MaryBassett_2015P[玛莉巴塞特][为何你的医生应该要关注社会公义].pdf

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1、www.XiYuS锡育软件When I moved to Harare in 1985,social justice was at thecore of Zimbabwes national health policy.我于1985年搬到哈拉雷,社会公义是津巴布韦的医疗核心政策。00:12The new government emerged from a long war ofindependence and immediately proclaimed a socialistagenda:health care services,primary education becameessenti

2、ally free.长期争取独立战争而涌现的新政府 立即宣布社会主义议程:医疗保健服务,小学敎育,大体上都成为免费的。00:20A massive expansion of rural health centers placed roughly80 percent of the population less than a two-hour walk fromthese facilities,a truly remarkable accomplishment.农村医疗中心大规模的扩充。地方约人口80%能在两小时内走到一个医疗中心。那是一个真正了不起的成就。00:32In 1980,the ye

3、ar of independence,25 percent ofZimbabwean children were fully immunized.在1980年独立的那一年,津巴布韦只有25%儿童有接种全套儿童疫苗。00:45By 1990,a mere decade later,this proportion stood at 80percent.到了1990年,仅仅10年后,儿童接种比率达到80%。00:52I felt tremendously privileged to be part of thistransformation,a revolution.我感到十分榮幸参与了这个大转变,

4、一个革命。00:58Zimbabwe:n.津巴布韦(国家名,位于非洲)proclaimed:公告 primary education:初等教育 rural:adj.农村的，乡下的；田园的，有乡村风味的 facilities:n.设施;工具,设备 remarkable:adj.卓越的；非凡的；值得注意的 accomplishment:n.成就;完成;技艺,技能 immunized:adj.免疫的/v.使免疫(immunize的过去式,过去分词形式)tremendously:adv.非常地;可怕地;惊人地 privileged:adj.享有特权的;有特别恩典的/v.给予特权;免除(privileg

5、e的过去分词)The excitement,the camaraderie,was palpable.这种兴奋,那种同志友情,无可言喻。01:05Working side by side with brilliant Zimbabweans-scientists,doctors,activists-I felt connected not only to anAfrican independence movement,but to a global progressivepublic health movement.能与优秀的津巴布韦市民并肩作战-当中包括科学家,医生,运动家等等-我觉得不单只

6、是与非洲独立运动连结,也与全球公共医疗运动的进步连系。01:10But there were daunting challenges.但我们曾有严峻的挑战。01:26Zimbabwe reported its first AIDS case in 1985,the year Iarrived.1985年,我初到津巴布韦的那年,那里出现首宗爱滋病病例。01:30I had taken care of a few patients with AIDS in the early1980s,when I did my medical training at Harlem Hospital,but-we

7、 had no idea what lay in store for Africa.80年代初我就照顾过一些患有爱滋病的病人。当时我到哈莱姆医院接受医疗训练,但是 那时我们无法想像非洲今日会有这样的情况。01:35Infection rate stood at about two percent in my early daysthere.早期我在这里时,感染率只有2%。01:49These would soar to one out of every four adults by the time Ileft Harare 17 years later.这个数字不断飊升,直到每4个成年人当中

8、有一个爱滋病患者。那是我17年后离开哈拉雷时的感染率,01:53By the mid-1990s,Id told hundreds of people in the primeof life that they were HIV-positive.在1990年代中期,我告诉过数百位在他们生命最高峰的人,他们患上爱滋病。02:02camaraderie:n.友情;同志之爱 palpable:adj.明显的;可感知的;易觉察的 side with:支持;站在的一边 daunting:adj.使人畏缩的;使人气馁的;令人怯步的 Harlem:n.黑人住宅区(纽约的)lay in:贮存I saw co

9、lleagues and friends die,my students,hospitalpatients,die.我看着同事及朋友死去,看着我的学生,医院内的病人离世。02:10In response,my colleagues and I set up a clinic.因此,我与我的一些同事成立一了间诊所。02:18We did condom demonstrations.我们示范避孕套用法。02:22We launched school education and workplace interventions.我们在学校和工作场所提供预防的资讯。02:24TED演讲者：Mary Ba

10、ssett|玛莉?巴塞特演讲标题：Why your doctor should care about social justice|为何你的医生应该要关注社会公义内容概要：In Zimbabwe in the 1980s,Mary Bassett witnessed the AIDS epidemic firsthand,andshe helped set up a clinic to treat and educate local people about the deadly virus.But lookingback,she regrets not sounding the alarm

