Emergency Medicine Mexico, Emergency Preparedness, Health & Wellness, Mexico, Palliative Care Mexico

PACE Pan-American Forum for Emergency Care and Global Health 2019 Theme: Global Health is Local

One of the biggest pleasures for those of us dedicated to healthcare (for me senior care and palliative care from a social, spiritual, and administrative perspective) is to attend a conference where one can network and learn from thought leaders focused on a similar mission – best practices for quality care.

The 2nd PACE Pan American Forum for Emergency Care and Global Health held at Hotel Real de Minas in San Miguel de Allende, Mexico last month, was a gift for all attendees. (Below, in the inadvertently tilted photo, is Hotel Posada de las Monjas in SMA, a former monastery, where the PACEforum.org offices are located).

PaceForum.org headquarters in San Miguel de Allende at Hotel Posada de las Monjas, a former monastery

 

The three-day conference focused on innovative ways to offer medical training to communities in lower-resource, culturally challenging settings through technology (tele-mentoring, digital health monitoring), and one-on-one communication and care skills.

 

PaceForum.org 2019  Hotel de Real Minas lobby mascots

 

Public health leaders in Emergency Medicine shared years of accumulated knowledge from state, national, and international levels. Tracks included general emergency medicine, disaster management, obstetrics, pediatrics, the ECHO tele-mentoring program, rural and wilderness medicine, palliative care, and many more. Attendees received CME credits.

Each track was of the utmost importance.

The most meaningful tracks for me were physicians teaching palliative care to emergency resident physicians, a demonstration of a clinically proven mental health protocol for first responders and physicians to keep themselves and others calm through Breath-Body-Mind (trade-marked), and the presentation by internationally renowned social entrepreneur, university professor, and conference founder Dr. Haywood Hall who focused on the formidable impact the PACE program has had in Mexico, plus a current international concern, health and mental health issues at the US-Mexico border.

Other presenters included Dr. Terrence Mulligan (creator of Emergency Medicine and acute care system development programs in over 20 countries); Dr. Camilo Gutiérrez (pediatric trauma); Dr. Robert Suter (President of the American College of Osteopathic Emergency Physicians on thromboembolic disease); Dr. Judith Tinitalli (expert in obstetrics and Editor-in-Chief of the best-selling Emergency Medicine text book); Dr. Gary Gaddis (specialist in low-resource settings); Dr. Monica Gaddis (specific issues in international emergency medicine); and Dr. Angel Rafael Braña-López public health instructor and preventive medicine specialist at Florida State University College of Medicine and San Juan Bautista School of Medicine in Puerto Rico. There were 36 other esteemed presenters.

Thanks to the international work of Dr. Angel Braña-Lopez, and New York integrative psychiatrists Drs. Richard Brown and Patricia Gerbarg of www.Breath-Body-Mind.com who work with disaster relief trauma, I was able to travel to San Miguel de Allende. Many thanks also to Dr. Haywood Hall!! It was a privilege to attend.

Other attendees were medical school professors from Latin America (mostly Mexico) and the U.S., specialists, generalists, nurses, mid-wives, paramedics, community health workers and others.

Cruz Roja (Red Cross) paradmedics at PaceForum.org 2019

More about PACE Global Health

PACE Global Health (aka Groupo PACE) is an off-shoot of the award-winning social impact program PACE MD, founded over 20 years ago “to improve emergency and general medical care in Latin America through community-based training in skills, knowledge and ability as well as to improve medical care in the US and Latino populations through MedSpanish’s language and cultural literacy training (offering CME and GME credits).”

PACE MD founder Haywood Hall is an Emergency Medicine Specialist, Telemedicine Physician, and Professor at the University of New Mexico and the University of North Carolina. He is an American fluent in Spanish language and culture, and is an Ashoka Change Maker Fellow who works with Duke University’s Innovations in Healthcare. His PACE program has trained and certified over 41,000 healthcare providers and 6,000 lay people in systems-based emergency care.

