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It comes as a shock to find that almost the only part of Zimbabwe's Government still functioning is the health system in the country's remote, deprived rural areas.
It functions so well, syas Victor Nyamandi, a senior Health Ministry official for the Makoni district 170 kilometres (105 miles) east of the capital, Harare, that the monitoring system ensures that tuberculosis medication is taken by every patient to whom it is prescribed.
Cholera has been kept away from the district's 300,000 people, who live in scattered villages connected by rutted tracks in the rolling landscape, for seven years. They have not seen a case of measles for more than three years. Measles immunisation days in any part of the district receive a 90 per cent attendance. Even the white-robed, crook-wielding Vapostori(Apostolic) sect, whose religion abhors, Western medicine, are having their children immunised.
"It's undoubtedly the best health structure in Africa," said the paediatrician Greg Powell, chairman of the Zimbabwe Child Protection Society. It was functioning in the bush far better than in the urban areas, where hospitals have been overwhelmed by national infrastuctural failure, he added.
The system could not work without a highly mobile corps of dedicated health workers who stay in constant contact with rural communities, using a fleet of tough, reliable motorbikrs. "Three quarters of the ministry's vehicles are managed by Riders for Health," Mr Nyamandi said. "They are the key to our success. We cannot do without them."
Starting before independence in 1980, and accelerating dramatically afterwards, health autherities created a unique and almost self-contained system of primary preventive healthcare among the country's unsophisticated rural communities, which had been devastated regularly by disease.
It comprises a constantly reinforced basic education programme that drives home to nearly every village a recognition of common diseases and their symptoms, the simple steps to prevent them (such as building safe wells and the remarkable Blair toilet, a simple brick structure, named after the state laboratory that designed it, with a deep pit and built-in fly trap, that has wiped out faeces-bearing flies all over the country), a limited range of treatments, and a nutritious diet to strengthen their immune systems.
The education is so thorough and simple that it needs outside control only in serious cases and is run virtually by the villagers alone.
"When we are not there, our backs are covered," Mr Nyamandi said. "They are quite conscious of their health."
The bottom rung of the system's infrastructure comprises thousands of unpaid volunteers drilled in a limited range of specific, simple tasks---home-based care givers who wash Aids sufferers, "chloroquine holders" who hand out malarial prophylactics at the correct intervals, village health workers with basic treatment skills keeping records of illnesses and symptoms, village Aids action committees staging cautionary plays about husbands visiting prostitutes, and garden clubs that grow nutritious foods.
The key to their success is their link with the outside world - the environmental health technician(EHT), who is responsible for bringing a steady supply of essential drugs, cement for building lavatories, and the constant surveillance of suspected disease outbreaks. The position also involves mobilising mothers for the immunisation of their children, raising awareness of HIV, and acting as the villagers'principal teacher.
Motorbikes were introduced in the 1980s so that the EHTs could move between villages and to the nearest hospital. After 1998, when the country's economic crisis began. the repair and replacement of motorbikes by the Government evaporated, and the rural health system began to stumble.
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