Twenty-four teams from four nations, one 20-page prompt, six individuals from three USC graduate schools, and only one whirlwind week to prepare. Sounds like a nightmare, but fortunately thanks to true teamwork and collaboration, this nightmare turned into a dream.
When I chose to attend the USC Masters in Public Health Program in January 2016, I entered only wanting to receive my degree and didn’t plan on pursuing outside activities. Because I currently work full-time and can only attend school part-time, I didn’t think I’d really make friends or join activities. Fortunately, however, one of my first classes was with Dr. Heather Wipfli, whose empowering and engaging teaching style and ability to juggle all professional, academic, and personal endeavors made me realize that I chose the right school. She highly encouraged our class to participate in the USC Global Health Case Competition, and so I joined with two of my classmates, Hrant Gevorgian and Cristina Gago, who eventually became my best friends. We had an amazing time at last year’s competition and even surprised ourselves by making the finals! We dreamed all next year about returning to hopefully win and represent USC the next year at Emory.
After successfully winning the USC Case Competition this past February and earning the privilege to compete at Emory University’s International Competition, we were all incredibly excited and nervous to compete. All of our group members are either working full-time, part-time, or heavily engaged in various academic organizations. This meant that we didn’t have an entire week to put our phones on silent and devote to creating a team design. In fact, we didn’t all meet as a team until the shuttle for our flight.
On paper, the odds were heavily stacked against us.
We received the case on Saturday morning at 9:00 a.m. I was honestly hoping it wasn’t a topic I was interested in so that I could detach myself instead of becoming fully engrossed in the topic. Unfortunately, it was a topic I was very interested in (mental health) and a location close to my heart (Liberia). Although I have never been to Liberia, I spent six months working in nearby Ghana in West Africa. The topic involved addressing the mental health needs of adolescents in Liberia after the nation and its health systems fell into disarray due to the recent civil wars and Ebola epidemic. Mental health in Liberia is further complicated by sociocultural norms including the pervasiveness of traditional medicine and local healers.
As a team, we went through many different solution approaches. Originally, we tried to tackle everything in accordance with Liberia’s Ministry of Health and social welfare strategic policy—from reducing stigma to increasing primary care capacity to aiding psychotropic drug supply. After consultations with Drs. Heather Wipfli and Shubha Kumar, we realized that while our approach addressed almost every need, it failed to do so in a concise and impactful manner while remaining interconnected to a theme.
When we arrived to Atlanta on Thursday night, we worked in the same hotel room late into the night perfecting our slides and trying to establish an overarching theme or connectedness to our ideas. Operating on little sleep, we worked hard on Friday in our matching USC Shirts embroidered with our nicknames (thanks, Brantynn).
We started growing attached to our idea, until we had a rather revealing feedback session from our case adviser, one of Emory Univerity’s global health faculty, whom was allotted one hour to hear our initial program on Friday afternoon. His feedback was promising, but what we still needed to achieve to be a competitive team was daunting. At this point, I had lost hope and felt comfortable being complacent. I’m thankful that our team continued to keep fighting and pushed us to reach our potential. For the remaining hours into the night, we edited our slides/scripts with most of it being cut. It was hard to watch that hard work go to the appendix slides, however I realized that we needed to be concise if we were to be memorable and impactful. It was during this time especially that I was grateful for our teammates from outside disciplines (Zaki in engineering and Brantynn and Julian in public policy) as they encouraged us to see that we were trying to insert every and any public health approach which became quite tedious and a bit overdone.
Friday night was a true crossroads for us and we were anxious to see what Saturday’s competition would bring.
Our solution involved tackling depression and anxiety among children ages 7-11 through a community-level approach building education, capacity, and action. We chose the target age of 7-11 based on Piaget’s Stages of Development, in which this age group is labeled “concrete operational,” meaning we could help teach healthy emotional processing and communicating emotions with peers and adults. We thought this would be the best approach and audience for a health promotion and prevention technique. We wanted to try reach adolescents in their early age so that we could help prevent future mental illness and promote positive coping skills and resilience. We specifically chose depression and anxiety because of its early manifestation in youth, as well as its high incidence rate in Liberia.
Our education component focused on a transmedia storytelling approach, which I had learned from a fantastic presentation from USC’s Doe Mayer at the Los Angeles Global Health Conference. This approach involved embedding culturally relevant characters and their health message into multiple media sources to better penetrate our target audience to feel connected to the character and remember our message. Media examples included that which were most local to Liberia including radio shows, school curriculum, community fair mascots or newspaper columns. The most unique part of the education component was the proposed game developed by Zaki, which involved simple, direct messaging to teach healthy peer-to-peer communication and the positive introduction of community health workers to users through a virtual game. Zaki explained this newer health approach of “gamificaton” and how virtual users could receive hearts by providing emotional support or calling for first aid for their peers in psychosocial distress.
Our second component, capacity, included our community-level approach of recruiting both an adult taskforce called Community Health Advocates from the government’s existing CHW program and also training local adult stakeholders (parents, teachers, law enforcement, etc.) and a youth taskforce (peer support and older mentors).
And finally, our third component involved action. We proposed to utilize the CHWs to train both the adult CHA taskforce and supervise the youth taskforce in the FOCUS Resilience Curriculum. This curriculum was introduced to us by USC’s Dr. Kathleen West as an evidence-based approach of engaging families and adolescents into effective communication strategies and handling distress as a family. Our CHA Taskforce would conduct community dialogues, a program successful in Liberia during the Ebola epidemic, to help communities learn about mental health strategies through FOCUS and also supervise the youth mentors in creating peer support groups.
