在印度 屏住呼吸 然後離開

NEW DELHI — FOR weeks the breathing of my 8-year-old son, Bram, had become more labored, his medicinal inhaler increasingly vital. And then, one terrifying night nine months after we moved to this megacity, Bram’s inhaler stopped working and his gasping became panicked.

新德里——在接連幾周的時間裏，我八歲的兒子布拉姆(Bram)的呼吸變得越來越吃力，他的藥用吸入器也變得越來越重要。然後，在我們搬到這個大都市九個月後的一個可怕夜晚，布拉姆的吸入器不再管用，他開始喘不過氣來。

My wife called a friend, who recommended a private hospital miles away. I carried Bram to the car while my wife brought his older brother. India’s traffic is among the world’s most chaotic, and New Delhi’s streets are crammed with trucks at night, when road signs become largely ornamental. We undertook one of the most frightening journeys of our lives, with my wife in the back seat cradling Bram’s head.

我妻子打電話給一個朋友，她推薦了一家數英里之外的私立醫院。我把布拉姆抱進車，我妻子帶着布拉姆的哥哥也上了車。印度是世界上交通最混亂的地區之一，新德里夜間的街道上擠滿了卡車，交通標誌基本上是擺設。妻子在後座上攬着布拉姆的頭，那是我們這輩子最可怕的旅程之一。

When we arrived, doctors infused him with steroids (and refused to provide further treatment until a $1,000 charge on my credit card went through). A week later, Bram was able to return home.

我們到達醫院後，醫生給布拉姆輸了類固醇（並且拒絕提供進一步的治療，直至我用信用卡支付的1000美元到賬）。一週後，布萊姆才得以回家。

When I became a South Asia correspondent for The New York Times three years ago, my wife and I were both excited and prepared for difficulties — insistent beggars, endemic dengue and summertime temperatures that reach 120 degrees. But we had little inkling just how dangerous this city would be for our boys.

三年前，當我成爲《紐約時報》的南亞通訊員時，妻子和我感到很興奮，同時也做好了迎接困難的準備——糾纏不休的乞丐，四處肆虐的登革熱，高達華氏120度的夏季溫度。但我們全然沒有料到，這個城市對我們的孩子會有多麼危險。

We gradually learned that Delhi’s true menace came from its air, water, food and flies. These perils sicken, disable and kill millions in India annually, making for one of the worst public health disasters in the world. Delhi, we discovered, is quietly suffering from a dire pediatric respiratory crisis, with a recent study showing that nearly half of the city’s 4.4 million schoolchildren have irreversible lung damage from the poisonous air.

我們逐漸瞭解到，德里真正危險的地方是它的空氣、水、食物和蒼蠅。在印度，這些危險因素每年導致數以百萬計的人患病、殘疾和喪生，這是世界上最嚴重的公共衛生災難之一。我們發現，德里正悄無聲息地遭遇着一場可怕的小兒呼吸道疾病危機，最近的一項研究顯示，在該市440萬學齡兒童中，有將近一半因有毒的空氣遭受了不可逆轉的肺部損傷。

For most Indians, these are inescapable horrors. But there are thousands of others who have chosen to live here, including some trying to save the world, others hoping to describe it and still others intent on getting their own small piece of it. It is an eclectic community of expatriates and millionaires, including car executives from Detroit, tech geeks from the Bay Area, cancer researchers from Maryland and diplomats from Dublin. Over the last year, often over chai and samosas at local dhabas or whiskey and chicken tikka at glittering embassy parties, we have obsessively discussed whether we are pursuing our careers at our children’s expense.

