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Humanitarian aid 101

Medicine-pediatrics resident Sonya Haw, M.D., served as her team’s medical specialist. (Photo: Scott Streble)

Students and clinicians get hands-on experience in international disaster relief

We’re in the midst of a deepening humanitarian crisis; chaos and confusion reign. The small disaster assessment team with which I’m traveling from one refugee camp to another has a seemingly straightforward mission — to gather information — but distractions and complications abound.

Bureaucratic roadblocks, political rivalries, run-ins with well-meaning but misguided missionaries, roving armed militias, aggressive journalists, even a rabid stray dog consume valuable time and attention. In turbulent Gopherstan, straining from a massive influx of refugees from Badgeria, it’s hard to stay focused on the task at hand.

Of course, Gopherstan isn’t a real place. It’s an imaginary country, a fictional composite of several global trouble spots, conceived by the American Refugee Committee’s Eric James and the University of Minnesota Medical School’s Sarah Kesler, M.D., for this year’s Global Health Course and James’s Humphrey Institute humanitarianism class. We’re actually at a Boy Scout camp in Cannon Falls, Minn., but the stress feels as palpable as the hot August sun overhead.

The Global Health Course, taught in collaboration with the Centers for Disease Control and Prevention, aims to decrease disparities in medicine, in part, by improving health care for immigrants, refugees, and travelers.

Painted sticks represent groups of people in this mock village. Each color signifies a person of a certain sex and age group. (Photo: Scott Streble)

The course is open to practicing health professionals in addition to resident physicians in training. Gopherstan is meant to give course participants a taste of working under pressure in “resource-limited settings.”

Made up of rookie specialists in health, water and sanitation, shelter, security, and more, the fictional NGO team is charged with rapidly assessing humanitarian needs in a series of Gopherstan refugee camps. Among its many challenges is to avoid duplicating efforts with the growing hodgepodge of other aid organizations responding to the crisis — and conditions change quickly, unpredictably. As in real life, efficiency, a high tolerance for ambiguity, and the ability to hit the ground running are invaluable assets.

“The idea was to make this as realistic as possible,” James says.

Gopherstan takes on ‘a life of its own’

At one makeshift camp, in the village of Enjab, villagers sound overwhelmed. A local merchant named Chuck tells medical representative Sonya Haw, M.D., that “people have been sick; some [refugees] are dying,” though he can’t offer numbers or specifics. “We have a river nearby — people are getting their water from there,” Chuck says. “And I’ve seen some shallow graves outside of town.” Shifting gears, the merchant then tries to sell the team beans, rice, and plastic sheeting for shelter.

Student Abdi Ahmed, the simulation’s water and sanitation expert who’s charged with assessing the most socially appropriate way to set up latrines for the refugees, says that understanding cultural norms is one of the team’s biggest and toughest responsibilities. In each location, he adds, it’s imperative to identify village and refugee leaders who can represent different communities affected by the crisis.

Days later, Kesler, an internist, reflects that she was pleasantly surprised at how “this [fictional] world really kind of took on a life of its own.” Volunteer role-players brought creativity and their own ideas to the simulation: In one village the team encountered a physician who was having a psychotic breakdown — a reaction, participants deduced, to anti-malarial medication.

Global Health Course director William Stauffer, M.D., M.S.P.H., whose school-age sons were gun-toting child militia members and whose family dog played the role of rabid stray, was struck by how “adaptable” most of the students proved to be. “Many had never worked in any situation like this, and they did well,” Stauffer says. “It was stressful, and people had a corresponding intense experience. … I was impressed by how well most rose to the occasion.”

Global Health Course director William Stauffer, M.D., M.S.P.H., briefs teams on the situation in Gopherstan at the beginning of the exercise. (Photo: Scott Streble)

Looking to the future

Participants learned the importance of talking to “regular folks” in affected villages and camps, Kesler says. During the exercises, “the teams that engaged the common people ended up getting better information” than those who dealt exclusively with the leaders. This mirrors Kesler’s experiences working with organizations like Doctors Without Borders: Those who reach out to the people on the ground meet with greater success.

Global Health Course student Masha Bowen, a pediatric nurse practitioner who’s volunteered in Honduras and Haiti, agrees. She says the exercise underscored for her the value of building relationships in the community in which she’s working. “Really being in the community — connecting with people and staying for a long time — is important” to move beyond “the Band-Aid” syndrome, Bowen says.

Organizers say that despite a few rough spots, their first disaster response simulation together likely won’t be the last. “I don’t know if this event was the next best thing [to real-life experience], but we’d like to turn it into that,” Kesler says.

Stauffer agrees. “Creating chaos takes a lot of planning,” he says. “I think [next time] it will be bigger, longer, and more involved now that we have an idea of what we can pull off.”

Bowen already plans to return next year as a volunteer. “It was wonderful. The whole exercise felt so real … after it was over I actually felt a little posttraumatic stress.”

By Susan Maas, a freelance writer and editor who lives in Minneapolis

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