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RebeccaOnie_2012P-_如果我们的健康保证系统让我们保持健康会怎么样_
So my freshman year of college 在我大学第一年的时候,
I signed up for an internship in the housing unit at Greater Boston Legal Services. 我就在波士顿法律系统的住房部 得到了一个实习机会。
internship:n.实习生;(美)实习期;实习医师职位; Boston:n.波士顿(美国城市); Legal:adj.法律的;合法的;法定的;
Showed up the first day ready to make coffee and photocopies , but was paired with this righteous , deeply inspired attorney named Jeff Purcell, who thrust me onto the front lines from the very first day. 当我第一天上班 准备喝点咖啡,复印东西的时候, 我就和Jeff Purcell这个 有正义感的律师组成了一组, 他把我从第一天起 就推到了前线。
photocopies:n.影印本;影印机(photocopy的复数);v.影印(photocopy的第三人称单数); righteous:adj.正义的;正直的;公正的; inspired:adj.受到启发的; v.鼓舞; (inspire的过去分词和过去式) attorney:n.律师(尤指代表当事人出庭者);(业务或法律事务上的)代理人; thrust:v.刺;塞;冲;挤;n.刺;插;重点;猛推;
And over the course of nine months 在9个月里,
I had the chance to have dozens of conversations with low-income families in Boston who would come in presenting with housing issues , but always had an underlying health issue. 我有机会 和波士顿低收入家庭 有许多对话, 他们和我谈起住房问题, 但这些问题都有一个潜在的卫生问题。
issues:n.重要议题;争论的问题;v.宣布;公布;发出;(issue的第三人称单数和复数) underlying:adj.根本的; v.构成…的基础; (underlie的现在分词)
So I had a client who came in, about to be evicted because he hasn't paid his rent. 我有一个客户跟我说, 他马上就要被驱逐出住所因为他付不起房租。
client:n.[经]客户;顾客;委托人; evicted:v.驱逐,赶出,逐出;(evict的过去分词和过去式)
But he hasn't paid his rent, of course, because he's paying for his HIV medication and just can't afford both. 当然他没有付房租, 不过是因为他要支付艾滋病治疗费用 所以他没法付起两样钱。
HIV:n.艾滋病病毒; medication:n.药;药物; afford:v.给予,提供;买得起;
We had moms who would come in, daughter has asthma , wakes up covered in cockroaches every morning. 我们的客户中有妈妈, 说她们的女儿有哮喘, 每天早上身上爬满蟑螂。
asthma:n.[内科][中医]哮喘,气喘; cockroaches:n.[昆]蟑螂(cockroach的复数);
And one of our litigation strategies was actually to send me into the home of these clients with these large glass bottles. 所以我们的一个诉讼手段就是 把我送到这些人家里 带着大玻璃瓶。
litigation:n.诉讼;起诉; strategies:n.策略;行动计划;部署;战略;(strategy的复数) clients:n.委托人;当事人;客户机;(client的复数)
And I would collect the cockroaches, hot glue-gun them to this poster board that we'd bring to court for our cases. 然后我用大玻璃瓶来收集这些蟑螂, 把他们封起来, 然后带到法院。
poster:n.海报;巨幅装饰画;发布消息的人;
And we always won because the judges were just so grossed out. 我们总赢 因为法官法官自己感到恶心。
grossed:v.总共赚得(gross的过去式及过去分词);
Far more effective , I have to say, than anything I later learned in law school. 我想说,这方法 比我在法学院以后学的所有东西都管用。
effective:adj.有效的,起作用的;实际的,实在的;给人深刻印象;
But over the course of these nine months, 但在那九个月里,
I grew frustrated with feeling like we were intervening too far downstream in the lives of our clients -- that by the time they came to us, they were already in crisis . 我觉得我们的工作已经太迟了, 并且我被这种感觉所折磨, 那些人 到我们这里的时候, 他们已经在危机当中。
frustrated:adj.失意的,挫败的;泄气的;v.挫败;阻挠;(frustrate的过去式和过去分词) intervening:adj.介于中间的;v.介入(intervene的ing形式); downstream:adv.下游地;顺流而下;adj.下游的;顺流的; crisis:n.危机;危险期;决定性时刻;adj.危机的;用于处理危机的;
And at the end of my freshman year of college, 所以在我大一结束的时候,
I read an article about the work that Dr. Barry Zuckerman was doing as Chair of Pediatrics at Boston Medical Center. 我读到了关于 巴里·扎克曼博士的工作 他在当儿科主任 在波士顿医疗中心。
Pediatrics:n.小儿科;
And his first hire was a legal services attorney to represent the patients . 他的第一个工作就是 作为律师代表病人。
represent:v.代表;表现;描绘;回忆;再赠送; patients:n.接受治疗者,病人;(patient的复数)
