TEDWomen 2017
Dixon Chibanda: Why I train grandmothers to treat depression
狄克森．奇邦達: 我為什麼要訓練阿嬤來治療憂鬱症？
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狄克森．奇邦達是辛巴威 12 位精神科醫生的其中一個，而全國有一千六百萬人口。他發現在他的國家，傳統的心理治療永遠無法滿足國內的需求，所以他協助發展出一個美好的解決計畫，支撐計畫的是一種無盡的資源：阿嬤。
這場不凡、鼓舞人心的演講介紹了「友誼長椅計畫」。這個計畫訓練阿嬤運用實證支持療法，把關懷、希望帶給那些需要的人。
Dixon Chibanda - Psychiatrist
Dixon Chibanda is passionate about the human brain, how it influences our behavior and what we can do to make everybody happy. Full bio
Dixon Chibanda is passionate about the human brain, how it influences our behavior and what we can do to make everybody happy. Full bio
Double-click the English transcript below to play the video.
00:12
On a warm August morning in Harare,
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八月，在哈拉雷，一個溫暖的早晨，
00:16
Farai,
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法拉艾，
00:18
a 24-year-old mother of two,
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二十四歲，兩個孩子的母親，
00:21
walks towards a park bench.
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走向公園的長椅。
00:24
She looks miserable and dejected.
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她看起來很悲慘、很沮喪。
00:28
Now, on the park bench
sits an 82-year-old woman,
sits an 82-year-old woman,
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公園長椅上坐著一位
八十二歲的老女人，
八十二歲的老女人，
00:33
better known to the community
as Grandmother Jack.
as Grandmother Jack.
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社區的人都叫她傑克阿嬤。
00:39
Farai hands Grandmother Jack
an envelope from the clinic nurse.
an envelope from the clinic nurse.
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法拉艾交給傑克阿嬤
一個診所護士給她的信封。
一個診所護士給她的信封。
00:47
Grandmother Jack invites Farai to sit down
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傑克阿嬤邀請法拉艾坐下，
00:50
as she opens the envelope and reads.
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她打開信封，閱讀內容。
00:53
There's silence for three minutes
or so as she reads.
or so as she reads.
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阿嬤讀信時，沉默持續了大約三分鐘。
00:58
And after a long pause,
Grandmother Jack takes a deep breath,
Grandmother Jack takes a deep breath,
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停頓了很長的一段時間之後，
傑克祖母深深吸了一口氣，
傑克祖母深深吸了一口氣，
01:02
looks at Farai and says,
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看著法拉艾，說：
01:06
"I'm here for you.
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「我在這裡陪你。
01:10
Would you like to share
your story with me?"
your story with me?"
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你願意和我分享你的故事嗎？」
01:13
Farai begins,
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法拉艾開始說，
01:15
her eyes swelling with tears.
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她的眼睛泛著淚光。
01:19
She says, "Grandmother Jack,
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她說：「傑克阿嬤，
01:22
I'm HIV-positive.
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我的愛滋病毒檢測是陽性。
01:24
I've been living with HIV
for the past four years.
for the past four years.
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我有愛滋病毒已經四年了。
01:28
My husband left me a year ago.
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我丈夫一年前離開了我。
01:30
I have two kids
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我有兩個孩子，
01:32
under the age of five.
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都不到五歲。
01:34
I'm unemployed.
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我沒有工作。
01:35
I can hardly take care of my children."
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我幾乎無法照顧我的孩子。」
01:40
Tears are now flowing down her face.
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眼淚沿著她的臉頰落下。
01:43
And in response,
Grandmother Jack moves closer,
Grandmother Jack moves closer,
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傑克阿嬤的回應是
先向她靠近了一些，
先向她靠近了一些，
01:47
puts her hand on Farai,
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把她的手放在法拉艾身上，
01:49
and says, "Farai, it's OK to cry.
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說：「法拉艾，哭吧，沒有關係。
01:53
You've been through a lot.
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你吃了很多苦。
01:56
Would you like to share more with me?"
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你願意和我多講一點嗎？」
01:59
And Farai continues.
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法拉艾繼續說：
02:02
"In the last three weeks,
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「在過去三週，
02:04
I have had recurrent thoughts
of killing myself,
of killing myself,
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我一直有想要自殺的念頭，
02:09
taking my two children with me.
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帶兩個孩子一起走。
02:12
I can't take it anymore.
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我無法再承受了。
02:15
The clinic nurse sent me to see you."
