预防 80% 的心脏病, 80% 的 2 型糖尿病, 和 40% 的癌症。
eliminate:v.消除;排除; physical:adj.[物]物理的;身体的;物质的;符合自然法则的;n.体格检查; inactivity:n.静止;不活泼;休止状态;不放射性; nutrition:n.营养,营养学;营养品; cancer:n.癌症;恶性肿瘤;
But we also know that changing health behaviors is very difficult. 但我们也知道, 健康习惯是很难改变的。
So we asked the question: 因此我们提出了这个问题:
What if we could create a resource that could motivate people to change health behavior? 可以鼓励人们 改变健康习惯的办法呢？
What if:如果…怎么办? resource:n.资源;资料;才智;财力;v.向…提供资金(或设备); motivate:v.激励;激发;成为…的动机;是…的原因;
The truth is, there are a lot of these resources out there that help people acquire these so-called self-management skills. 事实是,市面上已经有 很多这样的办法, 来帮助人们获取 所谓的自我管理技能。
resources:n.[计][环境]资源; v.向…提供资金(resource的第三人称单数); acquire:v.获得;取得;学到;捕获; so-called:adj.所谓的;号称的; self-management:n.自我管理;自主经营;
But many a time, they're not easily accessible or relatable, particularly to individuals within minority and underserved communities , who face bias in addition to barriers like language and culture and inadequate health insurance coverage . 但很多时候,这些资源难以获得 或者和个人情况不相符, 尤其是对于身处少数族裔 和服务水平低下的社区的人, 他们要面对的不仅是偏见, 还要面对诸如语言和文化的障碍 以及医疗保险范围的不足。
accessible:adj.易接近的;可进入的;可理解的; particularly:adv.特别地,独特地;详细地,具体地;明确地,细致地; individuals:n.[经]个人;[生物]个体(individual的复数); minority:n.少数民族;少数派;未成年;adj.少数的;属于少数派的; underserved:adj.服务不周到的;服务水平低下的; communities:n.社区;社会;团体;共有(community的复数) bias:adv.使有偏见;n.偏见;偏心;偏爱;v.使有偏见;使偏向;adj.斜的;[电]偏动的; barriers:n.障碍;栅栏;篱笆墙(barrier的复数形式); inadequate:adj.不充分的,不适当的; insurance:n.保险;保险业;保险费;保费;adj.胜券在握的; coverage:n.覆盖,覆盖范围;
And so in the last 12 years, my colleagues and I at Morehouse School of Medicine have created a technology-based application to assist with chronic illness care. 因此在过去的十二年里, 我和莫尔豪斯（Morehouse） 医学院的同事们 制作了一个基于科技的应用, 用于协助慢性疾病的护理。
colleagues:n.同事;同行(colleague的复数); technology-based:以科技为本的; application:n.应用;申请;应用程序;敷用;
It's freely available on the web and as an app. 它有网页版和应用软件版, 均可免费获取。
And what we do is get people to track variables -- blood pressure , blood sugar -- and then report it back to them in a color-coded format. 我们让人们追踪 像血压、血糖等数据, 并将这些数值用颜色 标注后反馈给他们。
track:n.小道;足迹;车辙;轨道;v.追踪;跟踪; variables:n.[数]变量; blood pressure:n.[医]血压; blood sugar:n.血糖; color-coded:颜色编码;
So green would indicate a healthy range, and red would indicate a problem that needs something done about it. 比如绿色代表在健康范围内, 红色代表存在健康问题, 需要采取行动来解决。
indicate:v.表明;显示;象征;暗示;
We link these stats to a curriculum . 我们将这些数据 和设计的课程相链接。
stats:n.统计数据;统计学; curriculum:n.课程;总课程;
The curriculum helps the individual learn about their health condition, whatever the chronic illness is. 课程可以帮助个人 增进对自己健康状况的了解, 不论他们患上的是哪种慢性疾病,
They also work with a health coach to learn self-management skills, skills that'll help them prevent complications of their illness. 还有健康教练辅导他们 学习自我管理的技能, 帮助他们预防疾病的并发症。
