演講MP3+雙語(yǔ)文稿:一個(gè)“老年癡呆村”

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【演講者及介紹】Yvonne van Amerongen

一名職業(yè)治療師和社會(huì)工作者。

【演講主題】重新定義老人護(hù)理的 "老年癡呆村"

【中英文字幕】

翻譯者Nancy Cai 校對(duì)者psjmz mz

00:12

This is the Hogeweyk. It's a neighborhoodin a small town very near Amsterdam, in the Netherlands. There are 27 housesfor six, seven people each. There's a small mall with a restaurant, a pub, asupermarket, a club room. There are streets, alleys, there's a theater. Itactually is a nursing home. A nursing home for people that live with anadvanced dementia and that need 24-7 care and support.

這是Hogeweyk。它是位于荷蘭阿姆斯特丹旁邊的一個(gè)小鎮(zhèn)的一個(gè)社區(qū)。這兒有27所住戶，每家有6，7個(gè)人，這兒有一個(gè)小商場(chǎng)，里面有一個(gè)餐廳，一個(gè)酒吧，一個(gè)超市，和一個(gè)娛樂室。這兒有街道和小巷，還有一個(gè)劇場(chǎng)。它其實(shí)是一個(gè)療養(yǎng)院，為那些患有重度癡呆的人提供24小時(shí)的護(hù)理和關(guān)懷。

00:47

Dementia is a terrible disease, and westill don't have any cure for it. It's getting to be a major problem in theworld, for the people, for the politicians, for the world -- it's getting to bea big problem. We see that we have waiting lists in the nursing homes. Mostpeople that come to the nursing homes with dementia are women. And that's alsobecause women are used to taking care of people, so they can manage to takecare of their husband with dementia, but the other way around is not so easyfor the gentlemen.

癡呆是一個(gè)很可怕的疾病，而且我們目前仍然沒法治愈它。它正在成為一個(gè)全世界的重大問題，給人民，政治家，還有全世界 都帶來(lái)了很大的問題。我們看到療養(yǎng)院還有等候名單。大部分來(lái)療養(yǎng)院的癡呆患者都是女性，這也是因?yàn)榕院芰?xí)慣于照顧別人，如果她們的丈夫患了癡呆，她們就可以照顧他們，但反過(guò)來(lái)對(duì)丈夫們就沒有那么簡(jiǎn)單。

01:26

Dementia is a disease that affects thebrain. The brain is confused. People don't know anymore what the time is,what's going on, who people are. They're very confused. And because of thatconfusion, they get to be anxious, depressed, aggressive.

癡呆是一種影響大腦的疾病。患者的大腦變得十分混亂，不知道幾點(diǎn)了，發(fā)生了什么事，也不認(rèn)識(shí)人。他們變得非常糊涂，還因此變得焦慮，抑郁，和易怒。

01:50

This is a traditional nursing home. Iworked there in 1992. I was a care manager. And we often spoke together aboutthe fact that what we were doing there was not what we wanted for our parents,for our friends, for ourselves. And one day, we said, "When we keep onsaying this, nothing is going to change. We are in charge here. We should dosomething about this, so that we do want to have our parents here."

這是一個(gè)傳統(tǒng)的療養(yǎng)院，我1992年的時(shí)候在那里工作，我負(fù)責(zé)照料患者。我們經(jīng)常會(huì)討論，如果我們的父母、朋友、甚至是自己生病了，我們不會(huì)想讓他們來(lái)這里。有一天，我們意識(shí)到，我們只是一直這么說(shuō)是沒用的，在這里我們做主，我們應(yīng)該做點(diǎn)什么，讓這里變成一個(gè)我們放心自己父母來(lái)的地方。

02:22

We talked about that, and what we saw everyday was that the people that lived in our nursing home were confused abouttheir environment, because what they saw was a hospital-like environment, withdoctors and nurses and paramedics in uniform, and they lived on a ward. Andthey didn't understand why they lived there. And they looked for the place toget away. They looked and hoped to find the door to go home again. And we saidwhat we are doing in this situation is offering these people that already have aconfused brain some more confusion. We were adding confusion to confusion. Andthat was not what these people needed.

我們每天看到的是住在這里的患者 對(duì)周邊的環(huán)境感到迷茫，因?yàn)樗麄兛吹降氖窍襻t(yī)院一樣的環(huán)境，有醫(yī)生、護(hù)士、穿著制服的護(hù)理人員，而且他們住在病房里。他們不明白為什么他們住在這里，他們想盡快離開。想要找到那個(gè)通往家的門。我們發(fā)現(xiàn)，在這種情況下，我們讓這些本來(lái)就糊涂的人，變得更糊涂了。我們?cè)诨靵y之上增添混亂，這反而是在幫倒忙。

03:11

These people wanted to have a life, and thehelp, our help, to deal with that dementia. These people wanted to live in anormal house, not in a ward. They wanted to have a normal household, where theywould smell their dinner on the stove in the kitchen. Or be free to go to thekitchen and grab something to eat or drink. That's what these people needed.And that's what we should organize for them.