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診所護士要我來找你。」
02:20
There's an exchange between the two,
which lasts about 30 minutes.
which lasts about 30 minutes.
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兩人之間交流了大約三十分鐘。
02:25
And finally, Grandmother Jack says,
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最後，傑克阿嬤說：
02:28
"Farai,
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「法拉艾，
02:30
it seems to me that you have
all the symptoms of kufungisisa."
all the symptoms of kufungisisa."
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在我看來，你似乎有
kufungisisa 的症狀。」
kufungisisa 的症狀。」
02:37
The word "kufungisisa"
opens up a floodgate of tears.
opens up a floodgate of tears.
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「kufungisisa」這個詞
打開了眼淚的防洪閘門。
打開了眼淚的防洪閘門。
02:44
So, kufungisisa is the local
equivalent of depression
equivalent of depression
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在我國家，「kufungisisa」一詞
02:48
in my country.
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等同於憂鬱。
02:50
It literally means
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字面上的意思是
02:52
"thinking too much."
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「想太多」。
02:56
The World Health Organization estimates
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世界衛生組織估計，
02:59
that more than 300 million people
globally, today, suffer from depression,
globally, today, suffer from depression,
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現今全球有超過三億人
受到憂鬱症的折磨，
受到憂鬱症的折磨，
03:05
or what in my country
we call kufungisisa.
we call kufungisisa.
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或是在我的國家，稱為 kufungisisa。
03:08
And the World Health
Organization also tells us
Organization also tells us
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世界衛生組織也告訴我們，
03:12
that every 40 seconds,
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每四十秒，
03:15
someone somewhere in the world
commits suicide
commits suicide
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世界上某處就有人自殺，
03:19
because they are unhappy,
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因為不快樂，
03:21
largely due to depression or kufungisisa.
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主要是出於憂鬱症或 kufungisisa。
03:24
And most of these deaths are occurring
in low- and middle-income countries.
in low- and middle-income countries.
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這些死亡案例多半發生
在中低收入的國家。
在中低收入的國家。
03:29
In fact,
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事實上，
03:30
the World Health Organization
goes as far as to say
goes as far as to say
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世界衛生組織甚至還說，
03:34
that when you look at the age group
between 15 to 29,
between 15 to 29,
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對於 15~29 歲的年齡層而言，
03:38
a leading cause of death
now is actually suicide.
now is actually suicide.
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自殺是這個年齡層的主要死因之一。
03:43
But there are wider events
that lead to depression
that lead to depression
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但有更多、更廣的事件會導致憂鬱，
03:47
and in some cases, suicide,
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有些情況會導致自殺，
03:49
such as abuse,
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這些事件包括虐待、
03:51
conflict, violence,
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衝突、暴力、
03:53
isolation, loneliness --
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孤立、寂寞──
03:56
the list is endless.
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還有許多其他的。
03:59
But one thing that we do know
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但我們的確知道一件事，
04:01
is that depression can be treated
and suicides averted.
and suicides averted.
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憂鬱是可以治療的，
自殺是可以避免的。
自殺是可以避免的。
04:06
But the problem is
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但，問題是，
04:07
we just don't have enough psychiatrists
or psychologists in the world
or psychologists in the world
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世界上沒有足夠的
精神病醫生或心理醫生
精神病醫生或心理醫生
04:11
to do the job.
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來做這件事。
04:12
In most low- and middle-income
countries, for instance,
countries, for instance,
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比如，在大部分中低入的國家，
04:15
the ratio of psychiatrists
to the population
to the population
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精神病醫生佔總人口的比例
04:18
is something like one for every
one and a half million people,
one and a half million people,
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大約是一百五十萬比一，
04:22
which literally means
that 90 percent of the people
that 90 percent of the people
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那表示，需要心理健康服務的人
04:26
needing mental health services
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當中就有九成
04:28
will not get it.
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無法取得服務。
04:30
In my country,
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在我的國家，
04:31
there are 12 psychiatrists,
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有十二名精神病醫生，
04:34
and I'm one of them,
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我是其中之一，
04:36
for a population
of approximately 14 million.
of approximately 14 million.
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全國人口有近一千四百萬人。
04:40
Now, let me just put that into context.
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讓我用一個情境來說明。
04:43
One evening while I was at home,
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有一晚，我在家的時候，
04:46
I get a call from the ER,
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我接到 ER 打來的電話，
04:48
or the emergency room,
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也就是急診室，
04:51
from a city which is some
200 kilometers away
200 kilometers away
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它在我家兩百公里外的
04:54
from where I live.
