龍應台:我們的村落(香港大學醫學院畢業典禮演講中文翻譯)

學程二期

我一般非常不情願在畢業典禮演講,因為這個場合的聽眾一定是最糟糕的聽眾——你還沒開口,他們就巴不得你已經結束,而且,不管你說甚麼,他們只要走出了這個大廳的門,就絕不會記得你今天說過的任何一句話。

雖然如此,我還是來了,不僅只是因為,受邀到此演講是一份給我的光榮和喜悅,也因為我「精打細算」過了——遲早有一天,我會「落」在你們的手裏。當那一天到來的時候,我自然渴望在床邊低頭探視我的你,不只在專業上出類拔萃,更是一個具有社會承擔、充滿關懷和熱情的個人。

我們都說這是一個畢業典禮,五六年非常艱難的醫學訓練,今天結束了。我倒覺得,是不是可以這樣看:今天其實只是你「學程一期」的畢業典禮,一期的核心科目是醫學。但是今天同時是你「學程二期」的開學典禮,二期的核心科目是「人生」。二期比一期困難,因為它沒有教科書,也沒有指導教授。在今天的十五分鐘裏我打算和你們分享的,是一點點我自己的「人生」筆記。

奶粉和頭蝨

我成長在台灣南部一個濱海的小城,叫做高雄。一九六一那一年,小學二年級,發生了一件大事。班上一個女生突然嚴重嘔吐,被緊急送到醫院。沒多久,學校就讓我們都回家了,全市的學校關閉。過了一段日子,當我們再回到學校的時候,班上幾個小朋友的座位,是空的。那是我第一次聽到有一種病,名叫「霍亂」。我們當時當然不知道,高雄的「鄰村」——香港,在同時,被同一波傳染病所襲擊,十五個人死亡。我們的命運早就是彼此相連的,但是我們懵懂無知。

是的,我是一個在所謂「第三世界」長大的小孩。想像一下這些黑白鏡頭:年輕的母親們坐在擁擠不堪的房間裏,夜以繼日地製作塑膠花和廉價的聖誕飾燈,孩子們滿地亂跑,身上穿的可能是美援奶粉袋裁剪出來的恤衫;那運氣特別好的,剛好在前胸就印着「中美合作」的標語,或者湊巧就是「淨重二十磅」。

一九七五年我到美國留學,第一件感覺訝異的事就是,咦,怎麼美國人喝的牛奶不是用奶粉泡出來的?一九六一年的班上,每一個女生都有頭蝨,白色細小的蝨卵附着在一根一根髮絲上,密密麻麻的,乍看之下以為是白粉粉的頭皮屑。時不時,你會看見教室門口,一個老師手裏舉着一罐DDT殺蟲劑,對準一個蹲着的女生的頭,認真噴灑。

香港人和台灣人有很多相同的記憶,而奶粉、廉價聖誕燈、霍亂和頭蝨,都是貧窮的印記。如果我們從我的童年時代繼續回溯一兩代,黑白照片裏的景象會更灰暗。一個西方傳教士在一八九五年來到中國,她所看到的是,「街頭到處都是皮膚潰爛的人,大脖子的、肢體殘缺變形的、瞎了眼的,還有多得無可想像的乞丐……一路上看到的潰爛皮膚和殘疾令我們難過極了」。

一九零零年,一個日本作家來到了香港,無意間闖進了一家醫院,便朝病房裏面偷看了一眼。他瞥見一個幽暗的房間,光光的床板上躺着一個「低級中國人,像蛆在蠕動,惡臭刺鼻」,日本人奪門而逃。

可是,為甚麼和你們說這些呢?為甚麼在今天這樣的時間、這樣的地點、這樣的場合,和你們說這些呢?

我有我的理由。

目光如炬者

你們是香港大學一百周年的畢業生,而香港大學的前身,是一八八七年成立的「香港華人西醫學堂」。如果這點你們不覺得有甚麼特別了不起,那我們看看一八八七年前後是一個甚麼樣的時代。我們不妨記得,在一八八七年,屍體的解剖在大多數中國人眼中還是大逆不道的,而西醫學堂已經要求它的學生必修解剖課。我們不妨記得,當魯迅的父親重病在床——那已是一八九七年,紹興的醫生給他開的藥引,是一對蟋蟀,而且必須是「元配」。了解這個時代氛圍,你才能體會到,一百二十四年前,創辦西醫學堂是一個多麼重大的、改變時代的里程碑,你才能意識到,那幕後推動的人,必須配備多麼深沉的社會責任感和多麼遠大的器識與目光,才可能開創那樣的新時代。是何啟和Patrick Manson這樣的拓荒者,把你們帶到今天這個禮堂裏來的。