So I called Barry, and with his blessing, in October 1995 walked into the waiting room of the pediatrics clinic at Boston Medical Center. 所以我打电话给巴里博士, 并且在他的帮助下,在1995年十月, 我走进了波士顿医疗中心的 儿科诊所等候室。
waiting room:na.候车室; clinic:n.诊所;临床实习;(医院的)门诊部;门诊时间;
I'll never forget, the TVs played this endless reel of cartoons. 我永远不会忘记 那里的电视不断地播放卡通。
endless:adj.无止境的;连续的;环状的;漫无目的的; reel:vi.卷;眩晕;蹒跚地走;退缩;vt.卷;使旋转;n.蹒跚;眩晕;旋转;
And the exhaustion of mothers who had taken two, three, sometimes four buses to bring their child to the doctor was just palpable . 还有母亲的劳累, 他们也许已经做了2回,3回,有时4回的公交车 就为了带她们的孩子来看以上, 这经历现在我都印象很深。
exhaustion:n.枯竭;耗尽;精疲力竭; palpable:adj.明显的;可感知的;易觉察的;
The doctors, it seemed, never really had enough time for all the patients, try as they might. 然而,医生似乎 永远没有足够的时间来看这些病人, 尽管他们很努力。
And over the course of six months, 在6个月里,
I would corner them in the hallway and ask them a sort of naive but fundamental question: "If you had unlimited resources , what's the one thing you would give your patients?" 我在走廊拐角看到他们 问他们一个很简单但基础的问题, “如果你有无限的组员, 你最想给这些病人什么？”
naive:adj.天真的,幼稚的; fundamental:n.基础; adj.十分重大的; unlimited:adj.无限制的;无限量的;无条件的; resources:n.[计][环境]资源; v.向…提供资金(resource的第三人称单数);
And I heard the same story again and again , a story we've heard hundreds of times since then. 我听到相同的答复, 这个答复我已经听到数百遍了。
again and again:adv.再三地,反复地;
They said, "Every day we have patients that come into the clinic -- child has an ear infection , 他们说:“每天我们都有病人, 对于耳朵感染的孩子,
infection:n.感染;传染;(身体某部位的)感染;传染病;
I prescribe antibiotics . 我给他们开抗生素。
prescribe:v.给…开(药);让…采用(疗法);开(处方);命令; antibiotics:n.抗菌素;抗生素(如青霉素);(antibiotic的复数)
But the real issue is there's no food at home. 但真正的问题是他们家没有食物。
The real issue is that child is living with 12 other people in a two-bedroom apartment. 真正的问题是 这个孩子在一个两居室里 和12个人同居。
two-bedroom:adj.双卧室的;n.双卧室;
And I don't even ask about those issues because there's nothing I can do. 所以我甚至就不问这些了 因为我什么也做不了。
I have 13 minutes with each patient. 对于一个病人我有13分钟。
Patients are piling up in the clinic waiting room. 病人在诊所等候室堆积。
piling:n.打桩;桩材;打桩工程;
I have no idea where the nearest food pantry is. 我不知道哪里能弄到吃的,
I have no idea:我没有头绪…; pantry:n.餐具室;食品室;食品储藏室;
And I don't even have any help." 我也没有帮助。”
In that clinic, even today, there are two social workers for 24,000 pediatric patients, which is better than a lot of the clinics out there. 在那个诊所,每天, 有两个社会工作者 来应对24000个儿童病人, 这也比其他诊所要强得多。
clinics:n.诊所(clinic的复数形式);
So Health Leads was born of these conversations -- a simple model where doctors and nurses can prescribe nutritious food, heat in the winter and other basic resources for their patients the same way they prescribe medication. 所以健康领导项目就在这些对话中产生了—— 一个简单的模型, 在其中医生和护士 可以像开药一样开食物, 在冬天开供暖 以及给病人开其他基本资源 和开药是一模一样的。
nutritious:adj.有营养的,滋养的;
Patients then take their prescriptions to our desk in the clinic waiting room where we have a core of well-trained college student advocates who work side by side with these families to connect them out to the existing landscape of community resources. 然后病人拿着他们的厨房 到我们在诊所等候室的桌子前 在这里我们有训练有素的大学生志愿者 来和这些家庭共同工作 把他们和已有的资源 连接起来。
prescriptions:n.医药处方,[医]药方(prescription复数形式); core:n.核心;要点;果心;[计]磁心;vt.挖...的核; well-trained:adj.训练有素的;良好训练; advocates:n.拥护者; vt.主张(advocate的第三人称单数); side by side:adj.并肩的;并行的; landscape:n.景观;乡村风景画;(文件的)横向打印格式;v.对…做景观美化;美化…的环境; community:n.社区;[生态]群落;共同体;团体;