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一個城市。
04:56
And the ER doctor says,
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急診室醫生說：
04:57
"One of your patients,
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「我們有一位病人
04:59
someone you treated four months ago,
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是你在四個月前治療過的，
05:01
has just taken an overdose,
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剛剛用藥過量，
05:03
and they are in the ER department.
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他們現在在急診室。
05:05
Hemodynamically, they seem to be OK,
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血液的流動似乎沒問題，
05:07
but they will need
neuropsychiatric evaluation."
neuropsychiatric evaluation."
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但會需要神經精神評估。」
05:11
Now, I obviously can't get into my car
in the middle of the night
in the middle of the night
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很顯然，我不可能大半夜跳進車裡，
05:14
and drive 200 kilometers.
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開兩百公里過去。
05:16
So as best as we could,
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所以我們最好的做法，
05:18
over the phone with the ER doctor,
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就是和急診室醫生透過電話，
05:21
we come up with an assessment.
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做出一項評估。
05:24
We ensure that suicidal
observations are in place.
observations are in place.
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我們確保有做好自殺觀察。
05:29
We ensure that we start reviewing
the antidepressants
the antidepressants
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我們確保我們會開始檢視這個病人
05:32
that this patient has been taking,
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服用的抗抑鬱劑，
05:34
and we finally conclude
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我們最後的結論是，
05:37
that as soon as Erica --
that was her name, 26-year-old --
that was her name, 26-year-old --
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等艾瑞卡──
這是她的名字，二十六歲──
05:40
as soon as Erica is ready
to be released from the ER,
to be released from the ER,
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等艾瑞卡準備好可以離開急診室了，
05:44
she should come
directly to me with her mother,
directly to me with her mother,
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她應該要和母親立刻直接來找我，
05:47
and I will evaluate
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我就會做評估
05:49
and establish what can be done.
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與確認哪些事是可以做的。
05:51
And we assumed that that would
take about a week.
take about a week.
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我們假設這大概會需要一週的時間。
05:54
A week passes.
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一週過去了。
05:56
Three weeks pass.
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三週過去了。
05:57
No Erica.
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沒有艾瑞卡。
05:59
And one day I get a call
from Erica's mother,
from Erica's mother,
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有一天，艾瑞卡的媽媽打電話給我，
06:02
and she says,
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她說：
06:04
"Erica committed suicide three days ago.
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「艾瑞卡在三天前自殺了。
06:07
She hanged herself from the mango tree
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她在芒果樹上上吊，
06:12
in the family garden."
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在我們家的院子裡。」
06:16
Now, almost like a knee-jerk reaction,
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幾乎就像膝反射一樣，
06:19
I couldn't help but ask,
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我忍不住問：
06:21
"But why didn't you come
to Harare, where I live?
to Harare, where I live?
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「為什麼你們不來哈拉雷，
來我住的地方？
來我住的地方？
06:25
We had agreed that as soon
as you're released from the ER,
as you're released from the ER,
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我們先前就達成同意，
一旦你們離開了急診室，
一旦你們離開了急診室，
06:28
you will come to me."
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就要來找我。」
06:30
Her response was brief.
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她的回應很簡短。
06:34
"We didn't have the 15 dollars bus fare
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「我們沒有十五元的公車錢
06:37
to come to Harare."
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可以去哈拉雷。」
06:40
Now, suicide is not an unusual event
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在心理健康的世界裡，
自殺並非不尋常的事件。
06:44
in the world of mental health.
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06:47
But there was something
about Erica's death
about Erica's death
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不知為什麼，艾瑞卡的死
06:49
that struck me at the core
of my very being.
of my very being.
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卻一直在我腦中揮之不去。
06:54
That statement from Erica's mother:
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艾瑞卡母親的那句話：
06:57
"We didn't have 15 dollars bus fare
to come to you,"
to come to you,"
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「我們沒有十五元的
公車錢去找你。」
公車錢去找你。」
07:03
made me realize
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讓我了解到，
07:05
that it just wasn't going to work,
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這樣不行的。
07:07
me expecting people to come to me.
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我不能期望人們來找我。
07:10
And I got into this state
of soul-searching,
of soul-searching,
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我開始沈思與反省，
07:14
trying to really discover my role
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試圖找到，在非洲，
身為精神科醫生的自己，
身為精神科醫生的自己，
我的角色到底是什麼，
07:18
as a psychiatrist in Africa.