11、for the real problem:the structural inequitiesembedded in the worlds political and economic organizations,inequities that makemarginalized people more vulnerable.These same structural problems exist in the United Statestoday,and as New York Citys Health Commissioner,Bassett is using every chance she

12、 has torally support for health equity and speak out against racism.We dont have to have all theanswers to call for change,she says.We just need courage.在辛巴威，在1980年代，玛丽巴塞特亲自目睹了爱滋病的疫情。她幫忙成立了一所治疗中心及教育当地人民如何面对这致命病毒。但回头看看，她很遗憾没有对这些发出警号：深植于世界政治和经济组织内的结构性不平等，使被边缘化的人群更加脆弱。今天在美国同样这些结构性问题也存在。身为纽约市卫生专员，巴塞特把握每

13、个机会大声疾呼，争取大众对医疗平等的支持以及反对种族主义。她说，“我们不必知道所有的答案，才呼吁变革，”“我们只是需要勇气。”We did research.We counseled the partners of infected menabout how to protect themselves.我们做研究。我们为被感染的男性伙伴做谘询。告诉他们如何保护自己。02:30We worked hard,and at the time,I believed that I was doingmy best.我们非常努力工作。在那时,我相信我已竭尽所能。02:36I was providing e

14、xcellent treatment,such as it was.我提供了,就当时而言,最好的治疗。我提供最好的治疗。02:41But I was not talking about structural change.但我没有谈到有关架构的改变,02:45Former UN Secretary Kofi Annan has spoken candidly abouthis personal failure leading to the Rwandan genocide.前联合国秘书长-科菲安南 他坦诚因自己个人的失误,而导致卢旺达种族灭绝。02:51In 1994,he was head

15、of the UN peacekeeping department.在1994年,他是联合国维和部的负责人。02:59condom:n.避孕套;阴茎套 demonstrations:n.示范,展示(demonstration复数)workplace:n.工作场所;车间interventions:n.法干预,干涉;处置(intervention的复数)counseled:v.建议;劝告;忠告;商讨(counsel的过去分词)infected:adj.被感染的/v.传染(infect的过去分词)structural:adj.结构的;建筑的 candidly:adv.坦白地;率直地;直率而诚恳地 g

16、enocide:n.种族灭绝;灭绝整个种族的大屠杀 peacekeeping:adj.维护和平的;执行停火协定的At a 10-year memorial for the genocide,he reflected,Ibelieved at the time I was doing my best,but I realized afterthe genocide that there was more I could and should havedone to sound the alarm and rally support.在这个种族灭绝的10周年,他说,当时我以为已经竭尽所能了,但在种

17、族灭绝之后,我才瞭解到 原来我是可以,也应该可以做更多。就是发出警报并争取支援。“03:03The AIDS epidemic caught the health communityunprepared,and today,when the World HealthOrganization estimates that 39 million people have lost theirlives to this disease,爱滋病的流行让卫生界猝不及防。今天,世界卫生组织估算 约有3900万人,因为爱滋病丧失生命。03:22Im not alone in feeling remorse a

18、nd regret at not havingdone more earlier.不只是我一个人感到自责和后悔 没有在早期采取更多行动。03:35But while living in Zimbabwe,I didnt see my role as anadvocacy or a political one.但是,当我住在津巴布韦时,我不觉得我的角色是提倡鼓吹,或是政治性的角色。03:43I was there for my technical skills,both my clinical and myresearch epidemiology skills.我是以我的专業技能在参与,我的临

19、床及研究流行病学两方面的技能。03:50And in my mind,my job was to take care of patients and todo research to better understand the population patterns oftransmission,and I hoped that wed slow the spread of thevirus.我那时认为我的工作就是照顾病人,以及从研究中去了解传染病在人口中的分布模式。我希望我们会减慢病毒传播。03:57reflected:adj.反射的;得自他人的/v.反射;思考(reflect的过去式和过去

20、分词)rally:vi.团结；重整；恢复；(网球等)连续对打/vt.团结；集合；恢复健康、力量等/n.集会；回复；公路赛车会/unprepared:adj.无准备的;即席的;尚未准备好的estimates:n.估计;预算(estimate的复数);概数/v.评价(estimate的三单形式);估量 remorse:n.懊悔;同情 advocacy:n.主张;拥护;辩护 clinical:adj.临床的；诊所的 epidemiology:n.流行病学;传染病学I was aware that socially marginalized populations were atdisproporti

