Lee Wallis Takes the Helm as Global EM Enters New Waters

Published on April 18, 2016
In 2016, the International Federation for Emergency Medicine will inaugurate Professor Lee Wallis, its first president from an African nation. Wallis is keen to use his term to help IFEM work more collaboratively with the World Health Organization, and make the federation more inclusive of non-physician emergency care workers.

EPI: What new opportunities do you see for IFEM over the next year or two?

Lee Wallis: We are working on a new strategic direction, which I proposed. I can speak about it, although it’s not yet IFEM policy.

For 25 years, IFEM has done a very good job of what it does: serving highly specialized emergency physicians (EPs). But I think that misses the vast majority of emergency care on the globe. Even in the US, where most emergency patients are seen by EPs, family physicians, nurses and PAs do a lot, particularly in rural areas. IFEM currently doesn’t capture any of that. So if we’re going to remain meaningful, given the lack of emergency care development in most of the world and given who provides emergency care in most of the world, we have to change our focus. We have a great opportunity to refocus and to expand from specialists in emergency medicine to providers of emergency care. And that’s what I proposed to the executive of IFEM: either that we focus on all doctors providing emergency care or we focus on all providers of emergency care, of which the majority won’t be doctors. We still need to debate that, and even I haven’t decided personally on that question.

Broadening our scope could afford us a great opportunity. Last January, WHO Geneva appointed their first ever lead for emergency care, Teri Reynolds. She’s a superstar. She’s been in the post for a year, and she wants us, IFEM, as an organization to be at the top table with her, directing global strategy and advising on roll-out and scale-up and direction and all of those sort of things. The problem is that, at the moment, everything about us is geared only toward EPs, which limits our appeal for a broader global reach, and which is part of the reason why I think we need to make the change. There’s an opportunity here to be at the top table with the WHO, which makes us really meaningful, but we need to change our focus to do that.

EPI: So this shift would take IFEM from being quite exclusive to being highly inclusive.

Wallis: Yes, and I think that is where IFEM needs to be. Whether we’re there in six months or in six years is not clear. It may be too big a step to take right now, and that will be okay because we already recognize that IFEM member societies don’t have to be composed strictly of EPs, but we do still have these requirements like having an EM residency. So I think we may need to take smaller steps, like looking at doctor groups. The end point has to be that multidisciplinary groups are represented, as opposed to focusing on specialist doctors only.

EPI: What might be lost as a result of IFEM taking such an expanded approach to its membership?

Wallis: We’d lose this commonality where we all speak the same language. Right now we all understand each other’s background, and that allows us to relate more easily to each other. We understand whether you’re from Argentina or Armenia, if you’re an EP you’ve had pretty much the same background and training and you speak a common language and your problems are probably the same. Whereas if you’re a mid level provider in a rural district hospital, you’ve got a different set of problems—you still have clinical patients to see, but you’ve got a different set of problems. With that greater diversity of backgrounds and practice, we’ll widen our influence and relevance, but communication, networking, and pitching and executing policies may no longer be as fluid or straightforward as it is now. We’ve already seen this in the African Federation of Emergency Medicine (AFEM). It’s harder to agree on things and get the level right when you’re looking at specialist doctors and general doctors and nurses and clinical officers and EMTs. It’s difficult to find the right level that suits everyone. Instead of producing one set of materials for a certain area, we’d have to produce five sets aimed at different targets. But that’s okay, as long as we understand that that’s what we’re taking on. It’s more work. It’s harder to do. But it’s further reaching in what it does.

People who have been in the organization for a decent amount of time may genuinely not believe it’s the right thing to do, or may only say it’s the right thing to do but harbor serious reservations. So, I think we’ve got some selling to do. It’s a fairly significant change, and I’d be disappointed if everyone rolled over and said, “Absolutely.”

EPI: How do you think your experiences working with middle and low-income countries as the head of AFEM prepared you for the role of IFEM President?

Wallis: There are a small number of residency programs across Africa producing small numbers of graduates. Everything else in emergency care systems are underdeveloped. They haven’t had resources pumped into them. In most places there is no one at the Ministry to think about emergency care or what’s been advancing over the last few years. Because there was this huge vacuum, particularly with so many low-income countries, AFEM very quickly because the go-to for the continent. Because I have the flexibility in my job, I’ve been very lucky to travel a lot, and I’ve been on the ground in a lot of countries with the people who are working in them now, and helping them find medium-term approaches to development problems or questions they have. With the parallel work that I’ve been able to do with Teri Reynolds and the WHO, I’ve developed an understanding of health systems which I wouldn’t have had being an EP in an ED and only working clinically. So both my job as the head of EM for the provincial government here in South Africa, and my role in AFEM have allowed me to engage on the country and regional levels and to understand systems in a way that I wouldn’t have been able to before. This also allows me to work with the existing structure in the societies; I think I can help IFEM leadership understand the realities, needs, and challenges of engaging with countries and with partners, and how we take the steps to help them build a system with us.

EPI: Can you give an example of how your unique vantage point has already determined decisions or directions you’ve made?

Wallis: This is an example I use frequently. So, a country has appointed a person in the Ministry and there is a doctor who’s been driving emergency care in the academic hospital. They’ve been talking and the Health Minister has allocated some funds, and the question is, “Should we buy a Mercedes ambulances or we should we buy a Toyota? What do you think? We want ambulances on the road.” Meanwhile, the roads are impassable, traffic is gridlocked, there is no money for equipment or for a communications system that the patients can phone. If they do get an ambulance, when they arrive at the hospital there’s nothing for them.

The first couple times I was approached I gave advice on which ambulances I thought were best. Then it only takes a few visits to countries and you see the same issues. Now my advice is, “Who cares? Don’t buy ambulances.” That’s the answer. Take that money, put it into the district level of your health system. Get emergency care right there, and let taxis do the transportation for a while until you’ve got enough money to buy. Get the basics right, get the community first aid, and get basic district hospital emergency care right. Everything else can follow from there.

EPI: Many EPI readers will be attendees at ICEM and might be interested in knowing how to get more involved in the policy side of EM. What advice would you give to a young physician?

Wallis: Serve your own national organization first. Volunteer to get involved. Get into the committees, do some hard work, and deliver. People will notice. If you want to do that through IFEM, our committees are open. You can come to the committee meetings, sit in the back, and talk to the people in the committees and share your particular areas of interest. We’ll get you involved in the committees. Again, just sitting on the committee isn’t very helpful to anybody. So this is about working. So do something productive and you will be noticed. I think people often feel too shy. Everyone’s smart; it’s not that they don’t have the skills, but they might feel they don’t really fit in or that they don’t know the organization. But we’re all doing this as volunteers. We don’t have time to micromanage people. So if someone really wants to get in there, jump in and put your hand up and say “I’ll do it” and deliver the work.

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