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07:21
And after considerable consultation
and soul-searching,
and soul-searching,
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經過大量的諮詢和深思探索，
07:25
talking to colleagues, friends and family,
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和同事、朋友、家人的交談，
07:28
it suddenly dawned on me
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我突然開始理解，
07:31
that actually, one the most reliable
resources we have in Africa
resources we have in Africa
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其實，非洲最可靠的資源之一，
07:36
are grandmothers.
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就是阿嬤們。
07:39
Yes, grandmothers.
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是的，阿嬤們。
07:41
And I thought,
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我心想，
07:43
grandmothers are in every community.
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每個社區都有阿嬤。
07:46
There are hundreds of them.
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有成百上千個阿嬤。
07:48
And --
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且──
07:49
(Laughter)
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（笑聲）
07:50
And they don't leave their communities
in search of greener pastures.
in search of greener pastures.
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她們不會離開她們的社區
去找更好的生存環境。
去找更好的生存環境。
07:55
(Laughter)
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（笑聲）
07:57
See, the only time they leave
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只有一種情況下，她們會離開，
07:59
is when they go to a greener
pasture called heaven.
pasture called heaven.
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去更好的地方，那就是去天堂。
08:01
(Laughter)
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（笑聲）
08:02
So I thought, how about
training grandmothers
training grandmothers
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所以，我心想，
來訓練這些阿嬤，會如何？
來訓練這些阿嬤，會如何？
08:06
in evidence-based talk therapy,
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教她們以證據為基礎的談話治療，
08:09
which they can deliver on a bench?
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她們在長椅上就能進行。
08:13
Empower them with the skills to listen,
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教導她們傾聽的技巧、
08:16
to show empathy,
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展現同理心，
08:19
all of that rooted
in cognitive behavioral therapy;
in cognitive behavioral therapy;
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這些都是來自認知行為治療；
08:22
empower them with the skills
to provide behavior activation,
to provide behavior activation,
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讓她們運用這些技巧，
提供行為活化治療、
提供行為活化治療、
計畫活動、
08:27
activity scheduling;
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08:28
and support them using digital technology.
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並用數字科技協助她們。
08:33
You know, mobile phone technology.
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你們知道的，行動電話科技。
08:35
Pretty much everyone in Africa
has a mobile phone today.
has a mobile phone today.
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現在非洲幾乎人人都有手機了。
08:38
So in 2006,
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在 2006 年，
08:40
I started my first group
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我開始了我的第一個
08:44
of grandmothers.
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阿嬤團隊。
08:45
(Applause)
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（掌聲）
08:49
Thank you.
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謝謝。
08:50
(Applause)
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（掌聲）
08:53
Today, there are hundreds of grandmothers
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現在，有數百名阿嬤，
08:56
who are working
in more than 70 communities.
in more than 70 communities.
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在超過七十個社區工作。
09:00
And in the last year alone,
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單單在去年，
09:03
more than 30,000 people received treatment
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就有超過三萬人接受治療，
09:08
on the Friendship Bench
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在「友誼長椅」上，
由在辛巴威社區的阿嬤所提供。
09:09
from a grandmother
in a community in Zimbabwe.
in a community in Zimbabwe.
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09:13
(Applause)
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（掌聲）
09:21
And recently, we published this work
that is done by these grandmothers
that is done by these grandmothers
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最近，我們發表了
這項由阿嬤完成的工作，
這項由阿嬤完成的工作，
09:26
in the Journal of the American
Medical Association.
Medical Association.
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在美國醫學會雜誌上。
09:29
And --
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且──
09:30
(Applause)
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（掌聲）
09:32
And our results show
that six months after receiving treatment
that six months after receiving treatment
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且我們的結果顯示，
接受阿媽治療後的六個月
09:38
from a grandmother,
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09:40
people were still symptom-free:
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病人的症狀沒有復發，
09:42
no depression,
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沒有憂鬱，
09:44
suicidal ideation completely reduced.
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自殺傾向完全減少。
09:47
In fact, our results --
this was a clinical trial --
this was a clinical trial --
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事實上，我們的結果
──這是一項臨床試驗──
──這是一項臨床試驗──
09:50
in fact, this clinical trial showed
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事實上，這項臨床試驗顯示，
09:52
that grandmothers were more effective
at treating depression
at treating depression
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在治療憂鬱上，阿嬤的成效
比醫生還好──
09:56
than doctors and --
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09:57
(Laughter)
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（笑聲）
09:58
(Applause)
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（掌聲）
10:06
And so,
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所以，
10:08
we're now working towards
expanding this program.
expanding this program.
