ABOUT THE SPEAKER
Elizabeth Howell - Maternal health reformer
Elizabeth Howell is working to address maternal mortality in the United States.

Why you should listen

Elizabeth Howell is a physician, researcher and advocate committed to improving the health and well-being of women. She is an expert in quality-of-care and racial and ethnic disparities in maternal and child health. Her research focuses on the intersection between quality-of-care and disparities in maternal and infant mortality and morbidity, as well as postpartum depression and its impact on underserved communities.

A graduate of both Harvard Medical School and the Harvard Kennedy School, Howell is a pioneer in research in health equity. She has conducted extensive research on maternal morbidity and mortality in New York City and the significant racial and ethnic disparities that exist. She is a professor in the Departments of Obstetrics, Gynecology, and Reproductive Sciences and Population Health Science and Policy at the Icahn School of Medicine at Mount Sinai. In addition, as the founding Director of the Blavatnik Family Women's Health Research Institute at Mount Sinai, Howell is building a competitive research program that advances the science of women's health across the life span. She has served on several expert committees for organizations including the National Academy of Medicine, National Institutes of Health, the Joint Commission and the American Congress of Obstetricians and Gynecologists.

More profile about the speaker
Elizabeth Howell | Speaker | TED.com
TEDMED 2018

Elizabeth Howell: How we can improve maternal healthcare -- before, during and after pregnancy

伊莉莎白 · 豪厄爾: 如何改善孕產婦的醫療保健——孕前、孕中、孕後

Filmed:
1,629,987 views

令人震驚,但事實確實如此:美國是所有已開發國家中,孕產婦死亡率最高的國家,但其中的 60% 是可以預防的。醫生伊莉莎白 · 豪厄爾清晰且迫切地解釋了孕產婦死亡的原因,並分享了醫院和醫生如何讓孕產婦在孕前、孕中和孕後能更加安全的方案計畫。
- Maternal health reformer
Elizabeth Howell is working to address maternal mortality in the United States. Full bio

