When Haywood Hall, MD, became an emergency physician many years ago, he seemed symbolic of the American dream. Here was a Mexican-born, pulled-up-by-his-bootstraps high-school dropout who, thanks to personal grit, beat tough odds to become a doctor. But after surmounting so many obstacles, he found he couldn’t get past the one lurking in every patient encounter: the potential lawsuit.

And that is the reason, or at least a big part of it, he ended up returning to his homeland, founding a Mexican program that teaches Spanish to emergency physicians, and finding professional renewal, as he describes it.

Called the Pan American Collaborative Emergency Medicine Development program (PACEMD), it has, in the past decade, welcomed hundreds of physicians, residents, and other health professionals, who visit and live in a setting that immerses them in Spanish, steeps them in cultural literacy, and allows them to practice emergency medicine in a picturesque Mexican village, San Miguel de Allende.

As one of its many physician participants, Judith Tintinalli, MD, said the experience was just phenomenal, and for several reasons. Participants live in the geographic heart of Mexico while learning the language, take Spanish classes in a charming historic inn turned academic center, and use newfound language skills professionally while providing treatment at the town’s emergency care facility.

But the PACEMD program, while impressive, is not the subject of Dr. Tintinalli’s highest praise; that she reserves for Dr. Hall.

He built this out of nothing. It is absolutely amazing. He did it without [outside] funding. His ability to negotiate and network just blows me away, said Dr. Tintinalli, a professor and the chairwoman emeritus of emergency medicine at the University of North Carolina, Chapel Hill.

From Meter Reader to EP
PACEMD actually is the result of a combination of events. On the heels of some agonizing litigation, Dr. Hall returned for a visit to Mexico, a place where he always felt safe and comfortable. In the United States, he said, I had reached a place where I had felt stable, and then I really began to question that.

He had survived early discrimination, and overcome feelings of being an outcast, only to have his hard-earned sense of security threatened again, this time by legal challenges. On an outing in the Sonora Desert of Mexico, he witnessed a brutal car crash. He intervened to save the life of a man by fashioning a chest tube out of an endotracheal tube and a glove. Mulling over the incident, he decided to find a way to spend more time professionally in his original homeland.

As it turned out, he actually never abandoned his practice in America. He simply expanded the scope of it, as well as his professional influence, south of the border. Raised in Mexico during early childhood, Dr. Hall was just another happy Mexican kid, he said. He was different, however, in terms of his heritage: an African American father and a Caucasian mother, both American expatriates.

The sense of serenity he remembers from those years changed abruptly around his eighth birthday when he relocated to the United States with his mother following his parents’ divorce. It was only then that he began to encounter discrimination, he said. I wasn’t black enough. I wasn’t white enough. I wasn’t Hispanic enough, he said.

Living in Ann Arbor while his mother earned her doctorate at the University of Michigan, Dr. Hall mastered English and enjoyed learning about science, but that wasn’t enough to ignite an interest in academics. The fact is, I was truant and could not sit still for junior high school, he recalled. I dropped out as soon as I could.

He loved music, however, and devoted every spare moment to it. By the time his mother had clinched a position at Rutgers University in New Jersey, he was tuning pianos to generate income. Eventually he got a steady job across the river in New York, reading meters for Con Edison. I was going nowhere, Dr. Hall recalled.

Then, in a stroke of fortuity, a bank of the meters he was assigned to read stood right outside the emergency department of a hospital. The vitality of the place intrigued him, and soon he became acquainted with physicians and nurses working just yards from that periodic stop. It wasn’t long before I started volunteering [there], he said.

The Path to Mexico
His experience in that ER convinced him he wanted a career in medicine, but he still hadn’t earned a high school diploma. So he reviewed materials for a general equivalency exam, passed it, and then went to Brooklyn College.

He left his meter-reading days behind, becoming a cab driver to have the money and flexibility to attend college full-time. Soon, he was also tutoring others in the very subjects that once had held no interest for him. It was during medical school that he began to see that his multi-cultural background was no longer a disadvantage but a real benefit, allowing him to connect almost immediately with minority patients. What seemed a weakness to me when I was younger was now a strength, he said.

And that strength also became a source of pride. As a result, he was determined to go to the Southwest, the part of America near the Mexican home of his youth. That is how, for several years, he wound up in New Mexico.

After he completed a residency in emergency and internal medicine at the University of New Mexico, he decided to stay there. Dr. Hall worked in rural emergency development in New Mexico, becoming the founding director for the emergency department at Heart Hospital of New Mexico. He also served as the Region III EMS Director for the State of New Mexico Health Department.

He left those posts when he moved his family to Mexico and started the PACEMD program. Now, to support the program, he makes a monthly day-long bus ride to an emergency department near Brownsville, TX. Eight shifts a month is all it takes to keep his life financially afloat back in Mexico.

He says it is more than worth it. I continued with my vocation, and ended up in this stunning colonial town, Dr. Hall said.

About PACEMD
For more information about the Pan American Collaborative Emergency Medicine Development program, visit www. pacemd.org or send an email to .(JavaScript must be enabled to view this email address).

Source: Emergency Medicine News:Volume 29(11)November 2007pp 14,19-20