關(guān)于樂(lè)觀主義的說(shuō)法在盧旺達(dá)已經(jīng)有些很有力的證據(jù),。四分之一世紀(jì)前,，一場(chǎng)種族滅絕將原已十分貧窮的東非國(guó)家一分為二，所以想研究可能性的話盧旺達(dá)是個(gè)好案例,。在前衛(wèi)生部長(zhǎng)阿格尼斯·比納格沃醫(yī)生等人的領(lǐng)導(dǎo)下,，盧旺達(dá)在醫(yī)療基礎(chǔ)設(shè)施、基層保健,、大規(guī)模兒童疫苗接種和孕產(chǎn)婦保健方面穩(wěn)步投入,。

多年來(lái)，蓋茨基金會(huì),、全球疫苗免疫聯(lián)盟,、全球基金和健康伙伴基金會(huì)之類機(jī)構(gòu)一直投入大筆資金支持，其中健康伙伴基金會(huì)由多年在盧旺達(dá)生活的保羅·法默聯(lián)合創(chuàng)立,。但很多創(chuàng)新和策略都來(lái)自本土,。與此同時(shí)，兒童死亡率已從撒哈拉以南非洲地區(qū)最高降到最低,。

該轉(zhuǎn)變非常驚人,，連哈佛大學(xué)全球衛(wèi)生和社會(huì)醫(yī)學(xué)教授、結(jié)核病治療著名先驅(qū)法默也專門成立學(xué)術(shù)中心研究,，該中心名為全球衛(wèi)生公平大學(xué),。（比納格沃任副校長(zhǎng)。）

“我們?cè)诤芏嗟胤蕉及l(fā)現(xiàn)：政府與聯(lián)合國(guó)機(jī)構(gòu),、非政府組織和其他機(jī)構(gòu)合作投資的真實(shí)例子,，但通過(guò)投資年輕人真正推動(dòng)未來(lái)發(fā)現(xiàn),，”德斯蒙德·赫爾曼說(shuō)?！安粌H盧旺達(dá)如此,，埃塞俄比亞、孟加拉國(guó)和其他地方也一樣,?！?/p>

“我們一定要認(rèn)清世界上事情的真實(shí)情況……但也要相信世界會(huì)越來(lái)越好?！薄妨者_(dá)·蓋茨

但蓋茨和幾乎全球所有衛(wèi)生專家都表示,，該工作必須持續(xù)下去。令人清醒的事實(shí)是,，盧旺達(dá)和尼日利亞一樣處于危險(xiǎn)邊緣,。如果抗擊瘧疾、結(jié)核病,、艾滋病和熱帶疾病的努力緩慢甚至限于停滯,，疾病病例不會(huì)保持穩(wěn)定，而是會(huì)上升,。下一代的孩子們也會(huì)失去發(fā)展的機(jī)會(huì),。

這就是為什么去年10月舉行的三年一次籌資活動(dòng)上，蓋茨夫婦如此努力為全球基金提供捐款,，還有之后向全球疫苗免疫聯(lián)盟補(bǔ)充資金,。兩家機(jī)構(gòu)都是蓋茨基金會(huì)的分支，二人花了很多慈善資金支持類似的醫(yī)療項(xiàng)目,。

“他們生活中的選擇很多,，”沃倫·巴菲特說(shuō)，“現(xiàn)在他們不僅花很多錢,，還投入大量時(shí)間和精力改善世界各地人們的生活,。仔細(xì)想想吧?！保ㄘ?cái)富中文網(wǎng)）

本文另一版本將發(fā)表于2019年5月出版的《財(cái)富》雜志上,。

譯者：馮豐

審校：夏林

The argument for optimism has some awfully good evidence in Rwanda. A quarter-century after a genocide tore the already poor East African country apart, Rwanda is a case study in what’s possible. Led by physician Agnes ?Binagwaho, the nation’s former health minister, and others, Rwanda has steadily invested in health infrastructure, primary care, massive childhood vaccination, and maternal health.

Groups like the Gates Foundation, GAVI, The Global Fund, and Partners in Health—cofounded by Paul Farmer, who lived in Rwanda for years—have financed the effort substantially. But much of the innovation and footwork has been homegrown. Child mortality, meanwhile, has dropped from one of the highest rates in sub-Saharan Africa to one of the lowest.

The turnaround is so extraordinary that Farmer, a Harvard professor of global health and social medicine and a celebrated pioneer in treating tuberculosis, has launched an academic center to study it: the University of Global Health Equity. (Binagwaho has been named vice chancellor.

“We see it in lots of places: real examples of governments making investments—working with UN agencies, with NGOs, with others, but really driving their own future by investing in their young people,” says Desmond-Hellmann. “It’s happening not just in Rwanda, but also in Ethiopia, Bangladesh, and elsewhere.”

“We have to be able to see the reality of what’s going on in the world … But we [also] have to believe in the world getting better.” – Melinda Gates

But it’s work that has to be sustained, say the Gateses—and virtually every other global health expert. The sobering truth is that Rwanda, like Nigeria, is on a knife’s edge: If efforts to combat malaria, TB, AIDS, and tropical diseases slow or even remain static, the cases of disease don’t stabilize, they go up. And the next generation of kids loses ground.

It’s why the Gateses are so focused now on replenishing contributions for The Global Fund, a triennial fundraising push that takes place in October—and the financial refueling of GAVI after that. These two institutions are the outstretched limbs of the Gates Foundation, and the couple have spent more of their philanthropic dollars supporting health delivery programs like these than anything else.

“They could have elected to do anything with their lives,” says Warren Buffett, “and both of them are not only spending money but huge amounts of their time and energy around the world to make life better for people. Think about that.”

A version of this article appears in the May 2019 issue of Fortune.