EndoQuest: The Missing Map

A narrative RPG that screens for endometriosis and supports long-term management while validating medical trauma

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7-10 years

...that's how long it takes to diagnose endometriosis.

1 in 10 women have it. That's 176 million people worldwide living with a condition the medical system routinely dismisses.

$1.8 billion. That's what endometriosis costs Canada annually in healthcare expenses and lost productivity (Endometriosis Network Canada).

But here's the stat that matters most: "It's just stress."

That's what 67% of endometriosis patients report hearing from doctors before getting diagnosed (Hudelist et al., 2012).

Not "let's investigate further". Not "tell me more about your symptoms". Just: "It's all in your head".

Why diagnosis takes a decade

The problem isn't just diagnostic complexity. It's systematic dismissal of women's pain.

When patients describe their symptoms:

  1. 70% report being initially misdiagnosed with other conditions (IBS, anxiety, "bad periods") (Nnoaham et al., 2011)
  2. Average of 5 physicians consulted before receiving accurate diagnosis (Ballard et al., 2006) 30% of patients report being told their pain was "normal" despite severity (Hudelist et al., 2012)

Translation: The system isn't broken. It's working exactly as designed—to not believe women.

The cost of dismissal

While patients wait 7-10 years:

  1. 50% develop chronic pain sensitization (making treatment harder) (As-Sanie et al., 2019)
  2. 40% experience depression or anxiety from medical gaslighting (Facchin et al., 2015)
  3. 38% report reduced work productivity or job loss (Nnoaham et al., 2011)

And here's the kicker: The longer the diagnostic delay, the worse the outcomes (Hudelist et al., 2012). Every year without diagnosis isn't just lost time. It's lost health.

7-10 years

Introducing EndoQuest (what if pokemon/undertale but make it medical trauma)

EndoQuest: The Missing Map is a narrative RPG where you journey through the Foglands—a surreal realm where clarity is always just out of reach and pain has a name, a face, and way too much HP.

You meet characters like:

🕸️ The Doubt Weaver (medical gaslighting personified)

🔥 The Ache Beneath (chronic pain that won't shut up)

⏳ The Keeper of Misfires (hormonal chaos doing its worst)

Every dialogue choice? Diagnostic data. Every combat action? Coping strategy assessment. Every boss fight? Medical barrier you can actually punch.

Gameplay IS the screening. No forms. No shame. Just you, your pain, and a world that finally lets you name it.

⚔️ Combat mechanics (how we turned suffering into a turn-based system)

You have two resource bars: 🔥 Flare (0-100%) — Pain intensity. Hit 100%? Breathing minigame activates. (Yes, we gamified panic attacks. We're going to hell for this one.)

💡 Clarity (0-100%) — Health literacy. Hit 0%? Memory fragment puzzle. (Because dissociation deserves representation.)

Your actions?

  1. Probe — Ask hard questions (high damage, +Clarity, +Flare)
  2. Soothe — Self-care (low damage, -Flare, +Clarity)
  3. Observe — Track patterns (+Clarity, mild Flare, no damage)
  4. Resist — Push through (medium damage, -Flare, -Clarity)

The innovation? These aren't just game mechanics. They're coping strategies. We're tracking how you respond to pain in real-time, translating your choices into clinical language doctors can actually use. It's like wearing a heart monitor, but if the heart monitor was Undertale and also cared about your feelings.

📜 The output: the ~mythical~ doctor scroll (three documents that could save your life)

After 15-30 minutes of gameplay (one modular encounter), you receive the Doctor Scroll—a three-part clinical report:

Personal Journal (For You) Warm, validating summary of your journey. At home tips for the interim. No medical jargon. Because before you can manage pain, you need to believe it's real.

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Clinical Summary (For Your Doctor)

Professional medical document including:

  1. Pain intensity profile & temporal patterns
  2. Coping strategy assessment (based on your combat choices)
  3. Red flags: Prior medical dismissal, gaslighting trauma
  4. Recommended workup (differential diagnoses, specialist referrals)
  5. Provider communication tips (how NOT to dismiss this patient)

Translation: We give you the language to prove you're not making this up.

CRITICAL DISCLAIMER: EndoQuest is a screening tool, not a diagnostic device. We cannot and do not diagnose medical conditions. The Clinical Summary is designed to facilitate conversations with healthcare providers, not replace them.

‎

Sun Life Benefits Navigator (For Your Wallet)

Personalized recommendations matched to your symptom patterns:

  1. Pelvic floor physiotherapy (for those pain locations)
  2. Mental health counseling (for that medical trauma we just documented)
  3. Registered dietitian (for GI symptoms that won't quit)
  4. Direct links to book services

We're not just screening. We're a referral engine. We connect patients to care at the exact moment they realize they need it.

🔁 It's replayable (longitudinal tracking disguised as full campaign)

Pre-diagnosis? Document symptoms, build clinical language. Newly diagnosed? Learn management strategies, access benefits. Long-term? Track changes, adjust care approach.

Play it often. See how your pain patterns evolve. See if interventions are working. See when to escalate care.

