Q&A with Mahesh Maskey, Nepal’s Ambassador to China.
The following is a transcript of an email interview with BUSPH epidemiology alumnus Dr. Mahesh Maskey, currently Nepal’s Ambassador to China, responding to questions from department faculty member Ken Rothman.
KJR: Mahesh, it’s kind of you to make time to update the BU community on your career and activities. Could we start by you recounting what brought you to BUSPH to study epidemiology, and what your studies at BUSPH meant to you at the time?
MM: When I came to BUSPH, I was keen to master the science of epidemiologic research. The reason was twofold. First, I thought then, and still believe, that epidemiology is the foundation of public health. Second, I wanted to have a good grasp of research methods, not only for carrying out health research per se, but more importantly, to promote evidence-based public-health policies. I had already made my transition from a medical doctor treating individual patients to a public-health professional engaged in the betterment of health of the people. In fact the frustration of not being able to provide adequate medical care to the individual patients because of their financial constraints forced me to think that macro-level interventions on health policies would be a better approach.
KJR: Are there any specific experiences you recall from your days as an epidemiology student that still influence you?
MM: The years I spent at BU were among the most rewarding of my academic career. BUSPH had outstanding teachers in epidemiology and in biostatistics. Aside from you, your colleagues Janet Lang and Charles Poole helped to avoid conventional stereotypical epidemiologic wisdom and provide deeper insights into the common thread that runs through different research designs, from clinical trials to case-control studies, all based on sound epidemiologic principles. The rescue of epidemiologic inference from the shadow of the P-value, and the rigor of thinking through issues such as chance, bias and confounding while making an inference about the underlying truth from available data was cultivated. I find that thinking through these alternative explanations helps in all logical thinking to understand reality, whether in science or in politics. The friendly behavior of my teachers toward their students is something I still cherish.
KJR: As you are Ambassador to China, your career has taken an unusual path. I know that after you left Boston to return to Nepal, you experienced some tumultuous events. What can you tell us about the early days after your BU studies, and how the turn of events influenced your career, culminating in your becoming Ambassador?
MM: I returned to Nepal in 2001, just weeks after the tragic Palace Massacre. I remember the kind suggestion of many teachers and friends not to return immediately at such times. However, as destiny would have it, I chose to return and never regretted that choice. I resumed my teaching job but I also tried to promote peace in a country that was locked in armed conflict between the state and Maoist rebels. Along with many likeminded intellectuals, I argued that a peaceful resolution of the violent conflict is possible by drafting a new constitution through a constituent assembly.
Since at that time the mainstream was arguing for a revised constitution rather than a new constitution through a constituent assembly, we asked for a referendum for the people to choose between these options. This was the time when a state of emergency was declared and we were held in military custody for 11 days. A the initiative of my friend Lois McCloskey in MCH, BU mobilized a huge international signature campaign for our release. I would like to take this opportunity to thank all for the support.
Later developments saw the tide turn in favor of the constituent assembly. It became the idea whose time had come. A powerful civil society movement arose, and the main political parties and the rebels came around to sign a 12 point agreement. A people’s movement erupted in 2006 that resulted in the constitutional monarch stepping down and declaring Nepal a republic. Although this was nearly a decade ago, after a long and difficult political transition and negotiation between former adversaries, the constitution was finally delivered only a few days ago through an elected constituent assembly.
In the new government, I became the chief advisor of the health minister, who was also the Deputy Prime Minister. Later I also became the Executive Chair of Nepal Health Research Council. During the 3 years of my being in that office, the interim constitution adopted basic health care as right of the people, to be available free of cost. Many policies were implemented to execute this principle, now expressed in the constitution. Achievement in health in Nepal became a topic of interest for the international community. Nepal was one of the few developing countries to be on track to achieve the health-related Millennium Development Goals, and among the top ten movers in the Human Development Index.
