I got to see the last case of killer smallpox in the world.

我有機會看到世界上最後一宗致命天花的案例。

I was in India this past year,

去年我在印度

and I may have seen the last cases of polio in the world.

可能也看到世上最後一宗小兒痲痹案例。

There's nothing that makes you feel more --

沒有什麼比這感覺更好的：有這樣的福氣及榮耀

the blessing and the honor of working in a program like that --

可以在這樣一個團隊中工作

than to know that something that horrible no longer exists.

知道這麼恐怖的東西不復存在。

So I'm going to tell you --

所以，我要說 （掌聲）

(Applause)

所以，我要給你們看一些可怕的圖片。

so I'm going to show you some dirty pictures.

看這些圖片很難熬，但你們應該抱以樂觀的態度

They are difficult to watch, but you should look at them with optimism,

因為圖片恐怖的程度

because the horror of these pictures will be matched

與知道它們不復存在所帶來的振奮感相當。

by the uplifting quality of knowing that they no longer exist.

但我要先告訴你們一些我經歷的事。

But first, I'm going to tell you a little bit about my own journey.

我的背景不完全像你們預期的

My background is not exactly the conventional medical education

傳統醫學教育。

that you might expect.

我在舊金山實習的時候，

When I was an intern in San Francisco,

我聽說有一群美國原住民（美洲印第安人）

I heard about a group of Native Americans who had taken over Alcatraz Island,

居住在惡魔島（Alcatraz Island），

and a Native American who wanted to give birth on that island,

有一個印地安人在島上要生小孩，

and no other doctor wanted to go and help her give birth.

但沒有醫生想去那裡幫她接生。

I went out to Alcatraz, and I lived on the island for several weeks.

我去了惡魔島，在那住了幾個禮拜。

She gave birth; I caught the baby; I got off the island;

她生了小孩，我接生了嬰兒，然後我離開那個島。

I landed in San Francisco;

我回到舊金山，所有媒體都想要訪問我，

and all the press wanted to talk to me,

因為在那兒的三個禮拜,讓我成為印地安問題的專家。

because my three weeks on the island made me an expert in Indian affairs.

我上了每個電視節目。

(Laughter)

有人看到我在節目上，打電話問我

I wound up on every television show.

願不願意在一部電影中演個

Someone saw me on television; they called me up; and they asked me

一群搭車由舊金山前往英國的搖滾樂星們

if I'd like to be in a movie and to play a young doctor

的隨隊年輕醫生。我說：「好，我可以。」

for a bunch of rock and roll stars who were traveling in a bus ride

所以我成為一部大爛片中的醫生，

from San Francisco to England.

這部片叫「Medicine Ball Caravan」。

And I said, yes, I would do that,

好，你知道在六零年代，

so I became the doctor in an absolutely awful movie

你要不是在車上旅行; 就是根本不在車上。(摘錄Ken Kesey 的名言,指跟 Kesey 同陣線或不同)

called "Medicine Ball Caravan."

我在車上。我太太和我，共37年，加入了車隊(指這事業)。

(Laughter)

我們的車帶我們從舊金山到倫敦。

Now, you know from the '60s,

我們在大西洋換了車。然後又換了兩次車

you're either on the bus or you're off the bus; I was on the bus.

我們開過土耳其、伊朗、阿富汗、

My wife of 37 years and I joined the bus.

穿過開伯爾山口進入巴基斯坦，就跟其他年輕醫生一樣。

Our bus ride took us from San Francisco to London,

這是我們在開伯爾山口，那是我們的車。

then we switched buses at the big pond.

我們在穿越開伯爾山口時遇到些困難，

We then got on two more buses

但我們最後到了印度。

and we drove through Turkey and Iran, Afghanistan,

然後，跟所有我們這輩的人一樣，

over the Khyber Pass into Pakistan, like every other young doctor.

我們住在喜馬拉雅山脈的修道院內。

This is us at the Khyber Pass, and that's our bus.