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

00:12
It was chaos混沌 as I got off the elevator電梯.
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當我踏出電梯,院裡正是一片混亂
00:15
I was coming未來 back on duty義務
as a resident居民 physician醫師
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身為住院醫師的我回院值班
00:18
to cover the labor勞動 and delivery交貨 unit單元.
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去增援分娩生產部門
00:20
And all I could see was a swarm一群
of doctors醫生 and nurses護士
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我看到產房裡一大群的醫生和護士
00:24
hovering徘徊 over a patient患者 in the labor勞動 room房間.
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圍在一個產婦身邊
00:26
They were all desperately拼命 trying
to save保存 a woman's女人的 life.
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拼命地搶救她的生命
00:29
The patient患者 was in shock休克.
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她已經休克了
00:31
She had delivered交付 a healthy健康 baby寶寶 boy男孩
a few少數 hours小時 before I arrived到達.
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在我抵達的前幾個小時
她剛產下一名健康的男嬰
00:36
Suddenly突然, she collapsed倒塌,
became成為 unresponsive反應 遲鈍,
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突然,她虛脫休克,沒有反應
00:39
and had profuse豐富的 uterine子宮的 bleeding流血的.
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並伴有嚴重的血崩(子宮出血)
00:42
By the time I got to the room房間,
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我進入產房時
00:44
there were multiple doctors醫生 and nurses護士,
and the patient患者 was lifeless死氣沉沉.
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裡面聚集了不同的醫護人員
但她已沒有了生命跡象
00:48
The resuscitation復生 team球隊
tried試著 to bring帶來 her back to life,
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醫療團隊嘗試搶救她的生命
00:51
but despite儘管 everyone's大家的 best最好 efforts努力,
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但儘管每個人都盡了最大的努力
00:53
she died死亡.
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她還是走了
00:55
What I remember記得 most about that day
was the father's父親的 piercing沖孔 cry.
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我仍記得那個父親悲傷欲絕的哭聲
00:59
It went through通過 my heart
and the heart of everyone大家 on that floor地板.
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穿透了我和那層樓所有人的心
01:02
This was supposed應該 to be
the happiest最幸福 day of his life,
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那本該是他人生中最快樂的一天
01:05
but instead代替 it turned轉身 out
to be the worst最差 day.
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但卻變成了最痛苦的一天
01:10
I wish希望 I could say this tragedy悲劇
was an isolated孤立 incident事件,
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我多希望這個悲劇只是個單一事件
01:13
but sadly可悲的是, that's not the case案件.
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但很遺憾,它並不是
01:16
Every一切 year in the United聯合的 States狀態,
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在美國,每一年
01:18
somewhere某處 between之間 700 and 900 women婦女 die
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有 700 至 900 位女性
死於妊娠相關的疾病
01:21
from a pregnancy-related與懷孕有關 cause原因.
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01:23
The shocking觸目驚心 part部分 of this story故事
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最令人震驚的是
01:25
is that our maternal母系 mortality死亡 rate
is actually其實 higher更高
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我們的孕產婦死亡率
遠高於其他高收入國家
01:29
than all other high-income高收入 countries國家,
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01:31
and our rates利率 are far worse更差
for women婦女 of color顏色.
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且非白人女性更為嚴重
01:35
Our rate of maternal母系 mortality死亡
actually其實 increased增加 over the last decade,
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在過去十年中
我們孕產婦死亡率攀升
01:40
while other countries國家 reduced減少 their rates利率.
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然而其他國家都在下降
01:43
And the biggest最大 paradox悖論 of all?
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這其中最大的悖論是什麼?
01:45
We spend more on health健康 care關心
than any other country國家 in the world世界.
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我們花在衛生保健上的費用
高於世界上任何一個國家
01:50
Well, around the same相同 time in residency住院醫師
that this new mother母親 lost丟失 her life,
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大約是我當住院醫師遇到
那位母親往生的那段時間
01:54
I became成為 a mother母親 myself.
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我自己也成為母親
01:56
And even with all of my background背景
and training訓練 in the field領域,
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即便擁有這個領域的背景和知識
02:00
I was taken採取 aback嚇了一跳
by how little attention注意 was paid支付
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我對鮮少人會關注提供孕產婦
高品質的保健而感到吃驚
02:03
to delivering交付 high-quality高質量
maternal母系 health健康 care關心.
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我思考著這意味著什麼呢
02:06
And I thought about what that meant意味著,
not just for myself
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不僅為我,更為千千萬萬的女性
02:09
but for so many許多 other women婦女.
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02:11
Maybe it's because my dad
was a civil國內 rights權利 attorney律師
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或許是因為我的父親是位民權律師
02:15
and my parents父母 were socially社交上 conscious意識
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我的父母很有社會意識
02:17
and demanded要求 that we stand up
for what we believe in.
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也要求我們要堅守自己的信念
02:20
Or the fact事實 that my parents父母
were born天生 in Jamaica牙買加,
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或是因為出生在牙買加的他們
02:22
came來了 to the United聯合的 States狀態
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移居美國
02:24
and were able能夠 to realize實現
the American美國 Dream夢想.
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並得以實現美國夢
