September 9, 2015

Originally published on ejspin.com

MedSpanish is a Mexican example of “horizontal relevance”, which happens when the learner acquires information so he/she can solve an immediate problem. It’s known as “just in time” learning. Its opposite is “just in case” (it’s on the test) learning.

Dr. Haywood Hall came to live in Mexico as a child, just in time because his parents fled the U.S. as political exiles. They returned when Haywood was eight, and that’s when his Odyssey through bad urban schools began. He finally decided to drop out, wanting nothing further to do with schools until discovering his passion while working as a hospital volunteer. He decided to apply his prodigious intelligence to getting a GED and admission to City College in New York, and subsequently to Baylor School of Medicine in Houston. He did residencies in Emergency Medicine and Internal Medicine, and worked in emergency rooms in New Mexico and Texas, attending more than seventy thousand patients. In these high-stress environments, he saw how his knowledge of Spanish helped protect him from the misunderstandings and mistakes made by many of his monolingual colleagues in treating Hispanic patients.

One day he decided to return to live in Mexico. In Guanajuato he founded a number of different programs under the umbrella of PACE MD, a non-profit foundation. PACE has evolved into one of the institutions with the greatest social impact in Latin America. Advanced Life Support for Obstetrics (ALSO) is one PACE program, training physicians in obstetrical emergency care. It was recognized by the State of Chiapas for helping reduce maternal mortality rates by 30%, and has trained over 10,000 doctors to save the lives of mothers and newborns throughout Mexico. In total, PACE programs have provided professional development for more than thirty thousand health care personnel.

Dr. Hall has cultivated excellent relationships with Mexican health care professionals and medical authorities (https://www.indiegogo.com/projects/pace-md-global-health-in-action#/story). In 2003 he was recognized as an outstanding social entrepreneur (Ashoka Fellow) by the Ashoka Foundation (https://www.ashoka.org/fellow/haywood-hall), and PACE as an outstanding social enterprise by the Miller Center for Social Entrepreneurship (http://i3latam.com/generacion-2014)

Dr. Hall didn’t forget his Hispanic patients in the United States. MedSpanish was designed for physicians, nurses, midwives, physicians’ assistants and emergency medical personnel who work with Latin patients in the States. It started up in the State of Guanajuato and currently operates in Guanajuato, San Miguel de Allende, Oaxaca, and San Cristóbal de las Casas, Chiapas. Students have two hours of one-on-one academic classes per day to get ready for their four-hour practical rotations at local hospitals and clinics. Each unit of study is evaluated by means of a structured encounter with patients. For example, at the end of Level I, unit 2, the student must conduct an intake interview using scripted questions and follow up with clarifying questions as needed. The end-of-unit evaluation for Level II, Unit 2, is to conduct a physical exam asking questions to determine symptoms, location, characteristics, intensity, frequency and relation to other circumstances, and go on to share a diagnosis with the patient as appropriate.

No other medical Spanish program offers student placement in practical rotations in Spanish-speaking hospitals and clinics, because these depend on the prestige and trust developed gradually by Dr. Haywood Hall with local medical authorities. No other program is as intensive or provides for more complete and rapid student learning. Class time is spent learning to do what has to be done the following day at work. Practical rotations are key to horizontal relevance, in which learning is applied to immediate problems.

A collateral benefit is that many MedSpanish students are experienced specialist physicians, which creates a medical dialogue between cooperating physicians of both countries. While there are some flawed foundations and dysfunctional areas in both the United States and Mexican health care systems, cooperation between doctors of both nations means that students are also teachers, and teachers, students. Together they can imagine how to overcome the dysfunctional aspects, just in time, problem by problem.