比爾・蓋茨:與小兒麻痹症作戰的收穫

Our foundation began working in India a decade ago, at a time when many feared that the country would become a flashpoint for HIV/AIDS. Since then, we have expanded into other areas, including vaccines, family planning and agricultural development. In all of this work, Melinda and I have seen many examples of India's poor making dramatic contributions. But nowhere has this power been demonstrated more clearly than in the fight to end polio. Indeed, India's accomplishment in eradicating polio is the most impressive global health success I've ever seen.

我們的基金會10年前開始在印度開展工作，當時許多人擔心印度會成爲艾滋病的導火索。從那時起，我們的工作擴展到其他領域，包括疫苗接種、計劃生育和農業發展。在所有這些工作中，梅琳達(Melinda)和我看到了許多印度窮人做出巨大貢獻的例子。但沒有什麼能比消滅小兒麻痹症之戰更清楚地證明了這種力量。實際上，印度根除小兒麻痹症的成就是我所見過的令人印象最深刻的全球衛生事業的勝利。

I first began traveling to India in the 1980s, drawn by a fascination with this ancient country that cherishes its history and harbors great ambitions for the future. My interest was professional as well as personal. Microsoft was expanding, our need for talent was growing, and I was attracted to the vitality and ingenuity of the Indian people.

20世紀80年代，懷着對這個歷史悠久、胸懷未來的古老國家的好奇，我第一次前往印度。我對印度的興趣既有職業原因，也有個人原因。微軟(Microsoft)當時正在擴張，我們對人才的需求不斷增長，印度人民的活力和創造力吸引了我。

A few years later, several colleagues and I were flying into Bangalore. As we made our final approach, I looked out the window and saw an area of densely packed, tiny, dilapidated homes stretching out for miles. At that moment, one of my Indian companions declared proudly, 'We have no slums in Bangalore.' Whether out of denial or innocence, my colleague didn't see the 'other' India. I don't mean to single him out. It can be easy to turn our eyes away from the poor. But if we do, we miss seeing a society's full potential.

幾年後，我和幾位同事飛往班加羅爾(Bangalore)。當我們最終到達時，我看向窗外，只見一片密密麻麻、狹小破舊的房屋綿延數英里之遠。那一刻，我的一位印度同事自豪地宣稱：“班加羅爾沒有貧民窟。”不管是出於開脫還是無知，我的同事沒有看到“另一個”印度。我無意指出他是誰。對窮人視而不見很容易。但如果我們這樣做，就不會發覺一個社會的全部潛力。

When Melinda and I started our foundation's work in India, we began to meet people from the areas we'd been flying over. They had little education and poor health, and lived in slums or poor rural areas -- the kind of people many experts had told us were holding India back. But our experience suggests the opposite: What some call a weakness can be a source of great strength.

當梅琳達和我開始基金會在印度的工作時，我們見到了飛機曾途經地區的人們。他們幾乎沒有接受過教育，健康狀況糟糕，住在貧民窟或貧困的農村地區──許多專家告訴我們，是這種人拖了印度的後腿。但我們的經驗表明，事實相反：一些人所謂的麻煩正可能是強大力量的來源。

In 1988, when there were approximately 350,000 new polio cases a year and the disease was crippling children in 125 countries, the World Health Assembly set the goal of eliminating polio world-wide. Progress came quickly. By 1994, the Americas were polio-free. Soon we saw the last case in China, the last case in the Pacific, the last case in Europe. By the year 2000, the number of polio cases had dropped by 99%. But the task of ending polio was not 99% done.

1988年，世界衛生大會制訂了在全球消滅小兒麻痹症的目標，當時每年約有350,000個新增小兒麻痹症病例，這種疾病仍在125個國家中使兒童致殘。這項工作進展迅速。1994年，美洲消滅了小兒麻痹症。很快，我們看到了中國的最後一個病例、太平洋地區的最後一個病例、歐洲的最後一個病例。截至2000年，小兒麻痹症病例數已下降了99%。但這並不等於消滅小兒麻痹症的任務完成了99%。

The remaining cases were concentrated in fewer countries, and India was one of the last nations left. This was no surprise. India's urban centers are among the world's most densely populated. Its rural communities are dispersed across a vast and often inaccessible terrain. The country suffers from poor sanitation. Its 1.2 billion citizens are highly mobile and give birth to 27 million new Indians every year. Experts predicted that polio would be eliminated in every other country before it was eliminated in India.

剩下的病例集中在少數國家，印度是最後一個。這並不令人意外。印度的市中心是世界上人口最密集的市中心之一。印度的農村社區分散在廣闊且通常難以到達的地區。印度的衛生條件惡劣。它的12億人口高度流動，每年有2,700萬名印度新生兒誕生。專家預測，其它各國都將在印度之前消滅小兒麻痹症。

But India surprised them all: The country has now been polio-free for more than two years. India's success offers a script for winning some of the world's most difficult battles in every area of human welfare. The key has been the participation of the humblest, most vulnerable members of the Indian population.

但印度讓他們所有人驚訝：印度已經兩年多未發現小兒麻痹症病例。印度的成功說明我們可以在每個人類福利領域打贏一些世界上最困難的戰役。關鍵在於印度最底層的弱勢羣體的參與。

To be successful, any campaign this big has to include a clear goal, a comprehensive plan and precise measurements of progress. But the antipolio campaign in India took a crucial extra step: It enlisted the support of the full sweep of Indian society, including health workers, ordinary citizens and some of the poorest people in the most impoverished regions of the country.