For his achievements in positively affecting the chain of survival through emergency care skills Dr. Hall has won the International Federation of Emergency Medicine Humanitarian Award as well as the College of Emergency Physician’s Hero of Emergency Medicine Award, LATAM’s Top 10 Social Impact Enterprise in Latin American and the Caribbean Award, the American Heart Association’s Silver Award, as well as 2nd place for Social Innovation from Mohammad Yunus Creative Labs.

PaceForum.org breakfast meeting with Ms. Karen, Dr. Angel Brana-Lopez, Elena Lopez of Hola Hospice, Wendy Jane Carrel of Wellness Shepherd and Book Ambassador,, and Dr. Haywood Hall, founder of PACEMD, Pace Forum, and MedSpanish

“The future of emergency medicine is here and it’s up to us to pave the way,” states Dr. Hall. “As front line healthcare providers we are in a unique position to be agents of change. We know the exact problems that plague our societies.”

If you are interested in learning more about Latin culture and how you can use healthcare technology to reach low resource areas you may wish to attend the next Pan-American Forum for Emergency Care and Global Health (date not yet set), or contact PACE via the information below:

Centro PACE/PACEMD.org

Hospitales 10

Colonial Marfil, Guanajuanto, MX CP 36250

Phone: 505 239-0143 (New Mexico number)

Phone: 473 733-0999 or 473 690-0654 (Mexico)

www.Centtro-PACE.org   info@pacemd.org   Monday-Friday 9 am to 5 pm

Another take away: What many people may not realize is the enormous effort and energy required to create innovative, sustainable public health programs, especially related to emergency medicine, which is often a 24/7 profession. Most participants, and PACE founder Dr. Hall, usually depend on their teaching income to fund their outreach passions and programs.

Note: PACE International is not to be confused with another PACE, a US federal Program of All Inclusive Care for the Elderly. The objectives are similar, however – to treat all with dignity, compassion, and quality care.

Resources

https://paceforum.org/

https://www.visualcv.com/haywoodhall/ comprehensive bio of Dr. Haywood Hall with video

https://www.acepnow.com/article/dr-haywood-hall-is-a-driving-force-for-em-education-in-the-americas/   Emergency Medicine magazine interview with Dr. Hall in June 2019

https://www.epijournal.com/new-events/2019/8/15/the-2nd-pan-american-forum-in-emergency-care-and-global-health

https://Medspanish.com  Information about the organization, mission, methods and the results of decades of advocacy.

 

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Alzheimer's, Dementia, Emergency Preparedness, Health & Wellness, Senior Services

Emergency Room Environment for Alzheimer’s Patients – Denver Hospital Takes the Lead

I would not call the emergency room featured in the article below “paradise”, but I would say it is a vast improvement over others in terms of amenities and should be considered for all emergency rooms, not only for those receiving persons with Alzheimer’s and dementia.

There are large clocks to read the time, big white boards written with exactly what tests and treatments you are receiving and how long they will last, softer lighting, no disruptive noises from monitors, curtains with soothing scenes to look at such as waterfalls.

The report claims the floors are designed with falls in mind but the bathroom floor looks like tile. No to tile! Use linoleum (rubber) or other material which can cushion falls and is quiet!!

Wondering if I missed seeing guard rails on the bed.

The senior TV correspondent in the video in the link falls short of being articulate, but the TV station footage captured at the hospital is worth viewing.

Congratulations to Denver’s Lutheran Medical Center for taking this first step. May the world follow your lead.

Note: The article in the link below was found on an excellent free weekly newsletter (via a Denver TV station). Alzheimer’s Weekly.

Aging, Assisted Living, Emergency Preparedness, Health & Wellness, Mental Health, Retirement, Senior Housing Security, Senior Living

Housing Security for Older Adults, Syria and the U.S., Three Stories

Below are two American tales, and one Syrian tale, each bringing up an important global issue for older adults – housing security.

This week the Washington Post published an article by Peter Holley about an elderly woman who has been asked to leave the only home she has known for decades, a rented cottage. Apparently, the owner has chosen not to honor the verbal agreement of the previous owner, whom he was related to. The situation could become a death sentence for the tenant in more ways than one, if indeed, she must leave.