So we began with a card table in the clinic waiting room -- totally lemonade stand style. 所以我们以一个小桌子作为开始—— 就像一个柠檬汁柜台那样。
card table:n.(折叠式)牌桌; lemonade:n.柠檬水;
But today we have a thousand college student advocates who are working to connect nearly 9,000 patients and their families with the resources that they need to be healthy. 但现在我们有1000个大学生, 来把尽9000患者和家庭 和资源联系起来让他们健康。
So 18 months ago 所以18个月前,
I got this email that changed my life. 我收到了一封改变我一生的邮件。
And the email was from Dr. Jack Geiger , who had written to congratulate me on Health Leads and to share, as he said, a bit of historical context . 这个邮件是从杰克·盖格博士发来的, 他祝贺我在健康领导项目上取得的成功 并且像他所说,和我分享 一些历史背景。
Geiger:na.Geiger; historical:adj.历史的;史学的;基于史实的; context:n.环境;上下文;来龙去脉;
In 1965 Dr. Geiger founded one of the first two community health centers in this country, in a brutally poor area in the Mississippi Delta . 在1965年,盖格博士建立了 这个国家两个最早的社区健康中心的一个, 在密西西比三角洲最贫穷的地方。
brutally:adv.残忍地;野蛮地;兽性地; Delta:n.(河流的)三角洲;德耳塔(希腊字母的第四个字);
And so many of his patients came in presenting with malnutrition that be began prescribing food for them. 然后有太多营养不良的病人 进来 使得他开始给他们开食物。
malnutrition:n.营养失调,营养不良; prescribing:v.给…开(药);让…采用(疗法);开(处方);命令;(prescribe的现在分词)
And they would take these prescriptions to the local supermarket, which would fill them and then charge the pharmacy budget of the clinic. 然后他们把这些处方带到当地超市, 然后超市提供食物 并从诊所的药物预算中拿钱。
pharmacy:n.药房;配药学,药剂学;制药业;一批备用药品; budget:n.预算,预算费;v.安排,预定;把…编入预算;adj.廉价的;
And when the Office of Economic Opportunity in Washington, D.C. -- which was funding Geiger's clinic -- found out about this, they were furious . 当华盛顿特区的经济机会办公室 ——这个办公室在自助盖格的诊所—— 发现这个的时候, 他们很生气。
Economic:adj.经济的,经济上的;经济学的; funding:n.基金;资金;提供资金;v.为…提供资金;拨款给;(fund的现在分词) furious:adj.激烈的;狂怒的;热烈兴奋的;喧闹的;
And they sent this bureaucrat down to tell Geiger that he was expected to use their dollars for medical care -- to which Geiger famously and logically responded , "The last time I checked my textbooks, the specific therapy for malnutrition was food." 并且当他们拍官员 告诉盖格用这些钱 来提供医疗服务的时候—— 盖格发表了著名且有逻辑的回应, “最近一次我看我的教科书的时候, 书上说营养不良的疗法就是食物。”
bureaucrat:n.官僚;官僚主义者; famously:adv.著名地;极好地; logically:adv.逻辑上;合乎逻辑; responded:v.回答,回应;作出反应;响应;反应灵敏;(respond的过去式和过去分词) specific:adj.特殊的,特定的;明确的;详细的;[药]具有特效的;n.特性;细节;特效药; therapy:n.治疗,疗法;
(Laughter) （笑声）
So when I got this email from Dr. Geiger, 所以当我收到盖格的邮件的时候,
I knew I was supposed to be proud to be part of this history. 我知道我应该为是这个历史的一部分 而感到自豪。
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)
But the truth is 但事实上,
I was devastated . 我很沮丧。
devastated:adj.不安的,混乱的,震惊的; v.彻底破坏; (devastate的过去分词和过去式)
Here we are, 45 years after Geiger has prescribed food for his patients, and I have doctors telling me, "On those issues, we practice a 'don't ask, don't tell' policy ." 现在是这个情况, 当盖格给病人开食物45年后, 有医生告诉我, “在那些问题上,我们保持”不许问,不许说“的政策。”
prescribed:v.给…开(药); (prescribe的过去式和过去分词) policy:n.政策,方针;保险单;
Forty-five years after Geiger, 45年后,
Health Leads has to reinvent the prescription for basic resources. 健康领导必须要重新发明 开基本资源的处方。
reinvent:v.以新形象示人;以新形式出现;
So I have spent hours upon hours trying to make sense of this weird Groundhog Day . 所以我花了很多小时, 来尝试途理解这个奇怪的土拨鼠节。
make sense of:搞清…的意思; weird:adj.奇怪的;奇异的;离奇的;n.命运;宿命;命运女神; Groundhog Day:n.[节]圣烛节;土拨鼠日;重现;[影视]偷天情缘;
