By Rodrigo Díaz Guerrero
We spoke with emergency physician Dr Haywood Hall, who comes from a family committed to positive social impact—his mother was historian Gwendolyn Midlo Hall, and his father was activist Harry Haywood. In the first part of this interview, published in the April 5 issue, Hall shared with us that, after witnessing a car accident in the state of Sonora, he decided to use his knowledge to serve people by creating the Programa de Actualizacion Continua en Emergencias (PACE), an international organization that provides continuous training in emergency services. It is committed to improving the health and well-being of communities and achieving equitable access to health systems for people around the world through training, forums, and other activities.
To mention a few achievements, the first public access defibrillator in Latin America was installed in San Miguel, and the first resuscitation symposium was held. This was the first event of the International Federation of Emergency Medicine (IFEM) in Latin America. One of the essential premises that governs Hall’s philosophy is to communicate that health is not just medicine; it is important to understand the context in order to really impact societies. “Health is something beyond just medicine, it is also what gives you well-being, it is knowing how to organize and be trained so that people can help their community achieve good health. Another thing that I started in 2015 was to implement telemedicine. In the US I worked as director of several telemedicine programs as a new medical service—but linked to the community—so that telemedicine is more than the care of a doctor remotely located without considering the context of the person attended,” Hall said.
RDG: So, if telemedicine is the assistance of a doctor via the internet, does this type of service not exclude communities where there is hardly any Internet?
HH: Here we are talking about places where access is difficult, where it is difficult to get to a health center, where you are in the middle of nowhere. Surely soon there will be internet everywhere. Obviously, we are not at this point, but we are also talking about human networks, and there will be people within the communities who do reach areas where they can communicate via the internet, and thus improve patient management. I think the general concept is to bridge the gap between a person’s needs and the professionals who can help. There are things that can be done, and that can make a difference. And now more technology is coming, more knowledge is coming. We will be able to create learning communities and communities of practice, and we will be able to move information faster. This can have direct and indirect effects, not just in direct communication with a patient who may not even have internet.
RDG: Let’s say that telemedicine can empower those who are able to help, giving them information in real time to improve a given situation.
HH: Exactly. For example, 70% of cases of postpartum hemorrhage can be controlled with external uterine massage. That resolves a lot of problems, especially in terms of time. There are several very basic actions that people can do that prevent disasters, things that everyone should know. But yes, everything is going to change, it is changing very fast. Telemedicine, the remote monitoring of patients is one. I have even seen home hospital concepts, where equipment and personnel can be brought into the home. We are going to see many changes in the health area; technology is changing very quickly.
RDG: What is your opinion on the use of artificial intelligence AI. How will it affect healthcare and how can its use be ensured ethically and equitably?
HH: This is a very complex area. I believe that the healthiest thing is to see it as «increased intelligence.” It must be used as an additional tool. Obviously, if people who have no knowledge or ethics are using it, the result will reflect how bad the person in question is. I think it’s reasonable to stop and think about what’s going on with all this. It can be something dangerous, certainly. For this reason there must be an expert who can review the information. As with anything, you must know the limits of the tool you are using. AI can build a scenario that is logically perfect, but that may not match reality. Someone has to guide these tools that will surely be very powerful. Knowledge, which AI can give you, is not everything, it is not enough. If you really want to have an impact—and we’ve learned this in the courses—you need skill. In some of our courses we do simulations to apply skills. You also need experience: the practice of that knowledge that allows you to know when you can do what and when you can’t in different situations. It is not the same to work with a model that has a steady weight and treating a person weighing over 150kg. The same applies to other variations, such as working in a place where certain medicines or drinking water are unavailable. These are social, not technical problems.
RDG: What plans do you have for the future, Dr Hall? HH: We want to grow our Civil Association in San Miguel, work more on social impact. In the US we are working on a project to train emergency physicians at the border. And yes, digital health is our biggest challenge: developing our App, obviously, but first deciding how we are going to implement the service in cities and communities. I don’t think that the application from cyberspace is useful if the context of the community is not understood. We are looking at how to integrate that part. It must be a hybrid service, because, as I said, there must be a person who truly becomes the agent of change.