Here’s a link to Story #1:

https://www.washingtonpost.com/news/morning-mix/wp/2016/02/24/its-a-death-sentence-facing-eviction-97-year-old-woman-could-wind-up-on-streets/

Here is a photo of 97-year-old Marie taken by her neighbor Lisa Kriger:

 

If you work your entire life to build what you have, and you cherish and are thankful for it, why should comfort and a sense of security be taken away if you are elderly, vulnerable, and not blessed with infinite financial resources?  What are the possible solutions? Moving and making major changes at an advanced age is not easy.

Furthermore, is it Marie’s fault society is crumbling down and things are drastically changing? Could she have known to prepare? No matter where she moves, if it turns out she has to move, it will be psychologically and physically traumatic. Since she may not be able to afford to move, it means she cannot afford to move to senior living, even though the article mentions she was asked about it. As a former senior living administrator I can comment that some seniors, not all, have a hard time adapting to senior living even if they can afford it, especially if they are mentally competent and independent minded.

I trust someone can help Marie and others in her situation create healthful ways to maintain independence, dignity, and sanity.The only saving grace seems to be that Marie has children. I hope they are in a position to come to the rescue.

Story #2  I recently witnessed a situation with an unhappy outcome, similar to Marie’s

A building on my block in West Hollywood was being torn down to build condos (each condo currently worth between $1-$2 million). Most of the tenants were elders under rent control who could not afford to move. Result? Almost every single elder died within the six months or year they were given to leave. No kidding. Heart-rending.

What are the lessons in this?  Could Marie or the seniors of West Hollywood have known to prepare for such an eventuality? Should we learn to be flexible, start paring down to basic clothing and furniture at age 50, give up all that makes us comfortable and content, and not enjoy what we worked to create?  If Marie were Buddhist, and attached to very little, it would still be a challenge to make a move because of one main factor, age.  Added stress as we age can be a contributing factor to a faster demise.

Story #3 takes the issue a step further.

Imagine being an 80 year old Syrian woman who has watched her loved ones killed, her home bombed, and has somehow managed to get to the Jordanian border for rescue. She is alone, has no clothing except what she is wearing, no funds of any kind, no way to make a living, and her home is a camp until a proper roof can be found, if one can be found. She is totally dependent on people she does not know. Quite frankly, at age 80, how would she have the energy to keep on despite the deep trauma and loss she must be feeling? What if she has a chronic health condition and needs meds?  What would it be like to live in exile? She is one of tens of thousands in this inhumane situation created by external circumstances.

For further reading on elder challenges around the world and in Syria, see the on-going rescue efforts being made by Help Age International, http://www.helpage.org . See also one of many stories posted on Syrian elders in exile at http://www.helpage.org/newsroom/press-room/press-releases/syria-three-years-on-older-refugees-in-exile-the-silent-casualties/.  Another telling story with facts about how disabled and elderly refugees are treated is at this link…  https://medium.com/@DFID_Inclusive/minimum-standards-for-age-and-disability-inclusion-in-humanitarian-action-e1932b32c141#.jd4061wxv .

Addendum:

At a recent conference on The Future of Housing for Grown-Ups: A National and Local Perspective, Dr. Anand Pareka, Senior Advisor at the Bipartisan Policy Center is quoted as saying

“I’m quickly realizing that housing is in many ways health. It’s a very important determinant of health.”

Addendum 2:

Liz Seegert of the Association of Health Journalists wrote an excellent piece about those who live with the stress of homelessness… they age faster than those who have a roof over their heads.

See http://healthjournalism.org/blog/2016/04/homeless-get-older-at-younger-ages-than-their-peers-research-says/#more-27689 

Ecuador, Ecuador Senior Living, Emergency Preparedness, Expats, Health & Wellness, Living Abroad

Cotacachi Health Chapters, Ecuador End-of-Life Planning Discussion

On June 7, 2015 I had the pleasure of speaking to the Cotacachi Health Chapters group at Gran Hotel Primitivo about End-of-Life Planning for Norte Americanos. (Cotacachi is a charming Andean city 2 1/2 hours from Quito).