How is it that if for decades we had a pretty straightforward tool for keeping patients, and especially low-income patients, healthy, that we didn't use it? 我们为什么 在几十年前就有一个很直接的手段来让我们的病人 特别是低收入病人健康, 但不用？
straightforward:adj.简单的;坦率的;明确的;径直的;adv.直截了当地;坦率地; especially:adv.尤其;特别;格外;十分;
If we know what it takes to have a healthcare system rather than a sick-care system, why don't we just do it? 如果我们知道什么组成一个健康保障系统, 而不是一个疾病治疗系统, 我们为什么不做？
healthcare:n.医疗保健;健康护理,健康服务;卫生保健;
These questions, in my mind, are not hard because the answers are complicated , they are hard because they require that we be honest with ourselves. 我认为,这些问题 不是因为答案很复杂而变得很难, 而是因为我们需要对我们自己诚实。
complicated:adj.复杂的;难懂的;v.使复杂化;(complicate的过去分词和过去式)
My belief is that it's almost too painful to articulate our aspirations for our healthcare system, or even admit that we have any at all. 我的观点是这太痛苦了 来说出来我们对健康系统的渴望, 或者甚至承认我们有一个健康系统。
painful:adj.痛苦的;疼痛的;令人不快的; articulate:vt.清晰地发(音); vi.发音; adj.发音清晰的; aspirations:n.愿望;
Because if we did, they would be so removed from our current reality. 因为如果我们这么做, 那些健康系统就会里 我们的现实太远了。
But that doesn't change my belief that all of us, deep inside, here in this room and across this country, share a similar set of desires. 但这不会改变我的观点: 我们所有人在内心深处 在这个房间里和国家里, 有一些相同的渴望。
That if we are honest with ourselves and listen quietly, that we all harbor one fiercely held aspiration for our healthcare: that it keep us healthy. 我们如果诚实对待我们自己, 仔细倾听, 我们有 一个强烈的渴望,对于我们的健康系统: 就是它让我们健康。
harbor:n.港口;港湾;(比喻)避难所;[军]坦克掩蔽场;v.停泊;包含;隐匿;怀抱(恶意); fiercely:adv.猛烈地;厉害地;
This aspiration that our healthcare keep us healthy is an enormously powerful one. 这个渴望 是一个很强有力的渴望。
enormously:adv.巨大地,庞大地;非常地,在极大程度上;
And the way I think about this is that healthcare is like any other system. 我是这么认为的: 健康系统和其他所有系统一样。
It's just a set of choices that people make. 只是人们做的一系列选择。
What if we decided to make a different set of choices? 如果我们决定 做出一套不同的选择会怎么样呢？
What if:如果…怎么办?
What if we decided to take all the parts of healthcare that have drifted away from us and stand firm and say, "No. 如果我们决定吧所有 离我们现实越来越远的部分拿出来 然后坚定地说
drifted:v.漂流;漂移;缓缓移动;缓慢行走;(drift的过去分词和过去式)
These things are ours. “不,这些是我们的。
They will be used for our purposes. 这些要为我们所用。
They will be used to realize our aspiration"? 这些要用来实现我们的 希望”又会怎么样呢？
What if everything we needed to realize our aspiration for healthcare was right there in front of us just waiting to be claimed ? 如果所有我们需要的 来实现我们的渴望 就在我们前方 等着我们去得到又会怎么样呢？
claimed:v.宣称;声称;断言;索取;认领;索要(claim的过去分词和过去式)
So that's where Health Leads began. 所以这就是健康领导的起点。
We started with the prescription pad -- a very ordinary piece of paper -- and we asked, not what do patients need to get healthy -- antibiotics, an inhaler , medication -- but what do patients need to be healthy, to not get sick in the first place ? 我们从处方板开始—— 一个很普通的值—— 然后我们不问病人需要什么来变得健康 ——抗生素,呼吸器,药物—— 而是病人需要什么来保持健康, 从根本上就不生病？
pad:n.软垫,护垫;便笺本;爪垫;肉掌;v.填充,覆盖,保护;蹑手蹑脚地走;做黑账; inhaler:n.[临床]吸入器;空气过滤器;吸入者; in the first place:首先;起初;
And we chose to use the prescription for that purpose. 所以我们选择 以这个目的来开处方。
So just a few miles from here at Children's National Medical Center, when patients come into the doctor's office, they're asked a few questions. 所以就在几英里外 在儿童国家健康中心, 当病人进入医生办公室是, 他们被问到一些问题。
They're asked, "Are you running out of food at the end of the month? 他们被问到:“你在月底还有吃的吗？
Do you have safe housing?" 你有健康的住房吗？
