时间:2018-12-16 作者:英语课 分类:VOA标准英语2015年(七月)


英语课

Rebuilding Liberia Health Care 重建利比里亚卫生保健系统


As Liberia rebuilds a healthcare system severely 1 damaged by the Ebola outbreak, researchers said the nation must provide better medical services in remote rural areas. A report examining barriers to health care has been published in the online Journal of Global Health.


Liberia was declared Ebola-free on May 9th. But several new cases of late show just how tenuous 2 that label can be. The first new case since May 9th was a 17-year-old boy, who died the last weekend in June.


John Kraemer has studied how Liberia dealt with the epidemic 3. He said that while health officials are acting 4 quickly, the fact that new infections were found is heartbreaking.


“The last time I was in Liberia was in February. The cases were essentially 5 gone. And there was this sort of palpable optimism everyplace. And so it's really disheartening to see these cases back. It does appear that the ministry 6 and their partners are on top of things, which is at least optimistic. Certainly, the system is fragile. 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.”


The Liberian teenager reportedly had been identified as having malaria 7, not Ebola.


Kraemer is an associate professor of health systems administration at Georgetown University. He’s also a technical consultant 8 to the organization Last Mile Health, which focuses on rural healthcare.


“Before Ebola, Liberia was coming out of the war, which ended in 2003, and health indicators 9 were really turning around. And so the progress that you saw in things like under-five mortality or maternal 10 health indicators was really impressive, given how little money there is in the system; given how few physicians of other health care providers were in the country. Ebola, to some extent, just decimated that system,” he said.


He said it’s too soon to tell what the long-term impact of the Ebola epidemic will be on Liberia’s healthcare system. But he said with the loss of many health workers to Ebola also came a loss of trust in the system.


Medical care is more available in urban areas than rural. So Kraemer and Last Mile Health looked at how the rural population copes.


“This is a population that’s as disadvantaged as any place on the planet. 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.


Kraemer said the main finding of the research is not surprising.


“Of course, as you get farther away from health facilities, access to care declines. And it declines fairly drastically. So, for example, one that measure we use is what we call the full maternal health cascade 11, which is at least four antenatal care visits, facility-based delivery and postnatal care for the mother and child. 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.”


That’s 75 percent less for those remote rural populations compared to rural populations closer to urban areas. The distance between those two rural groups may be just 11 to 40 kilometers.


He said, “The same thing is true for childhood illnesses. 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.”


But Kraemer said no matter what the distance, parents want their children to receive care for illnesses.


“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 12 – did they receive care from anybody? Distance didn’t matter in the answer to that question. 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. 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, by these providers called black baggers, which are sort of roving medical dispensaries,” he said.


He said the quality of care could be much lower in such cases.


“You don’t know what the drugs are. You don’t know if the drugs are expired or ever had active ingredients. You don’t really have diagnostic capabilities 13. 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.”


He said with today’s technology groups like Last Mile Health can provide diagnostic and treatment for malaria, acute respiratory infections and severe diarrhea and help with family planning, among other things.


The thing that’s really complicated, but is really, really important, is referral networks. A woman goes into labor 14. She needs to figure out a way how to get transported to a facility to be able to deliver in that facility. 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. So it’s thinking about engaging people who already drive from community to community because they’re delivering things. It’s amazing to me that this happens, but finding people who are motor biking small-level supplies, who can literally 15 put a woman in delivery on the back of the motor bike. I’ve never been in labor, but I can’t imagine that’s much fun,” he said.


To improve medical care in remote rural areas of Liberia, Kraemer and his colleagues recommend” community health worker-based service delivery; partnership 16 with traditional care providers; mobile clinics; providing transportation costs and reimbursing 17 families for seeking health care.


Kraemer is also a Scholar with the O’Neill Institute for National and Global Health Law at Georgetown University. He says that “international human rights law and ethical 18 norms oblige health ministries 19 and their development partners to promote equal access to essential health services.”