02:27
Or maybe it was my residency住院醫師 training訓練,
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又或我在接受住院醫師培訓時
02:29
where I saw firsthand第一手
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親眼目睹
02:31
how poorly不好 so many許多 low-income低收入
women婦女 of color顏色 were treated治療
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低收入的非白人婦女
在我們的醫療體系下
02:34
by our healthcare衛生保健 system系統.
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如何被惡劣地對待
02:36
For whatever隨你 the reason原因,
I felt a responsibility責任 to stand up,
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不論如何,我有責任站出來
02:40
not just for myself,
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不僅為我自己
02:41
but for all women婦女,
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更為所有的女性
02:43
and especially特別 those marginalized邊緣化
by our healthcare衛生保健 system系統.
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尤其是那些被醫療體系邊緣化的人
02:46
And I decided決定 to focus焦點 my career事業
on improving提高 maternal母系 health健康 care關心.
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於是我決定致力於改善孕產婦保健
02:52
So what's killing謀殺 mothers母親?
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所以,造成母親們死亡的原因為何?
02:54
Cardiovascular心血管 disease疾病, hemorrhage出血,
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心血管疾病、失血
02:57
high blood血液 pressure壓力
causing造成 seizures癲癇發作 and strokes,
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高血壓引發的癲癇及中風
03:00
blood血液 clots血塊 and infection感染
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血栓和感染
03:01
are some of the major重大的 causes原因
of maternal母系 mortality死亡 in this country國家.
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這些是美國孕產婦死亡的
部分主要原因
03:05
But a maternal母系 death死亡
is only the tip小費 of the iceberg冰山.
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然而孕產婦死亡還只是冰山的一角
03:09
For every一切 death死亡, over a hundred women婦女
suffer遭受 a severe嚴重 complication並發症
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每一例的死亡都代表著
有超過 100 位的女性
遭受與妊娠和分娩相關的嚴重併發症
03:14
related有關 to pregnancy懷孕 and childbirth分娩,
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03:16
resulting造成 in over 60,000 women婦女 every一切 year
having one of these events事件.
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每年有超過 60,000 名女性
會碰到其中的一項
03:21
These complications並發症,
called severe嚴重 maternal母系 morbidity發病率,
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這些併發症稱為孕產婦重大疾病罹患率
03:24
are on the rise上升 in the United聯合的 States狀態,
and they're life-altering改變生活.
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在美國呈現上升趨勢
而且它們會改變人的一生
03:28
It's estimated預計 that somewhere某處
between之間 1.5 and two percent百分
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據估計,在美國
每 400 萬次分娩中
03:32
of the four million百萬 deliveries交付
that occur發生 every一切 year in this country國家
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1.5% 至 2% 會出現這些病症
03:35
are associated相關 with one of these events事件.
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03:38
That is five or six women婦女 every一切 hour小時
having a blood血液 clot凝塊, a seizure發作, a stroke行程,
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也就是每小時有 5 到 6 位女性
會出現血栓、癲癇、中風
03:44
receiving接收 a blood血液 transfusion,
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接受輸血
03:45
having end-organ端器官 damage損傷
such這樣 as kidney failure失敗,
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終端器官損傷,如:腎衰竭
03:48
or some other tragic悲慘 event事件.
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或是其他悲劇
03:52
Now, the part部分 of this story故事
that's frankly坦率地說 unforgivable不可饒恕
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這件事情最無法原諒的部分是
03:55
is the fact事實 that 60 percent百分
of these deaths死亡 and severe嚴重 complications並發症
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這當中有 60% 的
死亡和嚴重併發症
04:00
are thought to be preventable預防的.
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是可以預防的
04:02
When I say 60 percent百分 are preventable預防的,
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60% 可以「預防」
04:04
I mean there are concrete具體 steps腳步
and standard標準 procedures程序
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是指有可實施的具體措施和標準流程
04:08
that we could implement實行
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04:09
that could prevent避免
these bad outcomes結果 from occurring發生
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來預防憾事的發生
04:12
and save保存 women's女士的 lives生活.
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並拯救這些女性的生命
04:14
And it doesn't require要求
fancy幻想 new technology技術.
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而這並不需要昂貴的新技術
04:17
We just have to apply應用 what we know
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只需要運用我們已知的知識
04:19
and ensure確保 equal等於 standards標準
between之間 hospitals醫院.
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並確保醫院間的標準要一致
04:23
For example, if a pregnant woman女人
in labor勞動 has really high blood血液 pressure壓力
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例如,如果一位產婦
在分娩過程中出現了高血壓
04:27
and we treat對待 her with the right
antihypertensive降壓 medication藥物治療
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我們能及時給她正確的抗高血壓藥
04:30
in a timely及時 fashion時尚,
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04:32
we can prevent避免 stroke行程.
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我們就能防止中風
04:34
If we accurately準確 track跟踪
blood血液 loss失利 during delivery交貨,
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如果我們準確記錄
分娩時的失血情況
04:37
we can detect檢測 a hemorrhage出血 sooner
and save保存 a woman's女人的 life.
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我們就能更快地發現大出血
從而拯救產婦的生命
04:41
We could actually其實 lower降低 the rates利率
of these catastrophic災難性的 events事件 tomorrow明天,
