Batoul Abuharb is a lot of things. She is intelligent and determined. She is a fourth-year student in the University of Houston College of Optometry. She will be graduating this spring in the class of 2016. She’s a person of great courage and determination who is making a difference at the global level. She was honored by President Obama at a special dinner at the White House. She is also a Palestinian refugee.
Born in a refugee camp in Gaza, she moved to Houston with her family when she was an infant. This gave her a chance to strive for the American dream, and she didn’t take that opportunity for granted. Upon graduating from Rice University with her undergraduate degree in 2012, she received a travel grant to return to Gaza to study immunization rates as a marker for quality of life. While there, her research took a new direction. Staff members at the United Nations Relief and Works Agency (UNRWA) clinics brought a vaccine shortage epidemic to her attention.
“I hadn’t been home in 10 years, and I saw they had an incredibly high rate of immunization. Almost 98 percent of the population was fully immunized for all the WHO-recommended vaccines,” Abuharb said. “We can’t even dream of having that number here in the U.S. We’re closer to 60-70 percent, maybe lower, so I wanted to see what the reason was for that and why people with such a high compliance rate weren’t immunized.”
She discovered that while people in Gaza wanted to be immunized, there was either something beyond the power of the clinics preventing them from getting the vaccinations in time, such as a vaccine shortage, or people were lost to follow up due to any number of reasons, ranging from death and disability to having incorrect contact information on file.
“If you live in a refugee camp, have more than five children and work, or if it takes a really long time to get to the clinic, your kids are at a disadvantage. We needed to find a way to make sure every child whose parents want them to be immunized is immunized,” she said. “The solution came with a simple text message to bring people back to the clinic to get immunized. Everybody in the developing world has access to a cell phone, no matter what their situation is. We live in a digital world, and people want to be part of it. I saw people turn on their power generators in the middle of the night to check their Facebook. Instead of using their limited fuel reserves for something like cooking, they want to be part of the world and participate and engage. We did a lot of basic research to see if people have cell phones, and it turns out they do. So, our idea to collect patient information and find a way to reach them was really solved with just one text message.”
Upon returning to the U.S., Abuharb collaborated with friend and fellow Rice graduate Jordan Schermerhorn to create a global health start-up in the Middle East for refugees and founded Dunia Health. To help further their efforts, the women recruited Cheire Fathy, a Vanderbilt University medical student who worked with UNRWA on health reform. In October 2012, Dunia Health was incorporated as a nonprofit in Texas with seed-funding from their friends and family.
“We wanted a name that is easy and with meaning that could be pronounced in Arabic and English, as well as in other languages,” Abuharb said. “We finally decided on the word ‘dunia,’ which means ‘world’ in about a dozen different languages.”
Abuharb and her collaborators then pitched their idea to the UNRWA, which was incredibly receptive to it. They piloted the project in a refugee camp, with almost 89 percent of the text messages sent out being received. The 11 percent who didn’t receive a text message had incorrect or outdated numbers in their medical records. Three years later, UNRWA independently expanded Dunia Health’s services to every refugee camp in Jordan, now reaching 1.2 million refugees. Abuharb and her colleagues have now been asked to expand Dunia Health’s services to the West Bank to serve several more refugee camps. By the end of 2016, the goal is to serve 3 million refugees.
When asked why she thinks this simple text message method works, Abuharb says these refugees just have a better understanding of the diseases that vaccines prevent, because they’ve seen them in their lifetimes. They’ve known people who have been exposed to those diseases, and they don’t want that for their children. Especially now, with the mass influx of refugees in the Middle East, from the Syrian crisis, Iraq and other countries, the threat of vaccine-preventable diseases is real. There was a polio outbreak among Syrian refugees, for instance, so people understand the reality. When someone reminds them to bring in their son or daughter to be vaccinated, they have firsthand knowledge of the importance of doing so.
“Palestinians have been refugees for 60-plus years. I was born in a refugee camp; my parents were born in refugee camps; my mom lost a brother to measles and my grandparents became refugees in 1948, so this is really personal to me,” she said. “I know people who have had measles and polio. I’ve seen people in wheelchairs, not because they’re elderly, but because they’ve survived polio. All of this is very real.”
“To feel like I can take my privilege here in the U.S. and the education I have to do something really simple that doesn’t take very much time out of my day but that has a very meaningful impact, means a lot to me to give back in that way.”
Most of Abuharb’s team members are also Arab-American, and they similarly find it rewarding to give back to the communities from which their families came. Finding a way to connect with their culture, even when they’re not living there, is very fulfilling for them in more than one way. Additionally, everyone on the team speaks and reads some degree of Arabic, which allows them to relate to those in the area and implement the Dunia Health program.
“We try to make a trip at least once or twice a year to the region. In 2014, I went to Gaza over the summer and got stuck in the conflict that erupted while we were there. But we had research that needed to be done and data we needed to collect,” she said matter-of-factly. “I had traveled with my family this time, with my mom and two younger siblings, and we got evacuated to Jordan. The very next day, I went back to the UNRWA clinics, because that’s what we were there for, and we have a responsibility to our patients to finish our job.”
UNRWA has asked Dunia Health to think about ways to incorporate their services into the field of non-communicable disease, such as diabetes, hypertension and high cholesterol, to find ways for refugees to better manage those chronic long-term diseases, so they don’t have complications that lead to hospitalization, losing a limb or vision, and then becoming an even greater burden on the organization when they can’t work and support themselves. Abuharb and her team are also trying to create training modules for nurses in the clinics, so they can run the text message system on their own. The hope is to get people to train in software skills and the like, making them employable in the future.
“We don’t pay ourselves a salary. It’s all volunteer-based work, and we do this full time in addition to being full-time graduate students,” she said. “Everyone is in some kind of health care field. I’m in optometry school, two other team members are full-time medical students and our last team member just finished her master’s degree at Duke’s Global Health Institute. We also have interns throughout the year who are medical students.”
The UH College of Optometry, Vanderbilt, Duke and Baylor College of Medicine all have provided financial support. Dunia Health’s biggest support has come from the Arab American Medical Association.
“The Houston chapter of the National Arab American Medical Association has not only given us financial support, but also mentorship and guidance. These are doctors who have been working for decades, so the insight they provide is extremely useful,” Abuharb said. “The Arab-American community in Houston is incredibly strong and tight-knit, which has allowed our organization to reach out for support and advice. The Arab Voices radio also helps by running advertisements for our fundraisers on air and their website.”
Dunia Health has made such an impact that the group’s work was recognized by President Bill Clinton at the Clinton Global Initiative and also at the White House Global Entrepreneurs Meeting, where they could talk with other people doing similar initiatives on a global scale. Most recently, Abuharb was invited to the White House’s annual Iftar dinner, hosted by President Barack Obama and First Lady Michelle Obama, to celebrate the Muslim month of Ramadan and to celebrate young leaders and women helping communities across the nation.
“I got to sit next to the President and have dinner with him and tell him all about what we are doing, so that was really awesome,” Abuharb said. “In his address that night, he mentioned our work and talked about Dunia Health and said Dunia Health’s name, and we gave him a copy of our annual report, so it was super cool.”