ABOUT THE SPEAKER
Sonia Shah - Science writer
Science historian Sonia Shah explores the surprisingly fascinating story behind an ancient scourge: malaria.

Why you should listen

Aided by economics, culture, its own resilience and that of the insect that carries it (the mosquito), the malaria parasite has determined for thousands of years the health and course not only of human lives, but also of whole civilizations. In her book The Fever, author Sonia Shah outlines the epic and devastating history of malaria and shows how it still infects 500 million people every year, and kills half a million, in a context where economic inequality collides with science and biology.

Shah’s previous book The Body Hunters established her as a heavy hitter in the field of investigative human rights reporting. She is a frequent contributor to publications such as Scientific American, The Nation and Foreign Affairs.

More profile about the speaker
Sonia Shah | Speaker | TED.com
TEDGlobal 2013

Sonia Shah: 3 reasons we still haven’t gotten rid of malaria

索尼亚·撒哈: 我们仍然没有清除疟疾的三个原因

Filmed:
1,233,836 views

自17世纪以来,我们就已经知道如何治疗疟疾了,那么,为何这种疾病每年仍然会杀害成千上万的人呢?记者索尼娅·沙阿认为它不仅仅是一个医学问题。翻看疟疾的历史,为我们揭示了消灭疟疾所面临的三大挑战。
- Science writer
Science historian Sonia Shah explores the surprisingly fascinating story behind an ancient scourge: malaria. Full bio

Double-click the English transcript below to play the video.