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未來我們確實可以降低
這些悲慘事件的發生率
04:46
but it requires要求 that we value
the quality質量 of care關心
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但前提是我們需重視
對孕產婦產前、產中
和產後的醫療照護品質
04:49
we deliver交付 to pregnant women婦女
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04:50
before, during and after pregnancy懷孕.
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04:54
If we raise提高 quality質量 of care關心 universally舉世
to what is supposed應該 to be the standard標準,
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如果我們將整體醫療照護品質
提高到應有的標準
04:58
we could bring帶來 the rates利率 of these deaths死亡
and severe嚴重 complications並發症 way down.
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我們就可大大降低
死亡和嚴重併發症的機率
05:03
Well, there is some good news新聞.
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好消息是
05:06
There are some success成功 stories故事.
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已經有了一些成功的案例
05:08
There are some places地方 that have
actually其實 adopted採用 these standards標準,
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一些地區落實了這些標準
並取得了顯著的成效
05:12
and it's really making製造 a difference區別.
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幾年前,美國婦產科醫師學會
05:13
A few少數 years年份 ago, the American美國 College學院
of Obstetricians產科醫生 and Gynecologists婦科醫生
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05:18
joined加盟 forces軍隊 with other
healthcare衛生保健 organizations組織,
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聯合了其他醫療機構
像我一樣的研究員和社區組織
05:21
researchers研究人員 like myself
and community社區 organizations組織.
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05:24
They wanted to implement實行
standard標準 care關心 practices做法
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他們希望在全國的醫院
和醫療體系中
05:27
in hospitals醫院 and health健康 systems系統
throughout始終 the country國家.
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執行標準化的醫療照護
05:30
And the vehicle車輛 they're using運用
is a program程序 called
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他們的方法是成立一個叫做:
05:33
the Alliance聯盟 for Innovation革新
in Maternal產婦 Health健康, the AIM目標 program程序.
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孕產婦健康創新聯盟
即 AIM 計畫
05:37
Their goal目標 is to lower降低 maternal母系 mortality死亡
and severe嚴重 maternal母系 morbidity發病率 rates利率
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旨在透過高品質和安全的新措施
05:42
through通過 quality質量 and safety安全 initiatives倡議
across橫過 the country國家.
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來降低孕產婦死亡率
和孕產婦重大疾病罹患率
05:45
The group has developed發達
a number of safety安全 bundles捆綁
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這個組織針對最可預防的
孕產婦死亡病因
05:48
that target目標 some of the most
preventable預防的 causes原因 of a maternal母系 death死亡.
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構建了一系列的「醫療工具包」
05:53
The AIM目標 program程序 currently目前
has the potential潛在 to reach達到
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AIM 目前應能涵蓋全美
超過 50% 的分娩所需
05:56
over 50 percent百分 of US births出生.
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05:59
So what's in a safety安全 bundle?
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醫療工具包裡有什麼呢?
06:01
Evidence-based基於證據 practices做法,
protocols協議, procedures程序,
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實證醫療、醫療計畫、程序步驟
06:04
medications藥物治療, equipment設備
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用藥指導、醫療器材
06:05
and other items項目 targeting針對
these conditions條件.
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以及其他相關的醫療用品
06:08
Let's take the example
of a hemorrhage出血 bundle.
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以大出血工具包為例
06:11
For a hemorrhage出血, you need a cart大車
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遇到大出血時
需要有一台治療推車
06:13
that has everything a doctor醫生 or nurse護士
might威力 need in an emergency:
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裡面裝有醫護人員急救所需的醫材:
06:17
an IVIV line, an oxygen mask面具, medications藥物治療,
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靜脈注射管線、氧氣面罩、藥物
06:20
checklists清單, other equipment設備.
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檢查表及其他醫療器材
06:22
Then you need something
to measure測量 blood血液 loss失利:
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接著你需要測量失血量的用品:
06:25
sponges海綿 and pads.
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海綿塊和棉墊
06:26
And instead代替 of just eyeballing眼球 it,
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醫護人員不僅目測失血量
06:28
the doctors醫生 and nurses護士
collect蒐集 these sponges海綿 and pads
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還把這些海綿塊和棉墊收集起來稱重
06:31
and either weigh稱重 them
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06:33
or use newer technology技術 to accurately準確
assess評估 how much blood血液 has been lost丟失.
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或用更先進的技術來準確評估失血量
06:39
The hemorrhage出血 bundle also includes包括
crises危機 protocols協議 for massive大規模的 transfusions輸血
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大出血工具包還包括
大量輸血的急救方案
以及定期的培訓與演練
06:44
and regular定期 trainings培訓 and drills演習.
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06:46
Now, California加州 has been a leader領導
in the use of these types類型 of bundles捆綁,
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加州在醫療工具包的
應用上已然成為急先鋒
06:50
and that's why California加州
saw a 21 percent百分 reduction減少
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這就是為什麼採用了
醫療工具包的加州醫院
06:54
in near death死亡 from hemorrhage出血
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在第一年裡因出血死亡的
產婦人數減少了 21%
06:56
among其中 hospitals醫院 that implemented實施
this bundle in the first year.
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07:00
