Game on! But at what cost?
- Beth Amato
While gaming has been used effectively as an alternative learning system, developers use the same principles as gambling to entrap.
Long before simulation labs in which students encounter life-like dummy patients and Minecraft-based classrooms, nurses at the µÚÒ»³Ô¹ÏÍø Medical School in the 1950s were already using board games to deepen their learning.
The game worked less like a race to the finish and more like a turn-based strategy game, where the outcome changed with each decision made. A nursing student, for instance, might move a token to a square marked “home visit” and draw a card. The scenario on the card might reveal that the patient is unwell but there is tension in the house, such as a drunk and disruptive family member. The nurse has a choice. What should be done first? Calm the family? Check the patient’s vital signs or call for help? Each choice would open a different route and result in a different outcome.
Whatever their choice, the students were learning how to manage complex situations, including the consequences of those choices.
Hosted by eFundanathi in the µÚÒ»³Ô¹ÏÍø School of Therapeutic Sciences, the inaugural Game On! Where Pedagogy Meets Play symposium presented an innovative programme that blends technology and adaptive learning processes. There, a small but growing academic gaming community reflected on the history of play for learning and explored further how games are used as tools for teaching, assessment, simulation, health communication and social change.
Amanda Jankowitz, a Lecturer at eFundanathi, explains how, in one Minecraft-based game, µÚÒ»³Ô¹ÏÍø occupational therapy students enter the rural world of Arabang, a fictional character living with her disabled daughter and granddaughter. Through Arabang’s life, they learn how water, distance, disability and family context shape health issues. In 2026, Arabang’s village expanded and the Ntuli family moved in, allowing students to work through household dynamics, disability and care needs.
In a different game, microbiology students are sent into a rural village after a disease outbreak to search for patient zero. In this setting, they learn to confront stigma, traditional-healer advice, vaccination misinformation and the fears that follow a rural family into hospital.
“During Covid-19, eFundanathi even built a virtual pharmacy so students could practise inspecting a pharmacy environment when they could not visit one in person,” says Jankowitz. When the game proved too data-heavy for some students, the team created a video version. “It was a reminder that ethical game-based learning in South Africa must also account for access, devices and data.”
Hidden dangers
Meanwhile, in a different setting, a nine-year-old boy logs onto Roblox after school. He has to use his mom’s phone to play and has been obsessively hounding her for it. His friends are there, and he gets into a game of ‘1 versus 1’ with them, if he is lucky to be chosen by the 12-year-old boys playing simultaneously. The game is colourful and noisy and works on the same principles of chance and reward that draws an adult into a casino. The boy usually has to pay with real money to enter, buy the “Robux” currency, open the box, spin for the prize and try again if he loses. The prize might not be cash but could be a rare character, a footballer card, a pet, a weapon ‘skin’ or a status item (which other children can admire).
“Imagine a casino entirely built for children. It runs on slot-machine psychology, charging real money for rewards with undisclosed odds. There is no parental supervision … in a real world of course, society would shut it down immediately,” says Associate Professor Michele van Eck from the µÚÒ»³Ô¹ÏÍø School of Law and Fellow in the µÚÒ»³Ô¹ÏÍø Machine Intelligence and Neural Discovery (MIND) Institute, who recently presented a webinar on grooming minors through gambling-like gaming practices.
Yet, the same psychological architecture is packaged inside a smartphone, called a video game and remains unchallenged. These types of games also fall through the cracks of South Africa’s legal framework.
This is the uneasy question at the centre of gaming today. If play is powerful enough to support learning and health, what happens when that same power is built into unchecked systems designed to keep children spending, returning, obsessing and perhaps being stalked by online predators?
It’s a gamble
Dr Alan Mattiassi, a gaming psychologist who was a keynote speaker at eFundanathi’s Game On! symposium, says that games are structured psychological environments in which a small change in a variable can alter behaviour. “This is what makes games powerful. It is also what makes them risky,” he says.
Mattiassi cautions against treating addiction as something unique to gaming. “There is a major trust breach in some children’s games. A casino announces itself as a gambling environment. A child’s game announces itself as fun. A parent sees entertainment. A child sees friends, avatars, colours and rewards. A developer sees a monetisation funnel.”
Parents are often told to monitor screen time, set limits and activate parental controls. “Responsibility is pushed downstream onto parents and children, while the architecture that creates the risk remains upstream with developers and publishers.
Children are expected to exercise restraint in environments built to undermine it. Parents are expected to supervise systems that they may not fully understand. Meanwhile, the companies designing these reward loops, virtual currencies and spending pathways face little direct accountability for the risks built into their products,” says van Eck.
Of course, not all these games use the same mechanics, and not every child who plays them will be harmed. “Children are growing up in digital environments where spending is abstracted and chance is normalised,” explains Mattiassi.
Jankowitz has seen how even educational rewards need careful handling. In one mostly online medicine and surgery course for occupational therapy and physiotherapy students, badges were introduced to improve engagement. Students loved them but the team found that some became too focused on collecting badges rather than on the learning itself. The system was redesigned, reducing the number of badges and spacing them out more carefully.
The question, then, is not whether games are good or bad.
“The challenge is not to remove games from children’s lives but to insist that the systems surrounding them are transparent, accountable and designed with children’s best interests in mind. Play can be a space for learning, care and imagination. It should not become a rehearsal for gambling before a child is old enough to understand the rules,” concludes van Eck.
- Beth Amato is a freelance writer.
- This article first appeared in CURIOS.TY, a research magazine produced by  and the .
- Read more in the 21st issue, themed #Trust — the invisible glue binding society, science and technology.