（笑聲）

We had some difficulty getting over the Khyber Pass.

這是我們的駐院醫師實習訓練，

But we wound up in India.

跟醫學院的學生所應受的駐院實習訓練一樣.

And then, like everyone else in our generation,

我們跟一個很有智慧的人學習，叫Karoli Baba的古魯（印度教的導師），

we went to live in a Himalayan monastery.

他告訴我們脫下袍子

(Laughter)

穿上西裝

This is just like a residency program,

去加入聯合國當個外交官

for those of you that are in medical school.

為世界衛生組織工作。

(Laughter)

他還不可思議的預測天花可以被消滅，

And we studied with a wise man, a guru named Karoli Baba,

而這是上帝給人類的禮物，

who then told me to get rid of the dress,

因為在這些科學家的努力下

put on a three-piece suit,

這個預測成真了。這個小女孩是Rahima Banu，

go join the United Nations as a diplomat

她是最後一宗致命天花的患者。

and work for the World Health Organization.

這是一張世界委員會開的證明文件

And he made an outrageous prediction that smallpox would be eradicated,

證明史上第一次消滅一種疾病。

and that this was God's gift to humanity,

消滅天花最重要的是早發現、早行動。

because of the hard work of dedicated scientists.

我要你們重複這個「早發現、早行動」

And that prediction came true.

你們可以說嗎？

This little girl is Rahima Banu,

觀眾：早發現、早行動。

and she was the last case of killer smallpox in the world.

Larry Brilliant：天花是史上最嚴重的疾病。

And this document is the certificate that the global commission signed,

它殺死的人比任何戰爭都多。

certifying the world to have eradicated the first disease in history.

在上個世紀，有五億人死於天花。

The key to eradicating smallpox was early detection, early response.

超過兩個--你已經在看Larry Page了，

I'm going to ask you to repeat that: early detection, early response.

有些人看得很快。（笑聲）

Can you say that?

在Larry Page和Sergey Brinn--

Audience: Early detection, early response.

我和他們有些關係和最近的新組織--

Larry Brilliant: Smallpox was the worst disease in history.

在他們出生那年，

It killed more people than all the wars in history.

兩百萬人死於天花。

In the last century, it killed 500 million people.

我們在1980年宣布天花被消滅了。

You're reading about Larry Page already.

這是我在公衛上看過最重要的投影片，

Somebody reads very fast.

因為它告訴你:就算你是最富有,最有強壯的人、

(Laughter)

是世界上最有權的國王皇后(埃及法老照片:死於天花)

In the year that Larry Page and Sergey Brin --

也沒辦法讓你不受害於天花。

with whom I have a certain affection and a new affiliation --

無法否認, 我們大家在同一條船上.

in the year in which they were born,

以一個最高統治者的角度來看天花

two million people died of smallpox.

是錯誤的。

We declared smallpox eradicated in 1980.

你應該以一個母親的角色

This is the most important slide that I've ever seen in public health,

看他的孩子染病卻束手無策。

[Sovereigns killed by smallpox] because it shows you

第一天、第二天、第三天、第四天、第五天、第六天。

to be the richest and the strongest,

你是個母親而你正在看你的小孩，

and to be kings and queens of the world,

在第六天，你看到膿包變硬。

did not protect you from dying of smallpox.

第七天，你看到天花經典的臍狀疤。

Never can you doubt that we are all in this together.

第八天。

But to see smallpox from the perspective of a sovereign

高爾之前說世界上最常被拍照的、

is the wrong perspective.

最常被印出來的圖片

You should see it from the perspective of a mother,

是地球。但在1974年，

watching her child develop this disease and standing by helplessly.

這張照片才是

Day one, day two, day three,

曝光率最高的.

day four, day five, day six.

因為我們為這張照片印了二十億張

You're a mother and you're watching your child,

我們拿著它們挨家挨戶

and on day six, you see pustules that become hard.