對於大多數印度人而言，這些恐怖之處是不可避免的。但也有數以千計的人們選擇居住在這裏，其中就包括一些試圖拯救世界的人，一些希望講述這裏的故事的人，還有一些熱衷於在這裏擁有一片自己的小天地的人。這是外籍人士和富豪組成的混雜社區，他們中有來自底特律的汽車高管，灣區的科技業人士，馬里蘭州的癌症研究人員，以及都柏林的外交官。過去一年裏，我們在本地飯館品嚐印度奶茶及三角餅時，或者在五顏六色的使館派對上享受威士忌和雞肉串時，常常着了魔似地討論一個話題：我們是否罔顧孩子的利益，來追求自己的事業？

Foreigners have lived in Delhi for centuries, of course, but the air and the mounting research into its effects have become so frightening that some feel it is unethical for those who have a choice to willingly raise children here. Similar discussions are doubtless underway in Beijing and other Asian megacities, but it is in Delhi — among the most populous, polluted, unsanitary and bacterially unsafe cities on earth — where the new calculus seems most urgent. The city’s air is more than twice as polluted as Beijing’s, according to the World Health Organization. (India, in fact, has 13 of the world’s 25 most polluted cities, while Lanzhou is the only Chinese city among the worst 50; Beijing ranks 79th.)

當然，數百年來一直有外國人在德里居住，但空氣和越來越多的關於其影響的研究已經變得如此觸目驚心，以至於有些人覺得，如果有人有選擇的機會，卻情願在這裏撫養孩子，那是不道德的。類似的討論無疑也正在北京等亞洲大城市展開，但在德里——地球上人口最稠密，污染最嚴重，最不衛生，病菌肆虐最甚的城市之一——這個問題似乎最爲緊迫。世界衛生組織的資料顯示，該城市的空氣污染程度超過北京的兩倍。（世界上25個污染最嚴重的城市中，有13個是印度城市。蘭州是前50名中唯一的中國城市；北京位列第79位。）

So many of our friends have decided to leave that the American Embassy School — this city’s great expat institution — is facing a steep drop in admissions next fall. My pastor, who ministers to a largely expat parish here, told me he feared he would lose 60 percent of his congregants this summer.

因此，我們的很多朋友都決定離開。美國使館學校(American Embassy School)是德里一家很棒的外籍生學校，今年秋天它面臨着生源的急劇下降。我的牧師負責這裏一個主要由外籍人員構成的教區，他告訴我，他擔心今年夏天自己會失去60%的教衆。

We nearly left two years ago, after Bram’s first hospitalization. Even after his breathing stabilized, tests showed that he had lost half his lung function. On our doctor’s advice, we placed him on routine steroid therapy and decided that as long as his breathing did not worsen again, we could stay in Delhi.

兩年前，在布拉姆的首次住院之後，我們也幾乎離開了這裏。但他的呼吸狀況穩定下來後，測試結果顯示他已經失去了一半的肺功能。在醫生的建議下，我們讓他進行常規的類固醇治療，並決定只要他的呼吸狀況沒有再次惡化，我們可以就留在德里。

Or at least I decided that. My wife seriously considered flying home immediately, and at the end of a summer visit to the United States with the kids months later, sobbed for hours on the return flight to Delhi.

或者至少我決定這麼做。我妻子當時就認真考慮過立即飛回家去；而且在數個月後，當我們與孩子結束了回美國探訪的夏季行程，在回德里的返程航班上，她抽泣了好幾個小時。

But after our second year here, Bram seemed fine. His earlier difficulties, though, led me to call some leading air pollution experts. The conversations were sobering.

不過，我們在這裏度過了第二年之後，布萊姆顯得一切安好。但是鑑於他之前遇到的狀況，我和一些頂尖的空氣污染專家通了電話。我們之間的交談發人深省。

“Knowing that I was putting my kids in a place that compromised their health for their lifetimes would be very difficult given all of the scientific evidence,” said W. James Gauderman, a professor of preventive medicine at the University of Southern California. He is the co-author of a landmark 2004 study showing that children raised in parts of Los Angeles — where pollution levels are a fraction of Delhi’s — face significant and probably permanent losses of lung function. Even children who move to less polluted places during childhood never seem to entirely recover from earlier high pollution exposures, another study found.