00:12
So over the long course课程 of human人的 history历史,
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在漫长的人类历史中,
00:16
the infectious传染病 disease疾病 that's killed杀害 more humans人类
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疟疾是
00:18
than any other is malaria疟疾.
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致死率最高的传染性疾病。
00:21
It's carried携带的 in the bites咬伤 of infected感染 mosquitos蚊子,
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它由受感染的蚊子叮咬传播,
00:24
and it's probably大概 our oldest最老的 scourge灾害.
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可能是人类最古老的灾难了。
00:26
We may可能 have had malaria疟疾 since以来 we evolved进化 from the apes类人猿.
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从人猿时代起疟疾可能就已经存在了。
00:30
And to this day, malaria疟疾 takes a huge巨大 toll收费 on our species种类.
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直至今天,疟疾已经夺去了许多许多人的生命。
00:33
We've我们已经 got 300 million百万 cases a year
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每年有3亿人疟疾患者,
00:36
and over half a million百万 deaths死亡.
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其中有超过50万人死亡,
00:39
Now this really makes品牌 no sense.
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这真让人匪夷所思。
00:42
We've我们已经 known已知 how to cure治愈 malaria疟疾
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自17世纪起,
00:44
since以来 the 1600s.
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我们就已经知道如何治疗疟疾。
00:46
That's when Jesuit耶稣会 missionaries传教士 in Peru秘鲁
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耶稣会传教士在秘鲁
00:48
discovered发现 the bark of the cinchona金鸡纳 tree,
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发现金鸡纳树的树皮。
00:51
and inside that bark was quinine奎宁,
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金鸡纳树树皮中的奎宁可以治疗疟疾,
00:53
still an effective有效 cure治愈 for malaria疟疾 to this day.
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这种方法至今有效。
00:56
So we've我们已经 known已知 how to cure治愈 malaria疟疾 for centuries百年.
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所以,我们知道如何治疗疟疾已经有几个世纪的时间了。
00:59
We've我们已经 known已知 how to prevent避免 malaria疟疾 since以来 1897.
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从1897年开始,我们就知道如何预防疟疾。
01:02
That's when the British英国的 army军队 surgeon外科医生 Ronald罗纳德 Ross罗斯
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那时英国军队外科医生罗纳德-罗斯
01:05
discovered发现 that it was mosquitos蚊子 that carried携带的 malaria疟疾,
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发现了是蚊子传染疟疾,
01:08
not bad air空气 or miasmasmiasmas, as was previously先前 thought.
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而不是之前认为的空气质量或雾霾问题
01:12
So malaria疟疾 should be a relatively相对 simple简单 disease疾病 to solve解决,
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所以,疟疾应该是一种容易攻克的疾病,
01:18
and yet然而 to this day, hundreds数以百计 of thousands数千 of people
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但直到今天,仍然有成千上万的人
01:22
are going to die from the bite of a mosquito蚊子.
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因为被一只蚊子叮咬而丧命。
01:25
Why is that?
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为什么呢?
01:26
This is a question that's
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这是一个很长时间以来
01:28
personally亲自 intrigued好奇 me for a long time.
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一直在困惑我的一个问题。
01:30
I grew成长 up as the daughter女儿 of Indian印度人 immigrants移民
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我来自一个印度移民家庭,
01:33
visiting访问 my cousins表兄弟 in India印度 every一切 summer夏季,
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每年夏天,我会去印度看望我的表兄弟姐妹们,
01:35
and because I had no immunity免疫 to the local本地 malariasmalarias,
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因为我对当地的疟疾没有免疫力,
01:38
I was made制作 to sleep睡觉 under this hot, sweaty出汗 mosquito蚊子 net every一切 night
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每晚我不得不睡在那种非常闷热的蚊帐里,
01:42
while my cousins表兄弟, they were allowed允许 to sleep睡觉
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但我的表兄弟姐妹们却可以被允许
01:44
out on the terrace阳台 and have
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在露台上睡觉,
01:45
this nice不错, cool night breeze微风 wafting飘出 over them.
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享受从他们身上吹佛而过的舒爽夜风。
01:48
And I really hated the mosquitos蚊子 for that.
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因为这个,我特别痛恨蚊子。
01:52
But at the same相同 time, I come from a Jain耆那教 family家庭,
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但与此同时,我也是来自一个耆那教的家庭,
01:55
and Jainism耆那教 is a religion宗教 that espouses拥护
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耆那教是一个极其信奉
01:57
a very extreme极端 form形成 of nonviolence非暴力.
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非暴力形式的宗教。
02:00
So Jains耆那教徒 are not supposed应该 to eat meat.
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所以,耆那教徒不吃肉。
02:04
We're not supposed应该 to walk步行 on grass,
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不能在草地上走,
02:06
because you could, you know,
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因为那样的话
02:07
inadvertently不经意间 kill some insects昆虫 when you walk步行 on grass.
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你无意中会杀死一些昆虫。
02:09
We're certainly当然 not supposed应该 to swat扑打 mosquitos蚊子.
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当然,我们也不能打蚊子。
02:12
So the fearsome可怕的 power功率 of this little insect昆虫
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所以,这小小的昆虫所拥有的如此可怕的力量,
02:15
was apparent明显的 to me from a very young年轻 age年龄,
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在我很小时候就令我印象深刻,
02:17
and it's one reason原因 why I spent花费 five years年份 as a journalist记者
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而这也是为什么我作为一名记者
02:20
trying to understand理解, why has malaria疟疾
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花了五年时间去尝试了解
02:23
been such这样 a horrible可怕 scourge灾害 for all of us for so very long?
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为什么疟疾会成为人类持续的灾难。
02:28