Yet然而 the use of these bundles捆綁
across橫過 the country國家 is spotty參差不齊 or missing失踪.
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然而國內醫療工具包的應用
卻存在著良莠不齊或不完整的現象
07:04
Just like the fact事實 that the use
of evidence-based循證 practices做法
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比如實證醫療和對安全的注重
07:07
and the emphasis重點 on safety安全
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07:09
differs不同 from one hospital醫院 to the next下一個,
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因各醫院而異
07:12
quality質量 of care關心 differs不同.
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醫療照護品質也有所差異
07:14
And quality質量 of care關心 differs不同 greatly非常
for women婦女 of color顏色 in the United聯合的 States狀態.
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在美國,非白人女性的
醫療差別待遇最為嚴重
07:19
Black黑色 women婦女 who deliver交付 in this country國家
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在國內黑人女性死於妊娠相關疾病的
機率是白人女性的 3 至 4 倍
07:21
are three to four times more likely容易
to suffer遭受 a pregnancy-related與懷孕有關 death死亡
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07:25
than are white白色 women婦女.
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07:27
This statistic統計 is true真正 for all black黑色 women婦女
who deliver交付 in this country國家,
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這個統計數據顯示的是
所有在美國妊娠的黑人女性
07:31
whether是否 they were born天生
in the United聯合的 States狀態
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無論她們是否在美國出生
07:33
or born天生 in another另一個 country國家.
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07:35
Many許多 want to think that income收入 differences分歧
drive駕駛 these disparities差距,
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很多人將差異歸咎於收入差距
07:39
but it goes beyond class.
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但這超越了社會階級
07:41
A black黑色 woman女人 with a college學院 education教育
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一個受過大學教育的
黑人女性的死亡率
07:44
is nearly幾乎 twice兩次 as likely容易 to die
as compared相比 to a white白色 woman女人
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比一個學歷不到高中的
白人女性高 2 倍
07:48
with less than a high school學校 education教育.
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07:50
And she is two to three times more likely容易
to suffer遭受 a severe嚴重 pregnancy懷孕 complication並發症
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且她在生產時出現重大產科併發症的
機率比白人女性高 2 至 3 倍
07:56
with her delivery交貨.
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07:58
Now, I was always taught to think
that education教育 was our salvation救恩,
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人們總說「教育可以改變人生」
08:02
but in this case案件, it's simply只是 not true真正.
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但在這個例子裡,卻行不通
08:06
This black-white黑,白 disparity差距
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據美國疾病管制與預防中心統計
08:08
is the largest最大 disparity差距
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在產前、產後所有人口的
健康基準差距中
08:10
among其中 all population人口
perinatal圍產期 health健康 measures措施,
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黑人與白人間的差距最大
08:12
according根據 to the CDCCDC.
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08:14
And these disparities差距
are even more pronounced宣判
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這些差異在一些城市中更為明顯
08:17
in some of our cities城市.
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08:18
For example, in New York紐約 City,
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如:在紐約
08:20
a black黑色 woman女人 is eight to 12 times
more likely容易 to die
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黑人女性死於妊娠相關疾病的機率
08:24
from a pregnancy-related與懷孕有關 cause原因
than is a white白色 woman女人.
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是白人女性的 8 至 12 倍
08:28
Now, I think many許多 of you
are probably大概 familiar with
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我想大家都聽說過
沙隆 · 歐文醫生令人痛心的故事
08:31
the heart-wrenching心臟痛心 story故事
of Dr博士. Shalon沙隆 Irving歐文,
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08:33
a CDCCDC epidemiologist流行病學家
who died死亡 following以下 childbirth分娩.
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她是在產後離世的美國疾病管制
與預防中心的流行病學家
08:37
Her story故事 was reported報導
in ProPublicaProPublica and NPR美國國家公共電台
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不到一年前
她的故事被 ProPublica
和全國公共廣播電台報導
08:41
a little less than a year ago.
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08:43
Recently最近, I was at a conference會議
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最近,我在一個會議上
08:45
and I had the privilege特權
of hearing聽力 her mother母親 speak說話.
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很榮幸地聽到了她母親的演說
08:47
She brought the entire整個 audience聽眾 to tears眼淚.
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所有聽衆都為她流下熱淚
08:50
Shalon沙隆 was a brilliant輝煌 epidemiologist流行病學家,
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沙隆曾是一位出色的流行病學家
08:53
committed提交 to studying研究
racial種族 and ethnic民族 disparities差距 in health健康.
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她致力於研究不同種族、民族
所受到的醫療差別待遇
08:56
She was 36 years年份 old,
this was her first baby寶寶,
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36 歲時,她產下了
人生中第一個孩子
08:59
and she was African-American非裔美國人.
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她是非裔美國人
09:02
Now, Shalon沙隆 did have
a complicated複雜 pregnancy懷孕,
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沙隆經歷了艱難的妊娠過程
09:05
but she delivered交付 a healthy健康 baby寶寶 girl女孩
and was discharged出院 from the hospital醫院.
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最終產下了一名健康女嬰並出院了
09:09
Three weeks later後來, she died死亡
from complications並發症 of high blood血液 pressure壓力.
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三週後,她死於高血壓併發症