一八八七年十月一日,香港華人西醫學堂首度舉行開學典禮,首任學堂院長Patrick Manson致辭——曾經在台灣和廈門行醫的Manson到今天都被尊稱為「熱帶醫學之父」——他說,這個西醫學堂,「會為香港創造一個機會,使香港不僅只是一個商品中心,它更可以是一個科學研究的中心」。看着台下的入學新生,他語重心長地說,「古典希臘人總愛自豪而且極度認真地數他們的著名偉人,我們可以期待,在未來的新的中國,當學者爭論誰是中國的著名偉人的時候,會有一些偉人來自香港,而且此刻就坐在這個開學典禮之中」。

三十多個學生參加了一八八七年的開學典禮,學習五年之後,一八九二年的首屆畢業生,卻只有兩名。其中之一,成為婆羅洲山打根的小鎮醫生,另一個,覺得醫治個別病人遠不如醫治整個國家,於是決定放棄行醫,徹底改行。

這個學名登記為「孫逸仙」的學生,起先只有一個非常小的計劃,有點像今天的大學生利用暑假去做社區服務。他走在香港的街頭,看見英國管理的城市如此井然有序,驚異之餘,百思不解:為甚麼只隔四五十里的距離,自己的家鄉,一個叫香山的小城,卻是如此混亂落後?他的小計劃,就是把香山變成一個小香港。說到做到,二十多歲的西醫學堂學生孫逸仙,利用寒暑假期,回到家鄉,號召同村的青年出來鋪橋修路,目標是修出一條路將兩個鄰村連通起來。這個小計劃,最後由於地方吏治的腐敗,以失敗告終。小計劃的失敗,震撼了他,他於是轉而進行一個略大的計劃,就是推翻整個帝國。

從Manson一八八七年的開學致辭到今天二零一一年的畢業演講,我們的生活方式有了深沉的改變,而這些改變,來自一些突出的人。目光如炬者,革新了教育制度;行動如劍者,改造了整個國家;還有很多既聰慧又鍥而不捨的人,發明了各種疫苗。今天你我所處的世界,天花徹底滅絕,瘧疾和霍亂病毒已經相當程度被控制,台灣和香港的女生已經不知道有「頭蝨」這個東西。西醫學堂創立一百二十四年之後的今天,港大醫學院培養出很多很多世界頂尖的學者和醫生,為全球社區的幸福做貢獻。

而你們,正是踏着這個傳統的足迹一路走來的。

亞洲的第一名

也許你會問,既然前面的「長老們」,譬如Patrick Manson,譬如孫逸仙,已經完成這麼多重大的貢獻,還有甚麼是你們這一代人,是你,可以做夢,可以挑戰,可以全身投入,可以奉獻和追求的呢?今天的世界,還有甚麼未完成、待完成的使命嗎?

我相信有。

四十三歲的Patrick Manson在創建西醫學堂之前,研究過他所處的時與地。地,是香港,那時香港華人的醫療照顧與對洋人的照顧相比是一個悲慘的狀態。時,是晚清,傳統的價值體系正分崩離析而新的秩序和結構還未成形。孫逸仙畢業時二十六歲,每天從上環爬上陡峭的石階上學,無時無刻不在「診斷」這個社會的存在狀態,思索如何為人創造更大的幸福。

那麼你們所處的時和地又是甚麼呢?

讓我們先看看你們是誰。香港大學醫學院的學生,百分之二十來自醫學專業家庭,也就是說,這百分之二十的學生有雙親或者雙親之一已經是醫生或護士。你們之中百分之六十的人,父母那一代已經具有高等學歷。很明確地說,你們是社會的菁英層。即便現在還不是,將來也會是。

而你們所身處的社會,又是一個甚麼樣的社會呢?

