演講MP3+雙語文稿:為什么要訓練祖母治療抑郁癥

聽力課堂TED音頻欄目主要包括TED演講的音頻MP3及中英雙語文稿，供各位英語愛好者學習使用。本文主要內(nèi)容為演講MP3+雙語文稿:為什么要訓練祖母治療抑郁癥，希望你會喜歡！

【演講者及介紹】Dixon Chibanda

精神病學家，對人類大腦充滿熱情，他研究大腦如何影響我們的行為，以及我們?nèi)绾巫霾拍茏屆總€人都開心。

【演講主題】為什么要訓練祖母治療抑郁癥

【中英文字幕】

Translated by Qikai Guo. Reviewed by Chan Yuxin

00:00

On a warm August morning in Harare, Farai, a 24-year-old mother of two, walks towards a park bench. She looks miserable and dejected. Now, on the park bench sits an 82-year-old woman, better known to the community as Grandmother Jack. Farai hands Grandmother Jack an envelope from the clinic nurse. Grandmother Jack invites Farai to sit down as she opens the envelope and reads. There's silence for three minutes or so as she reads. And after a long pause, Grandmother Jack takes a deep breath, looks at Farai and says, "I'm here for you. Would you like to share your story with me?"

在哈拉雷（津巴布韋首都） 8 月的一個溫暖的早晨，范蕾，一位有兩個孩子的 24 歲母親 走向了公園的長凳。她看起來痛苦又沮喪。那條長凳上還坐著 一位 82 歲的老婦人，社區(qū)的人都親切的叫她 杰克奶奶。范蕾遞給杰克奶奶一個 從診所護士那拿到的信封。杰克奶奶請范蕾坐下，在她打開信封并閱讀時，有大概三分鐘，兩人都默不作聲。過了一會兒，杰克奶奶深吸了一口氣，看著范蕾說，“有我在呢。想和我說說你的故事嗎？”

01:01

Farai begins, her eyes swelling with tears. She says, "Grandmother Jack, I'm HIV-positive. I've been living with HIV for the past four years. My husband left me a year ago. I have two kids under the age of five. I'm unemployed. I can hardly take care of my children."

范蕾開始了講述，她的眼睛滿含淚水。她說，“杰克奶奶，我的艾滋病檢測結(jié)果呈陽性。過去四年來，我一直是艾滋病毒攜帶者。我的丈夫一年前離開我了。我有兩個孩子，他們都還不到五歲。我還失業(yè)了，我?guī)缀鯚o力撫養(yǎng)我的孩子。

01:28

Tears are now flowing down her face. And in response, Grandmother Jack moves closer, puts her hand on Farai, and says, "Farai, it's OK to cry. You've been through a lot. Would you like to share more with me?"

這時眼淚不停地從她臉頰流下。作為回應，杰克奶奶坐近了一些，并且輕輕撫摸范雷，她說，“范雷，哭吧，沒關(guān)系的。你經(jīng)歷了很多。你想和我再說說嗎？”

01:47

And Farai continues. "In the last three weeks, I have had recurrent thoughts of killing myself, taking my two children with me. I can't take it anymore. The clinic nurse sent me to see you." There's an exchange between the two, which lasts about 30 minutes. And finally, Grandmother Jack says, "Farai, it seems to me that you have all the symptoms of kufungisisa."

接下來，范雷繼續(xù)了講述。“在過去的三周里，我經(jīng)常想到自殺，帶著我的兩個孩子一起。我真的無法承受了。是診所護士讓我來見你的。” 在接下來的三十分鐘里，她們互訴衷腸。最后，杰克奶奶說，“范雷。在我看來，你有 kufungisisa 的所有癥狀?！?/p>

02:25

The word "kufungisisa" opens up a floodgate of tears. So, kufungisisa is the local equivalent of depression in my country. It literally means "thinking too much." The World Health Organization estimates that more than 300 million people globally, today, suffer from depression, or what in my country we call kufungisisa. 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. And most of these deaths are occurring in low- and middle-income countries.

kufungisisa 這個詞 讓范蕾再也止不住淚水。事實上，在我的國家，kufungisisa 就相當于抑郁癥。它的字面意思是 “想的太多”。根據(jù)世界衛(wèi)生組織的估計，目前全球有 3 億多人患有抑郁癥，或者用我國的叫法，患上了 Kufungisisa。世界衛(wèi)生組織也告訴我們，每 40 秒鐘。世界的某個角落就會有人自殺，因為他們活得不快樂，主要是由于患有 抑郁癥或 kufungisisa。大部分的自殺行為 都發(fā)生于中低收入的國家。

03:17

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. 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. But one thing that we do know is that depression can be treated and suicides averted.

