Haywood Hall

Ashoka Fellow
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This description of Haywood Hall's work was prepared when Haywood Hall was elected to the Ashoka Fellowship in 2003.

Introduction

Haywood Hall is saving lives by cultivating public health capacity for emergency medicine in Mexico and Latin America.

L'idée nouvelle

Through the organization of collaborative efforts among doctors and medical institutions throughout the Americas, Haywood is developing leadership and skills for emergency medicine in countries ill-equipped to respond in emergency situations. A U.S.-trained emergency medicine doctor himself, Haywood has developed a variety of mechanisms to link doctors, technicians and public health officials in the United States, Mexico and other parts of Central and South America in a network of training, exchange and course development that leverages existing medical resources in Latin America to foster new emergency care capacity.

Le problème

Emergency medicine is relatively new, and its benefits have not yet reached Latin America. The reality of substandard emergency care affects not only health care delivery but also quality of life and economic development potential. Trauma and medical emergencies are a major cause of mortality and morbidity. In addition to unnecessary death, lack of emergency medicine can be linked to chronic disability, reduced ability to respond to disasters, toxic emergencies and the ability to properly address domestic violence.

Trauma does not discriminate - lack of emergency medicine touches everyone, regardless of any social classification. However, it remains true that young people are disproportionately affected by a lack of emergency care, resulting in many years of lost productivity and the subsequent impact on the economy. When emergency medicine is available, patient access to medical care improves. By its very nature as a public health service, emergency medicine cannot turn someone away for lack of ability to pay, and proper emergency care even creates cost effectiveness by incorporating specific abilities where other elements of primary and public health care already exist.

Inhibiting the development of emergency medical care in Latin America is a lack of Spanish language materials and limited training programs for physicians, nurses and paramedics in the region. A dearth in leadership compounds the problem. Although a variety of governmental and civil society organizations have attempted to address the problem, they have done so in an isolated manner, while the problem necessitates communication and collaboration.

La stratégie

Haywood is addressing the acute lack of emergency medical care and spreading his strategies throughout Latin America. The first step is building bridges between the United States and Mexico, using U.S. physicians to transfer knowledge to potential emergency medicine providers in Mexico. In collaborative partnership, they are developing a process of community-based education in emergency medicine that will allow dissemination of the training throughout Latin America. This pan-American strategy involves a center for course development and dissemination, cross-border exchanges for collaboration and faculty development, a "university without walls" methodology for wider dissemination of learning, and an annual leadership conference.

Haywood established the Pan American Collaborative Emergency Medicine Development Program (PACEMD) Training Center by taking advantage of existing Health Ministry plans to establish a medical training center in Guanajuato, Mexico. He approached the ministry, and they asked him to provide training in emergency ultrasound. Knowing that ultrasound should not be the top training priority, he agreed to do it with the understanding that he could also do other basic courses. This joint center now serves as the base for PACEMD's training and dissemination strategy. The center provides regular courses in advanced airway management and emergency ultrasound. It provides dissemination, or training of trainer, courses in basic trauma life support and specific trauma nurse care. The center is also developing courses in domestic violence awareness and problem-oriented medical management, and it brokers courses with other institutions in disaster management, toxicology and hazardous materials.

Courses are developed through collaboration between the PACEMD Training Center, the University of Guanajuato and a consortium of U.S. institutions. Each institution has varying levels of involvement in the project, but together they provide the necessary emergency medicine expertise to facilitate training, course development, and faculty development at the University of Guanajuato.

Haywood has also created specific programs to attract individual doctors to contribute to the center's training strategy. The center offers a month-long medical Spanish course to doctors, who gain language skills useful to their work among a growing Spanish-speaking population in the U.S., and in turn provide emergency care training for Mexican medical professionals. The doctors learn Spanish in the morning and spend their afternoons in hospitals, joined by Mexican medical residents from Mexico City and Guadalajara. Currently in development is an Emergency Medicine International and Border Health Fellowship. Upon finishing their medical programs, graduates seek out Fellowships through which to start their careers. Haywood will offer a unique border option that will bring recent graduates of accredited emergency medicine residency programs in the U.S. to spend one to three years on the U.S.-Mexican border. The Fellows will spend a week of each month working in a border emergency room, where volume is high, and two weeks as emergency medicine faculty at the University of Guanajuato. For each two Fellows recruited by the program, the University will thus have a full-time faculty position, allowing ongoing training and faculty development.