這些人想要有一個(gè)生活，還需要我們幫助他們來(lái)面對(duì)癡呆。他們想生活在一個(gè)正常的房子里，不是病房里。他們想要一個(gè)正常的家，想聞到廚房里爐子上飄出的晚飯的香氣，或是能自己走到廚房里，拿點(diǎn)什么吃的喝的。這是他們所需要的，也是我們應(yīng)該給他們提供的。

03:43

And we said we should organize this like athome, so they wouldn't live with a group of 15 or 20 or 30, like in a ward. No,a small group of people, six or seven, family-like. Like living with friends.And we should find a way to select people based on their ideas about life sothat they did have a good chance to become friends, when they lived together.And we interviewed all the families of the residents about "what isimportant for your father," "what's important for your mother,""what is their life like," "what do they want." And wefound seven groups, and we call them lifestyle groups.

我們覺得，為了營(yíng)造家的氛圍，不能讓他們十幾個(gè)或者幾十個(gè)人住在一起，像在病房一樣，他們以6-7個(gè)人為團(tuán)體住在一起，像家一樣。就好像和朋友住在一起。我們應(yīng)該想辦法篩選出生活興趣相同的人，這樣他們住在一起的時(shí)候能變成好朋友。我們也采訪了所有患者的家人，問他們“你的爸爸重視什么？”“你的媽媽重視什么？”“他們的生活是什么樣的？”“他們想要什么？”然后我們成立了7個(gè)小組，叫做“生活方式小組”。

04:29

And for instance, we found this formallifestyle. In this lifestyle, people have a more formal way of interacting witheach other, a distant way. Their daily rhythm starts later in the day, endslater in the day. Classical music is more heard in this lifestyle group than inother lifestyle groups. And their menu, well, is more French cuisine thantraditional Dutch.

比如，有一個(gè)小組的生活方式很正式，在這種生活方式下，大家互相交往的方式都很正式，保持適當(dāng)?shù)木嚯x。他們每天的生活開始得較晚，結(jié)束得也較晚。這個(gè)小組的人比別的小組更喜歡聽經(jīng)典音樂。他們更喜歡法國(guó)美食，而不是傳統(tǒng)的荷蘭美食。

04:53

(Laughter)

（笑）

04:55

In contrary to the craftsman lifestyle.That's a very traditional lifestyle, and they get up early in the morning, goto bed early, because they have worked hard their whole life, mostly with theirhands, very often had a very small family business, a small farm, a shop, orlike Mr. B, he was a farmhand. And he told me that he would go to his workevery morning with a paper bag with his lunch and one cigar. That one cigar wasthe only luxury he could afford for himself. And after lunch, he would havethat one cigar. And until the day he died in the Hogeweyk, he was in thislittle shed, every day, after lunch, to smoke his cigar.

另外一種“手藝人”的生活方式則很不同。這是一個(gè)很傳統(tǒng)的生活方式，他們很早起床，很早睡覺，因?yàn)樗麄円簧荚谂ぷ?，通常是用他們的雙手為生，他們通常有一個(gè)很小的家庭生意，一個(gè)小農(nóng)場(chǎng)，一個(gè)小商店。比如B先生，他曾是個(gè)農(nóng)場(chǎng)工人。他告訴我，他每天早上去工作，包里裝著午飯，還有一支雪茄。那一支雪茄就是他能負(fù)擔(dān)得起的唯一的奢侈品。吃完午飯，他就抽那支雪茄。一直到他在Hogeweyk去世的那一天，他每天午飯后都在這個(gè)小棚子里抽雪茄。

05:47

This is my mother. She's of the culturallifestyle, she's been living in the Hogeweyk six weeks now. And that lifestyleis about traveling, meeting other people, other cultures, interest in arts andmusic. There are more lifestyles. But that's what we talked about, and that'swhat we did.

這是我的母親，她喜歡文藝的生活方式，她住在Hogeweyk六周了，這種生活方式包括旅行，結(jié)識(shí)不同的人和不同的文化，探索藝術(shù)和音樂。還有更多別的生活方式。這是我們?cè)O(shè)想的，也是我們最終做到的。

06:09

But that's not life in a house with a groupof people, like-minded people, your own life, your own household. There's morein life, everybody wants fun in life and a meaningful life. We are socialanimals -- we need a social life. And that's what we started. We want to go outof our house and do some shopping, and meet other people. Or go to the pub,have a beer with friends. Or like Mr. W -- he likes to go out every day, see ifthere are nice ladies around.

但是這并不是生活的全部——在自己的房子里，和一群志同道合的人在一起，過(guò)自己的生活。生活中還有別的，每個(gè)人都要想要有樂趣的生活和有意義的生活，我們都是社會(huì)動(dòng)物，我們需要社交生活。而這就是我們所做的。人們都想出門去，去購(gòu)物，認(rèn)識(shí)不同的人，或者去酒吧，和朋友一起喝酒?；蛘呦馱先生那樣——他喜歡每天出門，看看周圍有沒有漂亮的姑娘。

06:48

(Laughter)

（笑）

06:50

And he's very courteous to them, and hehopes for smiles and he gets them. And he dances with them in the pub. It's afeast every day.