香港這個「村子」,有一個非常獨特的地方。享有近三萬美金的每年人均所得,七百萬居民中卻有一百二十三萬人生存在貧窮線下——所謂「貧窮線」,指的是收入低於市民平均所得的一半以下。如果這聽起來太抽象,沒感覺,你試試看走到大學前面般含道的某一個街口站一會兒,數一數放學回家走在馬路上的學童:一、二、三、四,在香港,每四個孩子之中,就有一個生活在貧窮線下。

我不知道你是否注意過,在最繁華、最氣派的中環,那些推着重物上坡的白髮老婆婆是如何佝僂着背,與她的負荷掙扎的?在你們所屬的這個社會裏,百分之四十的長輩屬於貧窮線下的低收入戶。

來到香港機場的訪客,馬上會被一個漂亮的招牌所吸引,廣告詞很簡單:「香港是亞洲的世界大都會。」這個廣告不說出來的是,香港是亞洲貧富不均第一名的大都會,貧富差距之大,超過印度,超過中國大陸。在全世界的已開發地區裏,香港的分配不均,也名列首位。

你和我所生活的這個社會,最特殊的地方就是,一個攝影師不必守候太久就可以在街頭捕捉到這樣的畫面:剛好一輛Rolls Royce緩緩駛過一個老人的身影,他正低着頭在路邊的垃圾桶裏翻找東西。

最尋常最微小的

我無意鼓吹你們應該效法魯迅棄醫從文,或者跟隨孫逸仙做革命家,或者全都去從事社會工作,因為人生有太多有趣的路可以選擇了。我想說的僅只是,身為這麼一個重要傳承的接棒人,你也許可以多花那麼一點點時間思索一下自己的來自哪裏、何處可之。一百二十四年前,第一顆石頭打下了樁,鋪出的路,一路綿延到下一村——你今天的所在。Patrick Manson抵抗無知,堅持科學實證的知識學習;孫逸仙抵抗腐敗,堅持清明合理的管理制度。你是否想過:在你的時代裏,在你的社會裏,你會抵抗些甚麼,堅持些甚麼?

我倒不希望你能立即回答,因為如果你能隨口回答,我反而要懷疑你的真誠。一個人所抵抗的以及所堅持的,滙成一個總體,就叫做「信仰」。但是信仰,依靠的不是隆重的大聲宣告;信仰深藏在日常生活的細節裏,信仰流露在舉手投足之間最尋常最微小的決定裏。

Patrick Manson後來擔任倫敦殖民部的醫療顧問,負責為申請到熱帶亞非地區做下層工作的人進行體檢,體檢不通過的,就得不到這樣的工作機會。這時,他發現了一個未曾預料的問題:百分之九十的體檢者都有一口爛牙,檢查不合格。畢竟,有錢人才看得起牙醫。他該怎麼辦呢?

Manson是這麼處理的。他給上司寫了封信,說,以爛牙理由「淘汰掉他們等同於淘汰掉整個他們這個階層的人」。他建議政府為窮困的人提供牙醫的服務。

有些專業者看見爛牙就是爛牙。有些人,譬如Manson,看見爛牙的同時,卻也看見人的存在狀態——他認識痛苦。就是這種看起來很不重要、極其普通的日常生活裏的判斷和抉擇,決定了我們真正是甚麼樣的人。

茉莉花

我十四歲那年,全家搬到一個台灣南部的小漁村。因為貧窮,孩子們生病時,母親不敢帶我們去看醫生——她付不起醫藥費。有一天,小弟發高燒,咳嗽嚴重到一個程度,母親不得不鼓起勇氣去找村子裏的醫生。我們都被帶去了。四個年齡不同、高高矮矮的孩子一字排開,楞楞地站在這個鄉村醫生的對面。他很安靜,幾乎不說話,偶爾開口,聲音輕柔,說的話我們卻一個字都聽不懂,是閩南語,還有日語。

林醫師仔細地檢查孩子的身體,把護士拿過來的藥塞進母親的手裏,用聽不懂的語言教導她怎麼照顧孩子,然候,堅持不收母親的錢。此後,一直到四個孩子都長大,他不曾接受過母親的付費。