In order for the coach to be successful, they have to be able to gain the trust of the individual that they're working with. 健康教练想要有所成效, 必须能够获得 他们辅导的个人的信任。
We tested this application in clinics , where the health coaches were medical assistants, and in a large urban church, where the health coaches were volunteers from the health ministry . 我们在诊所测试了这个应用, 由医学助理们担任健康教练; 也在一座大型城市教会 进行了测试, 这里的健康教练由 卫生部的志愿者们担任。
clinics:n.诊所(clinic的复数形式); urban:adj.城市的;都市的;城镇的;都市音乐的; volunteers:n.志愿者; v.自愿做; (volunteer的第三人称单数和复数) ministry:n.(政府的)部门;
A year later, a third of the participants were able to acquire three new self-management skills and maintain them to the extent that it was able to improve their blood pressures, their blood sugar and their exercise. 一年之后,三分之一的参与者 成功地学会了三项自我管理技能, 并且一直坚持使用这些技能, 让自己的血压、血糖 和运动量得到改善。
participants:n.参与者(participant的复数形式); maintain:v.维持;保持;维修;保养;坚持(意见); extent:n.程度;范围;长度; improve:v.改进;改善;
Now, what was simple yet fascinating to us was that the group from the church did just as well or even better than the group that were under purely medical care. 对于我们来说, 一个简单却奇妙的发现是, 教会的那组参与者 和单纯接受医疗护理的那组相比, 效果同样好,甚至要更好一些。
fascinating:adj.极有吸引力的;迷人的;v.深深吸引;迷住;(fascinate的现在分词) purely:adv.完全;仅仅;
And we wanted to learn why that was. 我们想知道其中的原因。
So we looked a little further into the research -- 400 hours of recorded conversation -- and what we learned was that the coaches from the church did have more time to spend with the patients, they had access to the patients' families, and so they could figure out what people needed and provide those resources for them. 于是我们进行了更深入的研究, 通过挖掘 400 个小时的对话录音, 我们发现,教会的健康教练们 有更多时间和患者们相处, 他们和患者的家庭有所接触, 因此能够了解人们的需求, 并为他们提供相应的资源。
My team and I call this " culturally congruent coaching." 我和我的团队将其称为 “文化一致的辅导”。
culturally:adv.从文化角度,文化意义上;在人文学方面; congruent:adj.适合的,一致的;全等的;合谐的;
To illustrate this concept of culturally congruent coaching, 为了阐释这个概念,
illustrate:v.解释;加插图于;给(书等)做图表;表明…真实;
I want to tell you about one of our patients. 我想给各位讲讲 一位患者的故事。
I'll call her Ms. Bertha. 我将她称为 伯莎女士（Ms. Bertha）。
So Ms. Bertha is an 83-year-old lady with diabetes and hypertension . 伯莎女士是一位 83 岁的女性, 患有糖尿病与高血压。
hypertension:n.高血压;过度紧张;
She was assigned to Anne, her health coach in the church. 她被分配给了安妮（Anne）, 即她在教会中的健康教练。
assigned:v.分配(某物);分派;指定;委派;(assign的过去分词和过去式)
Anne also happened to be a family friend to Ms. Bertha for many years, and they were fellow congregants . 安妮碰巧是伯莎女士 多年的家庭好友, 也是彼此的教友。
congregants:n.(会议)召集人;聚会者;
Anne observed after the first few visits that even though Ms. Bertha faithfully recorded her stats, they were all showing up as red. 安妮在头几次辅导后发现, 虽然伯莎女士忠实地 记录了自己的数据, 但数字全都是红色的。
observed:adj.观察的;观测的;v.观察;遵守;注意到(observe的过去分词形式); faithfully:adv.忠实地;如实地;诚心诚意地;深信着地;