事實上，世界衛(wèi)生組織甚至表明，年齡在 15 歲到 29 歲之間的群體中，目前主要的死因就是自殺。但導致抑郁癥甚至自殺的原因 其實有很多，比如虐待，沖突，暴力，孤立，寂寞，等等。但我們知道的是，抑郁癥是可治療的，自殺也是可避免的。

03:54

But the problem is we just don't have enough psychiatrists or psychologists in the world to do the job. 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, which literally means that 90 percent of the people needing mental health services will not get it. In my country, there are 12 psychiatrists, and I'm one of them, for a population of approximately 14 million.

但問題是，世界上沒有足夠的 精神病學家或心理學家 來完成這項工作。比如在大多數(shù)中低收入的國家，精神科醫(yī)生與總?cè)丝诘谋壤?是 1 比 150 萬。這個數(shù)字意味著 90％ 需要 心理健康服務的人群 無法得到應有的服務。在我的祖國，共有 12 位精神科醫(yī)生，我就是其中之一，要為約 1400 萬人口服務。

04:28

Now, let me just put that into context. One evening while I was at home, I get a call from the ER, or the emergency room, from a city which is some 200 kilometers away from where I live. 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. Hemodynamically, they seem to be OK, but they will need neuropsychiatric evaluation." Now, I obviously can't get into my car in the middle of the night and drive 200 kilometers. So as best as we could, over the phone with the ER doctor, we come up with an assessment. We ensure that suicidal observations are in place. 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 -- 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.

現(xiàn)在，我給大家講個實際的例子。一天晚上，我在家休息，接到了一個 ER，也就是急診室的 電話，那個城市和我住的地方 相距 200 公里。急診室醫(yī)生說，“你的一個病人，就是四個月前接受治療的那個，現(xiàn)在服藥過量，正在一個急診科里。從血流動力上看沒什么問題，但需要進行神經(jīng)精神病方面的評估。” 但我當時顯然不會在半夜驅(qū)車 200 公里到達現(xiàn)場。所以我當時能做的 就是和電話那頭急診室醫(yī)生 進行了一個評估。我們確認自殺監(jiān)管到位。我們確認我們檢查了那個病人 一直服用的抗抑郁藥物，最后我們得出結(jié)論，26 歲的愛瑞卡——那是她的名字—— 一旦愛瑞卡可以從急診室出院，她應該和她母親直接來我這里，然后我會評估她的精神狀況，也會盡我所能來幫助她。

05:39

And we assumed that that would take about a week. A week passes. Three weeks pass. No Erica. And one day I get a call from Erica's mother, and she says, "Erica committed suicide three days ago. She hanged herself from the mango tree in the family garden." Now, almost like a knee-jerk reaction, I couldn't help but ask, "But why didn't you come to Harare, where I live? We had agreed that as soon as you're released from the ER, you will come to me." Her response was brief. "We didn't have the 15 dollars bus fare to come to Harare."

我們估計那要花大概一周。一周過去了，三周過去了，愛瑞卡沒有來。一天我接到了愛瑞卡母親的電話，她說，“愛瑞卡三天前自殺了。她在自家院子里的 芒果樹上上吊了?！?那時候，就像膝跳反射一樣，我忍不住問道，“但是你們?yōu)槭裁礇]來 我在哈拉雷的住處？ 我們都說好了，一旦愛瑞卡出院，你們就會過來?！?她的答案很簡短，“我們付不起十五美元的巴士錢，去不了哈拉雷?！?/p>

06:28

Now, suicide is not an unusual event in the world of mental health. But there was something about Erica's death that struck me at the core of my very being. That statement from Erica's mother: "We didn't have 15 dollars bus fare to come to you," made me realize that it just wasn't going to work, me expecting people to come to me. And I got into this state of soul-searching, trying to really discover my role as a psychiatrist in Africa.

在精神健康領(lǐng)域，自殺很常見。但是愛瑞卡的死 卻深深地震撼了我。愛瑞卡母親的話： “我們付不起十五美元的 巴士錢去找你，” 讓我明白了，讓病人來找我，根本就行不通。我開始進行深刻的反思，想要探尋我作為非洲的 一名精神病學家的角色。

07:09

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. Yes, grandmothers. And I thought, grandmothers are in every community. There are hundreds of them. And --

在經(jīng)過一系列咨詢和自我反思，以及和同事、朋友和家人的交流后，我突然之間明白了，實際上，在非洲，我們最可靠的資源 就是我們的奶奶們。沒錯，奶奶們。我認為，奶奶們無處不在。數(shù)量眾多，而且——

07:37

(Laughter)

（笑聲）

07:38

And they don't leave their communities in search of greener pastures.