Our first round of presentations on Saturday was a little disappointing. We had some A/V difficulties and nerves as we faced our first two judges with backgrounds in psychiatry. They knew exactly the theories we were discussing and wanted to make sure we understand their evidence base and cultural relevance to this prompt. The atmosphere was very serious as we presented to around 30 individuals and two judges (the only familiar face was Brantynn’s dad, who lives in Atlanta). In our stream of six teams, only one would advance to the finals and none of us really knew whether that would happen for us. We then ate lunch and tried to talk about anything but the case, before heading back to the auditorium later that afternoon to hear the announced finalists. They announced the four finalist teams and when we weren’t announced during the first three names, all of us started to slowly look at our backpacks to begin packing. And then, Team 7 was announced as the last finalist and invited to come to the front row. We all were in complete shock and knew we couldn’t even revel much in the moment, because at that exact moment they announced that there would be a new twist to the prompt we had to incorporate in the next 45 minutes.
The new twist was that an American philanthropist was interested in our program, but had a keen interest in developmental disorders and needed this to be incorporated. We frantically grabbed our bags and headed to the nearby nursing school to utilize a conference room.
It was during these 45 minutes that our teamwork was unparalleled.
Everyone set aside their egos and each individual took a different task. Team agreement was needed in a matter of seconds or minutes as opposed to our usual approach of belaboring points until cohesion. This prompt actually only enhanced our presentation as one of our members, Cristina Gago, has been working on a project to adapt Children’s Hospital Los Angeles’s Kids N Fitness program for autistic children in south Los Angeles. Thankfully, autism fit well with our overall purpose and evidence-based approaches. As finalists, you are not allowed to view any other finalist presentations until after you present. We were the third team to present, so we only saw one other competitor whose presentation was incredibly strong and polished.
We presented to nearly 200 people in an auditorium with microphones and camera flashes going off. In this moment stars aligned because despite our approximately 20 run-throughs throughout the week, this was by far our best performance for every individual. We then answered questions from our esteemed judges for 10 minutes and everyone in the auditorium could see how this was an interdisciplinary and collaborative team. On our team, every person spoke and was knowledgeable answering questions on their subject matter. Not one person dominated the questions or the presentation.
It was a true team effort.
As we headed to the reception, we just wanted to know what was going to happen instead of these long waiting games. Throughout the competition, Brantynn, Hrant and Julian were steadfastly passionate and optimistic that we could succeed. Cristina and I were always skeptics and very critical of our presentation. It was a perfect combination, as our male team members kept us hopeful and focused on what we needed to do. As we waited in line for food, we were approached by another team’s faculty advisor. They admitted that when they saw our first presentation (their team was in our stream), they didn’t think we deserved to advance to the finals instead of their team. He then stated, however, that when he saw us in the finals, he agreed we were completely deserving to be finalists and strong competitors for an award. This made us incredibly happy as we knew we had exponentially improved from our first presentation, but also made us happy to hear it from another person, particularly another university’s faculty.
As we tried to enjoy our dinner, we slowly began to talk with our teams and congratulate our other finalists. We soon were all brought inside where a big printed check for $6,000 waited on a canvas. They announced the teams starting from fourth place to first and provided feedback or explanation after each team was announced. Because we had only seen the last team present—Team 20 from University of Toronto, which was incredibly strong—we didn’t know how we stacked up to other teams. The final nerve-wracking moments as the judges admitted that the differences between second and first place were incredibly difficult only made us even more nervous. However, when they announced that second place went to Team 20, we immediately were overwhelmed with emotion.
I must admit that both Cristina and I, the female skeptics, always hard on ourselves, started to tear up to see all of our hard work did not go unnoticed. It was a true fairytale. As they announced that Team 7 from University of Southern California was the first-place winner, we were invited to the podium with cheers and handed our big check to pose for pictures. After filling out our forms to receive our winning payment, we also Facetimed with Dr. Wipfli, which was hilarious and exciting as we all couldn’t stop screaming and dancing with excitement. The entire moment was incredibly surreal and it still hasn’t sunk in today.
I am grateful for such an incredible team—Julian and Brantynn from the Price School of Public Policy, Zaki from the Viterbi School of Engineering and my peers Hrant and Cristina from the Keck School of Medicine of USC. Every individual truly strived to try their very best and demonstrated tremendous leadership. We are also fortunate that Zaki was recommended to join as our team as he brought unique insight, a talent for innovation, and great leadership to our already wonderful team. And finally, I am incredibly grateful for the professors along the way who have shaped all of us as students and future public health professionals.
This program has given me more knowledge and passion for global health than I ever thought possible.
We were particularly helped by the feedback of our advising faculty Drs. Kumar, Wipfli, Kathleen West, Doe Mayer and communications manager Larissa Puro throughout forming our presentation. I’m honored and happy we could solidify the foundation that these mentors and peers have worked to establish the powerhouse of USC Global Health Institute. Thank you for believing in us and empowering us. Fight on!
Ashley Millhouse is a student in the USC Master of Public Health program at the University of Southern California.
Photos courtesy Ashley Millhouse and Rufus Washington.