“考慮到有各種科學證據，知道自己讓孩子住在某個地方，可能損害他們一生的健康，會讓我非常難受，”南加州大學的預防醫學教授W·詹姆斯·高德曼(W. James Gauderman)說。他是2004年一份具有里程碑意義的研究的合著者，該研究顯示，在洛杉磯部分地區——污染程度遠低於德里——長大的兒童，遭受了明顯的、可能是永久性的肺功能損失。另一項研究發現，如果孩子早年在高污染環境中生活，即使在兒童時期搬遷到了污染較低的地方，他們似乎也無法完全恢復健康。

Sarath Guttikunda, one of India’s top pollution researchers, who moved to Goa, on the west coast of India, to protect his two young children, was unequivocal: “If you have the option to live elsewhere, you should not raise children in Delhi.”

爲了保護兩個年幼的孩子，印度最頂尖的污染研究人員之一薩拉斯·古提昆塔(Sarath Guttikunda)舉家搬遷到了印度西海岸的果阿。他明確地說：“如果你可以在別處居住，就不該在德里撫養子女。”

These and other experts told me that reduced lung capacity in adults is a highly accurate predictor of early death and disability — perhaps more than elevated blood pressure or cholesterol. So by permanently damaging their lungs in Delhi, our children may not live as long.

他們和其他專家告訴我，成人肺活量不足，對於預測早逝和殘疾來說準確度非常高——可能高於血壓或膽固醇升高。因此，由於在德里遭受了永久性的肺損壞，我的孩子的壽命可能縮短了。

And then there are nascent areas of research suggesting that pollution can lower children’s I.Q., hurt their test scores and increase the risks of autism, epilepsy, diabetes and even adult-onset diseases like multiple sclerosis.

在一些方興未艾的領域，研究表明：污染可能會讓兒童智商降低，影響他們的考試成績，並增加罹患自閉症、癲癇、糖尿病的風險，甚至像多發性硬化症等成年後才發作的疾病，患病風險也會提高。

C. Arden Pope III, a professor of economics at Brigham Young University and a leading expert on the health consequences of air pollution, noted that accurate pollution monitors have existed only since the 1980s. “If Delhi’s readings aren’t the highest ever, they’re among the highest ever,” he said. “Certainly no city in the United States, including Los Angeles, has ever come close.”

楊百翰大學(Brigham Young University)的經濟學家C·阿登·波普三世(C. Arden Pope III)是研究空氣污染對健康的影響的權威專家，他指出，準確的污染監測儀器直到20世紀80年代纔出現。“就算德里的讀數值不是有史以來最高的，也是有史以來最高的之一，”他說。“包括洛杉磯在內的任何美國城市肯定都與那樣高的讀數值相距甚遠。”

That means the extent of the damage Delhi is doing to our children can only be guessed, he said. Several medical ethicists said it would be impossible to get approval for a clinical trial to send a group of children to Delhi to monitor their health. “Not a chance,” said Adil E. Shamoo, editor in chief of Accountability in Research and a bioethicist at the University of Maryland School of Medicine. “It’s O.K. to survey people already there, but moving children into harm’s way? No.”

這意味着，我孩子在德里遭受的損害嚴重程度只能靠猜測，他說。幾位醫學倫理學家稱，送一羣孩子到德里去，並監測他們的健康狀況，這樣的臨牀試驗是不可能得到批准的。“絕對不可能，”《研究中的問責》(Accountability in Research)的主編、馬里蘭醫學院(Maryland School of Medicine)的生物倫理學家阿迪爾·E·薩莫(Adil E. Shamoo)說。“調查已經在那裏的人是可以的；但把孩子搬遷到有危害的地方？不行。”

And children are by no means the only ones harmed. Many adults suffer near-constant headaches, sore throats, coughs and fatigue. Arvind Kejriwal, Delhi’s chief minister, had to leave the city for 10 days in March to cure a chronic cough.