And when the doctor begins the visit, she knows height, weight, is there food at home, is the family living in a shelter. 并且当医生开始走访, 她知道是否家里有食物, 是否有住所。
And that not only leads to a better set of clinical choices, but the doctor can also prescribe those resources for the patient, using Health Leads like any other sub-specialty referral . 这不仅导致了更好的临床选择, 更能让医生给病人开这些资源, 在健康领导的指引下。
clinical:adj.临床的;诊所的; referral:n.参照;提及;被推举的人;转诊病人;
The problem is, once you get a taste of what it's like to realize your aspiration for healthcare, you want more. 问题是, 一旦你知道怎样 实现你对健康系统的愿望, 你就想要更多。
So we thought, if we can get individual doctors to prescribe these basic resources for their patients, could we get an entire healthcare system to shift its presumption ? 所以我们想, 如果我们能让医生个人 来开这些基本资源, 我们能让整个健康系统 改变吗？
individual:n.个人;有个性的人;adj.单独的;个别的; shift:n.移动;变化;手段;轮班;v.移动;转变;转换; presumption:n.放肆,傲慢;推测;
And we gave it a shot. 现在我们在做这个工作。
So now at Harlem Hospital Center when patients come in with an elevated body mass index , the electronic medical record automatically generates a prescription for Health Leads. 在哈雷姆医疗中心, 当身高体重指数过高的病人进来时, 电子医疗系统 自动为健康领导开除处方。
Harlem:n.黑人住宅区(纽约的); elevated:adj.提高的;高尚的;欢欣的;v.提高;振奋;提拔;(elevate的过去分词和过去式) mass:n.块,团; adj.群众的,民众的; v.聚集起来,聚集; index:n.指标;指数;索引;指针;v.做索引;指出;编入索引中; electronic:adj.电子的;电子器件的;电子设备的; automatically:adv.自动地;机械地;无意识地;adj.不经思索的; generates:[计]生成;发生;
And our volunteers can then work with them to connect patients to healthy food and excercise programs in their communities . 然后我们的志愿者就可以和他们一起工作 来把病人和食物及健身项目联系起来 这全在他们的社区里。
volunteers:n.志愿者; v.自愿做; (volunteer的第三人称单数和复数) communities:n.社区;社会;团体;共有(community的复数)
We've created a presumption that if you're a patient at that hospital with an elevated BMI, the four walls of the doctor's office probably aren't going to give you everything you need to be healthy. 我们提出了一个新的概念 就是如果你是一个 身高体重指数过高的病人, 那么医生办公室 也许不能给你所有 你需要来保持健康的东西。
You need more. 你需要更多。
So on the one hand , this is just a basic recoding of the electronic medical record. 所以与方面, 这只是一个 电子医疗基础记录。
on the one hand:一方面; recoding:v.重新编码(recode的ing形式);
And on the other hand , it's a radical transformation of the electronic medical record from a static repository of diagnostic information to a health promotion tool. 但另一方面, 这是一个 电子医疗记录的根本的改变 从静止诊断信息 到健康促进工具。
on the other hand:另一方面; radical:n.自由基;激进分子;游离基;adj.根本的;彻底的;完全的;全新的; transformation:n.转变;(用于南非)民主改革; static:adj.静止的; n.[物]静电(干扰); repository:n.贮藏室,仓库;知识库;智囊团; diagnostic:adj.诊断的;特征的;n.诊断法;诊断结论;
In the private sector , when you squeeze that kind of additional value out of a fixed-cost investment , it's called a billion-dollar company. 在私人领域, 当你把这些额外价值 从一个固定成本投资中挤出来, 这是一个十亿美元公司的做法。
private sector:n.(国家经济的)私营部分; squeeze:v.挤;紧握;勒索;压榨;n.压榨;紧握;拥挤;佣金; additional:adj.附加的,额外的; investment:n.投资;投入;封锁;
But in my world, it's called reduced obesity and diabetes . 但在我的世界里, 这是减少肥胖和糖尿病的方法。
obesity:n.肥大,肥胖; diabetes:n.糖尿病;多尿症;
It's called healthcare -- a system where doctors can prescribe solutions to improve health, not just manage disease . 这是健康保障 ——一个系统其中医生可以 开出解决方案来促进健康, 而不只是治疗疾病。
improve:v.改进;改善; disease:n.病,[医]疾病;弊病;vt.传染;使…有病;
Same thing in the clinic waiting room. 同样的事发生在诊所等候室里。
So every day in this country three million patients pass through about 150,000 clinic waiting rooms in this country. 每天在这个国家 三百万病人 从150000个等候室里走过。
