Rebuilding Liberia Health Care
2015-07-03 15:23:05


As Liberia rebuilds a healthcare system severely damaged by the Ebola outbreak, researchers said the nation must provide better medical services in remote rural areas.(1)
随着利比里亚重建严重受损的埃博拉出血热疫情的医疗保健系统,研究人员说,这个国家必须提供更好的医疗服务,在偏远的农村地区。

A report examining barriers to health care has been published in the online Journal of Global Health.(2)
检查卫生保健障碍的报告已被发表在在线全球卫生杂志 》 上。

Liberia was declared Ebola-free on May 9th. But several new cases of late show just how tenuous that label can be.(3)
5 月 9 日被宣布无埃博拉的利比里亚。但几个新例晚期显示该标签可以是多么脆弱。

The first new case since May 9th was a 17-year-old boy, who died the last weekend in June.(4)
第一次的新情况下,自 5 月 9 日是 17 岁的男孩,死在 6 月最后一个周末。

John Kraemer has studied how Liberia dealt with the epidemic.(5)
约翰 · 克雷默研究利比里亚如何处理这一流行病。

He said that while health officials are acting quickly, the fact that new infections were found is heartbreaking.(6)
他说,虽然卫生官员行动迅速,发现新的感染是令人心碎的事实。

“The last time I was in Liberia was in February. The cases were essentially gone.(7)
"上一次在利比里亚在二月。这宗基本上消失了。

And there was this sort of palpable optimism everyplace. And so it's really disheartening to see these cases back.(8)
还有这种明显乐观各地。所以它是真的很令人沮丧的看到这些案件回来。

It does appear that the ministry and their partners are on top of things, which is at least optimistic. Certainly, the system is fragile.(9)
它会显示现时部和他们的合作伙伴是事情,这是至少乐观。当然,该系统是脆弱的。

What these cases indicate is hard to know, but it’s concerning that the young man who died doesn’t appear to have been on anybody’s list of contacts.”(10)
这些案例表明了什么是很难知道,但它是关于那死去的年轻的人似乎并没有一直在任何人的联系人列表中."

The Liberian teenager reportedly had been identified as having malaria, not Ebola.(11)
利比里亚少年据报被认定患上疟疾,不埃博拉病毒。

Kraemer is an associate professor of health systems administration at Georgetown University.(12)
克雷默是卫生系统管理的乔治敦大学副教授。

He’s also a technical consultant to the organization Last Mile Health, which focuses on rural healthcare.(13)
他也是最后一英里健康,重点是农村医疗保健组织技术顾问。

“Before Ebola, Liberia was coming out of the war, which ended in 2003, and health indicators were really turning around.(14)
"埃博拉,利比里亚出来的战争,在 2003 年结束,前后健康指标真的转过身。

And so the progress that you saw in things like under-five mortality or maternal health indicators was really impressive, given how little money there is in the system;(15)
所以你看到的事情的进展像五岁以下儿童死亡率和孕产妇健康指标是真的令人印象深刻,给多少钱是在系统内;

given how few physicians of other health care providers were in the country.(16)
给出多少医生的其他卫生保健提供者在该国。

Ebola, to some extent, just decimated that system,” he said.(17)
埃博拉病毒,在某种程度上,只是摧毁了这一制度,"他说。

He said it’s too soon to tell what the long-term impact of the Ebola epidemic will be on Liberia’s healthcare system.(18)
他说: 它还为时过早,告诉埃博拉疫情的长期影响将是关于利比里亚的医疗保健系统。

But he said with the loss of many health workers to Ebola also came a loss of trust in the system.(19)
但他说: 失去了很多健康的埃博拉病毒的工人也来了在系统中的信任损失。

Medical care is more available in urban areas than rural.(20)
医疗服务是更多的可用在城市地区比农村。

So Kraemer and Last Mile Health looked at how the rural population copes.(21)
所以克雷默和最后一英里健康看如何应对农村人口。

“This is a population that’s as disadvantaged as any place on the planet.(22)
"这是是这个星球上的任何地方处于不利地位的人口。

And so we really wanted to understand what particular barriers this population faces in order to be able to deliver services as well as possible,” he said.(23)
所以我们真的想要了解这个人口才能够提供的服务,以及可能面临着什么特别的障碍,"他说。

Kraemer said the main finding of the research is not surprising.(24)
克雷默说,研究的主要发现是不令人惊讶。

“Of course, as you get farther away from health facilities, access to care declines. And it declines fairly drastically.(25)
"当然,当你远离保健设施,提供护理的下降。它相当急剧下降。

So, for example, one that measure we use is what we call the full maternal health cascade,(26)
因此,例如,一个我们使用这项措施是我们所说的全部孕产妇健康的级联,

which is at least four antenatal care visits, facility-based delivery and postnatal care for the mother and child.(27)
这是至少四次产前检查、 基础设施的交付和产后护理的母亲和孩子。

And when we look at this measure among people who live in the most distant parts, the most remote parts of this rural population, only about seven percent or so receive that full cascade.”(28)
当我们看着那些生活在最遥远的地方的人的这项措施,最偏远地区的农村人口中,大约只有 7%左右接收,全梯级。"