受到危害的不僅是孩子。很多成年人幾乎常年頭痛、喉嚨痛、咳嗽，以及疲勞乏力。今年3月，德里首席部長阿爾溫德·凱傑裏沃(Arvind Kejriwal)爲了治療慢性咳嗽，不得不離開了這裏十天。

It’s not just the air that inflicts harm. At least 600 million Indians, half the total population, defecate outdoors, and most of the effluent, even from toilets, is dumped untreated into rivers and streams. Still, I never thought this would come home to my family quite as dramatically as it did.

危害健康的不只是空氣。至少有六億印度人在戶外排便，佔總人口數量的一半，而大部分的污水，甚至來自廁所的污水，都未經處理就傾倒入江河。但是，我從來沒有想過，它們會戲劇性地來到我的家中。

We live in a four-year-old, five-story apartment building that my wife chose because its relatively new windows could help shut out Delhi’s appalling nighttime air. Its cookie-cutter design — by the same developer who built dozens of others in the neighborhood — gave us confidence that things would function, by no means assured for new construction here.

我們住在一棟四年前修建的五層公寓樓裏，我的妻子選擇這裏是因爲它配備了相對較新的窗戶，有助於將德里的可怕夜間空氣隔絕在外。公寓樓平凡無奇的設計——同一家開發商在附近修建了數十棟這樣的建築——給了我們信心，覺得它的設施會運行良好；不是所有德里的新建築都能保證這一點的。

About six months after we moved in, one of our neighbors reported that her tap water suddenly smelled like sewage. Then the smell hit another neighbor and another. It turned out that the developer had dug open channels for sewage that had gradually seeped into each apartment’s buried water tank. When we pulled up the floor tiles on the ground floor, brown sludge seemed to be everywhere.

搬進去大約半年後的一天，一名鄰居說她的自來水突然散發污水味道。然後鄰居們一個接一個遇到這種情況。原來是開發商把下水道挖開了，污水逐漸滲透到每間公寓埋在地下的水箱裏。當我們揭開一樓的地磚時，褐色污泥似乎到處都是。

I was in the shower when this sewage mixture arrived in our apartment. Sounds horrible, but I shrugged and toweled off because that smell is such a frequent presence here.

混合了污水的自來水抵達我們公寓時，我正在淋浴。這聽起來很可怕，但我只是聳聳肩，擦乾了身體，因爲那種味道在這裏經常都能聞到。

For much of the year, the Yamuna River would have almost no flow through Delhi if not for raw sewage. Add in the packs of stray dogs, monkeys and cattle even in urban areas, and fresh excretions are nearly ubiquitous. Insects alight on these excretions and then on people or their food, sickening them.

如果不是未經處理的污水傾倒入亞穆納河，那麼在一年中的很多時候，這條河在德里幾乎是斷流的。再加上德里城區中也時常看到的一羣羣流浪狗、猴子和牛，新的排泄物幾乎隨目可見。昆蟲在這些排泄物上落足，然後再在人類或他們的食物上停留，傳染疾病。

Most piped water here is contaminated. Poor sanitation may be a crucial reason nearly half of India’s children are stunted.

這裏的大多數自來水都遭受了污染。惡劣的衛生條件，可能是近一半印度兒童發育遲緩的一個關鍵原因。

The list of health threats sounds harrowing when considered together, but life goes on and can be quite nice here. Our apartment building eventually installed aboveground water tanks. My children’s school and travel in the region are terrific, and many expats are far more influential here than they would be in their home countries.

綜合考慮這些威脅健康的因素，你會感到痛心疾首，但這裏的生活還在繼續，而且也可以過得相當不錯。我們的公寓樓最終把水箱安裝在了地面上。我孩子的學校和在該地區進行的旅行都很棒。很多外國人在這裏擁有了比在本國遠遠更大的影響力。

Yet one afternoon this spring, someone in our neighborhood burned something toxic, and an astringent cloud spread around our block. My wife was out walking with a friend, and their eyes became teary and their throats began to close. They bolted back inside our apartment where they found Bram gasping again, for the first time in two years. In some places in Delhi, the levels of fine particles that cause the most lung damage, called PM2.5, routinely exceed 1,000 in winter in part because small trash and other fires are so common, according to scientists. In Beijing, PM2.5 levels that exceed 500 make international headlines; here, levels twice that high are largely ignored.

