What does a role-playing game have to do with improving the health of mothers and their children?
Researchers at USF鈥檚 (COPH) are aligning them in a classroom setting, where a new game based on real-life experiences promotes student learning and decision making.
Called 鈥淪ystems Under Strain,鈥欌 the game is the result of a $3,000 Innovative Teaching Award from the Association of Teachers of Maternal and Child Health. The association accepted a proposal from a multi-disciplinary team led by , assistant professor in the. He wanted to give students in his Global Maternal and Child Health course a better feel for what they might encounter in their future careers.

Dr. Richard Powis (Photo courtesy of Powis)
鈥淎s a nerd for tabletop role-playing games like Dungeons & Dragons, I thought it would be fun to design a role-playing game for classroom use,鈥欌 said Powis, who also is a medical anthropologist. 鈥淚 wanted to orient students toward many of the problems and challenges that I鈥檝e seen play out in my career and in peer-reviewed literature.鈥欌
The team who developed the game include: Dr. Amber Mehmood, associate professor, ; Taylor Pineda, a DrPH student in COPH; COPH faculty alumni Dr. Cheryl Vamos, professor and director of the USF Center of Excellence in MCH Education, Science and Practice; and Dr. Rone茅 Wilson, associate professor, Department of Epidemiology.

The rules of the "Systems Under Strain" game (courtesy of Dr, Powis).
Assisting the USF team was Dr. Adrienne Strong, associate professor of anthropology, University of 91社区; and Dr. Nicholas Mizer, assistant professor of games and experiential media, Rensselaer Polytechnic Institute, Troy, N.Y.
Their experience in the field, some of it in African countries such as Senegal, offered plenty of data on women and children struggling to stay healthy against monetary, cultural and physical odds.
鈥淓very single thing in the game is intentionally based on something our team experienced in our careers or read in peer-reviewed literature,鈥欌 Powis said. 鈥淭he scenario and the dynamics of negotiations represent actual events, people and relationships that we want students to learn about and experience before they head out into their own global careers.鈥欌
鈥淪ystems Under Strain鈥欌 divides up to 16 students into four groups, or factions, that play roles in Eluvia, a fictional low-middle income country. The factions include the Eluvian Ministry of Health, which represents government interests; a local non-government entity representing community interests; a foreign group representing donors; and a Silicon Valley tech startup representing shareholders.
Each faction assumes specific goals and must deal with limited resources. In one scenario, a civil conflict and violence break out, and poor water quality and cholera create health threats. On top of this, blocked roads and interrupted power supplies impede deliveries of vaccines and antibiotics.
From there, the factions must design their own 鈥渋nitiative鈥 to address one of these problems and prevent disaster. But lacking resources, they are forced to negotiate, broker, bargain and make decisions about how to reach their goal.
A realistic conclusion in the game is compromise: Rather than identifying an ideal solution to a problem, teams had to decide what was practical within given limitations, time constraints and competing priorities, said Alekhya Doggala, who plans to graduate with a PhD in public health this summer.

Alekhya Doggala (Photo courtesy of Doggala)
鈥淥ne of the most valuable lessons for me was realizing how difficult collaboration becomes during a public health emergency,鈥欌 she said. 鈥淎lthough our responsibility was to protect population health, we couldn鈥檛 achieve that independently. We had to negotiate with foreign non-government organizations, local ones and the private sector, each bringing different priorities and constraints.鈥欌
鈥淧ublic health is not only about understanding evidence but learning how to make thoughtful decisions in a crisis,鈥 Doggala added. 鈥 鈥楽ystems Under Strain鈥 provides a safe space to develop those skills, helping future public health professionals become better prepared for the realities of crisis response.鈥欌
鈥淭he game requires critical thinking, teamwork and timing, and playing in a group is tense and at times marked by moments of anxiety,鈥 said Anastasia Iwuagwu, a PhD student in sociology. 鈥淏ut unlike most games, it isn鈥檛 about winning or losing.鈥
鈥淎lthough we won the first round of the game,鈥欌 she said of a recent match, 鈥渢here were no losers because every faction works toward achieving the same goal.鈥欌