That’s 75 percent less for those remote rural populations compared to rural populations closer to urban areas.(29)
这是为那些偏远的农村人口,农村人口更接近于城市地区相比减少了 75%。

The distance between those two rural groups may be just 11 to 40 kilometers.(30)
这两个农村群体之间的距离可能只是 11 到 40 公里。

He said, “The same thing is true for childhood illnesses.(31)
他说,"同样的事情是真实的儿童疾病。

If you looked at fever treatment, we saw about nine percent of kids in the most distant group getting care for fever, potential malaria, compared to 43 percent in the nearest, but still rural, group.”(32)
如果你看看发烧治疗,我们看到大约 9%的孩子在最遥远的小组得到照顾发烧,潜在的疟疾,相比,最近,但还是农村,组中的 43%."

But Kraemer said no matter what the distance, parents want their children to receive care for illnesses.(33)
但克雷默说,不论什么距离,父母希望自己的孩子接受的疾病保健。

“If you sort of step back a level and you ask parents:(34)
“If you sort of step back a level and you ask parents:

when your child had fever – when your child had acute respiratory illness, potential pneumonia – did they receive care from anybody?(35)
当你的孩子发烧 — — 当你的孩子有急性呼吸道疾病,潜在的肺炎 — — 没有任何人收到护理吗?

Distance didn’t matter in the answer to that question.(36)
距离并不重要的那个问题的答案。

And that’s also, of course, not surprising, right? So parents want their kids to be treated and parents would seek care from somebody no matter where they were.(37)
而且这也是,当然,不令人惊讶,不是吗?所以父母想要他们待的孩子和家长将寻求从无论他们在那里有人照顾。

But parents who lived in the most rural parts of this rural area would be much more likely to get their kids treated by a traditional provider,(38)
但是父母住在大部分农村地区的农村地区会更有可能要让孩子对待传统的供应商,

by these providers called black baggers, which are sort of roving medical dispensaries,” he said.(39)
他说,被称为黑色的政客,是巡回医疗药房排序,这些提供程序"。

He said the quality of care could be much lower in such cases.(40)
他说: 可以在这种情况下要低得多的护理质量。

“You don’t know what the drugs are. You don’t know if the drugs are expired or ever had active ingredients.(41)
"你不知道的药物有哪些。你不知道是否药品已过期,或曾经有活性成分。

You don’t really have diagnostic capabilities.(42)
你真的没有诊断功能。

And so the optimistic part of that, I think, is that it suggests that there is real demand for healthcare services that can be met if you can get services out to where people actually live.”(43)
所以乐观其中的一部分,我认为,是,这表明是有真正的需求,如果你可以到人们居住出去服务可以满足的医疗服务。

He said with today’s technology groups like Last Mile Health can provide diagnostic and treatment for malaria,(44)
他说,与今天的技术团体像最后一英里健康可以提供诊断和治疗疟疾,

acute respiratory infections and severe diarrhea and help with family planning, among other things.(45)
急性呼吸道感染和严重腹泻和计划生育,除其他外的帮助。

The thing that’s really complicated, but is really, really important, is referral networks. A woman goes into labor.(46)
东西实在太复杂,但却是真的,真的很重要,是转诊网络。一个女人进入劳动。

She needs to figure out a way how to get transported to a facility to be able to deliver in that facility.(47)
她需要找出如何得到运往设施必须能够提供这种设施。

In the U.S. that would be done by an ambulance or a friend would drive the person. Here, you have to become a lot more creative.(48)
在美国,并将能通过一辆救护车或朋友会开车的人。在这里,你要变得更有创造力。

So it’s thinking about engaging people who already drive from community to community because they’re delivering things.(49)
所以它思考已经开车从社区到社会,因为正在提供这些东西的人进行接触。

It’s amazing to me that this happens, but finding people who are motor biking small-level supplies,(50)
它是惊人的对我这种情况发生,但寻找的人是电机自行车小级用品、

who can literally put a woman in delivery on the back of the motor bike.(51)
谁可以随便放在交付一个女人在电机的自行车的后座上。

I’ve never been in labor, but I can’t imagine that’s much fun,” he said.(52)
我从来没有在劳动中,但我不能想象那是好玩的"他说。

To improve medical care in remote rural areas of Liberia, Kraemer and his colleagues recommend” community health worker-based service delivery;(53)
改善医疗服务在偏僻的农村地区的利比里亚、 克雷默和他的同事们推荐"社区工作者根据提供的保健服务;

partnership with traditional care providers; mobile clinics; providing transportation costs and reimbursing families for seeking health care.(54)
伙伴关系与传统保健提供者;流动诊所;提供运输费用和偿还家庭寻求卫生保健。

Kraemer is also a Scholar with the O’Neill Institute for National and Global Health Law at Georgetown University.(55)
克雷默也是与国家和乔治城大学的全球卫生法奥尼尔研究所学者。

He says that “international human rights law and ethical norms oblige health ministries and their development partners to promote equal access to essential health services.”(56)
他说,"国际人权法律和道德规范要求卫生部门和他们的发展伙伴,为促进平等获得基本卫生服务。"


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