Report and Reflection: The 2nd UVa Global Health Case Competition

“5:30am,” replied the bleary eyed student.

It was Saturday morning and I had just asked her what time she had gone to bed the previous night. No, she hadn’t been partying it up on the corner—she and her interdisciplinary team had been polishing up their presentation for the second UVA Global Health Case Competition. The first iteration of this event in 2013 had challenged participants to present proposals to control the menace of extremely-drug-resistant tuberculosis and other health concerns in the slums of Mumbai, India. This year’s case was equally challenging: prioritize the health needs of Syrian refugees and develop a pilot program to address these needs in Syria’s neighboring countries.

Case Competition Flyer (courtesy: Manya Cherabuddi)

The case, written by a group of students from across the University and including members of last year’s winning team, objectively described several problems and complicating factors that the United Nations High Commissioner for Refugees is currently facing. About six million Syrians are internally displaced and another 2.5 million have been scattered across the middle-east and Europe as a result of the crisis, which many believe to be the most serious humanitarian crisis since the Rwandan genocide of 1994-1995. Syria’s health infrastructure has been reduced to rubble by the conflict, leaving Syrians with no preventative health services. Consequently, the recurrence of polio was unsurprising, but horrifying for a global community that has invested some much to eradicate this disease.

The case also focused significantly on social and health issues plaguing the women among the Syrian refugees. Not only are there insufficient obstetric and gynaecological services available to Syrian women in the refugee camps, they are also forced into an oppressive social dynamic. For instance, young Syrian girls are coerced to marry older local males in hopes of establishing economic security for their families. The danger of rape and molestation is ever-present in the tumult of large refugee camps. The case cited the example of women in the Za’atari camp who actually dehydrate themselves during the day to minimize toilet use as they fear lurking rapists. The case challenged students to propose a realistic initiative with a maximum budget of $25 million to ameliorate one or more identified issues in Syrian refugee populations.

One of the finalists explaining their vision

The students were given the case on Monday and had until Saturday morning to formulate their proposals. Some of the teams were pre-made and others were randomly created with students who had applied to participate in the competitions individually. All in all, we had fourteen teams with representatives from at least three different disciplines. Within a week, they researched the situation, identified the issues they were going to tackle, and designed an innovative intervention. From my participation in the 2012 Emory Global Health Case Competition in Atlanta, I know the incredibly hard work required to produce a presentable solution. My team members and I easily spent more than 30 hours individually to develop an appropriate health intervention for Sri Lanka. I saw teams put in equally hectic hours for our internal competition this year.

The product of their labours was commensurately incredible. I really enjoyed the detailed and diverse proposals on display. The proposed interventions ranged from cash transfers and social entrepreneurship grants in Lebanon to enhancing the educational facilities in Jordan. The winning team, Healthy Hoo’s, had students from the Frank Batten School of Leadership and Public Policy, the Curry School of Education, and the College and Graduate school of arts and sciences. They were notable for the wonderful way in which they interwove their innovative proposals with the narratives of individual Syrian refugees, reminding us of the mass of humanity at the root of this situation. The runners up, Power Rangers, were a team of RAs, who were impressive in the focus and detail of their proposed GIS surveillance system.

Our wonderful judges

Obviously, I didn’t engage with the case with anything close to the intensity that the teams displayed. However, I think I learned an important lesson from our incredible case writing team and dedicated contestants. A common and powerful theme in all the presentations was the importance of providing normalcy to the refugees. Medical education instils a strong predilection for pragmatism into students like me. This leads us to focus on things like diarrhea, obstetric complications, and vaccinations. The importance and cost-efficacy of interventions like these are above questions, but are they enough?

Before medical school, I fancied myself to be a biologist and often had to consider whether an element in a given molecular process was necessary, sufficient, or both. In this case, I believe that our pragmatic medical priorities are necessary, but not sufficient. Refugees are not just broken bodies to be fixed and mouths to be fed. They include children who dream of becoming astronauts, teachers with a passion to inspire generations, and carpenters who take pride in things they construct with their hands. Often-times we forget this and, years after their formation, refugee camps continue functioning in an emergency-mode, putting bandages on wounds but not charting a path back to normal life.

At the 2014 UVa Global Health Case Competition I realized that working with (and I mean WITH) the refugees to construct channels back to a productive and vibrant life, in which they can heal from the scars of conflict, is as legitimate a priority as giving them clean water and food.