21、onate risk of getting and dying of AIDS.我知道社会边缘化人群对患爱滋病风险或 死于此病的比率特别高。04:11And on the sugar plantations,which really more closelyresembled feudal fiefdoms than any modern enterprise,60percent of pregnant women tested HIV-positive.在甘蔗种植园区,那里其实比想像更是封建领地,比起现代任何企業,百分之60的怀孕妇女 在爱滋病测试中呈阳性反应。04:18I worked t

22、o show how getting infected was not a moralfailure but instead related to a culture of male superiority,toforced migrant labor and to colonialism.我致力于宣导爱滋病并不是表示道德败坏。而是与男尊女卑的文化有关,与被迫害的农民工,和与殖民主义有关。04:32Whites were largely unscathed.白种人几乎没受到影响。04:43As health professionals,our tools were pitifully weak

23、:imploring people to change their individual behaviors,usecondoms,reduce number of partners.身为医疗专業人员,我们的工具非常薄弱:我们恳请人们改变他们的个人行为,使用安全套,和减少性伴侣。04:46aware:adj.意识到的；知道的；有方面知识的；懂世故的/marginalized:使边缘化/忽略/排斥(marginalize的过去式和过去分词)disproportionate:adj.不成比例的/不成比例地 plantations:n.农种植园(plantation的复数形式)resembled:像

24、,类似(resemble的过去式)feudal:adj.封建制度的；领地的；世仇的 fiefdoms:n.封地,采邑(等于fief)superiority:n.优越，优势；优越性 migrant:n.候鸟;移居者;随季节迁移的民工/adj.移居的;流浪的 colonialism:n.殖民主义;殖民政策unscathed:adj.未受伤的 professionals:n.管理专业人员(professional的复数)pitifully:adv.可怜地,令人怜悯地;可恨地imploring:adj.恳求的;哀求的/v.恳求(implore的ing形式)condoms:n.医避孕套;橡皮套(cond

25、om复数形式)Infection rates climbed,and when treatment becameavailable in the West,treatment that remains our mostpotent weapon against this virus,it was unaffordable to thepublic sector across Africa.可惜感染率仍不断上升。当西方国家有爱滋病的治疗方法时,那治疗是我们对抗这种病毒最有力的武器。对抗这种病毒 在整个非洲的一般大众无法负担得起。04:58I didnt speak out about the u

26、nequal access to these life-saving drugs or about the underlying economic and politicalsystems that were driving infection rates in such huge swathsof the population.我对于 无法公平取得这些救命药品,或引起高传染率的基本经济和政治体制 没有大声疾呼。在如此庞大人口的区域,05:14I rationalized my silence by reminding myself that I was aguest in the count

27、ry,that sounding the alarm could even getme kicked out,keep me from doing good work,taking careof my patients,doing much-needed research.我对我的沈默自我合理化。我提醒自己我只是这国土的一位客人,我若发出警报,可能会被驱逐出境,让我无法做好我的工作,不能照顾好我的病人,以及做急需的研究工作。05:33So I didnt speak out about the governments early stance onAIDS.所以我没说出 有关政府早期对爱滋病的

28、态度。05:48I didnt voice my concerns loudly enough.我没大声提出我的担忧。05:53potent:adj.有效的;强有力的,有权势的;有说服力的 unaffordable:adj.买不起的 speak out:畅所欲言;大胆地说;大声地说unequal:adj.不平等的;不规则的;不胜任的/n.不等同的事物 life-saving:n.救生/adj.救生的 underlying:adj.潜在的；根本的；在下面的；优先的/v.放在的下面；为的基础；优先于(underlie的ing形式)swaths:n.细长的列;收割的刈痕;收割的宽度 rational

29、ized:adj.合理化的;有理化的/v.使合理化;使消根;为找借口(rationalize的过去分词)reminding:n.提醒注意/v.提醒;使联想起(remind的ing形式)sounding:n.音响;试探;测探水深/adj.发出声音的 stance:n.立场;姿态;位置;准备击球姿势loudly:adv.大声地,响亮地Many doctors,health professionals,may think I did nothingwrong.许多医生,专業医疗人员,可能觉得我没有做错。05:57Our pact with our patients,the Hippocratic O

30、ath and itsvariants,is about the sanctity of the patient-doctorrelationship.我们和病人的协议,我们虚伪（成为医师时）的宣誓,是关于医患之间神圣关系。06:03And I did everything I could for each and every patient ofmine.对于我的每位病人,我都做了我所能做到的。06:13But I knew that epidemics emerge along the fissures of oursociety,reflecting not only biology,b