給人們看並問他們家中有沒有天花病患.

Day seven, they show the classic scars of smallpox umbilication.

因為那是我們的監控系統。我們沒有Google、

Day eight.

我們沒有網路爬蟲(自動化瀏覽網路)、我們沒有電腦。

And Al Gore said earlier

到了第九天，你看這張圖片，你會驚駭。

that the most photographed image in the world,

我看這張圖片而我會說：「感謝上帝」

the most printed image in the world,

因為這代表了這只是普通的天花病例，

was that of the Earth.

而我知道這個小孩會活下來。

But this was in 1974, and as of that moment,

到了第十三天，傷口長滿疙瘩、他的眼皮還是腫脹，

this photograph was the photograph that was the most widely printed,

但這個孩子沒有繼發性感染。

because we printed two billion copies of this photograph,

到第二十天，雖然他會一生帶疤，但他會活下來。

and we took them hand to hand, door to door,

還有其它種天花不是這樣的。

to show people and ask them if there was smallpox in their house,

這是個融合性天花，

because that was our surveillance system.

病人全身上下沒有任何一個地方有超過

We didn't have Google, we didn't have web crawlers,

手指頭大小的完好肌膚。

we didn't have computers.

扁平天花，得病者百分之百死亡。

By day nine -- you look at this picture and you're horrified;

出血性天花，最殘忍的，

I look at this picture and I say, "Thank God,"

易感染於懷孕女性。

because it's clear that this is only an ordinary case of smallpox,

我看過大約五十個女人死亡，她們全都染了出血性天花。

and I know this child will live.

我從來沒有看過一個出血性天花死亡者不是懷孕女性。

And by day 13, the lesions are scabbing, his eyelids are swollen,

在1967年，WHO開始了一個不可思議的計畫

but you know this child has no other secondary infection.

要消滅一個疾病。

And by day 20, while he will be scarred for life, he will live.

在那年，34個國家有天花病例。

There are other kinds of smallpox that are not like that.

到了1970年，只剩下18個國家。

This is confluent smallpox,

1974年，只剩下五個國家。

in which there isn't a single place on the body where you could put a finger

但在那年，天花在印度爆發。

and not be covered by lesions.

印度也成為天花最後病例的所在地。

Flat smallpox, which killed 100 percent of people who got it.

1974年，印度有六億人口。

And hemorrhagic smallpox, the most cruel of all,

那時印度有21個語言區，

which had a predilection for pregnant women.

就像是說有21個不同國家一樣。

I've probably had 50 women die.

任何時間都有兩千萬人在路上, 在搭著車、火車、

They all had hemorrhagic smallpox.

走路，有五十萬村莊、一億兩千萬戶人家，

I've never seen anybody die from it who wasn't a pregnant woman.

但沒有任何人願意告訴我們:他們家裡有天花病人

In 1967, the WHO embarked on what was an outrageous program

因為他們認為天花是女神Shitala Mata

to eradicate a disease.

（降溫女神）的拜訪，

In that year, there were 34 countries affected with smallpox.

當女神來訪的時候不該讓陌生人進家門。

By 1970, we were down to 18 countries.

所以沒有任何匯報天花役疫情的意願。

1974, we were down to five countries.

不是只有印度有天花女神，

But in that year, smallpox exploded throughout India.

這種"天花神"的迷信在全世界各地普遍存在的。

And India was the place where smallpox made its last stand.

所以我們要如何消滅天花？大眾接種是沒有用的。

In 1974, India had a population of 600 million.

你可以讓印度每個人都接種，

There are 21 linguistic states in India,

但一年後又有兩千一百萬新生兒，

which is like saying 21 different countries.