pass through:穿过;经历;经验;遭受;
And what do they do when they're there? 他们在那里做什么？
They sit, they watch the goldfish in the fish tank, they read extremely old copies of Good Housekeeping magazine. 他们坐着,看着鱼缸里的金鱼, 读着很旧的 杂志。
extremely:adv.非常,极其;极端地; Housekeeping:n.家政;家务管理;家用开支;
But mostly we all just sit there forever, waiting. 但通常我们只是坐在那里,等候。
How did we get here where we devote hundreds of acres and thousands of hours to waiting? 我们怎样实现 我们付出几百英里几千小时 等待？
devote:v.贡献;把…专用于;听任;
What if we had a waiting room where you don't just sit when you're sick, but where you go to get healthy. 如果我们有一个等候室 在其中你不仅仅坐着, 而是在那里就变得健康会怎样？
If airports can become shopping malls and McDonald's can become playgrounds, surely we can reinvent the clinic waiting room. 如果机场可以变成商场, 麦当劳可以变成操场, 当然我们可以重新创造等候室。
airports:n.[航]机场;[航]航空港(airport的复数形式);
And that's what Health Leads has tried to do, to reclaim that real estate and that time and to use it as a gateway to connect patients to the resources they need to be healthy. 这就是健康领导在做的, 重新利用那片地和时间 并且把它做成一个过道 来连接病人 和让他们健康的资源。
reclaim:v.开拓;回收再利用;改造某人,使某人悔改;n.改造,感化;再生胶; real estate:n.房地产;不动产;
So it's a brutal winter in the Northeast , your kid has asthma, your heat just got turned off, and of course you're in the waiting room of the ER, because the cold air triggered your child's asthma. 在东北部寒冷的冬天, 你的孩子有哮喘,但你却没有暖气, 当然你在等候室里, 因为外面的冷风会让你的孩子咳嗽。
Northeast:adj.东北的;来自东北的;n.东北;adv.向东北;来自东北; triggered:v.发动;引起;触发;开动;起动;(trigger的过去分词和过去式)
But what if instead of waiting for hours anxiously , the waiting room became the place where Health Leads turned your heat back on? 但如果不是在等候室里焦急的等几个小时, 而是让等候室变成一个平台 利用这个平台健康领导能让你的暖气重新工作会怎样呢？
anxiously:adv.不安地,忧虑地;
And of course all of this requires a broader workforce . 当然这需要 很多的劳动力。
workforce:n.劳动大军;全体员工;
But if we're creative , we already have that too. 但如果我们有创意,我们已经有了。
creative:adj.创造性的;
We know that our doctors and nurses and even social workers aren't enough, that the ticking minutes of health care are too constraining . 我们知道我们的医生和护士 甚至社会工作者 的力量并不够, 医疗护理的时间 还太有限。
health care:n.卫生保健; constraining:约束;
Health just takes more time. 健康需要更多时间。
It requires a non-clinical army of community health workers and case managers and many others. 它需要一个非临床的队伍 这个队伍由社区健康工作者和特例经理 以及其他许多的人组成。
What if a small part of that next healthcare workforce were the 11 million college students in this country? 如果一小部分队伍 是1100万大学生又会怎么样呢？
Unencumbered by clinical responsibilities, unwilling to take no for an answer from those bureaucracies that tend to crush patients, and with an unparalleled ability for information retrieval honed through years of using Google . 不受临床责任所限, 不想从那些想压迫病人 的官员口中 得到不行的答案, 并且具备无可匹敌的 信息收集能力 且被不断从用谷歌中加强。
Unencumbered:adj.没有阻碍的;没有负担的;不受妨碍的; unwilling:adj.不愿意的;不情愿的;勉强的; bureaucracies:n.繁文褥节;官僚政治(bureaucracy的复数); crush:v.压碎;弄皱,变形;使…挤入;n.粉碎;迷恋;压榨;拥挤的人群; unparalleled:adj.无比的;无双的;空前未有的; retrieval:n.检索;恢复;取回;拯救; honed:adj.磨光的;亚光;v.把…磨光(hone的过去式及过去分词); Google:谷歌;谷歌搜索引擎;
Now lest you think it improbable that a college volunteer can make this kind of commitment , 现在免得你认为 一个大学志愿者可以 做出这种工作是不可能的,
lest:conj.唯恐,以免;担心; improbable:adj.不大可能的,未必确实的;不可信的; commitment:n.承诺;投入;保证;许诺;
I have two words for you: 我有两个词给你:
March Madness. 三月疯狂。
The average NCAA Division I men's basketball player dedicates 39 hours a week to his sport. 平均一个美国顶级大学生篮球联赛球员 每周付出39小时在运动中。