My hosts were community organizer Caroline Goering – a true delight – and a team of other amazing, supportive people – Dan and Janda Grove, Mike and Linda Munhall, and Bill and Ann Henry. What to do in case of a health emergency, especially if you don’t speak Spanish, is their focus.

Caroline introduces Wendy
Caroline introduces Wendy Jane Carrel
Cotacachi Health Group, June 2015
Cotacachi Health Group

 

school marm...
school marm…

We discussed physicians, who to call and why, transportation, the importance of having end-of-life documents prepared, attorneys and notaries, cremation options, and disposition of remains to North America.

Fortunately, bi-lingual nurse practitioner Mary Grover, a former Peace Corps volunteer, can be of service to the estimated 200 expats in the area. I introduced Mary to those who had not met her.

A special thanks to CHC for the invitation. I was exhausted by the time I arrived, but content to meet a group that understands the importance of planning ahead, just in case, when living abroad.

Aging, Ecuador, Ecuador Senior Living, Emergency Preparedness, Health & Wellness, Retirement

Senior Care Options in Ecuador, Overseas Radio Program

Hello dear friends and readers,

I was on the radio today.
http://overseasradio.com/ashley-rogers-and-michel-blanchard/   See the archives for January 5, 2015 for the download.

Big oops. My hostess was stellar. I was energetically flat for a subject I am so passionate about, and a bit off point. I know better. Am praying to redeem myself on another program later. 😉

Here below are a few observations I had intended to clarify:

I have lived or worked in over 40 countries and am truly blessed that I have maintained my health with the exception of being thrown from the back of a Vespa in Rome, Italy – Vespa hit by a truck – two cracked vertebrae. I fortunately healed and have no residual effects.

This experience, among others, led to one important point of our radio chat…

No matter where you choose to live, please give thought to your physical and mental well-being, especially if you are over 50. Self-care is everything for your future, though accidents are sometimes not in our control.

We are all subject to falls despite the place we choose to reside in or travel to. In Ecuador, where sidewalks are rarely flat, smooth, and wide, you can unwittingly fall into ditches, and the street. You can also trip on exposed rebar and protruding cement edges. When it rains, you can glide right across the marble and shiny tiles in front of buildings and splat. Do you want broken bones? Plan on looking down a lot and being mindful.

We are not all made the same when it comes to oxygen intake. The altitude in most Andean cities is between 6,000 and 9,500 feet. Some who are new to high altitude adjust well, others do not and do not know it. I recommend bringing a blood pressure cuff and reading your blood pressure each day. Also, as one ages, I am told we receive less oxygen into our bodies than when we are younger.  Options: bring liquid oxygen drops (haven’t found them here) drink coca de mate tea easily found in any store, go slowly, or, move to a lower elevation. The North American community has lost members who arrived with no chronic health conditions and a clean bill of health – they unwittingly succumbed because of the oxygen issue. These incidents remind me of the childhood story of Heidi and the fresh mountain air in Switzerland that healed her. I had always concluded that high elevation would be good for me or anyone else. Patrick Coady of http://www.southamericanhealth.com has written a fine article about living at high altitude and how to handle it:
http://cuenca-news.gringotree.com/living-at-elevation-cautions-advantages-for-your-health/

If you plan to live in Ecuador, make certain to create a Constancia or a Documentacion Juramentada for end-of-life arrangements. Your Advanced Health Care Directive or your Five Wishes are not valid in the country even if notarized, apostilled and translated into Spanish.  Again, your North American documents will not be recognized. If you wish to be cremated this is especially important. The number of days and bureaucracy required for your loved ones to negotiate the system is more than challenging, especially if they are grieving and far away. Different culture, different mentality.