31、ut more importantlypatterns of marginalization,exclusion,discriminationrelated to race,gender,sexuality,class and more.但我那时就知道 该疫情沿着我们的社会裂隙出现,不只反映在生理上,更重要的是,他们被边缘化,排斥,以及由于种族,性别,性取向,阶级和更多方面被歧视的模式。06:22It was true of AIDS.对爱滋病而言是如此。06:42It was true just recently of Ebola.对最近发生的埃博拉病毒亦然。06:44Medical ant

32、hropologists such as Paul Farmer,who workedon AIDS in Haiti,call this structural violence:structuralbecause inequities are embedded in the political andeconomic organization of our social world,医疗人类学者如保罗法玛尔博士 他在海地致力于爱滋病工作,称之为架构性的暴力:它是架构性的,因为深植于不平等 我们社会的政治和经济组织内。06:48pact:n.协定;公约;条约;契约 Hippocratic:ad

33、j.(古希腊医师)希波克拉底的;希波克拉底医学派的 Oath:n.誓言,誓约;诅咒,咒骂variants:n.计变体;变异型(variant的复数)sanctity:n.圣洁;尊严;神圣不可侵犯性 epidemics:n.流行病;蔓延(epidemic的复数);时疫 fissures:n.裂纹(fissure的复数形式);涂料材龟裂/v.(使)分裂(fissure的第三人称单数形式)reflecting:adj.反射的;沉思的/v.反射;表明;考虑(reflect的ing形式)marginalization:n.边缘化;忽视;排斥 exclusion:n.排除;排斥;驱逐;被排除在外的事物 d

34、iscrimination:n.歧视；区别，辨别；识别力 gender:n.性;性别;性交/vt.生(过去式gendered,过去分词gendered,现在分词gendering,第三人称单数genders,形容词genderless)sexuality:n.胚性别;性欲;性征;性方面的事情(比如性行为或性能力)Ebola:n.埃博拉病毒 anthropologists:人类人类学家 Haiti:n.海地 inequities:n.不公平待遇(inequity的复数形式)embedded:adj.嵌入式的;植入的;内含的/v.嵌入(embed的过去式和过去分词形式)often in ways

35、that are invisible to those with privilege andpower;and violence because its impact-premature deaths,suffering,illness-is violent.那些有特权和权力的人通常是看不到的;它是暴力的,因为它所造成的影响-过早死亡,痛苦,疾病-这就是暴力。07:05www.XiYuS锡育软件We do little for our patients if we fail to recognize thesesocial injustices.我们为病人做得很少,如果我们没有意识到 这些社会

36、的不公平。07:21Sounding the alarm is the first step towards doing publichealth right,and its how we may rally support to breakthrough and create real change together.发警报是走向正确的公共医疗的第一步,我们也才得到支援,去突破及共同创造真正的改变。07:28So these days,Im not staying quiet.因此现在,我不会再保持沉默。07:43Im speaking up about a lot of things,ev

37、en when it makeslisteners uncomfortable,even when it makes meuncomfortable.我会讲出很多事情,即使听众听起来不舒服,即使连自己也不舒服。07:46And a lot of this is about racial disparities andinstitutionalized racism,things that were not supposed tohave in this country anymore,certainly not in the practice ofmedicine or public heal

38、th.许多是有关种族差异对待,及制度化的种族主义。这些其实不应该还存在于我们的国家,特别不应该在医疗,或公共卫生。07:57But we have them,and we pay for them in lives cut short.但我们都还有这些问题,我们以许多的早夭的生命付出代价。08:11premature:adj.早产的；不成熟的；比预期早的/n.早产儿；过早发生的事物 injustices:n.不公正;不讲道义 breakthrough:突破;突围;有重要创见 listeners:n.听众;监听器(listener的复数)disparities:不一致(disparity的复数)

39、institutionalized:adj.使成惯例的;有组织的/v.使成为惯例(institutionalize的过去式和过去分词)racism:n.种族主义,种族歧视;人种偏见 cut short:v.缩短;打断;缩减Thats why sounding the alarm about the impact of racism onhealth in the United States,the ongoing institutional and这就是为什么要响起警报 在美国种族主义对医疗的影响,继续在发生的对有色人种的机构性和人际的暴力,发出警报。这些加上我们的悲剧性的遗产health i