Division:n.师;分配;分开;分歧; dedicates:vt.致力;献身;题献;
Now we may think that's good or bad, but in either case it's real. 现在不过我们认为这时好时坏, 这是事实。
And Health Leads is based on the presumption that for too long we have asked too little of our college students when it comes to real impact in vulnerable communities. 并且健康领导是基于这样一个事实: 已经有太长时间, 我们关于学生问的太少了 当谈及脆弱社区的实际影响。
impact:n.影响;效果;碰撞;冲击力;v.挤入,压紧;撞击;对…产生影响; vulnerable:adj.易受攻击的,易受…的攻击;易受伤害的;有弱点的;
College sports teams say, "We're going to take dozens of hours at some field across campus at some ungodly hour of the morning and we're going to measure your performance , and your team's performance , and if you don't measure up or you don't show up, we're going to cut you off the team. 高校运动队说, “我们要花几十个小时 在一些校园里的地方,在一些不虔诚的小时,在早上, 我们要去衡量你的表现和你的团队的表现, 如果你不来衡量或者不来了, 我们就要把你淘汰。
campus:n.(大学)校园;大学,大学生活;校园内的草地; ungodly:adj.邪恶的;不敬畏神的;荒唐的; performance:n.性能;表现;业绩;表演; measure up:合格;符合标准;
But we'll make huge investments in your training and development, and we'll give you an extraordinary community of peers ." 但我们会投资大量的钱 用于你的训练和发展, 并且我们会给你很出色的队友。”
investments:n.[经]投资,投资的财产;投资学;(investment的复数) extraordinary:adj.非凡的;特别的;离奇的;临时的;特派的; peers:n.平辈,同事(peer的复数);v.凝视;比得上(peer的三单形式);
And people line up out the door just for the chance to be part of it. 门外排队的人 只是为了成为它的一部分。
So our feeling is, if it's good enough for the rugby team, it's good enough for health and poverty . 所以我们的感觉就是, 如果它对于橄榄球队很好, 他也对健康和贫困很好。
rugby:n.英式橄榄球;拉格比(英格兰中部的城市); poverty:n.贫困;困难;缺少;低劣;
Health Leads too recruits competitively , trains intensively , coaches professionally , demands significant time, builds a cohesive team and measures results -- a kind of Teach for America for healthcare. 健康领导也用一个很苛刻的条件选拔志愿者, 给予高强度的训练, 专业的训练, 需要大量的时间, 来筑造一个有凝聚力的团队 并且检测结果 — — 类似一个为美国而教学的健康保障。
recruits:n.新兵; v.征募; competitively:adv.有竞争力地;好竞争地; intensively:adv.强烈地;集中地; professionally:adv.专业地;内行地; significant:adj.重大的;有效的;有意义的;值得注意的;意味深长的;n.象征;有意义的事物; cohesive:adj.有结合力的;紧密结合的;有粘着力的;
Now in the top 10 cities in the U.S. 现在,在美国的10个
with the largest number of Medicaid patients, each of those has at least 20,000 college students. 医疗补助患者最多的城市, 每一个人拥有至少 20000 名高校学生。
Medicaid:n.(美)医疗补助计划;
New York alone has half a million college students. 纽约一个州就有50万大学生。
And this isn't just a sort of short-term workforce to connect patients to basic resources, it's a next generation healthcare leadership pipeline who've spent two, three, four years in the clinic waiting room talking to patients about their most basic health needs. 这不只是一种短期的劳动力 来进行把病人和基本资源连接的工作, 它是下一代医疗保健领导的通道 那些花了二、 三、 四年 在诊所等候室 给病人谈论他们最基本的卫生需求的人。
short-term:adj.短期的;
And they leave with the conviction , the ability and the efficacy to realize our most basic aspirations for health care. 他们带着决心离开, 能力和效率 来实现我们对卫生保健的最基本愿望。
conviction:n.判罪;定罪;坚定的看法(或信念);坚信;肯定; efficacy:n.功效,效力;
And the thing is, there's thousands of these folks already out there. 所以,成千上万的人已经到了。
So Mia Lozada is Chief Resident of Internal Medicine at UCSF Medical Center, but for three years as an undergraduate she was a Health Leads volunteer in the clinic waiting room at Boston Medical Center. 米亚洛是UCSF健康中心 的内科负责人, 但作为在本科的三年里 她是健康领导的志愿者 在波士顿医疗中心诊所等候室工作。
Resident:adj.居住的;住院医师;定居的;n.居民; Internal:n.内脏;本质;adj.内部的;里面的;体内的;(机构)内部的; undergraduate:n.本科生;