那是我記憶中第一個醫生。那個小小的診療室,幾乎沒甚麼家具,地板是光禿禿的水泥,卻是一塵不染。診療室外連着一個窄窄的院落,灑進牆裏的陽光照亮了花草油晶晶的葉子。茉莉花盛開,香氣一直在房間裏繞着不散。
Members of the faculty, distinguished guests, proud parents, and graduates:
I am most reluctant in giving graduation addresses because the given audience is usually the worst kind–before you open your mouth, they wish you were already done, and whatever you say, they are determined that they won’t remember a thing once they are out of the hall.
Under these tough circumstances, I still have to say that it’s not only an honor and pleasure for me to be here with you today; it’s also a calculated pre-emptive measure because sooner or later, one way or another, I am going to fall into your hands. And when our paths do cross, I naturally would hope that you are not only professionally excellent but also socially committed and compassionate.
Today is the graduation ceremony for your Study Phase I, medicine, and it’s also the inauguration ceremony for your Study Phase II, the study of life. So I’d like to share with you some of my own notes about life.
I grew up in a port city in southern Taiwan called Kaohsiung. In 1961, when I was in the 2nd grade, something happened to my class. A girl vomited so violently that she had to be taken to the hospital. Very soon we were told to go home; all schools were shut down indefinitely. When we came back to the classroom some days later, several seats were empty. That was the first time I heard of the disease called “cholera.” Of course I didn’t know that our neighboring “village,” Hong Kong, was hit by the same epidemic that year and 15 people died from it. We are much more connected than we know.
I was a child of the so-called “third world.” Imagine these snapshots in black and white: young mothers spent all day piecing together plastic flowers and cheap Christmas lights in the crammed living rooms while their children ran around with T-shirts sewn together from sacks in which milk powder had been transported as American aid; printed over the chest of a child might happen to be the picture of two masculine hands engaged in a shake, with the caption, “China-US Cooperation,” or “net weight 20 pounds.” One of the major surprises I had when I arrived in the US for my graduate studies in 1975 was to discover that the milk people were drinking was not made from dried powder. In my class of 1961, nearly every girl had head lice in her hair—the tiny white eggs of the lice sticking to the hair look like dandruff, and oftentimes you would see a schoolteacher holing up a can of DDT, a synthetic insecticide, spraying at the head a crouched girl.
Hong Kong people of my generation have very similar memories of their past. Milk powder and cheap Christmas lights, cholera and head lice were all footprints of poverty. And if we go one or two generations further back, the pictures would be even bleaker. A Western missionary who arrived in China in 1895 described what she saw on the streets: “Everywhere are people whose skin have festering sores, people whose thyroid gland was so overblown that they couldn’t walk straight; everywhere are the deformed, the blind and beggars of incredible shapes and forms.”
A Japanese writer called Ohashi Otowa visited Hong Kong in 1900. By chance he stepped into a hospital and caught sight of a sickroom: “I peeped into an ill-lit room and saw a lowly Chinaman lying on a bare board wriggling like a maggot. It was so filthy and the stench so penetrating that we took immediate flight.”
But why am I telling you this? Why am I telling you this on this particular day, for this particular occasion, at this particular place?