Haywood's plan for dissemination of the training courses developed in Guanajuato involves a network of primary and secondary sites and a community based education methodology, like a "university without walls". The dissemination network will maintain its primary domestic site in Guanajuato, but Haywood plans to open secondary sites in Mexico City and Guadalajara as well. Internationally, Haywood has begun building bridges for chapters in Panama, Ecuador and Argentina. Secondary international sites may include Honduras, Guatemala, Cuba, Dominican Republic, Colombia, Peru, Chile and Brazil.

The community-based education methodology is critical to insuring rapid, cost-effective dissemination. It aims to avoid prolonged institutional-based training, focusing instead on training medical professionals where they work, and to utilize practical, problem oriented techniques. Specific strategies PACEMD has developed include focused certification courses, mobile patient simulation laboratories for hands-on skill development, web-based distance education in emergency departments, and the connection of local training centers throughout the hemisphere through distance education technology.

The engine that keeps this complex, collaborative structure moving forward is an annual conference at which all the players from both North and South America convene to discuss organizational development, review future dissemination courses, and compare strategies and successes. Perhaps most significantly, the conference provides leadership training to nurture a new faction of local emergency medicine practitioners and leaders who can foster the emergency medicine culture in Latin America and reduce the dependence of the training process on U.S. institutions.

To provide institutional reinforcement to the program, Haywood is seeking World Health Organization (WHO) accreditation of the Guanajuato training center. He recognizes that a WHO Collaborative Center for the Dissemination of Community Oriented Emergency Medicine could help raise money, leverage the program's efforts in Mexico and Latin America, and immunize the program from any political positioning. Mexico's National Health Ministry has requested accreditation on behalf of the Guanajuato center.

La personne

Haywood's quest to bring emergency medicine to Latin America began when he happened upon an accident in the Sonora desert of Mexico and realized how little experience the attending paramedics had. However, the path that led a well-paid American emergency physician to seize the opportunity this happenstance encounter presented began much earlier.

Haywood spent the first nine years of his life in Mexico with his white civil rights activist mother and his elderly African-American father whose own parents had been born slaves. His parents had met in France, where his mother had been exiled by her parents to study piano after getting involved in race politics in their home state of Louisiana. His father, who came back from World War I radicalized, became well known for his activism with the African Black Brotherhood and the first version of the Black Panthers. The two married and returned to Brooklyn, where Haywood was born. The three of them then moved to Mexico, where Haywood remembers a good life free from racial strife. Nine years later, however, his parents divorced, and his mother returned with him to the U.S.

Back in his own country, Haywood struggled to fit in. He didn't speak English and was accused of not being black enough or white enough or Hispanic enough. Meanwhile, his mother struggled to get by. After being driven out of North Carolina, where she taught at a black college, they ended up in the slums of Detroit for a while. Just as riots were burning down the neighborhood, his mom was accepted to the University of Michigan for graduate work. They moved to Ann Arbor, where Haywood learned English and eventually joined a band. He had struggled so hard to find a peer group that when his mother got a job at Rutgers when he was fifteen, he stayed behind to stick with the band. Upon getting run out of his house, however, he hitchhiked his way to New Jersey to reunite with his mother.

Life did not get easier. Tired of consistent harassment by police officers in his New Jersey town, Haywood dropped out of high school and moved to New York, where for years he read electric meters and drove a cab. Once when he was reading meters in a hospital, he looked around at the medical professionals and said to himself, "I can do this." A fellow meter reader who - Haywood discovered three years later - turned out to be a pathological liar claimed himself a pre-med student at the time and ironically inspired Haywood to complete his high school equivalency.

Eventually Haywood ended up at Baylor University for medical school, thinking it was close to Mexico. Still feeling like an outsider, though, he transferred to the University of New Mexico, where he finally found a home, staying through his residency. While there, he created an interdisciplinary graduate public health program, battling university politics the whole way. When the initiative started gaining steam, an initially disinterested medical school dean took over the program and pushed him out. Disillusioned with academia, where he had intended to create his career, he located a desert hospital in need of an emergency room doctor and joined that hospital.

Although Haywood established a lucrative career as not only a physician but also an administrator, after various battles with the US health system, he again began looking for the place he could contribute most. The accident in Mexico, which he witnessed while on vacation, inspired him to begin investigating what sort of Spanish language emergency medicine training materials existed in Latin America. He found nothing. At that time, he learned of the medical training center the Health Ministry planned to launch in Guanajuato and began the process of launching PACEMD.