Mia says, "When my classmates write a prescription, they think their work is done. 米亚说, 如果我的同学们开了处方, 他们就认为他们的工作已经完成了。
When I write a prescription, 当我写了药,
I think, can the family read the prescription? 我认为,家庭可以理解这个处方吗？
Do they have transportation to the pharmacy? 他们能到药房吗？
transportation:n.运输;运输系统;运输工具;流放;
Do they have food to take with the prescription? 他们有吃的吗？
Do they have insurance to fill the prescription? 他们有保险吗？
insurance:n.保险;保险业;保险费;保费;adj.胜券在握的;
Those are the questions I learned at Health Leads, not in medical school." 这些是我在健康领导中学到的, 而不是在医学院。
Now none of these solutions -- the prescription pad, the electronic medical record, the waiting room, the army of college students -- are perfect. 现在没有任何这些解决方案 — — 药方,电子医疗记录, 等候室, 大学生队伍—— 是完美的。
But they are ours for the taking -- simple examples of the vast under-utilized healthcare resources that, if we reclaimed and redeployed , could realize our most basic aspiration of healthcare. 但他们是我们的责任 — — 简单的例子 关于大量未充分利用医疗资源的 如果我们回收和重新调配, 可以实现我们最基本的愿望 卫生保健。
reclaimed:adj.回收的,再生的;翻造的;v.回收利用;改造(reclaim的过去分词);开垦土地; redeployed:v.调配;重新部署;(redeploy的过去式和过去分词)
So I had been at Legal Services for about nine months when this idea of Health Leads started percolating in my mind. 所以我一直在约九个月的法律服务 当这个健康领导项目被我想时。
percolating:v.渗入;渗透;逐渐流传;传开;滤煮咖啡;(percolate的现在分词)
And I knew I had to tell Jeff Purcell, my attorney, that I needed to leave. 我知道我不得不告诉我的律师,杰夫 · 珀塞尔 我需要离开。
And I was so nervous, because I thought he was going to be disappointed in me for abandoning our clients for some crazy idea. 我很紧张, 因为我以为他要将对我失望 因为我放弃我们的客户而进行一些疯狂的想法。
abandoning:v.放弃;屈服;(abandon的现在分词)
And I sat down with him and I said, "Jeff, I have this idea that we could mobilize college students to address patients' most basic health needs." 他坐下,我说, 杰夫,我有这种想法 我们可以调动大学生 来解决病人最基本的健康需要。”
mobilize:v.动员;动员;调动;组织;鼓动;调用;
And I'll be honest, all I wanted was for him to not be angry at me. 我是诚实的 我只是他不是生我的气。
But he said this, "Rebecca, when you have a vision, you have an obligation to realize that vision. 但他表示,这一点, 罗贝卡,当你有一个远景 你就有义务要实现这一理想。
obligation:n.义务;责任;职责;(已承诺的或法律等规定的)义务;
You must pursue that vision." 你必须追求这一愿景。
pursue:v.继续;从事;追赶;纠缠;
And I have to say, I was like "Whoa. 我不得不说,我就像 哇。
That's a lot of pressure." 这压力很大。”
I just wanted a blessing, 我只想要祝福,
I didn't want some kind of mandate . 我不想要命令。
mandate:n.授权;命令,指令;委托管理;受命进行的工作;vt.授权;托管;
But the truth is 但事实是
I've spent every waking minute nearly since then chasing that vision. 自那时以来我几乎花了醒着的每一分钟 追求这一愿景。
I believe that we all have a vision for healthcare in this country. 我相信我们都有一个关于 这个国家医疗保健的远景。
I believe that at the end of the day when we measure our healthcare, it will not be by the diseases cured, but by the diseases prevented. 我相信,在一天结束时 当我们来衡量我们的卫生保健, 标准不是被治好的疾病, 而是被预防的疾病。
diseases:n.[医]病(disease的复数);[医]疾病;[植保]病害;疾病种类;
It will not be by the excellence of our technologies or the sophistication of our specialists, but by how rarely we needed them. 标准不是我们的技术有多好, 或者我们专家有多专业, 而是我们多么不需要他们。
excellence:n.优秀;美德;长处; technologies:n.技术;科技(technology的复数); sophistication:n.复杂;诡辩;老于世故;有教养; rarely:adv.很少地;难得;罕有地;
And most of all, 最重要的是,
I believe that when we measure healthcare, it will be, not by what the system was, but by what we chose it to be. 我认为当我们见此的健康保障是, 标准不是这个系统是什么, 而是我们让它变成什么。
Thank you. 谢谢。
(Applause) （掌声）
Thank you. 谢谢。
(Applause) （掌声）