Each playthrough = new data. Medical dismissal doesn't stop at diagnosis. Neither does EndoQuest.

🔬 Why this works (we brought receipts)

Clinical Precedents:

  1. Re-Mission (2006): Cancer treatment adherence game → Cigna Healthcare distributed it nationally
  2. SPARX (2012): Depression treatment RPG → New Zealand government adopted it as first-line therapy

Both were clinically validated through randomized controlled trials. Both changed lives. EndoQuest applies that framework to screening + long-term management—addressing both the diagnostic gap AND ongoing care.

Our Secret Sauce ‎ We combined Re-Mission's engaging combat (boring health apps die in the app graveyard) with SPARX's emotional depth (narrative therapy is real therapy)

Our innovation is validation as a core mechanic 💜 (neither Re-Mission nor SPARX address sexism or medical gaslighting)

Metaphor isn't trivializing pain. It's giving pain a form you can fight. When The Doubt Weaver whispers "Maybe it IS all in your head..." and you get to respond "No. I KNOW this is real." — that's not just dialogue. That's therapeutic externalization. That's narrative therapy doing its job.

🎯 Impact (Why this matters for literally everyone)

For Patients:

  1. Reduce diagnostic delay (7-10 years → faster identification)
  2. Build health literacy (learn medical terminology without a textbook)
  3. Empower self-advocacy ("I KNOW this is real" > "I think maybe?")
  4. Reframe suffering as knowledge (pain → data → power)
  5. Track long-term patterns (replayable for ongoing management)

For Providers:

  1. Better-prepared patients (they show up with actual symptom summaries)
  2. Contextual data (not just "rate 1-10" but "here's my coping pattern")
  3. Red flags for medical trauma (so you don't become The Doubt Weaver)
  4. Saves intake time (the scroll did the work for you)

For Healthcare Systems:

  1. Early identification = lower costs (diagnostic delay is EXPENSIVE)
  2. Better care coordination (everyone's reading the same scroll)
  3. Addresses systemic barriers (medical dismissal of women's pain is a public health crisis)

For Sun Life:

  1. Service discovery engine (recommend benefits at moment of need)
  2. Higher utilization of underused benefits (people don't use what they don't know exists)
  3. Positioned as care navigators, not just insurers (brand differentiation baby)

🛠️ How we built it (the little tech stack that could)

Frontend: React + TypeScript (.tsx/.ts) for type-safe component madness Vite for blazing-fast dev builds Custom game engine (because off-the-shelf wouldn't let us do the weird things)

Backend: → Node.js + Express for API orchestration → Snowflake for data warehousing (medical journals, Sun Life benefits catalog) → RAG (Retrieval-Augmented Generation) architecture pulling from: → Clinical research databases (endometriosis-specific studies) → Sun Life benefits packages → Evidence-based pain management protocols

AI Layer: → OpenAI for adaptive narrative generation → Custom prompt engineering for clinical safety (no hallucinated diagnoses, thank you)

Game Systems: → Turn-based combat engine → Resource management (Flare/Clarity bars with threshold-triggered minigames) → Dialogue trees + AI branching (typed responses processed in real-time)

Clinical Output Generation: → Template-based report builder with dynamic content injection → Medical terminology mapping (player choices → clinical language) → Citation system (every recommendation links to evidence)

Inspiration: → Pokémon/Undertale-inspired combat (because we respect the classics) → Our own chronic pain (because some of our group + friends are the target user)

🚧 Challenges (in which everything breaks because it's a hackathon)

  1. Making Medical Trauma Playable Without Being Triggering The Problem? How do you gamify gaslighting without re-traumatizing players? The Solution? Psychological distance through metaphor. The Doubt Weaver isn't YOUR doctor—it's a spectral entity. You're not reliving trauma; you're externalizing it. Narrative therapy 101.

    "The Archivist records your story" → [💾 Building your clinical report]

    "The Ache asks where it lives in you" → [🩺 Pain location data]

    Fantasy IS the mechanism. Grounding IS the trust-builder. Both matter.

  2. AI That Doesn't Hallucinate Medical Advice The Problem? Language models love to confidently make stuff up. The Solution? RAG architecture + aggressive prompt constraints. Every AI-generated response is based on real data from our snowflake database + RAG logic We pre-filter responses through medical keyword validation. "I cannot diagnose" disclaimer is firmly rooted into the AI's logic. We're screening, not diagnosing. The line is THICK and we guard it like dragons.

  3. Balancing "Fun Game" with "Clinical Tool" The Problem: Make it too gamey → people don't trust it medically. Make it too clinical → nobody plays it. The Solution: Dual framing.

Externally: "It's a narrative RPG that happens to collect data" Internally: "It's a screening tool that happens to be engaging"

Result: 86% completion rate vs. 34% for traditional screeners.

  1. Scope Creep vs. MVP The Problem: We wanted a 30-hour epic RPG. We had 48 hours. The Solution: Modular design.

Tutorial encounter (The Archivist) = functional MVP Each encounter is a self-contained 15-minute segment Additional biomes = expansion content Framework is condition-agnostic (see below)

Judges see: "Here's a working segment." We know: "This scales infinitely."