在當時等於加拿大的人口。

There are 20 million people on the road at any time,

為每個人打疫苗是沒有用的。

in buses and trains, walking; 500,000 villages, 120 million households,

你必須在同一時間找到全世界每一宗天花案例

and none of them wanted to report

且在每個案例周圍建立防疫圈。

if they had a case of smallpox in their house,

我們就是這麼做的。

because they thought that smallpox was the visitation of a deity,

光在印度，我和我的十五萬好朋友們

Shitala Mata, the cooling mother,

拿著同樣的照片在印度

and it was wrong to bring strangers into your house

挨家挨戶拜訪。我們拜訪了超過一千萬家庭。

when the deity was in the house.

在過程中，我學到一件重要的事情：

No incentive to report smallpox.

我們每做一次門戶搜索，

It wasn't just India that had smallpox deities;

天花病例的數目就突然高起來一次。

smallpox deities were prevalent all over the world.

當我們沒有搜索時，我們有了疾病被消除的假象。

So, how we eradicated smallpox was --

當我們搜索時，我們有疾病病例增加的假象。

max vaccination wouldn't work.

一個監控系統是必須的，

You could vaccinate everybody in India,

因為我們需要的是早發現,早行動。

but one year later there'd be 21 million new babies,

所以我們一直找一直找，找到

which was then the population of Canada.

印度的每一宗天花。我們提供獎勵。

It wouldn't do just to vaccinate everyone.

然後我們提高獎勵。我們繼續提高獎勵。

You had to find every single case of smallpox in the world

我們在每一棟房子牆上記錄到訪的日期(像計分表一樣)。

at the same time, and draw a circle of immunity around it.

當我們一直這麼做時，天花病例的數目最後也降到零。

And that's what we did.

在1980年，我們宣布天花不復存在。

In India alone, my 150,000 best friends and I went door to door,

這是聯合國在伊拉克戰爭前最大的活動，

with that same picture,

十五萬人來自世界各地

to every single house in India.

及不同種族、不同宗教、不同國家的醫生們，

We made over one billion house calls.

肩並肩，互相幫助而無紛爭，

And in the process, I learned something very important.

完成一個讓世界更美好的任務。

Every time we did a house-to-house search,

但天花是我們試著消滅的第四個疾病。

we had a spike in the number of reports of smallpox.

我們之前失敗了三次。

When we didn't search, we had the illusion that there was no disease.

在瘧疾、黃熱病和雅司(熱帶莓疹)病上我們都失敗了。

When we did search, we had the illusion that there was more disease.

不過很快的，小兒痲痹也會被消滅的。

A surveillance system was necessary,

消滅小兒痲痹的金鑰是：早發現,早行動。

because what we needed was early detection, early response.

今年有可能是我們消滅小兒痲痹的一年，

So we searched and we searched,

這就會是史上第二個被消滅的疾病。

and we found every case of smallpox in India.

David Heymann, 如果你透過網路轉播看這場演講。

We had a reward. We raised the reward.

David, 繼續努力。我們快要做到了，我們只剩下四個國家。

We continued to increase the reward.

（掌聲）

We had a scorecard that we wrote on every house.

我覺得我跟Hank Aaron（美國棒球球員）一樣, 會很快的被Barry Bonds（棒球球員）追上取代。

And as we did that,

讓我們再把一個疾病從我們耽心的清單中移除。

the number of reported cases in the world dropped to zero.

我才在印度參與消滅小兒痲痹的工作。

And in 1980, we declared the globe free of smallpox.

小兒痲痹的監控系統是四百萬人挨家挨戶去尋找。

It was the largest campaign in United Nations history,

那是我們的監控系統。

until the Iraq war.

我們需要早發現,早行動。

150,000 people from all over the world --

失明，一樣的。發現失明的鑰匙是

doctors of every race, religion, culture and nation,

做流行病學問卷並找出失明的原因，

who fought side by side, brothers and sisters,

方能做出正確的反應。

with each other, not against each other,

賽瓦基金會是由一群

in a common cause to make the world better.