然而，今年春天的一個下午，有人在居民區裏焚燒有毒物質，氣味酸澀的濃煙在我們的街區蔓延。我妻子和一位朋友當時在外面散步，她們被嗆出了眼淚，感覺快要窒息。於是狂奔回我們的公寓，結果發現布拉姆又在喘息，這還是兩年裏的第一次。在德里有些地方，名爲PM 2.5的細顆粒物的水平導致了非常嚴重的肺損傷，在冬季，該數值經常超過1000，科學家表示，部分原因是對小件垃圾和其他東西的焚燒在這裏極爲普遍。在北京，PM 2.5水平超過500會成爲國際頭條新聞；而在這裏，比北京高出一倍的污染水平基本上被人們無視。

But Bram notices.

但布拉姆注意到了。

He spent the next five days at home, with my wife giving him heavy doses of inhaled steroids through a mask. He has a quiet sadness during these crises, perhaps because they force him to accept the idea that his health is more fragile than that of his brother or friends.

接下來的五天裏，他一直待在家裏，我妻子讓他透過口罩服用了大量吸入性類固醇。在這些危機期間，他有一種靜默的憂傷，因爲他要被迫接受，自己的健康比哥哥或朋友更脆弱。

Before coming to Delhi, Bram had had a couple of breathing episodes that doctors assured us he would most likely outgrow. Now he has full-blown asthma and must take powerful daily medications.

來德里之前，布拉姆也出過幾次呼吸方面的問題。醫生曾向我們保證，布拉姆很有可能會隨着年齡的增長而擺脫那些問題。但現在，他真的得了哮喘病，每天都必須服用強效藥物。

Would he have developed asthma if we had stayed in the United States? Pediatric asthma is far more likely to start and worsen in polluted locales. The sidelines at kids’ soccer games here are littered with inhalers.

如果我們留在美國，他還會得哮喘嗎？在受污染的地方，小兒哮喘發病和惡化的可能性要大得多。在這裏的足球場外，散落着許多吸入器。

Ruth R. Faden, director of the Johns Hopkins Berman Institute of Bioethics, said children have a special claim to protection. “First, because they are so dependent on us for their well-being, and second because deprivations in childhood have such an outsize effect,” she said.

約翰·霍普金斯大學伯曼生物倫理學研究所(Johns Hopkins Berman Institute of Bioethics)主任魯斯·R·費登(Ruth R. Faden)說，孩子特別需要保護。“首先，因爲他們的健康很依賴我們，其次因爲童年時期健康受損的影響非常大，”她說。

There is a growing expatriate literature, mostly out of China, describing the horrors of air pollution, the dangers to children and the increasingly desperate measures taken for protection. These accounts mostly end with the writers deciding to remain despite the horrors.

外籍人士撰寫的相關文章越來越多。它們大多來自中國，描寫了對空氣污染的恐懼、對孩子的危害以及所採取的越來越誇張的保護措施。在這些文章的結尾，雖心懷恐懼，但作者大多還是決定留下。

Not this one. We are moving back to Washington this week.

但本文不同。我們將於這周返回華盛頓。

The boys are excited. Aden, 12, wants a skateboard and bicycle, accouterments of freedom in a place he is allowed to wander by himself. His younger brother’s wish may be harder to realize.

孩子們很興奮。12歲的亞丁(Aden)想要滑板和自行車。在一個允許他獨自閒逛的地方，那是享受自由的裝備。他弟弟的願望則可能更難實現。

“My asthma will go away,” Bram said recently. “I hope so, anyway.”

“我的哮喘會消失，”布拉姆前不久說。“總之，希望如此。”