And I think there's three main主要 reasons原因 why.
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我认为主要有三个原因,
02:30
Those three reasons原因 add up to the fourth第四 reason原因,
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这三个原因共同导致第四个原因,
02:33
which哪一个 is probably大概 the biggest最大 reason原因 of all.
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而这第四个可能就是其中的主导因素。
02:36
The first reason原因 is certainly当然 scientific科学.
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第一个原因是科学相关的。
02:39
This little parasite寄生物 that causes原因 malaria疟疾,
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这种引起疟疾的小小的病原寄生虫,
02:41
it's probably大概 one of the most complex复杂
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可能是人类已知的最复杂
02:43
and wily诡计多端的 pathogens病原体 known已知 to humankind人类.
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最狡猾的病原体之一。
02:45
It lives生活 half its life inside the cold-blooded冷血 mosquito蚊子
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它生命的一半时间生活在冷血动物――蚊子体内,
02:49
and half its life inside the warm-blooded温血的 human人的.
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另一半生命则生活在恒温动物――人类体内。
02:53
These two environments环境 are totally完全 different不同,
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这是两种完全不同的环境,
02:56
but not only that, they're both utterly完全 hostile敌对.
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而且它们在两种环境下都是有害的。
02:59
So the insect昆虫 is continually不断 trying to fight斗争 off the parasite寄生物,
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因此,昆虫不断试图击退寄生虫,
03:03
and so is the human人的 body身体 continually不断 trying to fight斗争 it off.
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人类的身体也不断地尝试抵抗它。
03:06
This little creature生物 survives生存 under siege围城 like that,
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这种小小的生物体正是在这种围困下生存下来,
03:10
but not only does it survive生存, it has thrived蓬勃发展.
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而且还在蓬勃发展。
03:13
It has spread传播. It has more ways方法 to evade逃避 attack攻击 than we know.
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它拥有超过我们想象的更多方法来逃避攻击,继而传播蔓延。
03:17
It's a shape-shifter形状移位器, for one thing.
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就某一方面而言,这是一种蜕变。
03:19
Just as a caterpillar毛虫 turns into a butterfly蝴蝶,
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就像一条毛毛虫变成一只蝴蝶,
03:23
the malaria疟疾 parasite寄生物 transforms变换 itself本身 like that
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疟疾寄生虫在其生命中有7次
03:25
seven times in its life cycle周期.
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这样的蜕变。
03:28
And each of those life stages阶段 not only looks容貌 totally完全 different不同 from each other,
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各个生命阶段不只形态迥异,
03:33
they have totally完全 different不同 physiology生理.
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而且都有完全不同的生理状态。
03:36
So say you came来了 up with some great drug药物
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所以,当你找到一种很强大的药物
03:38
that worked工作 against反对 one stage阶段 of the parasite's寄生虫 life cycle周期.
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来对抗这种疟疾寄生虫生命周期的某一个阶段,
03:41
It might威力 do nothing at all to any of the other stages阶段.
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但对其他生命阶段可能完全无效。
03:44
It can hide隐藏 in our bodies身体, undetected未被发现,
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它隐藏在我们的体内,不被发现,
03:47
unbeknownst不知情 to us, for days, for weeks,
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瞒着我们,几天、几个星期、
03:49
for months个月, for years年份, in some cases even decades几十年.
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几个月、几年,有时甚至是几十年。
03:53
So the parasite寄生物 is a very big scientific科学 challenge挑战 to tackle滑车,
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所以这种疟疾寄生虫对科学研究而言形成巨大挑战,
03:58
but so is the mosquito蚊子 that carries携带 the parasite寄生物.
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携带疟疾寄生虫的蚊子也如此。
04:01
Only about 12 species种类 of mosquitos蚊子
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只有大约12种的蚊子
04:03
carry携带 most of the world's世界 malaria疟疾,
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携带了世界上大部分的疟疾,
04:05
and we know quite相当 a bit about the kinds of
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我们知道
04:07
watery含水 habitats栖息地 that they specialize专攻 in.
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它们擅长生活在有水的栖息地。
04:10
So you might威力 think, then, well, why don't we just
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所以,你可能会认为,
04:13
avoid避免 the places地方 where the killer凶手 mosquitos蚊子 live生活? Right?
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我们可以避开蚊子滋生的地方,对吧?
04:16
We could avoid避免 the places地方 where the killer凶手 grizzly灰熊 bears live生活
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我们可以不接近凶猛灰熊的住地
04:18
and we avoid避免 the places地方 where the killer凶手 crocodiles鳄鱼 live生活.
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也可以远离凶悍鳄鱼的活动区域。
04:21
But say you live生活 in the tropics热带
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但如果你生活在热带地区
04:24
and you walk步行 outside your hut棚屋 one day
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某天你在自家的房屋外面走
04:27
and you leave离开 some footprints脚印 in the soft柔软的 dirt污垢
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脚印留在了
04:29
around your home.
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门口的泥土上。
04:31
Or say your cow does, or say your pig does,
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又或是你的牛或猪在土中留下了一些蹄印,
04:35
and then, say, it rains降雨,
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然后,下雨了,
04:37
and that footprint脚印 fills填充 up with a little bit of water.
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那些印记里积满了水。
04:39
That's it. You've created创建 the perfect完善
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就这样,你已经为那些疟疾蚊子
04:41
malarial疟疾 mosquito蚊子 habitat栖息地 that's right outside your door.
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在你家门口打造了完美的栖息地。
04:45