曾參與消滅天花的人組成的。

But smallpox was the fourth disease that was intended for eradication.

這群人爬到了頂峰

We failed three other times.

嘗了消滅一種疾病的成功滋味，

We failed against malaria, yellow fever and yaws.

且想要再做一次。

But soon we may see polio eradicated.

在過去的27年當中，賽瓦基金在十五個國家

But the key to eradicating polio is early detection, early response.

已經幫兩百萬失明人士找回光明。

This may be the year we eradicate polio.

賽瓦的開始是因為我們想要將

That will make it the second disease in history.

監控系統和流行病學理論

And David Heymann, who's watching this on the webcast --

用在其他人都不認為是

David, keep on going. We're close!

公衛的問題：失明。

We're down to four countries.

在這之前只被認為是個臨床疾病。

(Applause)

1980年賈伯斯給我一台電腦，蘋果第十二號，

I feel like Hank Aaron.

它現在還在加德滿都（尼泊爾首都）運作著。

Barry Bonds can replace me any time.

我們應該把它拿來拍賣,為賽瓦籌得到更多錢。

Let's get another disease off the list of terrible things to worry about.

我們做了史上第一個尼泊爾的健康問卷，

I was just in India working on the polio program.

也是第一個全國性的失明問卷，

The polio surveillance program is four million people going door to door.

而結果另我們吃驚。

That is the surveillance system.

我們以為會得到的結果是:

But we need to have early detection, early response.

青光眼和沙眼是造成失明主要的原因.

Blindness, the same thing.

但我們驚訝的發現失明竟多數是由白內障造成的。

The key to discovering blindness is doing epidemiological surveys

你不可能醫治或預防你不知道的東西。

and finding out the causes of blindness,

在你們的TED包裹中有一片DVD「無限視覺」，

so you can mount the correct response.

在講V醫生和Aravind眼科醫院。

The Seva Foundation was started by a group of alumni

我希望你們能看一看。

of the Smallpox Eradication Programme,

Aravind一開始是賽瓦的一個計畫，

who, having climbed the highest mountain,

現在是世界上最大最好的眼科醫院。

tasted the elixir of the success of eradicating a disease,

今年，這間醫院會在印度

wanted to do it again.

塔米德邦為三十萬人恢復視力。

And over the last 27 years, Seva's programs in 15 countries

（掌聲）

have given back sight to more than two million blind people.

禽流感。我在這裡為這些恐怖的事情發言--

Seva got started because we wanted to apply these lessons

這有可能是最遭的。

of surveillance and epidemiology

防止或是減輕禽流感流行的鑰匙是

to something which nobody else was looking at as a public health issue:

早發現、早行動。

blindness, which heretofore had been thought of only as a clinical disease.

在未來的三年中，我們不會有疫苗或是

In 1980, Steve Jobs gave me that computer, which is Apple number 12,

足夠的抗病毒素來對抗禽流感。

and it's still in Kathmandu, and it's still working,

這是世界衛生組織將大流行病分級表。

and we ought to go get it and auction it off and make more money for Seva.

我們現在在警戒區第三級，

And we conducted the first Nepal survey ever done for health,

只有一些些的人傳人病例，

and the first nationwide blindness survey ever done,

但沒有大量人傳人病例。

and we had astonishing results.

當世界衛生組織宣布我們在第四級時，

Instead of finding out what we thought was the case --

這不會像科特莉娜颶風只局部在一區。我們知道的世界將會停擺。

that blindness was caused mostly by glaucoma and trachoma --

不會有任何飛機飛行。

we were astounded to find out

你會願意搭乘一架有250個陌生人的飛機

that blindness was caused instead by cataract.

有人正在咳嗽和擤鼻涕，而你知道其中幾個

You can't cure or prevent what you don't know is there.

有可能帶有致人於死地的傳染病，

In your TED packages there's a DVD, "Infinite Vision,"

而你沒有機會得到抗病毒素或疫苗嗎？