Not every career path in medicine follows a straight line, but the twists and turns can make one a better, more compassionate physician. Haywood Hall, MD, FACEP, FIFEM, FAAEM, didn’t finish high school, dropping out to work a variety of jobs in New York City. One day, while working outside of a Brooklyn emergency department, he decided he could be an emergency physician. He got his GED, completed his medical training, and joined the ranks of emergency medicine. However, he never lost the appreciation of diversity and community that he developed from his childhood in Mexico and early work in New York, and the desire to help and support communities infuses his work to this day.

Dr. Hall recently sat down with Andrea Green, MD, FACEP, an emergency physician and chair of ACEP’s Diversity, Inclusion, and Health Equity Section, to discuss his career. Here are some highlights from that discussion.

AG: From the beginning of your career to being acknowledged as a hero of the specialty was quite an interesting journey. How did you get started in EM?

HH: I was raised in Mexico and come from a multicultural family. I went to 12 different schools by the time I was in 10th grade and actually dropped out and became a musician, a piano tuner, a mechanic, and I was even a New York cab driver. All of these things were me trying to find where I fit in the world. As I got older, I realized that being able to work in a multicultural environment, like New York, is a very important skill.

One day, I was reading electric meters outside of a hospital ED in Brooklyn and I realized, “Wow, I could be doing this,” because I always had an interest in science. I always had an interest in different cultures and being able to find a way to help. That was just part of my DNA. Suddenly, it struck me like a bolt of lightning, and I got a GED with the idea of becoming an emergency physician.

AG: Tell us about how you see the social impact of emergency medicine.

HH: The ED is such a central part of the community wherever you are. We really get to see everything that’s wrong and everything that’s not working; it’s not just a particular illness or particular medical condition. It could be that there are no pediatricians in the community and you have all the kids in the ED, or it could be a new wave of drugs that comes in. I really see the emergency department and emergency care as a barometer of what is happening in the community on a public health level.

AG: You’re a fellow of the International Federation for Emergency Medicine (IFEM). What inspired your interest in international emergency medicine?

HH: I, like many people, was very idealistic about health care, but I felt limited in trying to find new solutions that would require developing health care and health care systems in various places. I respect the kind of metro-centric big city and big medical center part because that’s clearly the base, but I felt the challenge to go out to where those things are not and to figure out how to make an impact there.

Having been raised in Mexico, I always felt there was something missing in my life in the U.S. I was on vacation and came across a big car accident in an isolated place in Mexico. Very few people seemed to know what to do. An ambulance came, and I wound up decompressing somebody’s chest who had a pneumothorax. I was struck with the idea that my skills and knowledge might be able to go very far here if I started a training center.

AG: You founded the Pan American Collaborative Emergency Medicine Development (PACE MD) program in 2002 with the goal of improving the quality of emergency care patients receive in underserved areas of Latin America. Can you briefly describe the program?

HH: We started off just by making ourselves available to the health ministry in Guanajuato, Mexico. They were working on a prehospital system. Before long, we had some students who came on to help with the project who wanted to learn Spanish, so we created this medical Spanish program. When they came down, we started working on different projects, and then over time, we became a training center. We started buying mannequins, and we became a training center for the American Heart Association.

We started an advanced life support for obstetrics program, and we’ve trained 17,000 people in that program. Altogether, we’ve trained 35,000 people in the various modular programs we’ve developed. We established the first public-access defibrillator program in Latin America, and we also set up a technical conference on forensic emergency care, especially as it relates to sexual assault. We’ve helped set up a series of conferences and actually did the vast majority of the work for the successful bid for the International Conference on Emergency Medicine held in Mexico City last year.

A big role that I took within the IFEM was going country by country, finding where residency programs existed and where they were recognized by the government, and encouraging them to become voting members of the IFEM. We did that for Panama, the Dominican Republic, Cuba, Ecuador, and Venezuela. On the ground, it was really training people in emergency care, which could make a big difference in the outcomes.

AG: Congratulations on receiving the IFEM Humanitarian Award through your work with PACE MD. Can you summarize your relationship with the federation?

HH: Emergency medicine is a relatively new specialty, and we take it for granted that this exists everywhere, but that’s not the case. Until recently, there were four countries, the United States, Canada, England, and Australia,  that really had any development of our specialty. The work that we’ve done at PACE MD for Latin America has been happening all over the world, and now there are some 60 countries that recognize the specialty of emergency medicine and have training programs. IFEM is sort of the World Health Organization of EM.

AG: What opportunities exist for residents and physicians from the United States to participate in PACE MD?

HH: People could come as medical student electives or residents. We started providing CME, and we even have a pre-professional program to encourage people to go into health care and to understand the cultural aspects of care. We’re not just a language school; we’re actually a medical operation, and so we’re able to, through the medical Spanish program (www.medspanish.com), have people learn what is now an essential medical skill. There are 50 million Spanish speakers in the United States.

AG: So residents who participate in the PACE MD program get credits for their residency as a rotation?

HH: They have to clear it with their dean of students if they’re medical students, or their residency program director, but yes.

AG: How do practicing emergency physicians get involved with PACE MD?

HH: They can contact us through www.pacemd.org or contact me at Haywood.Hall@pacemd.org. They can get the CME credit provided through the University of New Mexico. We can provide up to 50 CME credits, and physicians are primarily here to learn how to communicate with Spanish-speaking patients. I do have to point out that we’re not licensed physicians in Mexico. Our role is really putting emergency physicians in contact with the physicians who actually have responsibilities for these patients.

AG: Can you say a little bit about what you’re seeing on the border?

HH: I’ve always said that I’m sort of a migrant worker, tongue-in-cheek, but it’s actually quite real. I’ve spent a lot of my career flying up to the border on the Mexican side and crossing the bridge twice a month. The emergency departments on the border have a very special burden. Migrants—and some are undocumented—have been through hell, and they’re scared to death. They wouldn’t have shown up in the emergency department if they didn’t feel there was a serious problem. I’ve seen some unusual things, like people showing up needing dialysis, and the ED had to somehow find a way to dialyze them. They’re not U.S. citizens, and they’re not in the system. Some emergency departments actually have dialysis units.

I don’t think people understand the magnitude of this problem. All politics aside, there’s somewhere around 40,000 or so unaccompanied minors who show up across the border every year, and they’re almost all from Central America. The unaccompanied minors are not coming from Mexico, and that’s creating a whole other burden. A few children have died in custody, and so now ICE is sending them to emergency departments to get medical clearance. This is a very large number of people. We occasionally see tetanus, rabies, and tropical illnesses like dengue.

AG: Thank you so much for all the work that you’ve done.