So it's not easy简单 for us to extricate解脱 ourselves我们自己 from these insects昆虫.
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所以说,我们要摆脱这些昆虫并不容易。
04:48
We kind of create创建 places地方 that they love to live生活
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我们生活,
04:50
just by living活的 our own拥有 lives生活.
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其实也在为它们创建合适的生活环境。
04:52
So there's a huge巨大 scientific科学 challenge挑战,
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所以,这对科学来说是个巨大挑战,
04:54
but there's a huge巨大 economic经济 challenge挑战 too.
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对于经济来说,也同样是一个巨大挑战。
04:56
Malaria疟疾 occurs发生 in some of the poorest最穷
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疟疾发生在地球上那些最贫穷的
04:58
and most remote远程 places地方 on Earth地球,
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和最偏僻的地方,
05:00
and there's a reason原因 for that.
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这是有原因的。
05:02
If you're poor较差的, you're more likely容易 to get malaria疟疾.
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如果你很穷,你更有可能患上疟疾。
05:04
If you're poor较差的, you're more likely容易 to live生活
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因为你的贫穷使你更可能生活
05:06
in rudimentary初步 housing住房 on marginal边缘 land土地 that's poorly不好 drained倒掉.
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在贫瘠偏远地区简陋的房屋中,那里的排水往往不好,
05:10
These are places地方 where mosquitos蚊子 breed品种.
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也正是是滋生蚊子的好地方。
05:13
You're less likely容易 to have door screens屏幕 or window窗口 screens屏幕.
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你不太可能有门或窗户的屏障。
05:17
You're less likely容易 to have electricity电力
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你不太可能有电
05:19
and all the indoor室内 activities活动 that electricity电力 makes品牌 possible可能,
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所有通过电力所产生的室内活动都不太可能有,
05:22
so you're outside more.
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所以你会更多在户外待着,
05:23
You're getting得到 bitten被咬 by mosquitos蚊子 more.
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更多地被蚊子叮咬。
05:25
So poverty贫穷 causes原因 malaria疟疾,
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所以说贫穷导致疟疾。
05:27
but what we also know now is that malaria疟疾 itself本身
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但我们也知道
05:30
causes原因 poverty贫穷.
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疟疾本身也会导致贫困。
05:31
For one thing, it strikes罢工 hardest最难 during harvest收成 season季节,
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一方面,疟疾爆发最严重的时间是在收获季节,
05:34
so exactly究竟 when farmers农民 need to be out in the fields领域
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说以正当农民要在田地里收割庄稼的季节
05:37
collecting搜集 their crops作物, they're home sick生病 with a fever发热.
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他们经常会发烧生病在家。
05:41
But it also predisposes易患 people to death死亡
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当然这也容易引起其它疾病
05:44
from all other causes原因.
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最终导致死亡。
05:45
So this has happened发生 historically历史.
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所以,过去我们已经有能力
05:47
We've我们已经 been able能够 to take malaria疟疾 out of a society社会.
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将疟疾从人类社会中铲除。
05:50
Everything else其他 stays入住 the same相同,
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但其他一切却仍保持不变,
05:52
so we still have bad food餐饮, bad water, bad sanitation卫生,
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我们的食品安全、饮用水安全以及公共卫生都没有改善
05:54
all the things that make people sick生病.
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所有这些都会让人生病。
05:56
But just if you take malaria疟疾 out,
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但是,只要你清除了疟疾,
05:58
deaths死亡 from everything else其他 go down.
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其它因素致死的情况也会减少。
06:02
And the economist经济学家 Jeff杰夫 Sachs萨克斯 has actually其实 quantified量化
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经济学家杰夫-萨克斯对这一问题导致的社会影响
06:05
what this means手段 for a society社会.
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进行过量化分析
06:07
What it means手段 is, if you have malaria疟疾 in your society社会,
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这意味着,如果有疟疾存在,
06:10
your economic经济 growth发展 is depressed郁闷
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社会经济增长
06:12
by 1.3 percent百分 every一切 year,
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会因为这一种疾病
06:16
year after year after year, just this one disease疾病 alone单独.
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每年减少1.3%,
06:20
So this poses姿势 a huge巨大 economic经济 challenge挑战,
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这必然带来巨大的经济挑战。
06:22
because say you do come up with your great drug药物
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因为即便你有好的药品
06:25
or your great vaccine疫苗 -- how do you deliver交付 it
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或者强大的疫苗
06:27
in a place地点 where there's no roads道路,
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但对于一个车都不通
06:29
there's no infrastructure基础设施,
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没有基础设施
06:31
there's no electricity电力 for refrigeration冷藏 to keep things cold,
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没有电力制冷来低温保存物品
06:34
there's no clinics诊所, there's no clinicians临床医生
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没有诊所,也没有临床医生的地方,
06:37
to deliver交付 these things where they're needed需要?
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你如何把它们发送到那里去?
06:39
So there's a huge巨大 economic经济 challenge挑战 in taming驯服 malaria疟疾.
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所以,在制服疟疾时我们面临巨大的经济挑战。
06:43
But along沿 with the scientific科学 challenge挑战 and the economic经济 challenge挑战,
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在面临科学和经济挑战时,
06:46
there's also a cultural文化 challenge挑战,
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我们还面临文化方面的挑战,