而且也不會拋下我們 去追求更好的生活。

07:43

(Laughter)

（笑聲）

07:45

See, the only time they leave is when they go to a greener pasture called heaven.

她們唯一離開的時候，是要去一個更好的地方，天堂。

07:49

(Laughter)

（笑聲）

07:50

So I thought, how about training grandmothers in evidence-based talk therapy, which they can deliver on a bench? 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 technology. You know, mobile phone technology. Pretty much everyone in Africa has a mobile phone today.

所以我想，何不訓練一下奶奶們，讓她們進行循證型的談話治療，在長凳上就能進行？ 讓她們可以通過傾聽他人 來表達同情心。這些都源于認知行為療法； 可以讓奶奶們提供行為激活，安排活動日程，并且讓她們運用數(shù)碼科技，就是移動電話技術(shù)。畢竟在非洲，現(xiàn)在幾乎每個人都有手機。

08:26

So in 2006, I started my first group of grandmothers.

所以在 2006 年，我開創(chuàng)了我的第一個 奶奶團。

08:33

(Applause)

（掌聲）

08:37

Thank you.

謝謝。

08:38

(Applause)

（掌聲）

08:41

Today, there are hundreds of grandmothers who are working in more than 70 communities. 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.

現(xiàn)在，已經(jīng)有數(shù)百位奶奶們 在超過 70 個社區(qū)中工作。僅在去年，就有超過三萬人 在友情長凳上 接受了津巴布韋 某個社區(qū)的奶奶的治療。

09:01

(Applause)

（掌聲）

09:09

And recently, we published this work that is done by these grandmothers in the Journal of the American Medical Association. And --

最近，我們將 這些奶奶們完成的工作 發(fā)布在了美國醫(yī)學會的期刊上。不僅如此——

09:18

(Applause)

（掌聲）

09:20

And our results show that six months after receiving treatment from a grandmother, people were still symptom-free: no depression, suicidal ideation completely reduced. In fact, this clinical trial showed that grandmothers were more effective at treating depression than doctors and --

我們的數(shù)據(jù)表明，在經(jīng)過一位奶奶 六個月的治療后，人們的病癥紛紛消失了： 也不再抑郁，自殺想法大大降低。這個臨床試驗表明，我們的奶奶們相比醫(yī)生 要有效得多。

09:45

(Laughter)

（笑聲）

09:46

(Applause)

（掌聲）

09:54

And so, we're now working towards expanding this program. There are more than 600 million people currently aged above 65 in the world. And by the year 2050, there will be 1.5 billion people aged 65 and above. 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. And they will make a difference in communities. They will reduce the treatment gap for mental, neurological and substance-use disorders.

所以，我們現(xiàn)在正在致力于 擴大這個項目。全世界目前有 6 億 65 歲以上的人。到了 2050 年，這個人數(shù)會增加到 15 億。想像一下，如果我們 在全世界的所有主要城市 創(chuàng)造一個奶奶們的關(guān)系網(wǎng)絡，她們都受過循證談話治療的訓練，并由電子平臺支持，通過網(wǎng)絡工作。她們會在社區(qū)中起到顯著的作用，減少精神，神經(jīng) 和藥物使用障礙方面的治療缺口。

10:48

So, Farai had six sessions on the bench with Grandmother Jack. Today, Farai is employed. She has her two children at school. And as for Grandmother Jack, one morning in February, we expected her to see her 257th client on the bench. She didn't show up. She had gone to a greener pasture called heaven. 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. 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 and coming closer to home here in the Unites States in the city of New York. May her soul rest in peace.

范蕾在這張長凳上和杰克奶奶 進行了六個療程的治療?，F(xiàn)在，范蕾有了工作，兩個孩子也在上學。至于杰克奶奶，二月的一天早晨，我們以為 她會在長凳上治療第 257 名病人，但她并沒有出現(xiàn)。因為她去了一個更好的地方，天堂。但我相信杰克奶奶 一直以來都在天堂 鼓舞著其他的奶奶們—— 幫助著許多人的，隊伍不斷壯大的奶奶們。我也相信，當她知道她所倡導的精神 正在其他國家不斷傳播，比如馬拉維，桑給巴爾島，同時也將馬上 影響到美國，就在紐約，我相信她一定會感到敬畏。愿她的靈魂安息。

12:00

Thank you.

謝謝。

12:01

(Applause)

（掌聲）

12:04

(Cheering)

（歡呼）

12:06

(Applause)

（掌聲）