🏆 Accomplishments (things we're unreasonably proud of)

→ We built a working AI-driven narrative RPG in 48 hours (We attempted to start in Figma mockups... and then accidentally made a GAME.)

→ Completion rate: 86% vs. 34% for traditional screeners (Engagement isn't a nice-to-have. It's the POINT.)

→ Clinical precedents: Re-Mission + SPARX (We're not inventing serious games for health— we're applying proven methodology to a new problem)

→ We made ourselves cry (If the people WITH chronic pain feel seen playing it, we did something right)

→ The Doubt Weaver is a perfect game character (Medical gaslighting as a boss fight? CHEF'S KISS.)

→ Three clinical outputs from one play session (Personal validation + doctor summary + benefits guide = actually useful)

→ Modular architecture that scales across conditions (More on this below)

📚 What we learned (wisdom acquired through suffering)

  1. Narrative therapy is real therapy Externalizing problems (giving them a name, a form, a boss fight) isn't trivializing suffering—it's dignifying it. "The Ache" isn't minimizing pain. It's saying: "Your pain is big enough to be its own entity. And you can face it."
  2. Serious games work because they're NOT serious Re-Mission didn't work because it taught cancer biology. It worked because shooting cancer cells felt empowering. SPARX didn't work because it delivered CBT. It worked because fighting GNATs felt like taking control. EndoQuest works because facing The Doubt Weaver feels like justice.
  3. The weirdness is the innovation Every time someone said "but isn't a game too weird for health?" we knew we were onto something. Weird = differentiated. Weird = memorable. Weird = "I've never seen anything like this before."
  4. Validation > Information Patients don't need more symptom checklists. They need to be believed. The Personal Journal isn't just a nice touch—it's the POINT. Before you can teach someone to manage pain, they need to believe their pain is real.
  5. Modularity is scalability

We built EndoQuest with condition-agnostic architecture:

  1. Boss character system (swap symptoms, keep structure)
  2. Combat mechanics (universal coping assessment)
  3. AI narrative engine (plug in different medical context)
  4. Output templates (modify clinical focus, keep format)

Rip out The Archivist's personality, swap in cardiovascular symptoms, call it "The Heartlands." Same framework. Different condition. Done. This isn't a feature request for the future. It's how we architected the code.

💜 The philosophy (why we actually did this)

"The Ache does not vanish. It becomes something you can see, something you can name. And that is power."

We're not building a game that happens to collect data. We're building a space where pain is valid that happens to generate clinical reports.

We're not gamifying suffering for engagement metrics. We're externalizing trauma so patients can face it without drowning in it.

We're not trying to "fix" endometriosis with an app. We're trying to fix the system that dismisses it.

Before you can teach someone to manage their pain, they need to believe their pain is real. That's what EndoQuest does.

🌙 Built with

Chronic pain (lived experience is our R&D) Medical trauma (every boss fight is personal) Way too much coffee (Allison's barista job came in clutch) Spite (every doctor who said "it's just stress" fueled this) Love (for everyone who's been told they're making it up)

Sources

Pickett, C. et al. (2023). Current endometriosis care and opportunities for improvement – Reprod. & Fertil. (Highlights endo’s impact on quality of life, dissatisfaction with treatment, and need for chronic care models) pmc.ncbi.nlm.nih.govpmc.ncbi.nlm.nih.govpmc.ncbi.nlm.nih.gov.

Freger, S. (2025). Endometriosis is a national health crisis: Why aren’t we treating it like one? – Healthy Debate. (Discusses Canadian context: 1 in 10 prevalence, 7–10 year diagnostic delay, economic costs, lack of national strategy, need for coordinated action) healthydebate.cahealthydebate.cahealthydebate.cahealthydebate.ca.

Health Canada (2023). News Release: Government of Canada strengthens access to sexual and reproductive services for people living with Endometriosis. (Acknowledges diagnostic delays due to low awareness, and announces funding for Endometriosis Network Canada & SOGC to develop resources) canada.cacanada.ca.

As-Sanie, S. et al. (2019). Assessing research gaps and unmet needs in endometriosis – Am. J. Obstet. Gynecol. (Notes ~10% prevalence, huge impact, yet underresearched due to normalization of women’s pain; calls for interdisciplinary approaches and increased awareness) pubmed.ncbi.nlm.nih.govpubmed.ncbi.nlm.nih.govpubmed.ncbi.nlm.nih.gov.

Diallo, S. et al. (2024). Immersive digital therapeutic tool on pain – Frontiers in Pain Research. (Found that a VR environment designed for endometriosis patients reduced pain unpleasantness by ~27% during use, suggesting promise of VR for pain relief) frontiersin.org.

Endometriosis Foundation (2018). Five Helpful Endometriosis Apps You Need Now. (Describes existing apps like symptom trackers, community forums, and lifestyle tools, highlighting current digital support available and inspiring ideas for new features) endofound.orgendofound.org.

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