他對(duì)她們非常禮貌，他想得到微笑，于是他得到了，他每天都在酒吧里和她們跳舞，每天都是一場(chǎng)盛宴。

06:59

There are people that would rather go tothe restaurant, have a wine with friends, or lunch or dinner with friends andcelebrate life. And my mother, she makes a walk in the park, and sits on abench in the sun, hoping that a passerby will come and sit next to her and havea conversation about life or about the ducks in the pond.

還有的人更愿意和朋友去飯店，喝點(diǎn)紅酒，或者和朋友共進(jìn)午餐或晚餐，慶賀人生。我母親喜歡在公園里走走，坐在長(zhǎng)椅上曬曬太陽(yáng)，希望一個(gè)路人會(huì)過(guò)來(lái)坐在她身旁，和她討論人生，或者討論池塘里的鴨子。

07:22

That social life is important. It meansthat you're part of society, that you belong. And that's what we people need.Even if you're living with advanced dementia.

社交生活是很重要的，它意味著你是社會(huì)的一份子，人們需要這種歸屬感，即使患有嚴(yán)重癡呆的人也需要。

07:37

This is what I see from my office window.And one day, I saw a lady coming from one side, and the other lady from theother side, and they met at the corner. And I knew both ladies very well. Ioften saw them walking around outside. And now and then, I tried to have aconversation with them, but their conversation was ... rather hard tounderstand. But I saw them meeting, and I saw them talking, and I saw themgesturing. And they had fun together. And then they said goodbye, and each wenttheir own way. And that's what you want in life, meeting other people and beingpart of society. And that's what I saw happening.

這是從我的辦公室窗戶看出去的景色，有一天，我看到一位女士從一邊走過(guò)來(lái)，另一位女士從另一邊走過(guò)來(lái)，她們?cè)诠战翘幣龅搅?，我跟她們兩個(gè)都很熟，經(jīng)?？吹剿齻?cè)谕饷嫔⒉?。我?huì)時(shí)不時(shí)地和她們對(duì)話，但是她們的對(duì)話——很難理解。但我看到她們碰面、交談，我看到她們做手勢(shì)，她們?cè)谝黄鸷荛_心，然后她們互相道別，繼續(xù)各自行路了。這就是你在生活中想要的，結(jié)識(shí)不同的人，融入社會(huì)。這也是我看到正在發(fā)生的，

08:26

The Hogeweyk has become a place wherepeople with very advanced dementia can live, have freedom and safety, becausethe professionals working there and the volunteers working there know how todeal with dementia. And the professionals know how to do their professionalwork in a way that it fits in a natural way in the life of our residents. Andthat means that the management has to provide everything those people need todo their work. It needs a management that dares to do this. To do thingsdifferently than we always have done in a traditional nursing home.

Hogeweyk已經(jīng)變成了一個(gè) 能讓患有嚴(yán)重癡呆的人居住，并且感到自由和安全的地方。因?yàn)檫@里的專業(yè)人員和志愿者知道如何應(yīng)對(duì)癡呆，這里的專業(yè)人員知道如何既完成他們的工作，又不影響患者的正常生活。這意味著管理層需要為他們提供他們工作中需要的一切。這需要一個(gè)敢于付諸行動(dòng)的管理層，敢于在一個(gè)傳統(tǒng)的療養(yǎng)院里，用不同尋常的方法做事。

09:10

We see that it works. We think this can bedone everywhere, because this is not for the rich. We've been doing this withthe same budget as any traditional nursing home has in our country. We workonly with the state budget.

我們看到了它是有效的，我們認(rèn)為這在任何地方都能實(shí)現(xiàn)，因?yàn)檫@不是只有富人才能享受的。我們的預(yù)算和我們國(guó)家每一個(gè)傳統(tǒng)療養(yǎng)院都一樣，我們只有州政府的財(cái)政預(yù)算。

09:32

(Applause)

（鼓掌）

09:40

Because it has to do with thinkingdifferent, and looking at the person in front of you and looking at what doesthis person need now. And it's about a smile, it's about thinking different,it's about how you act, and that costs nothing. And there's something else:it's about making choices. It's about making choices what you spend your moneyon. I always say, "Red curtains are as expensive as gray ones."

這需要的是改變思路，看看你面前的人，想想這個(gè)人現(xiàn)在需要什么。這需要的是一個(gè)微笑，需要的是換一個(gè)方式思考，需要的是做出行動(dòng)，而這些都不需要花錢。還有一點(diǎn)，關(guān)乎如何做選擇，選擇把錢花在什么地方。我經(jīng)常說(shuō)，“紅窗簾和灰色窗簾一樣貴。”

10:16

(Laughter)

（笑）

10:17

It's possible, everywhere.

在任何地方，我們都能做到。

10:21

Thank you.

謝謝！

10:22

(Applause)

（鼓掌）