06:48
and this is probably大概 the part部分 about malaria疟疾
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这大概是疟疾
06:51
that people don't like to talk about.
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让人们常常讳莫如深的那个方面。
06:54
And it's the paradox悖论 that the people
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悖论在于:世界上疟疾最多的地方,
06:56
who have the most malaria疟疾 in the world世界
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也是疟疾最不受重视
06:58
tend趋向 to care关心 about it the least最小.
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最不被在乎的地方。
07:01
This has been the finding发现 of medical anthropologists人类学家 again and again.
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医学人类学家的发现已经一次次的证明过这一点。
07:04
They ask people in malarious parts部分 of the world世界,
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他们问世界上疟疾流行地区的人们,
07:07
"What do you think about malaria疟疾?"
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"你怎么看疟疾这件事?"
07:09
And they don't say, "It's a killer凶手 disease疾病. We're scared害怕 of it."
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他们不会说,"它是一种致命的疾病。我们害怕它。”
07:13
They say, "Malaria疟疾 is a normal正常 problem问题 of life."
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他们说,"疟疾是一个正常的生活问题"。
07:18
And that was certainly当然 my personal个人 experience经验.
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那的确也是我的亲身经历。
07:20
When I told my relatives亲戚们 in India印度
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当我告诉我在印度的亲人们
07:22
that I was writing写作 a book about malaria疟疾,
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我正在写一本关于疟疾的书
07:24
they kind of looked看着 at me like
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他们看我的眼神,
07:26
I told them I was writing写作 a book about warts or something.
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好像我写的是一本关于瘊子之类的书。
07:28
Like, why would you write about something so boring无聊,
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仿佛在问,那么无聊的话题,你也写啊!?
07:31
so ordinary普通? You know?
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这太平常了,知道吗?
07:33
And it's simple简单 risk风险 perception知觉, really.
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它真是一个简单的风险认知。
07:36
A child儿童 in Malawi马拉维, for example,
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比如,有一个来自马拉维的小孩,
07:38
she might威力 have 12 episodes发作 of malaria疟疾 before the age年龄 of two,
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两岁之前就已经得过12次疟疾,
07:43
but if she survives生存,
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但是,如果她活下来了,
07:45
she'll贝壳 continue继续 to get malaria疟疾 throughout始终 her life,
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她的一生都将不停地患上疟疾,
07:48
but she's much less likely容易 to die of it.
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但因此致死的可能性会越来越小。
07:50
And so in her lived生活 experience经验,
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所以在她的生活里,
07:52
malaria疟疾 is something that comes and goes.
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疟疾不过是为来来去去的访客。
07:56
And that's actually其实 true真正 for most of the world's世界 malaria疟疾.
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对于世界上大部分的疟疾来说的确是这样的。
07:58
Most of the world's世界 malaria疟疾 comes and goes on its own拥有.
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世界上大部分的疟疾都是自己来自己去。
08:01
It's just, there's so much malaria疟疾
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只是,疟疾病例如此之多
08:04
that this tiny fraction分数 of cases that end结束 in death死亡
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一起起致死的病例加起来,
08:08
add up to this big, huge巨大 number.
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也就累积成巨大的数字。
08:11
So I think people in malarious parts部分 of the world世界
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所以,我认为在世界上疟疾流行地区的人们
08:13
must必须 think of malaria疟疾 the way
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看待疟疾的态度
08:15
those of us who live生活 in the temperate适度的 world世界
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就和我们这些生活在温带地区的人们看待
08:16
think of cold and flu流感. Right?
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感冒和流感一样。对吧?
08:18
Cold and flu流感 have a huge巨大 burden负担 on our societies社会
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感冒和流感对我们的社会和我们的生活
08:22
and on our own拥有 lives生活,
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造成了巨大的负担,
08:24
but we don't really even take
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但我们并不会
08:25
the most rudimentary初步 precautions注意事项 against反对 it because
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考虑采取一些哪怕是最基本的防范措施,
08:27
we consider考虑 it normal正常 to get cold and flu流感
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因为我们认为它们只不过是普通的疾病,
08:30
during cold and flu流感 season季节.
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就像在感冒和流感季节中常见的感冒和流感一样。
08:32
And so this poses姿势 a huge巨大 cultural文化 challenge挑战 in taming驯服 malaria疟疾,
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所以,这对驯服疟疾带来了巨大的文化挑战。
08:37
because if people think it's normal正常 to have malaria疟疾,
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因为,如果人们认为患上疟疾是正常的,
08:41
then how do you get them to run to the doctor医生
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那么,你怎么能让他们跑到医生那里
08:44
to get diagnosed确诊, to pick up their prescription处方,
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去治疗,开处方
08:47
to get it filled填充, to take the drugs毒品,
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拿药
08:49
to put on the repellents驱虫剂, to tuck in the bed nets?
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用上驱蚊用品,躺到蚊帐中去呢?
08:52
This is a huge巨大 cultural文化 challenge挑战 in taming驯服 this disease疾病.
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这的的确确是一个巨大的文化挑战。
08:57
So take all that together一起.
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所以把这些因素都凑在一起,
08:58
We've我们已经 got a disease疾病. It's scientifically科学 complicated复杂,