1 severely
adv.严格地;严厉地;非常恶劣地
  • He was severely criticized and removed from his post.他受到了严厉的批评并且被撤了职。
  • He is severely put down for his careless work.他因工作上的粗心大意而受到了严厉的批评。
2 tenuous
adj.细薄的,稀薄的,空洞的
  • He has a rather tenuous grasp of reality.他对现实认识很肤浅。
  • The air ten miles above the earth is very tenuous.距离地面十公里的空气十分稀薄。
3 epidemic
n.流行病;盛行;adj.流行性的,流传极广的
  • That kind of epidemic disease has long been stamped out.那种传染病早已绝迹。
  • The authorities tried to localise the epidemic.当局试图把流行病限制在局部范围。
4 acting
n.演戏,行为,假装;adj.代理的,临时的,演出用的
  • Ignore her,she's just acting.别理她,她只是假装的。
  • During the seventies,her acting career was in eclipse.在七十年代,她的表演生涯黯然失色。
5 essentially
adv.本质上,实质上,基本上
  • Really great men are essentially modest.真正的伟人大都很谦虚。
  • She is an essentially selfish person.她本质上是个自私自利的人。
6 ministry
n.(政府的)部;牧师
  • They sent a deputation to the ministry to complain.他们派了一个代表团到部里投诉。
  • We probed the Air Ministry statements.我们调查了空军部的记录。
7 malaria
n.疟疾
  • He had frequent attacks of malaria.他常患疟疾。
  • Malaria is a kind of serious malady.疟疾是一种严重的疾病。
8 consultant
n.顾问;会诊医师,专科医生
  • He is a consultant on law affairs to the mayor.他是市长的一个法律顾问。
  • Originally,Gar had agreed to come up as a consultant.原来,加尔只答应来充当我们的顾问。
9 indicators
(仪器上显示温度、压力、耗油量等的)指针( indicator的名词复数 ); 指示物; (车辆上的)转弯指示灯; 指示信号
  • The economic indicators are better than expected. 经济指标比预期的好。
  • It is still difficult to develop indicators for many concepts used in social science. 为社会科学领域的许多概念确立一个指标仍然很难。
10 maternal
adj.母亲的,母亲般的,母系的,母方的
  • He is my maternal uncle.他是我舅舅。
  • The sight of the hopeless little boy aroused her maternal instincts.那个绝望的小男孩的模样唤起了她的母性。
11 cascade
n.小瀑布,喷流;层叠;vi.成瀑布落下
  • She watched the magnificent waterfall cascade down the mountainside.她看着壮观的瀑布从山坡上倾泻而下。
  • Her hair fell over her shoulders in a cascade of curls.她的卷发像瀑布一样垂在肩上。
12 pneumonia
n.肺炎
  • Cage was struck with pneumonia in her youth.凯奇年轻时得过肺炎。
  • Pneumonia carried him off last week.肺炎上星期夺去了他的生命。
13 capabilities
n.能力( capability的名词复数 );可能;容量;[复数]潜在能力
  • He was somewhat pompous and had a high opinion of his own capabilities. 他有点自大,自视甚高。 来自辞典例句
  • Some programmers use tabs to break complex product capabilities into smaller chunks. 一些程序员认为,标签可以将复杂的功能分为每个窗格一组简单的功能。 来自About Face 3交互设计精髓
14 labor
n.劳动,努力,工作,劳工;分娩;vi.劳动,努力,苦干;vt.详细分析;麻烦
  • We are never late in satisfying him for his labor.我们从不延误付给他劳动报酬。
  • He was completely spent after two weeks of hard labor.艰苦劳动两周后,他已经疲惫不堪了。
15 literally
adv.照字面意义,逐字地;确实
  • He translated the passage literally.他逐字逐句地翻译这段文字。
  • Sometimes she would not sit down till she was literally faint.有时候,她不走到真正要昏厥了,决不肯坐下来。
16 partnership
n.合作关系,伙伴关系
  • The company has gone into partnership with Swiss Bank Corporation.这家公司已经和瑞士银行公司建立合作关系。
  • Martin has taken him into general partnership in his company.马丁已让他成为公司的普通合伙人。
17 reimbursing
v.偿还,付还( reimburse的现在分词 )
  • All banking charges outside Korea and reimbursing are for account of beneficiary. 所有韩国以外的用度及偿付行用度由受益人承担。 来自互联网
  • A reimbursing bank's charges are for the account of the issuing bank. 然而,如果费用系由受益人承担,则开证行有责任在信用证和偿付授权书中予以注明。 来自互联网
18 ethical
adj.伦理的,道德的,合乎道德的
  • It is necessary to get the youth to have a high ethical concept.必须使青年具有高度的道德观念。
  • It was a debate which aroused fervent ethical arguments.那是一场引发强烈的伦理道德争论的辩论。
19 ministries
(政府的)部( ministry的名词复数 ); 神职; 牧师职位; 神职任期
  • Local authorities must refer everything to the central ministries. 地方管理机构应请示中央主管部门。
  • The number of Ministries has been pared down by a third. 部委的数量已经减少了1/3。