任何這種大型運動都必須有明確的目標、周全的計劃和精確衡量的進度才能成功。而印度的抗擊小兒麻痹症運動還邁出了至關重要的一步：它獲得了印度全社會的支持，包括衛生工作者、普通公民和印度最貧困地區的部分最貧困的人。

The heart of the plan was a simple and inspiring mission: to find the children. To defeat polio, it is essential to achieve up to 95% vaccination coverage in afflicted areas. There is no way to measure whether you're meeting that mark unless you know how many children there are, where they are and whether they've been vaccinated.

這項計劃的核心是一個簡單而鼓舞人心的任務：找到孩子們。爲了抗擊小兒麻痹症，受感染地區的疫苗接種率必須達到95%。沒有方法來衡量是否達到這一標準，除非你知道那裏有多少孩子，他們在哪裏，他們是否已經接種。

India responded to this challenge with an army of more than 2 million vaccinators, who canvassed every village, hamlet and slum. Vaccinators took the best maps they had and made them better. They walked miles every day and worked late into the night. They found children in the poorest areas of Uttar Pradesh and in the remote Kosi River area of Bihar -- an area with no electricity that is often flooded and unreachable by roads. They found the sons and daughters of migrant workers in bus stations and train stations, accompanying their families on their way to find work.

印度配備了200多萬人的接種員隊伍以應對這一挑戰，他們走遍了每個村莊、聚落和貧民窟。疫苗接種員帶上了他們最好的地圖並讓它更加完善。他們每天步行很遠，工作直到深夜。他們找到了最貧困的北方邦(Uttar Pradesh)地區和比哈爾邦(Bihar)偏遠的戈西河地區(Kosi River) ──一個經常遭受洪水，沒有路可走也不通電的地區──的孩子們。他們在汽車站和火車站找到被出來打工的家人帶在身邊的民工子女。

When Melinda and I visited India in March 2011, two months after the last case of polio was identified, we traveled to a brick kiln whose workers labored long hours at low wages and lived in mud huts. We met a young mother and asked if her children had been vaccinated. She ducked into her hut, retrieved a bag that held all her possessions, and rummaged around the bottom of it until she proudly produced an immunization card listing the names of all her children and showing that each had received the polio vaccine -- not just once, but several times. We were amazed.

梅琳達和我2011年3月訪問印度時，已是最後一例小兒麻痹症被發現的兩個月後。我們前往一個磚窯，那裏的工人工作時間長，薪水微薄，住在泥棚裏。我們見到了一位年輕母親，並問她的孩子是否接種了疫苗。她 進她的棚屋裏，拿出一個裝着她全部財產的袋子，翻了個底朝天，直到驕傲地拿出一張寫着她所有孩子名字的免疫卡，證明每個孩子都接種了小兒麻痹症疫苗接種──不是隻有一次，而是好幾次。我們驚呆了。

Wherever India's vaccinators have gone, they've had help from local residents. In one Kolkata slum, a group of schoolchildren who call themselves the Daredevils have been relentless in this effort. Their community had never had house numbers, so the children assigned numbers. Using donated cellphones connected to global positioning satellites, they created a digital map, marking each house where children hadn't been vaccinated.

不管印度接種員們走到哪裏，他們都會得到當地居民的幫助。在加爾各答(Kolkata)的一個貧民窟，一羣稱自己爲夜魔俠的學童爲此做出了堅韌不拔的努力。他們的社區沒有門牌號碼，於是孩子們將門牌號碼分發到各家各戶。他們使用捐贈的手機連接到全球定位衛星，繪製出一張數字地圖，標記上每棟孩子尚未接種疫苗的房子。

The fight to end polio is not over, not even in India, and new polio cases in the Horn of Africa and Syria underscore the importance of eradicating polio everywhere. Still, if the world maintains its funding and commitment, we can eradicate the disease globally within six years.

消滅小兒麻痹症的鬥爭尚未結束，甚至在印度也如此，非洲之角(Horn of Africa)和敘利亞的小兒麻痹症新發病例凸顯了在世界各地根除小兒麻痹症的重要性。不過，如果全球各國堅持提供資金並堅守承諾，我們就能在六年內在全球範圍內消滅這種疾病。

The accomplishments of India's vaccinators and children and politicians will not end when polio ends in their country. Now that they have found India's children, they can bring them and their families other vaccines, clean water, education, advice on maternal and child health, and support for agriculture -- all the things that people need to live healthy and productive lives.

小兒麻痹症在印度消失了，但印度接種員、孩子們和政治家的成就不會消失。現在，他們已經找到了印度的孩子們，可以給他們和他們的家庭帶去其它疫苗、清潔的水源、教育、對孕婦和兒童的健康諮詢和農業支持──人們健康富裕生活所需的一切。

Years ago, on that day we were landing in Bangalore, I didn't know nearly as much about India as I do now. I saw India's obvious talent and energy, but, like my colleague, I missed its hidden strength -- the rich, the powerful and the poor working together toward a common goal.

多年前，當我們的飛機在班加羅爾着陸時，我對印度的瞭解不如現在這樣多。我看到了印度顯而易見的人才和活力，但和我的同事一樣，我沒有看到它隱藏的力量──富人、強者和窮人向着一個共同目標精誠合作的力量。