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我们可以说,
09:03
it's economically经济 challenging具有挑战性的 to deal合同 with,
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疟疾在医学上很复杂,在经济上的挑战也不好处理,
09:05
and it's one for which哪一个 the people who stand
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那些最该关注此疾病的人们
09:07
to benefit效益 the most care关心 about it the least最小.
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却对它不加重视
09:09
And that adds增加 up to the biggest最大 problem问题 of all,
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这所有一切加总起来,就导致了最大问题,
09:11
which哪一个, of course课程, is the political政治 problem问题.
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当然,就是政治问题。
09:14
How do you get a political政治 leader领导 to do anything
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政治领导人要怎样
09:17
about a problem问题 like this?
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才能为这类问题做一些什么呢?
09:19
And the answer回答 is, historically历史, you don't.
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答案是,从历史上看,不能。
09:24
Most malarious societies社会 throughout始终 history历史
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在整个历史上,大部分疟疾流行的社会
09:26
have simply只是 lived生活 with the disease疾病.
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就是简单地和这种疾病共存。
09:28
So the main主要 attacks攻击 on malaria疟疾 have come
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所以疟疾面对的主要攻击来源于
09:30
from outside of malarious societies社会,
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外部社会因素,
09:33
from people who aren't constrained受限
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来自于那些
09:34
by these rather paralyzing瘫痪 politics政治.
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不受制于此类瘫痪政治的人们。
09:37
But this, I think, introduces介绍 a whole整个 host主办 of other kinds of difficulties困难.
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但我觉得这一点必然会导致一系列各式各样的问题。
09:41
The first concerted一致 attack攻击 against反对 malaria疟疾
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第一次针对疟疾的协力防治
09:43
started开始 in the 1950s.
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开始于20世纪50年代,
09:45
It was the brainchild顺风顺水 of the U.S. State Department.
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耗费了美国国务院不少心血,
09:48
And this effort功夫 well understood了解 the economic经济 challenge挑战.
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在此期间也充分考虑了经济面临的挑战。
09:51
They knew知道 they had to focus焦点 on cheap低廉, easy-to-use使用方便 tools工具,
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他们知道必须着眼于便宜、 便捷的工具,
09:54
and they focused重点 on DDTDDT.
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所以着力使用了滴滴涕(译者注:DDT,一种杀虫剂)。
09:56
They understood了解 the cultural文化 challenge挑战.
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他们也理解了文化面临的挑战。
09:58
In fact事实, their rather patronizing光顾 view视图 was that
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事实上,当时的观点十分照顾病人,人们认为
10:01
people at risk风险 of malaria疟疾 shouldn't不能 be asked to do anything at all.
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不能向处于感染疟疾风险之中的人们提什么要求,
10:04
Everything should be doneDONE to them and for them.
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只要为他们采取一切可能采取的措施就行了。
10:07
But they greatly非常 underestimated低估 the scientific科学 challenge挑战.
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但他们大大低估了科学所面临的挑战。
10:10
They had so much faith信仰 in their tools工具
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他们对他们的工具如此有信心
10:13
that they stopped停止 doing malaria疟疾 research研究.
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以至于他们停止了对疟疾的研究,
10:16
And so when those tools工具 started开始 to fail失败,
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因此,当这些工具失败的时候,
10:18
and public上市 opinion意见 started开始 to turn against反对 those tools工具,
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公众的舆论开始反对,
10:21
they had no scientific科学 expertise专门知识 to figure数字 out what to do.
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而他们没有专业的科学知识可以应对这些。
10:25
The whole整个 campaign运动 crashed坠毁, malaria疟疾 resurged死灰复燃 back,
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整个运动残败,疟疾又死灰复燃、卷土重来了,
10:29
but now it was even worse更差 than before
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而且甚至比先前更猛烈
10:30
because it was corralled抢下 into the hardest-to-reach最难到达的 places地方
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因为它已经以最难控制的形式,
10:33
in the most difficult-to-control难以控制 forms形式.
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抢占了我们最难接触到的地方。
10:36
One WHO official官方 at the time actually其实 called that whole整个 campaign运动
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那时一位世界卫生组织的官员称那整个运动是
10:40
"one of the greatest最大 mistakes错误 ever made制作 in public上市 health健康."
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"在公共卫生领域所做犯过的最大错误之一"。
10:45
The latest最新 effort功夫 to tame驯服 malaria疟疾 started开始 in the late晚了 1990s.
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1990年代后期,新一轮驯服疟疾的运动启动了,
10:47
It's similarly同样 directed针对 and financed资助 primarily主要
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它的指导和经济支持
10:51
from outside of malarious societies社会.
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仍然来源于疾病肆掠的社会之外。
10:53
Now this effort功夫 well understands理解 the scientific科学 challenge挑战.
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这次努力很好的理解了科学所面临的挑战,
10:56
They are doing tons of malaria疟疾 research研究.
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他们做了无数的疟疾研究。
10:58
And they understand理解 the economic经济 challenge挑战 too.
235
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他们也很了解经济面临的挑战,
11:00
They're focusing调焦 on very cheap低廉, very easy-to-use使用方便 tools工具.
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主要集中在便宜、易用的工具上。
11:04
But now, I think, the dilemma困境 is the cultural文化 challenge挑战.
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但是却遇上了文化方面的困境。
11:08
The centerpiece核心 of the current当前 effort功夫 is the bed net.
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目前主要的努力是利用蚊帐,