09:14
Shalon沙隆 was seen看到 four or five times
by healthcare衛生保健 professionals專業人士
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在這三週裡
她由專業的醫療人員看診了四、五次
09:19
in those three weeks.
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09:20
She was not listened聽了 to,
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但沒有人傾聽她的主訴
09:22
and the severity嚴重 of her condition條件
was not recognized認可.
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也沒人辨識出她的嚴重病症
09:27
Now, Shalon's沙隆的 story故事
is just one of many許多 stories故事
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沙隆的故事只是衆多
09:30
about racial種族 and ethnic民族 disparities差距
in health健康 and health健康 care關心
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美國不同種族的
醫療差別照護的故事之一
09:33
in the United聯合的 States狀態,
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09:35
and there's a growing生長 recognition承認
that the social社會 determinants決定因素 of health健康,
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越來越多人瞭解到
醫療保健的社會決定因素
例如種族歧視、貧窮
教育、隔離的住宅區
09:39
such這樣 as racism種族主義, poverty貧窮, education教育,
segregated隔離 housing住房,
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09:44
contribute有助於 to these disparities差距.
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導致了醫療差異的擴大
09:46
But Shalon's沙隆的 story故事 highlights強調
an additional額外 underlying底層 cause原因:
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但沙隆的故事突顯了另一潛在因素:
09:50
quality質量 of care關心.
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醫療照護的品質
09:52
Lack缺乏 of standards標準 in postpartum產後 care關心.
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產後醫療照護缺乏標準程序
09:55
Shalon沙隆 was seen看到 multiple times
by clinicians臨床醫生 in those three weeks,
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在那三週中,沙隆多次去醫師那看診
09:58
and she still died死亡.
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但她還是死了
10:00
Quality質量 of care關心
in the setting設置 of childbirth分娩
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分娩時的醫療照護品質
10:03
is an underlying底層 cause原因
of racial種族 and ethnic民族 disparities差距
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在美國是造成不同種族間
孕產婦死亡率和重大疾病罹患率
10:06
in maternal母系 mortality死亡
and severe嚴重 maternal母系 morbidity發病率
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10:09
in the United聯合的 States狀態,
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差異的潛在因素
10:10
and it's something we can address地址 now.
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而我們可以從現在開始改變它
10:14
Research研究 by our team球隊 and others其他
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我們和其他的研究團隊已證明
10:16
has documented記錄 that,
for a variety品種 of reasons原因,
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由於各種原因
10:18
black黑色 women婦女 tend趨向 to deliver交付
in a specific具體 set of hospitals醫院,
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黑人女性往往會在某些特定醫院分娩
10:22
and those hospitals醫院 often經常 have worse更差
outcomes結果 for both black黑色 and white白色 women婦女,
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排除病人自身的風險因素
這些醫院的黑人和白人女性
經常面臨更高的孕期風險
10:26
regardless而不管 of patient患者 risk風險 factors因素.
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10:29
This is true真正 overall總體 in the United聯合的 States狀態,
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這種現象存在於整個美國
10:31
where about three quarters住處
of all black黑色 women婦女
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約 75% 的黑人女性
會在這些特定醫院分娩
10:34
deliver交付 in a specific具體 set of hospitals醫院,
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10:36
while less than one-fifth五分之一 of white白色 women婦女
deliver交付 in those same相同 hospitals醫院.
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但少於 20% 的白人女性
會選擇這些醫院
10:40
In New York紐約 City, a woman's女人的 risk風險
of having a life-threatening危及生命 complication並發症
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在紐約
女性在分娩時,發生
具生命危險併發症的機率
10:44
during delivery交貨
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在不同醫院間有高達 6 倍的差距
10:46
can be six times higher更高
in one hospital醫院 than another另一個.
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10:49
Not surprisingly出奇, black黑色 women婦女
are more likely容易 to deliver交付
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所以,黑人女性在醫院分娩時
面臨更高的風險就不足為奇了
10:53
in hospitals醫院 with worse更差 outcomes結果.
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10:55
In fact事實, differences分歧 in delivery交貨 hospital醫院
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事實上,產科醫院間的差異
10:57
explain說明 nearly幾乎 one-half一半
of the black-white黑,白 disparity差距.
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解釋了近半數黑人與白人女性間
差異的原因
11:01
While we must必須 address地址
social社會 determinants決定因素 of health健康
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如果我們想要在美國
擁有真正公平的醫療照護
11:04
if we're ever going to truly have
equitable公平 health健康 care關心 in this country國家,
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就必須設法解決這些社會決定因素
11:08
many許多 of these are deep-seated根深蒂固
and they will take some time to resolve解決.
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其中很多因素根深蒂固
需要投入時間去解決
11:12
In the meantime與此同時,
we can tackle滑車 quality質量 of care關心.
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同時我們可以處理醫療品質的問題
11:15
Providing提供 high-quality高質量 care關心
across橫過 the care關心 continuum連續
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在整個醫療照護期中
提供高品質的醫護服務
11:19
means手段 providing提供 access訪問 to safe安全
and reliable可靠 contraception避孕
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意味著為生育期的女性
11:22
throughout始終 women's女士的 reproductive生殖 lives生活.
220
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提供安全而可靠的避孕方法
11:25
Before pregnancy懷孕, it means手段
providing提供 preconception偏見 care關心,
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在孕前,提供孕前保健
