The most pressing health threat in the Latin American country of Honduras has nothing to do with germs or superbugs.
It’s from the barrel of a gun.
Every day, patients with gunshot wounds seek treatment, overwhelming the country’s few hospitals. Violence is the third-leading cause of death in the country of 8.2 million people. For four years running now, The U.N. Office on Drugs and Crime has ranked San Pedro Sula, the second-largest city in Honduras, as the world’s most violent city.
So how do you stop it?
That’s the challenge that faced 140 students who came to Emory University’s Global Health Case Competition this weekend.
The topic was quite a surprise to participants. Given the global attention last year to Ebola, medical student Benjamin Ebeling figured their task might be related to the outbreak in West Africa.
But the soon-to-be doctor from the University of Copenhagen in Denmark was wrong.
Those participating in Emory’s annual case competition got the 20-plus page scenario six days ago. And it’s a challenging one, full of nuance and subtle clues. For example, one line tells students many Honduran refugees return back to the country with little in the way of reintegration. The broader implication, however, is left untold.
Taking such clues and turning them into a winning presentation will be difficult, Ebeling admits.
Unlike some other health concerns, this one can’t be solved by a breakthrough medication or vaccine.
Now that the students are here in Atlanta, it’s crunch time. They’re divided into 24 teams, and in less than 24 hours, each team must present its solution to a panel of judges.
As the two men and four women on Ebeling’s team sit around a classroom table, laptops open, frustration builds.
“We need to agree on what we’re doing, because right now it seems like we have a lot of different things going on,” says Rasmus Knudsen, irritation obvious in his voice.
The case tells them that Honduran men between 15-24 are the most at risk of carrying out a violent crime or being a victim. So team members agree education must be a central component. Beyond that, the group seems fractured.
One idea on the table: urban planning. Ebeling suggests more public parks might curtail the gunfire. “The more you get women and kids out on the streets, the safer [the streets] become,” he says. To encourage those groups, Ebeling proposes bolstering infrastructure, including street lights and safe-zone call boxes. Press a button, and the box immediately relays to police that someone is in danger.
A teammate challenges the idea. Sure, it sounds good on paper, he says. “But if we don’t have strong evidence on lighting — if we cannot measure it — we cannot sell that.”
Others throw around a few ideas. What about job creation? Or micro-financing, which could spur entrepreneurship by putting startup funds in the pockets of those who couldn’t qualify for a loan?
“They’re so standard,” Knudsen laments. “Do you think we’ll win by coming up with something like ‘creating jobs’?”
Maybe. Maybe not. But hashing it out like this is exactly what organizers want, says Robert Breiman, director of the Emory Global Health Institute.
Gun violence in Honduras is not a topic with easy solutions, says Breiman. That’s why the competition requires each team to include members from at least three academic disciplines. Some teams here are heavy on public health and medical students; others, however, are made up of theology students and MBA-candidates. “A health person might not think of the legal issues or the religious issues or business angle,” Breiman notes. He says when students view the problem through different lenses, the best solutions rise to the top.
And it turns out the “best solution” need not be complex.
“How simple are the solutions to implement? Are these solutions sustainable? Are they scalable?” asks Asha Varghese, a case competition judge and director of global health for the GE Foundation, which sponsors the Emory event.
Ultimately, top honors — and the $6,000 grand prize — went to the University of California, Berkeley, for its three-pronged approach called “Breaking the Cycle of Violence.”
Step one: The team proposes to build “human capital.” Officials will rebrand the country as a tourist destination — play down its violent reputation and draw attention to ancient ruins and postcard-esque waters. The jobs that follow will fuel GDP growth.
Step two: Create a culture of peace. The team suggests moving foreign aid away from the broken criminal justice system and allocating it to job programs. Then tone down the machismo that fosters gang mentality. By teaching gender equality through sex education, the team believes men won’t have to prove their manhood by violence.
The final peg involves “improving public safety.”
Almost every team had a safety proposal, right down to a gun-buyback program.
But unlike other teams, the University of California students brought in allies to help promote safety. Nuns and priests. The idea? Build on the religiosity of the country by having them mediate truces between rival gangs.