11:11
It's treated治疗 with insecticides杀虫剂.
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它是用杀虫剂处理过的。
11:13
This thing has been distributed分散式 across横过 the malarious world世界
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这个蚊帐已在疟疾流行地区
11:15
by the millions百万.
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发放了数百万件。
11:17
And when you think about the bed net,
242
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当你想到蚊帐时,
11:19
it's sort分类 of a surgical外科 intervention介入.
243
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它就像某种外科手术。
11:22
You know, it doesn't really have any value
244
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你知道,除了有助于防止疟疾外,
11:24
to a family家庭 with malaria疟疾 except that it helps帮助 prevent避免 malaria疟疾.
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它对一个已经患上疟疾的家庭来说真的没有任何意义。
11:27
And yet然而 we're asking people to use these nets every一切 night.
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我们还会要求人们
11:31
They have to sleep睡觉 under them every一切 night.
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每晚都必须睡在蚊帐当中,
11:33
That's the only way they are effective有效.
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这是唯一有效的途径。
11:35
And they have to do that
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他们不得不这样做
11:36
even if the net blocks the breeze微风,
250
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3086
即便这些蚊帐挡住了风,
11:39
even if they might威力 have to get up in the middle中间 of the night
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3145
他们有可能不得不
11:42
and relieve缓解 themselves他们自己,
252
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1534
在深夜起床透透气,
11:44
even if they might威力 have to move移动 all their furnishings家具
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2249
他们可能需要移动他们所有的家具
11:46
to put this thing up,
254
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1467
来把这东西挂起来,
11:48
even if, you know, they might威力 live生活 in a round回合 hut棚屋
255
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2853
而他们很可能住在一个圆形的小屋
11:50
in which哪一个 it's difficult to string up a square广场 net.
256
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3737
很难挂起一个方形的蚊帐……
11:54
Now that's no big deal合同 if you're fighting战斗 a killer凶手 disease疾病.
257
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但所有这些麻烦,对于要与一种致命疾病抗争来说
11:59
I mean, these are minor次要 inconveniences不便之处.
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我觉得都微不足道。
12:01
But that's not how people with malaria疟疾 think of malaria疟疾.
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3839
而患上疟疾的人们也许不这样认为
12:05
So for them, the calculus结石 must必须 be quite相当 different不同.
260
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他们有着完全不同的逻辑。
12:10
Imagine想像, for example, if a bunch of well-meaning善意 Kenyans肯尼亚人
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想象一下,如果有一群好心的肯尼亚人
12:14
came来了 up to those of us in the temperate适度的 world世界 and said,
262
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2081
来到我们这些在温带世界生活的人面前,告诉我们说
12:16
"You know, you people have a lot of cold and flu流感.
263
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2822
"你知道,你们有很多的感冒和流感。
12:19
We've我们已经 designed设计 this great, easy-to-use使用方便, cheap低廉 tool工具,
264
727502
3128
我们设计出了这个伟大的、便利的、廉价的工具,
12:22
we're going to give it to you for free自由.
265
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1070
并愿意无偿送给你们。
12:23
It's called a face面对 mask面具,
266
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1433
它叫口罩,
12:25
and all you need to do is
267
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3873
你们只需要
12:29
wear穿 it every一切 day during cold and flu流感 season季节
268
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2410
在感冒和流感季节来临时,
12:31
when you go to school学校 and when you go to work."
269
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2754
上班上学都戴着它。"
12:34
Would we do that?
270
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1930
我们会这样做吗?
12:36
And I wonder奇迹 if that's how people
271
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我猜想那些生活在疟疾泛滥地区的人们
12:38
in the malarious world世界 thought of those nets
272
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第一次收到蚊帐的时候,
12:40
when they first received收到 them?
273
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1703
就是这么看待那些蚊帐的吧?
12:42
Indeed确实, we know from studies学习
274
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3398
事实上,根据我们的调查
12:45
that only 20 percent百分 of the bed nets
275
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2678
我们第一次派发的蚊帐中只有20%
12:48
that were first distributed分散式 were actually其实 used.
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3168
被实际使用了,
12:51
And even that's probably大概 an overestimate估计过高,
277
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1711
甚至连这个数字也是高估的,
12:52
because the same相同 people who distributed分散式 the nets
278
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2422
因为分发蚊帐的那人回访时
12:55
went back and asked the recipients收件人,
279
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1491
问那些受助人
12:56
"Oh, did you use that net I gave you?"
280
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2473
"哦,你使用我给你的蚊帐了吗?"
12:59
Which哪一个 is like your Aunt姑妈 Jane asking you,
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2612
这就像你的姑妈Jane在问你,
13:01
"Oh, did you use that vase花瓶 I gave you for Christmas圣诞?"
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2961
"嘿,我圣诞节送你的礼物用了没有?"
13:04
So it's probably大概 an overestimate估计过高.
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所以它很可能是被高估了。
13:06
But that's not an insurmountable不可逾越 problem问题.
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但这不是一个不能克服的问题。
13:10
We can do more education教育,
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我们可以多做教育工作,
13:11
we can try to convince说服 these people to use the nets.
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试着说服这些人使用蚊帐,
13:14
