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When I first became a doctor in Benin City, Nigeria, some 30-odd years ago, I was drawn to help people live full lives.
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，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。
Here I was, a brand-new doctor with all these skills,
我这个初出茅庐的医生掌握了各种技能，
but I couldn't cure my patients who had chronic diseases -- illnesses like heart disease, asthma, diabetes
却无法治愈被慢性病--诸如心脏病、哮喘、糖尿病之类的疾病，
and needed more than just handing them a prescription or providing grief counseling in the office to get the job done.
折磨的病人们，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。
Fast-forward 15 years later: I'm in Atlanta, Georgia; it's a different world, but it was déjà vu all over again.
将时间快进到十五年后：我身处佐治亚州亚特兰大；这是个截然不同的世界，却有似曾相识的既视感。
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。
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. If you have medications you're supposed to take every day, what do you do when you're sick?
让我给各位举几个例子。如果你有每天需要服用的药物，在患病时你该怎么办？
Are you still supposed to take it? How do you recognize a complication when it happens?
你还应该继续吃药吗？你该如何识别并发症？
How do you recognize a side effect when it happens? What do you do with it?
你该如何识别副作用？该如何应对这些状况？
In addition to all of this,
除此之外，
they're dealing with the inevitable loneliness, isolation and anxiety that people who have chronic illnesses deal with.
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 the US alone, six in 10 adults have a chronic illness. That's 125 million people.
仅在美国，十个成年人中就有六个患有慢性疾病，加起来就是1.25亿人。
A recent report from the Robert Wood Johnson Foundation showed that
罗伯特·伍德·约翰逊基金会一项最近的报告显示，
health habits account for 50 percent of the health outcomes that people experience,
健康习惯能决定人们健康结果的50%，
while medical care only accounts for 20 percent.
而医疗护理只能决定20%。
In fact, the Centers for Disease Control says that if we could eliminate smoking, physical inactivity and poor nutrition,
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，
that we can prevent 80 percent of heart disease, 80 percent of type 2 diabetes and 40 percent of cancer.
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。
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: What if we could create a resource that could motivate people to change health behavior?
因此我们提出了这个问题：如果我们能创建一个可以鼓励人们改变健康习惯的办法呢？
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。
But many a time, they're not easily accessible or relatable,
但很多时候，这些资源难以获得或者和个人情况不相符，
particularly to individuals within minority and underserved communities,
尤其是对于身处少数族裔和服务水平低下的社区的人，
who face bias in addition to barriers like language and culture and inadequate health insurance coverage.
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。
And so in the last 12 years, my colleagues and I at Morehouse School of Medicine
因此在过去的十二年里，我和莫尔豪斯医学院的同事们
have created a technology-based application to assist with chronic illness care.
制作了一个基于科技的应用，用于协助慢性疾病的护理。
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
我们让人们追踪像血压、血糖等数据，
and then report it back to them in a color-coded format.
并将这些数值用颜色标注后反馈给他们。
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。
We link these stats to a curriculum.
我们将这些数据和设计的课程相链接。
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,
还有健康教练辅导他们学习自我管理的技能，
skills that'll help them prevent complications of their illness.
帮助他们预防疾病的并发症。
In order for the coach to be successful,
健康教练想要有所成效，
they have to be able to gain the trust of the individual that they're working with.
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,
我们在诊所测试了这个应用，由医学助理们担任健康教练；
and in a large urban church, where the health coaches were volunteers from the health ministry.
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。
A year later, a third of the participants were able to acquire three new self-management skills
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，
and maintain them to the extent that it was able to improve their blood pressures, their blood sugar and their exercise.
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。
Now, what was simple yet fascinating to us was that
对于我们来说，一个简单却奇妙的发现是，
the group from the church did just as well or even better than the group that were under purely medical care.
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。
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
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，
and what we learned was that the coaches from the church did have more time to spend with the patients,
我们发现，教会的健康教练们有更多时间和患者们相处，
they had access to the patients' families,
他们和患者的家庭有所接触，
and so they could figure out what people needed and provide those resources for them.
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”。
To illustrate this concept of culturally congruent coaching, I want to tell you about one of our patients.
为了阐释这个概念，我想给各位讲讲一位患者的故事。
I'll call her Ms. Bertha. So Ms. Bertha is an 83-year-old lady with diabetes and hypertension.
我将她称为伯莎女士。伯莎女士是一位83岁的女性，患有糖尿病与高血压。
She was assigned to Anne, her health coach in the church.
她被分配给了安妮，即她在教会中的健康教练。
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。
Anne observed after the first few visits that
安妮在头几次辅导后发现，
even though Ms. Bertha faithfully recorded her stats, they were all showing up as red.
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。
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。
She told her that there were times when her medications made her feel weird,
她告诉安妮，有些时候她的药让自己感觉怪怪的，
and she wouldn't take them the way they were prescribed,
于是她没有按照医嘱吃药，
because she thought it was due to the medicines but she didn't tell her doctor that.
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。
She also skipped out on some doctor appointments for a variety of reasons,
她还因为种种原因跳过了几次和医生预约的看诊，
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.
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。
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, Anne was able to print out a log of all these stats that Ms. Bertha had been collecting,
在那次辅导中，安妮打印出了伯莎女士一直在收集的数据的记录，
gave them to her and encouraged them to go see the doctor together, which they did.
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。
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
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，
and probe Ms. Bertha's deep culture and was able to reach her at that level.
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. That's our culture.
我们都有深层的无意识准则驱动我们做出健康决策。这即是我们的文化。
The relationship and the conversation between Anne and Ms. Bertha illustrates
安妮和伯莎女士的关系与对话向我们彰显了
what's possible when we have conversations with our patients, our friends and our neighbors on a deep cultural level.
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。
And personally, I'm beyond excited to think that with this simple concept of culturally congruent coaching,
就我个人来说，我感到无比激动，当我想到这个简单的文化一致的辅导，
we could change the lives of 125 million Americans and many others across the world that are living with chronic diseases. Thank you.
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的时候。谢谢大家。