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我們現在在努力擴展這個計畫。
10:14
There are more than 600 million people
currently aged above 65 in the world.
currently aged above 65 in the world.
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在全世界，有超過六億人的
年齡在六十五歲以上。
年齡在六十五歲以上。
10:21
And by the year 2050,
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到 2050 年，
10:23
there will be 1.5 billion people
aged 65 and above.
aged 65 and above.
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將會有十五億人的年齡
在六十五歲以上。
在六十五歲以上。
10:29
Imagine if we could create
a global network of grandmothers
a global network of grandmothers
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想像一下，如果我們能
在世界上每個主要都市
10:35
in every major city in the world,
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創造一個全球的阿嬤網，
這些阿嬤受過實證支持療法的訓練，
10:39
who are trained
in evidence-based talk therapy,
in evidence-based talk therapy,
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10:44
supported through digital platforms,
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由數位平台協助，
10:46
networked.
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聯成網路。
10:48
And they will make a difference
in communities.
in communities.
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她們將會為社區帶來改變。
10:53
They will reduce the treatment gap
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她們會縮小治療的空缺，
心理、神經或藥物濫用造成的空缺。
10:55
for mental, neurological
and substance-use disorders.
and substance-use disorders.
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11:00
Finally,
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最後，
11:01
this is a file photograph
of Grandmother Jack.
of Grandmother Jack.
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這是傑克阿嬤的照片。
11:05
So, Farai had six sessions on the bench
with Grandmother Jack.
with Grandmother Jack.
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所以，法拉艾在長椅上接受了
傑克阿嬤的六次治療。
傑克阿嬤的六次治療。
11:12
Today, Farai is employed.
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現在，法拉艾有工作了。
11:14
She has her two children at school.
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她的兩個孩子都在上學。
11:18
And as for Grandmother Jack,
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至於傑克阿嬤，
11:20
one morning in February, we expected her
to see her 257th client on the bench.
to see her 257th client on the bench.
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二月的一個早晨，她應該要在
長椅上看她的第 257 個病人。
長椅上看她的第 257 個病人。
11:28
She didn't show up.
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她沒有出席。
11:31
She had gone to a greener
pasture called heaven.
pasture called heaven.
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她去了更好的地方，天堂。
11:34
But I believe that Grandmother Jack,
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但我相信，傑克阿嬤
11:37
from up there,
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就在上頭
11:39
she's cheering on
all the other grandmothers --
all the other grandmothers --
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為所有其他阿嬤加油──
11:42
the increasing number of grandmothers
who are making a difference
who are making a difference
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有越來越多的阿嬤，
正改變數以千計的人的生命。
11:46
in the lives of thousands of people.
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11:50
And I'm sure she's in awe
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我確信她會心存敬畏，
11:52
when she realizes that something
that she helped to pioneer
that she helped to pioneer
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如果她能知道她協助開創的這個計畫
11:57
is now spreading to other countries,
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現在正在向其他國家拓展，
12:00
like Malawi,
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比如馬拉威、
12:01
the island of Zanzibar
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溫古賈島，
12:02
and coming closer to home
here in the Unites States
here in the Unites States
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以及美國這裡更靠近家的地方，
12:06
in the city of New York.
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紐約市。
12:09
May her soul rest in peace.
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願她的靈魂安息。
謝謝。
12:12
Thank you.
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12:13
(Applause)
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（掌聲）
12:16
(Cheering)
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（歡呼）
12:18
(Applause)
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（掌聲）
ABOUT THE SPEAKER
Dixon Chibanda - PsychiatristDixon Chibanda is passionate about the human brain, how it influences our behavior and what we can do to make everybody happy.
Why you should listen
Dixon Chibanda is the director of the African Mental Health Research Initiative (AMARI). He's based in Zimbabwe, where he works on the Friendship Bench program, a cognitive behavioral therapy–based approach to kufungisisa, the local term for depression, literally translated into “thinking too much.” At the Friendship Bench, patients receive individual problem-solving therapy from a specifically trained lay health worker.
Chibanda is passionate about connecting with ordinary people in ways that improve their lives using simple but effective programs that can be carried out by non-specialists or professionals. He likes to think outside the box as he explores ways of helping people with conditions such as depression, PTSD and ADHD.
Dixon Chibanda | Speaker | TED.com