11:30
so we can manage管理 chronic慢性 illness疾病
and optimize優化 health健康.
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從而管理慢性病並優化健康狀態
11:34
During pregnancy懷孕, it includes包括
high-quality高質量 prenatal產前 and delivery交貨 care關心
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在孕中,提供高品質的產前和分娩保健
11:38
so we can produce生產 healthy健康 moms媽媽 and babies嬰兒.
224
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從而保障母子的健康
11:41
And finally最後, after pregnancy懷孕, it includes包括
postpartum產後 and inter-pregnancy孕產間 care關心
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在孕後,提供產後
和兩次孕間期的保健
11:46
so we can set moms媽媽 up
to have a healthy健康 next下一個 baby寶寶
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可讓媽媽為下一個健康的寶寶
11:49
and a healthy健康 life.
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和健康的生活做好準備
11:51
And it can literally按照字面 spell拼寫 the difference區別
between之間 life and death死亡,
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這個方法運用在瑪麗亞身上時
11:54
as it did in the case案件 of Maria瑪麗亞,
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確實造成了天大的差異
11:56
who checked檢查 into the hospital醫院
after having an elevated提高的 blood血液 pressure壓力
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她在產檢後發現血壓增高而住院
11:59
during a prenatal產前 visit訪問.
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12:01
Maria瑪麗亞 was 40, and this
was her second第二 pregnancy懷孕.
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瑪麗亞 40 歲
這是她的第二次懷孕
12:05
During Maria's瑪麗亞 first pregnancy懷孕
that had happened發生 two years年份 earlier,
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兩年前她第一次懷孕時
12:08
she also didn't feel so well
in the last few少數 weeks of her pregnancy懷孕,
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她同樣在產前最後幾週
感到身體不適
12:12
and she had a few少數
elevated提高的 blood血液 pressures壓力,
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並出現了幾次血壓偏高現象
12:14
but nobody沒有人 seemed似乎 to pay工資 attention注意.
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但醫護人員不以為意
12:16
They just said, "Maria瑪麗亞,
don't worry擔心, you'll你會 be fine.
237
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他們只是告訴她:「別擔心,會好的
這是第一次懷孕
你只是有點緊張罷了」
12:19
This is your first pregnancy懷孕.
You're a little nervous緊張."
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12:22
But it did not end結束 well
for Maria瑪麗亞 last time.
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但瑪麗亞的狀況並沒有改善
12:24
She seized during labor勞動.
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她在分娩時癲癇發作
12:26
Well, this time her team球隊 really listened聽了.
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不過這一次,醫療團隊
認真傾聽了她的主訴
12:29
They asked smart聰明 and probing探測 questions問題.
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他們的問診精準而詳細
12:31
Her doctor醫生 counseled勸告 her about
the signs跡象 and symptoms症狀 of preeclampsia子 癇 前期
243
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3904
她的醫生告知了她
子癇前症的徵兆和症狀
並告訴她,如果感到身體不適
12:35
and explained解釋 that
if she was not feeling感覺 well,
244
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她需要回診做檢查
12:37
she needed需要 to come in and be seen看到.
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12:40
And this time Maria瑪麗亞 came來了 in,
246
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這一次瑪麗亞回診後
12:42
and her doctor醫生 immediately立即
sent發送 her to the hospital醫院.
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她的醫生立即將她送往醫院
12:45
At the hospital醫院, her doctor醫生
ordered有序 urgent緊急 lab實驗室 tests測試.
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在醫院,醫生囑咐了立即的檢測
12:49
They hooked迷上 her up
to multiple different不同 monitors顯示器
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他們將她接上各種監視器
12:51
and paid支付 special特別 attention注意
to her blood血液 pressure壓力,
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並特別關注她的血壓
12:54
the fetal heart rate tracing追踪
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監測胎兒心率
12:55
and gave her IVIV medication藥物治療
to prevent避免 a seizure發作.
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給予靜脈注射用藥來防止癲癇發作
12:59
And when Maria's瑪麗亞 blood血液 pressure壓力 got
so high it put her at risk風險 for a stroke行程,
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當瑪麗亞的血壓過高
有引發中風的危險時
13:03
her doctors醫生 and nurses護士 jumped跳下 into action行動.
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醫生和護士立即採取行動
13:05
They repeated重複 her
blood血液 pressure壓力 in 15 minutes分鐘
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他們在 15 分鐘內反覆測量血壓
13:07
and declared聲明 a hypertensive高血壓 emergency.
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然後宣佈高血壓危症
13:10
They gave her the right IVIV medication藥物治療
according根據 to the latest最新 correct正確 protocol協議.
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根據最新而有效的方案
給她正確的靜脈注射用藥
13:14
They worked工作 smoothly順利 together一起
as a coordinated協調 team球隊
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他們團隊協作有條不紊
13:17
and successfully順利
lowered降低 her blood血液 pressure壓力.
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成功地降低了她的血壓
13:21
As a result結果, what could have been
a tragedy悲劇 became成為 a success成功 story故事.
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最終,他們將一場悲劇
逆轉為成功的故事:
13:25
Maria's瑪麗亞 dangerous危險 symptoms症狀
were controlled受控,
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瑪麗亞的危險症狀得到了控制
13:27
and she delivered交付 a healthy健康 baby寶寶 girl女孩.
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並產下了一名健康的女嬰
13:30
And before Maria瑪麗亞 was discharged出院
from the hospital醫院,
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在瑪麗亞獲准出院前
13:33
her doctor醫生 counseled勸告 her again about
the signs跡象 and symptoms症狀 of preeclampsia子 癇 前期,
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她的醫生再次告知