And that's what happening事件 now.
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而我们现在就正在这么做。
13:15
We're throwing投掷 a lot more time and money
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我们花费了更多的时间和金钱
13:17
into workshops研讨会 and trainings培训 and musicals音乐剧 and plays播放
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进行讲习和培训,还通过音乐剧和戏剧,
13:22
and school学校 meetings会议,
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通过学校会议,
13:24
all these things to convince说服 people
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所有这些努力都是为了说服人们
13:26
to use the nets we gave you.
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去使用我们送的蚊帐,
13:29
And that might威力 work.
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这也许可能奏效。
13:31
But it takes time. It takes money.
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只是需要时间和花钱,
13:34
It takes resources资源. It takes infrastructure基础设施.
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需要资源和基础设施。
13:36
It takes all the things that that cheap低廉,
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为了这便宜又简便的蚊帐
13:39
easy-to-use使用方便 bed net was not supposed应该 to be.
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我们必须大费周折。
13:42
So it's difficult to attack攻击 malaria疟疾 from inside malarious societies社会,
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所以,在疟疾流行的社会,与疟疾的斗争很困难。
13:45
but it's equally一样 tricky狡猾 when we try to attack攻击 it
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但其实当我们试图从这些社会外部去攻击疟疾时,
13:48
from outside of those societies社会.
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也会遇到相同的阻碍。
13:51
We end结束 up imposing威风 our own拥有 priorities优先
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最终,我们把关注的焦点
13:52
on the people of the malarious world世界.
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放在了世界上疟疾流行地区的人们身上。
13:54
That's exactly究竟 what we did in the 1950s,
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这正是我们在1950年代所做的,
13:57
and that effort功夫 backfired事与愿违.
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而结果却是事与愿违。
13:59
I would argue争论 today今天,
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今天,我想说的是,
14:00
when we are distributing分布 tools工具 that we've我们已经 designed设计
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我们分发我们设计的那些
14:04
and that don't necessarily一定 make sense in people's人们 lives生活,
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不一定会有意义的工具时,
14:08
we run the risk风险 of making制造 the same相同 mistake错误 again.
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我们其实在再次冒风险犯同样的错误。
14:12
That's not to say that malaria疟疾 is unconquerable不可战胜的,
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这并不是说疟疾是不可战胜的,
14:14
because I think it is,
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我觉得它可以攻克,
14:15
but what if we attacked袭击 this disease疾病
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只是在疾病攻关时
14:17
according根据 to the priorities优先 of the people who lived生活 with it?
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我们是不是应该优先考虑那些受疟疾困扰的人们?
14:21
Take the example of England英国 and the United联合的 States状态.
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举个英国和美国的例子。
14:23
We had malaria疟疾 in those countries国家 for hundreds数以百计 of years年份,
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数百年来,在这些国家中都有疟疾,
14:26
and we got rid摆脱 of it completely全然,
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我们已经完全摆脱了它,
14:29
not because we attacked袭击 malaria疟疾. We didn't.
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但不是因为我们攻克了疟疾,我们没有。
14:32
We attacked袭击 bad roads道路 and bad houses房屋
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我们攻克的其实是破旧的道路和鄙陋的住房
14:36
and bad drainage引流 and lack缺乏 of electricity电力 and rural乡村 poverty贫穷.
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不良的排水系统,不足的电力供应和贫困的农村经济,
14:41
We attacked袭击 the malarious way of life,
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易感染疟疾的生活方式是我们攻击的目标。
14:44
and by doing that, we slowly慢慢地 built内置 malaria疟疾 out.
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通过这样做,我们慢慢地将疟疾驱赶出去。
14:50
Now attacking进攻 the malarious way of life,
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攻击与疟疾为伴的生活方式
14:51
this is something -- these are things people care关心 about today今天.
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才是今天人们所关心的。
14:55
And attacking进攻 the malarious way of life,
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攻击与疟疾为伴的生活方式
14:57
it's not fast快速, it's not cheap低廉, it's not easy简单,
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不是一种可以迅速见效、廉价或者容易的办法,
15:02
but I think it's the only lasting持久 way forward前锋.
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但却是可持续走下去的唯一选择。
15:05
Thank you so much.
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非常感谢。
15:06
(Applause掌声)
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(掌声)
Translated by Guangqiu Shen
Reviewed by Tingting Zhao

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ABOUT THE SPEAKER
Sonia Shah - Science writer
Science historian Sonia Shah explores the surprisingly fascinating story behind an ancient scourge: malaria.

Why you should listen

Aided by economics, culture, its own resilience and that of the insect that carries it (the mosquito), the malaria parasite has determined for thousands of years the health and course not only of human lives, but also of whole civilizations. In her book The Fever, author Sonia Shah outlines the epic and devastating history of malaria and shows how it still infects 500 million people every year, and kills half a million, in a context where economic inequality collides with science and biology.

Shah’s previous book The Body Hunters established her as a heavy hitter in the field of investigative human rights reporting. She is a frequent contributor to publications such as Scientific American, The Nation and Foreign Affairs.

More profile about the speaker
Sonia Shah | Speaker | TED.com