Leaving the government in 2010, I established the Nepal Public Health Foundation as an apex body for public-health action, and I also developed the ‘Motherhood Method’ for measuring maternal mortality in developing countries. In 2011, two close friends who often discussed with me China’s development became Prime Minister and Foreign Minister. They thought I would be a good ambassador to China. From student days I had had an interest in the development of China. As the Chinese experience was drawn upon to formulate the Alma Ata declaration of 1978, understanding China had become important for me as a health professional also. I guess all these factors culminated in making me the Ambassador to People’s Republic of China.
KJR: How has your public health background influenced the way you conduct your work as Ambassador?
MM: When I submitted my credentials to President Hu Jintao in 2012, he said that I have a rich background in public health, which is highly regarded in China. A few months later, Tsinghua University invited me to deliver a keynote speech in public health and made me Honorary Chair of the Asian Health Communication Platform for Public Health. They found it quite interesting for an Ambassador to have a public-health background. Thereafter I got connected to health in various ways here. I was also invited by Peking University to participate in a panel discussion with WHO director general Margaret Chan and former Health Minister of China Chen Zhu.
As an ambassador I am mainly engaged in diplomatic activities and promoting bilateral cooperation between Nepal and China. My activities are geared for the development of Nepal and fostering friendship between Nepal and China by organizing and participating in high-level meetings. The scope of this job is immense since I have to deal with all the ministries of the government of both countries as well as maintain people-to-people interaction. My knowledge of China’s development since my student days, as well as my engagement in development issues through health, has sustained me in carrying out my responsibilities. This job demands considerable expertise in keeping and fostering public relations, something that is also true for public health. So I believe my background in public health has prepared me well for the current job.
KJR: News reports suggest that Nepal is still reeling after the earthquake earlier this year. How are recovery efforts going? Is there anything useful that alumni and others can do?
MM: On April 25 this year, our country was hit by high-magnitude earthquake and faced one of the worst natural disasters in her history. However, with the incredible support of international community, the Nepali government and people also launched a massive rescue and relief operation and a campaign to prevent epidemics. Now we are in post-disaster recovery and reconstruction phase. Nepal has suffered a lot in terms of human lives, destruction of houses and damage of world cultural heritage sites. But the Nepali people are also determined to turn this crisis into opportunity for all-round development of the country. Huge support has been generated in a recent international donor conference, and with the new constitution, I believe the situation is favorable.
A few months ago BU students, alumni and teachers tried to generate some financial support for Nepal. I think the best way to lend support is to channel resources and skills through organizations in Nepal that are working in the field, particularly in the health sector. The Nepal Public Health Foundation could be one such organization.
KJR: What advice would you offer to BUSPH epidemiology students who are just embarking on their epidemiology career?
MM: Let me offer four pieces of advice:
- Epidemiology prepares you for evidence-based intervention in all levels of prevention, from primary to tertiary. You have to find out where your abilities find the best fit.
- It also takes you to the heart of philosophy-of-science debates about theories of causation. It is extremely rewarding to wade through them.
- As a researcher you always should pay attention to the possibility of explanations other than what you hold to be true, and to be particularly aware of your own biases.
- Epidemiology is a young science still in making. There may not always be a ready-made answer. Grasp of the fundamental concepts will help to overcome difficulties in uncharted paths.
Perhaps I should narrate a story to explain the last point. While at BU, I came to Nepal to conduct a small study on neonatal tetanus funded by Population Reference Bureau in Washington. In the field setting I found the conventional methods did not work because of lack of records and rarity of cases. To obtain data on the study base that gave rise to the NNT cases, either a very large sample or census of mothers delivering a baby during a specified time had to be taken. Constrained by budget and time I could do neither. So I used proxy measures of vaccination registers to identify the list of mothers who had delivered in a that particular community in a particular time, and augmented the list with focus group discussions among the listed mothers in a small group setting. This approach effectively gave me a census of the geographic study base with the case histories, so that neonatal disease, and neonatal, infant and under-five mortality rates could be calculated. To my surprise, this study was acknowledged as the best of the batch by the PRB in Washington. My Supervisor Janet Lang encouraged me to apply it to the difficult study of measuring maternal mortality in Nepal in my doctoral thesis. Later it was developed into “Motherhood Method” measuring maternal mortality in developing countries like Nepal, co-authored by Janet.