Health Care Prevention and Emergencies in Cuenca in brief:

I had not intended to sound like an advertisement for people whose work I admire, but there is no getting around it. Trainers Ken Dobberpuhl of ZealCenter.com, Chelsea Gary at http://www.shaome.com, and Sky Rajewski will help you stay in shape if you have balance issues or injuries. They will also recommend physical therapists. They focus on keeping you well.

In 2014, the In Case of Emergency Cuenca volunteer team created lists of health-related emergency resources.  You can locate the information on a local church web site, http://www.internationalchristiancommunity.org/health-resources.html. The names include providers who speak English – but please beware, you are provided with lists, not recommendations. Do your due diligence as you would in your country of origin or elsewhere as to the person or persons whom you will feel comfortable with.  The church kindly provided space for the In Case of Emergency Cuenca team to deliver free seminars of interest to Europeans and North Americans residing in the city in 2014.  The next seminar will focus on End-of-Life and is planned for sometime in spring 2015.  Look for announcements on on-line newsletters Gringo Post and Gringo Tree.

Other holistic mentions for Cuenca:

Cuenca Holistic Network founded by psychologist Robert Higgins, a group of North American and Ecuadorian alternative healthcare workers    www.CuencaHolisticHealth.com

Patrick Coady and Silvana Spano of http://www.SouthAmericanHealth.com

Dr. Hugo Alvarez, MD and naturopath, a Cuencano who lived 25 years in Canada

Dr. Francisco Malo Tamariz, General Medicine and Ayurveda

Other MD’s are on the church web site link above.

When discussing senior health care in Latin America, the quality of care in Mexico was inadvertently omitted.  In many cities, medical care is truly excellent.  Assisted living in Mexico is often on a par with the U.S., depending what state and city of Mexico you are in, and as in the U.S., what funds you have.  The “carino” that was mentioned is also prevalent in Mexico.  Cuba, a leader is gerontology, has waiting lists at assisted living homes.  This is due to current economics.  Chile, also a leader in gerontology, has sophisticated senior care in Santiago.

Emergency Preparedness, Health & Wellness, Long-Term Care, Senior Services

CMS (Medicare and Medicaid Services) Proposes Stepped-Up Emergency Preparedness

In light of devastating and continuing natural disaster challenges throughout North America, the Centers for Medicare and Medicaid Services proposes increased emergency preparedness standards for long-term care facilities.  May this plan be implemented soon!!  Below is an article with more details by  for McKnight’s

January 03, 2014

CMS proposes more rigorous emergency preparedness rules for long-term care facilities

CMS proposes more rigorous emergency preparedness rules for long-term care facilities
CMS proposes more rigorous emergency preparedness rules for long-term care facilities

Long-term care facilities would have to meet more comprehensive emergency preparedness guidelines, under a newly proposed rule from the Centers for Medicare & Medicaid Services.

Events such as the Sept. 11 attacks, Hurricane Katrina and recent devastating floods around the nation have shown that current emergency preparedness requirements for Medicare and Medicaid providers are inadequate, according to the 120-page proposed rule. Therefore, CMS has drafted more robust requirements for providers and suppliers.

Long-term care facilities would be subject to similar requirements proposed for hospitals. These are based on the principle of “all-hazards planning,” the rule states. This means planning should not involve developing highly specific plans for every conceivable threat, but should focus on creating the capacity to handle a spectrum of emergencies. The government has identified 15 scenarios for healthcare providers to use in assessing their risks, including natural disasters, cyber attacks and biological attacks.

Based in part on a risk assessment, hospitals should develop specific policies and procedures, the rule states. These include such items as tracking the location of staff and patients, and ensuring that medical records are “secure and available” in an emergency.

Long-term care facilities would be responsible for meeting all the hospital requirements, with some specific adjustments and additions, according to the rule. LTC facilities would specifically be directed to account for missing residents during a disaster, would have to determine what emergency planning information should be shared with residents and families, and should evaluate the need for chargers or electrical outlets for items such as motorized wheelchairs.

Click here to access the complete document, issued Dec. 27. Comments are being accepted through Feb. 25.