Author: Ina Andersson
CW: Mentions of traumatic pregnancy and migration experiences
The Global Health Case Challenge is an annual competition taking place in Copenhagen. Each year, students from different universities and countries come together to tackle the most pressing global health issues of our time. Teams have 24 hours to come up with a proposed solution to the challenge, which they pitch to a panel of experts. The winners receive help taking their solution from idea to reality. In 2017, the challenge required students to think of ways to increase access to sexual and reproductive health for migrating women. This week in Eye on Global Health, a member of the 2017 winning team shares their solution.
Meet Maya. She is 23 years old and her route fleeing the war in Syria takes her through Turkey and Greece. Maya is five months pregnant, she has pre-eclampsia and a high-risk pregnancy. She arrives in Turkey and attends a Doctors Without Borders antenatal clinic. Maya’s medical records were destroyed in Syria, but at her check-up she receives a paper copy of her results and status of her pregnancy. Maya’s husband pays a smuggler to take them both from Turkey to Greece, crossing the Mediterranean by boat. During the journey Maya’s check-up paper is destroyed. On arrival in Greece, Maya is feeling ill and needs additional antenatal care. She attends a mobile Red Cross clinic in Greece, but due to the lost records she finds it difficult to receive appropriate care.
Maya’s story formed the basis for our solution at the Case Challenge. She is a fictional character, but the problems she faces are experienced by many migrating women. Their circumstances restrict their access to quality sexual and reproductive healthcare. This is because their health records are often missing or incomplete, their existing health records are stored centrally by the health care provider that created them, and information on their own health is often inaccessible to them.
Without access to this information, women are also robbed of their agency and autonomy. They face having to re-tell details about their sexual health over and over again, which can be an uncomfortable experience. What if, we thought, Maya and other migrant women had ownership of their own health data, and the agency to share this with the medical professional they choose, when they choose?
There was an interest in the group in making use of new technology in our solution. We had heard of blockchain technology and were excited by the ways it could be used to benefit a population in a vulnerable situation. The blockchain can be described as an un-hackable, decentralised database, like a large spreadsheet that updates on many computers simultaneously. Crucially, data is not stored centrally by one stakeholder, but decentralised and owned by the individual. Data is encrypted and can only be added to by an authorised person. For migrant women, storing health records using blockchain technology means that they can use a personal code or fingerprint to access their health record at any clinic or elsewhere, on any computer or smart device that has the software. We saw this as increasing not only access, but importantly also autonomy over one’s own health in a population often depicted as powerless victims of global forces.
We pitched our solution to the expert panel and they picked us as winners. For them, it was important to emphasise the agency of women and create a solution that did not risk victimising them further. They also liked that the solution could be used by women throughout their lives, also in their destination country.
Since winning the Case Challenge, we have explored making our idea reality. Meetings with a wide range of stakeholders has cemented our view that an initiative like our solution is both needed and wanted. Still, there are many questions left to answer. The technology is in its infancy and challenges of infrastructure, design and upscaling remain. Yet, migration is on the rise and the lived realities of thousands of women on the move make clear the need for better access to health care. We still hope that this is what the future holds.
This year’s Global Health Case Challenge, addressing “Synergies in Urban Development”, is taking place on 23rd and 24th November. Find out more here.