I have my reasons.
You are the centenary graduates of the University of Hong Kong, which was built on the foundation of the Hong Kong College of Medicine for Chinese established in 1887. Keep in mind that in 1887, post-mortem examination was still considered by most Chinese as a sacrilege, an offense, if not a crime; keep in mind that in 1897 when Lu Xun’s father was fatally ill, the local doctor’s prescription for him was to find a pair of crickets, which must be “yuan pei” (元配)—a pair from first mating. Only in this historical context you come to realize that the founding of the Hong Kong College of Medicine 124 years ago was a ground-breaking, epoch-making milestone and the people who made it possible must have been people with a tremendous sense of commitment and, above all, with the power of vision. It’s people like Ho Kai and Patrick Manson who paved the way for you to arrive in this hall today.
On October 1, 1887, the inauguration ceremony for the Hong Kong College of Medicine took place and its first Dean, Dr. Patrick Manson, who is still revered today as the founder of the tropical medicine field, gave the address. This medical college, he predicted, will offer an opportunity for Hong Kong “to become a center and distributor, not for merchandise only, but also for science.” Looking at the freshmen amongst the audience, he added, “The old Greek cities used to boast of their great men, and claim them with jealous care. Let us hope that in the new and greater China of the future, when the learned dispute of their great men, not a few may be claimed for Hong Kong and for the school today inaugurated.”
Among the 30 some students inaugurated in 1887, only 2 graduated, in 1892. One became a country doctor in Malaysia, and the other, thinking that “healing men” is not as important as “curing the country,” gave up the medical profession for something else.
Originally, when Sun Yat Sen was still a student in Hong Kong, he had in mind only a very modest project. So impressed by the modern management of this colony, he intended to carve out a Hong Kong “on small scale” out of his hometown, Heungshan. The young man began to build a road with shovel and pickax, hoping that it would connect his own village with the next. Only when this small project failed due to local corruption, he turned to something bigger—he overthrew the Chinese empire.
From Manson’s inauguration address of 1887 to this graduation speech of 2011, our lives—yours and mine–have been changed by many extraordinary people. Some men of vision transformed education; some men of action started a revolution and founded a new nation; some men and women with perseverance and intelligence created vaccines or provided cure–small pox and rinderpest are eradicated, malaria is largely eliminated, cholera is under control, and most school girls of Taiwan and Hong Kong today do not know what head lice are. 124 years down the road, this medical college of the University of Hong Kong, which began with the daring dream of a handful of people, is turning out some of the best scientists and professionals shaping the future of the global community.
And you are part and parcel of this heritage. However, if so much has been accomplished by your “village elders” like Patrick Manson and Sun Yat Sen, is there anything left for your generation, for you, to dream, to dare, to devote yourselves to?
I think yes, there is.
Before the 43-year-old Dr. Manson decided to help found the Hong Kong School of Medicine, he had studied his place and time. The place was Hong Kong, where health care for the local population was in a miserable state. The time was late Ching, when old structures had begun to crumble and new values had not been formed. Sun Yat Sen was 26 when he graduated from this college but decided to make the country his patient. He studied medicine, he walked the streets of this colony, and he pondered upon the maladies of the nation, looking for remedies.
So what is your place and time? First let us look at who you are. About 20% of you, the medical students of HKU, come from families with both parents or one of the parents being healthcare professionals– doctors, nurses, CM practitioners. Close to 60% of you come from families with a post-secondary education. It is pretty safe to say that you are, or will be, the elite of the society.
But exactly what kind of society do you find yourselves in?
There is something very “unique” about this “village” you belong to. In a city of 7 million people with an average per capita income of nearly US$30,000, 1.2 million people live below the poverty line. If that sounds abstract, try stand on a corner of Bonham Street and count the children who walk by–one, two, three, four–one out of every four children in this glamorous city live in poverty.
And have you ever paid attention to those elderly women who are pushing heavily loaded trolleys up the steep hills in Central? In this society, nearly 40% of the elderly fall below the poverty line. When visitors arrive at the airport, they immediately see an attractive slogan: “World City of Asia.” What’s not spelled out in that slogan is that income equality of this city is the worst in Asia, worse than India or Mainland China, and the wealth gap here ranks the biggest among all developed economies in the world.
This society that you and I have membership of is probably the easiest place in the world for a photographer to find a spot on any street and he can catch the moment when a Rolls Royce or a Bentley happens to be driving by an elderly man who is scavenging a garbage bin.
I am not suggesting that you should follow Lu Xun and turn to radical writing, or emulate Sun Yat Sen and engage in politics or become social workers. Life offers too many interesting as well as surprising possibilities. But as centenary graduates of this institution of such important heritage, you might consider spending more thoughts on where you have come from and where you may choose to go. The first stone of the road was laid down 124 years ago with the hope to connect to the next village, which is where you are today. Patrick Manson fought against ignorance and insisted on learning; Sun Yat Sen fought against corruption and insisted on good governance; as the torch relay continues, what will you fight against, and what will you insist on?
I hope you don’t have ready answers for me, because if you do, I would be suspicious. What one fights against and what one insists on, taken in its totality, are called personal beliefs. Personal beliefs are not declared. They are practiced in the minute details of life. They are revealed in the smallest decisions of daily routine.
Patrick Manson later worked as advisor to the Colonial Office in London and his main job was to examine recruits and select those who are physically fit for jobs in the tropics. An unexpected problem arose, that is, he discovered that more than 90% of the applicants for subordinate positions such as railroad workers had bad teeth, which by regulation should disqualify them. He had to make a decision what to do.
Manson wrote to the Colonial Office: “To reject these would amount to almost wholesale rejection of all men of their class.” He therefore suggested that the government provide dental care for those who couldn’t afford it. Some professionals would see decayed teeth just as decayed teeth, but some others, people like Manson, would see things on the existential level–he sees human plight. And it’s small, banal decisions such as this that make us what we truly are.
My family moved to a fishing village when I was 14. We were so poor that, when the children got sick, my mother would not dare to go to a clinic. One day, my youngest brother had a fever so high and coughed so badly that my mother was forced to go to the village doctor. We all went–four children of different age and height stood face to face with this very quiet man. He hardly spoke, and when he did speak, with a very soft voice, it was either Japanese or the Fukien dialect, which we could not understand a word of. He checked the little boy, pressed the medicine into my mother’s hand, coached her in the unintelligible language how to care for the young, and refused to accept fees. And thereafter, throughout our childhood, he declined any fees from us.
That was my very first memory of a doctor’s visit. The room was barely furnished but extremely clean and outside the room was a small courtyard, glittering with afternoon sunshine, and I could smell the scent of the summer jasmine in full bloom.
I wish you success and happiness, and thank you all.

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