子癇前症的徵兆和症狀
13:36
the importance重要性 of having
her blood血液 pressure壓力 checked檢查,
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以及檢查血壓的重要性
特別是產後第一週
13:39
especially特別 in this first week postpartum產後
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13:41
and gave her education教育 about
postpartum產後 health健康 and what to expect期望.
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醫生還告訴她
產後保健事項和可能發生的狀況
13:46
And in the weeks and months個月 that followed其次,
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在接下來的幾個月
13:48
naturally自然, Maria瑪麗亞 had follow-up跟進 visits訪問
with her pediatrician兒科醫師
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她持續到兒科醫師那裡回診
13:51
to check in on her baby's寶寶 health健康.
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檢查嬰兒的健康情況
13:53
But just as important重要,
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同樣重要的是
13:54
she had follow-up跟進 visits訪問 with her ob-gyn婦產科
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她之後也到婦產科回診
13:57
to check in on her health健康,
her blood血液 pressure壓力,
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檢查她的健康狀況和血壓
13:59
and her cares管它 and concerns關注
as a new mother母親.
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並幫成為新生兒母親的她
解答其關心在意的問題
14:02
This is what high-quality高質量 care關心
across橫過 the care關心 continuum連續 looks容貌 like,
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以上就是整個醫療照護期
該有的高品質醫療服務
14:06
and this is how it can look.
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是可以做到這個樣子的
14:08
If every一切 pregnant woman女人 in every一切 community社區
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如果每個社區的孕婦
14:11
received收到 this kind of high-quality高質量 care關心
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都能得到這樣高品質的醫療照護
14:14
and delivered交付 at facilities設備 that utilized利用
standard標準 care關心 practices做法,
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並在遵循標準醫療制度的機構裡分娩
14:18
our maternal母系 mortality死亡 and severe嚴重
maternal母系 morbidity發病率 rates利率 would plummet鉛墜.
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我們的孕產婦死亡率
和孕產婦重大疾病罹患率
就能大幅驟降
14:22
Our international國際 ranking排行
would no longer be an embarrassment困窘.
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我們的國際排名將不再令人汗顏
14:25
But the truth真相 is, we've我們已經 had decades幾十年
of unacceptably不可接受 high rates利率
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但事實是,幾十年來
我們的孕產婦死亡率
和嚴重產科併發症的發生率
14:30
of maternal母系 death死亡 and life-threatening危及生命
complications並發症 during delivery交貨
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高到令人無法接受
14:35
and decades幾十年 of devastating破壞性的 consequences後果
for moms媽媽, babies嬰兒 and families家庭,
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幾十年來母親、嬰兒和家庭
都承受著極具破壞性的後果
14:40
and we have not been moved移動 to action行動.
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卻沒有人採取行動
14:43
The recent最近 media媒體 attention注意 on
our poor較差的 performance性能 on maternal母系 mortality死亡
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近期媒體對居高不下的
孕產婦死亡率的報導
14:47
has helped幫助 the public上市 to understand理解:
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讓公衆意識到
14:49
high-quality高質量 maternal母系 health健康 care關心
is within reach達到.
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高品質的孕產婦醫療照護
其實不難獲得
14:52
The question is:
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問題是:
我們的社會準備好要重視
每個社區中的孕婦了嗎?
14:53
Are we as a society社會 ready準備 to value
pregnant women婦女 from every一切 community社區?
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14:59
For my part部分, I'm doing everything I can
to ensure確保 that when we do,
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就我而言,我正竭盡所能地
確保當我們這樣做時
我們擁有充足的技術和實證基礎
15:03
we have the tools工具 and evidence證據 base基礎 ready準備
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15:06
to move移動 forward前鋒.
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往前大步邁進
15:09
Thank you.
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謝謝大家
15:10
(Applause掌聲)
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(掌聲)
Translated by Harper Zhang
Reviewed by SF Huang

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ABOUT THE SPEAKER
Elizabeth Howell - Maternal health reformer
Elizabeth Howell is working to address maternal mortality in the United States.

Why you should listen

Elizabeth Howell is a physician, researcher and advocate committed to improving the health and well-being of women. She is an expert in quality-of-care and racial and ethnic disparities in maternal and child health. Her research focuses on the intersection between quality-of-care and disparities in maternal and infant mortality and morbidity, as well as postpartum depression and its impact on underserved communities.

A graduate of both Harvard Medical School and the Harvard Kennedy School, Howell is a pioneer in research in health equity. She has conducted extensive research on maternal morbidity and mortality in New York City and the significant racial and ethnic disparities that exist. She is a professor in the Departments of Obstetrics, Gynecology, and Reproductive Sciences and Population Health Science and Policy at the Icahn School of Medicine at Mount Sinai. In addition, as the founding Director of the Blavatnik Family Women's Health Research Institute at Mount Sinai, Howell is building a competitive research program that advances the science of women's health across the life span. She has served on several expert committees for organizations including the National Academy of Medicine, National Institutes of Health, the Joint Commission and the American Congress of Obstetricians and Gynecologists.

More profile about the speaker
Elizabeth Howell | Speaker | TED.com