40、n the United States,the ongoing institutional andinterpersonal violence that people of color face,compounded by our tragic legacy of 250 years of slavery,90years of Jim Crow and 60 years of imperfect equality,sounding the alarm about this is central to doing my jobright as New York Citys Health Comm

41、issioner.的暴力,发出警报。这些加上我们的悲剧性的遗产更为严重:250年的奴隶制度,90多年的种族隔离,以及60多年来的不平等。对这些问题拉警报,是我做为纽约市卫生专员 的工作核心。08:18In New York City,premature mortality-thats death beforethe age of 65-is 50 percent higher for black men thanwhite ones.在纽约市,市民过早死亡-即65岁之前去逝-黑人男性比白人高出50%。08:55A black woman in 2012 faced more than 10 t

42、imes the risk ofdying related to childbirth as a white woman.在 2012 年的黑人女性,在分娩时死亡的机率 是白人妇女的十倍。09:04And though weve made enormous strides in reducinginfant mortality rates,a black baby still faces nearly threetimes the risk of death in its first year of life as compared to awhite baby.尽管我们在 黑人婴儿09:13

43、institutional:adj.制度的;制度上的/学会的;由来已久的;习以为常的/公共机构的;慈善机构的 compounded:adj.生物复合的,化合的/v.混合;组成(compound的过去分词)legacy:n.遗赠，遗产 imperfect:adj.有缺点的;未完成的;半过去的;未完成时的/n.未完成体/adv.有瑕疵地;有缺点地 Commissioner:n.理事;委员;行政长官;总裁 mortality:n.死亡数,死亡率;必死性,必死的命运 childbirth:n.分娩 enormous:adj.庞大的，巨大的；凶暴的，极恶的 strides:n.大步;步幅(stride的

44、复数形式)/v.跨过;迈步(stride的第三人称单数形式)New York Citys not exceptional.纽约市也不例外。09:31These statistics are paralleled by statistics found across theUnited States.这些统计数字09:33A recent New York Times analysis reported that there are 1.5million missing black men across the country.最近纽约时报的一个分析,报导说全国各地有150万黑人男性失踪。09:

45、42They noted that more than one out of every six black menwho today should be between the ages of 25 and 54 yearshave disappeared from daily life,lost either to prison orpremature death.他们指出在 每六名黑人男性中至少有一位,他们现在的年龄应该是在25至54岁之间,从日常生活中消失。他们正被监禁或过早死亡。09:53There is great injustice in the daily and dispro

46、portionateviolence faced by young black men,the focus of recentprotests under the banner#BlackLivesMatter.对于 面对日常和过份暴力的年轻黑人男性很不公平。聚焦于最近举着”黑人生命可贵“标语抗议活动。10:12But we have to remember that enduring and disparate ratesand the occurrence and outcome of common medicalconditions-heart disease,cancer,diabet

47、es,HIV-diseasesthat may kill slowly and quietly and take even more blacklives prematurely.但是我们必须记着 那忍耐能力和截然不同进度 常见疾病的发生率和结果 心脏病,癌症,糖尿病,爱滋病等 那些慢慢地安静地杀死我们的疾病,让更多黑人更早逝。10:25exceptional:adj.异常的，例外的/n.超常的学生 statistics:n.统计;统计学;统计统计资料 paralleled:adj.并行的,平行的injustice:n.不公正;不讲道义 protests:v.抗议;反对(protest的三单形

48、式)/n.抗议(protest的复数)enduring:adj.持久的;能忍受的/v.忍耐(endure的ing形式)disparate:adj.不同的;不相干的;全异的/n.无法相比的东西 diabetes:n.糖尿病;多尿症prematurely:adv.过早地;早熟地As the#BlackLivesMatter movement unfolded,I feltfrustrated and angry that the medical community has beenreluctant to even use the word racism由于”黑人生命可贵“运动展开,我感到沮丧和愤

49、怒,因为医学界,在我们的研究和工作中发现,10:46in our research and our work.甚至不愿意用“种族主义”这字眼。11:00Youve probably felt something every time Ive said it.每次我讲到这里可能你们已经感受到11:02Our medical students held die-ins in their white coats,butthe medical community has largely stood by passively asongoing discrimination continues to a

50、ffect the disease profileand mortality.我们的医学学生穿着白色外套举行装死示威,但是医学界基本上是袖手旁观着 持续的歧视继续影响着 疾病的资料和死亡率.11:06And I worry that the trend towards personalized andprecision medicine,looking for biological or genetic targetsto better tailor treatment,may inadvertently cause us tolose sight of the big picture,tha