So she probed a little deeper to try to understand what was going on with Ms. Bertha, and Ms. Bertha gave her the real-real. 于是安妮更深入地询问了一下, 试图了解伯莎女士的情况, 而伯莎女士向她 吐露了实情。
probed:探测;探索(probe的过去式和过去分词);
(Laughter) （笑声）
She told her that there were times when her medications made her feel weird , and she wouldn't take them the way they were prescribed , because she thought it was due to the medicines but she didn't tell her doctor that. 她告诉安妮,有些时候 她的药让自己感觉怪怪的, 于是她没有按照医嘱吃药, 因为她觉得不适感 是药物造成的, 但她并没有把这个情况告诉医生。
weird:adj.奇怪的;奇异的;离奇的;n.命运;宿命;命运女神; prescribed:v.给…开(药); (prescribe的过去式和过去分词)
She also skipped out on some doctor appointments for a variety of reasons, but one of them was she wasn't doing better and she didn't want to make her doctor mad, so she just didn't go. 她还因为种种原因跳过了几次 和医生预约的看诊, 但理由之一是 她的状况没有改善, 她不想让医生发火, 所以她就干脆没去。
appointments:n.约会;预约;约定;任命;委任;职位;(appointment的复数) variety:n.多样;种类;杂耍;变化,多样化;
So Anne talked to Ms. Bertha and asked her to bring her daughter in for the next visit, which she did. 和伯莎女士交谈之后, 安妮请她在下次辅导时 把女儿一同带来,伯莎也照做了。
And at that visit, 在那次辅导中,
Anne was able to print out a log of all these stats that Ms. Bertha had been collecting, gave them to her and encouraged them to go see the doctor together, which they did. 安妮打印出了 伯莎女士一直在收集的 数据的记录, 把记录交给了她女儿, 并鼓励她们一起去看医生, 她们也这么做了。
With that information, the doctor was able to make changes to Ms. Bertha's treatment . 根据这些信息, 医生得以对伯莎女士 的治疗方案做出改动。
treatment:n.治疗;疗法;对待;处理;讨论;
Within three months, Ms. Bertha's numbers were all in the green. 三个月之内,伯莎女士 的数字都变绿了。
No one was more excited or surprised than Ms. Bertha herself. 没有人比伯莎女士自己 更加兴奋与惊讶。
Now, Anne was successful as a health coach because she cared enough to go below the surface and probe Ms. Bertha's deep culture and was able to reach her at that level. 安妮作为健康教练无疑是成功的, 因为她的关切之深 让她潜入表层之下, 探查伯莎女士深层的文化, 并在那一层面碰触到了她。
She knew how to listen, and she knew how to ask the right questions to get to what was needed. 她懂得如何聆听, 她也懂得如何通过 问正确的问题 找到对方的需求。
We all have deep unconscious rules that drive the way we make our health decisions. 我们都有深层的无意识准则 驱动我们做出健康决策。
unconscious:adj.无意识的;失去知觉的;未发觉的;
That's our culture. 这即是我们的文化。
The relationship and the conversation between Anne and Ms. Bertha illustrates what's possible when we have conversations with our patients, our friends and our neighbors on a deep cultural level. 安妮和伯莎女士 的关系与对话 向我们彰显了 当我们和我们的患者、 朋友与邻居 在深入的文化层面上对话时 所产生的可能性。
illustrates:v.阐明;举例说明(illustrate的三单形式);给…加插图;
And personally , I'm beyond excited to think that with this simple concept of culturally congruent coaching, we could change the lives of 125 million Americans and many others across the world that are living with chronic diseases. 就我个人来说, 想到这个简单的 文化一致的辅导 能让我们改变患有慢性疾病 的 1.25 亿美国人 以及世界各地的许多人的生活, 我就感到无比激动。
personally:adv.个人;亲自;本人;就本人而言;
Thank you. 谢谢大家。
(Applause) （掌声）