‘I Thought in Those Riskier Times I Was Needed More’.
Mahesh Maskey (SPH’01) Alumnus; Executive and Founding Chair of the Nepal Public Health Foundation, Executive Vice Chair of the High Level Health Policy Committee of the Nepali Ministry of Health, Honorary Chair of the Joint Asia Pacific Public Health Initiative, and former Nepali Ambassador to China
Breakfast: “This morning for breakfast my wife and I had something we had not had before. We had it in Harvard Square, and it was a popover sandwich—it was new, but very tasty.”
Hometown: Biratnagar, Nepal (“I was born in the countryside, and then my father settled in Biratnagar, so my childhood was there. In 1990 I came to Kathmandu and made my home there.”)
Extracurricular: “I love to read poetry, novels, and other literature, but these days I’m too occupied with other work so I have very little time. My favorite writer is a Nepali poet and writer who has passed away, Parijat. We were very good friends.”
First of all, congratulations on receiving a BU Distinguished Alumni Award last weekend.
My first reaction was thinking, Why am I so lucky? I had just received the SPH Distinguished Alumni Award in 2013, and then in 2017 they honored me with the Boston University-wide award. I felt so honored. Then, when I came to the award ceremony and saw the video introduction and this activist stance, I realized that the activist part of me, being an academician and an activist combined, may be one of the reasons they selected me.
Where does that activist part of you come from?
From my early childhood I was exposed to differences in social status. Some of my friends were from a very poor community, and they were very good at school but they could not continue their education because of their economic constraints. Some actually died before they reached high school because of poverty.
I was also exposed to the larger political situation that was brewing against the king and the government at the time. I grew up in a very politically charged atmosphere, where some of my own relatives were activists. Biratnagar is actually famous for being a very politically active city, and it has produced many prime ministers, not to mention every other kind of minister.
As I grew up I wanted to have a career in health. I was fortunate to get a scholarship to get my medical education in India, and in my courses we were learning how to deal with poor patients, so we had to face the question of why they don’t have access to very basic healthcare—which, as human beings, they should have. In the search for an answer to this question I learned that you have to have both a very good academic standing and a way to put your academic skill to use in a larger political sense.
At the same time, the World Health Organization (WHO) made the Alma Ata Declaration, and part of the declaration is about health being a fundamental human right, and how you have to have political will in order to be successful in dealing with the health of the have-nots. I think all of these exposures, from childhood to adulthood, led to these academic and political aspects balancing in me.
While completing your DSc in epidemiology at SPH, you developed a method for measuring maternal and child health. What led to that focus?
What I originally wanted to do was look at neonatal tetanus, the tetanus that happens in a newborn baby. The world was gearing up to eradicate neonatal tetanus. I went to Nepal and found that all of the methods that I had studied didn’t work. I had to find a way of getting that information from the ground, a targeted census, to try to find mothers whose babies suffered from neonatal tetanus.
I succeeded in that, and my supervisor, Janet Lang, [former professor of epidemiology], said, “Why don’t you elaborate it? If your method works on neonatal tetanus, then—because you’re dealing with both the newborn and the mother—it should also work on newborn children, and on stillbirth.” She encouraged me, and we developed this method, and that became my dissertation.
We found that it not only covers perinatal health, but it also works for maternal mortality, and infant mortality, and neonatal mortality—with the same method you could measure four or five different mortality rates.
After I finished my dissertation we did a huge piloting program in Nepal, specifically focusing on this method that we called the motherhood method, comparing it to the sisterhood method. The standard method WHO uses is asking a mother how many sisters she has, and taking the pregnancy histories of all of her sisters. I said, ‘Why not go directly and talk to all of the mothers who have given birth in a set period of time? If you have a way to find all of the mothers and ask them directly, that will be much more accurate than asking one woman about her sisters and having her try to recall from memory.’ It worked, and the motherhood method was published in the Indian Journal of Medical Research, and now it’s getting popular in Nepal.
When you finished your DSc, you returned to Nepal even though the country was in the midst of a civil war. Why did you decide to take that risk?
When I came to SPH I was very clear about one thing: I came to learn something that I could utilize back in Nepal. I was not of two minds about whether I should stay here for the kind of privileged life I would have here compared to the risks I would have in Nepal. I thought that if I could utilize that knowledge even for five years, and was able to train the next generation, then there would be a critical mass of people who would be useful for doing health research and making our health policy stronger.
I also thought that in those riskier times I was needed more in Nepal, because I might intervene in such a way that there may be some kind of way out of the conflict. Indeed, we argued for the election of a constituent assembly as a peaceful way out, which ultimately prevailed.
So I had felt that I should go back, and I had strong support from my wife. We went happily, even though we knew there would be some risk. Of course, we didn’t know that the risk would be so high as to put me in military custody, but I was willing to take the risk, and fortunately I survived.
You were instrumental in making healthcare access universal in Nepal after the civil war. How did the country make the jump from deciding healthcare is a human right, to actually making it a reality?
When we were struggling for health rights in the 1990s, holding banners that said, “Health Is a Right Not a Privilege,” we didn’t think we would ever reach a policymaking level and have a chance to actually implement it. We were not sure about our lives, we were not sure whether we would survive or whether we would be in a place to influence policy, whether we would just be political opposition expressing our opinion but not actually having access to those decisions.
It so happened we survived a big historical moment in 2006, and all of the political changes that happened after. It was a great moment of optimism, of hope, when the war ended and 2006 and all of these political changes happened. The king had stepped down, we were a free people, and we were trying to design and implement the things that we thought were most important. The new health minister took me as his chief advisor, and from that time onward I had the opportunity to put into practice what we had been theoretically discussing. It was a great experience, I can tell you! That was the most fulfilling period of my life, and I think it has also paid off because now Nepal is always in the news for its health sector.
You served as Nepal’s ambassador to China from 2012 to 2016. Did public health skills carry over into that role?
I became ambassador under very special circumstances, where one of my friends became the prime minister and another became the foreign minister at the same time. I used to advise them about China because I used to study China—because China was one of the examples of the Alma Ata Declaration, and health for all, and good health at low cost, so China as a model was always being discussed. I accepted the ambassadorship because I thought it was a great opportunity for me. I wasn’t sure how good I would be, but when I started I soon realized public health had trained me in a very multisectoral way to think about economics, politics, government efforts, the nongovernment level, the level of the business community, and literary arts, and everything else.
When I was presenting my credentials to the then-president of China, Hu Jintao, in our first meeting—he’s sitting there, and I’m sitting here, and the president says, ‘So, you’re a public health expert. China has a very great respect for public health professionals, so I’m sure you’ll do a good job as an ambassador to China.’ These were very encouraging words for me!
After some time, Tsinghua University approached me and I became the honorary chair of the Joint Asia Pacific Public Health Initiative, and Peking University invited me for a nice plenary discussion with Margaret Chan, the then-director general of WHO. I was still carrying out public health responsibilities as an ambassador, so when I came back into the field of public health it was very easy for me, and now I’m the chair of the Nepal Public Health Foundation, and executive vice chair of the High Level Health Policy Committee of the Ministry of Health of Nepal, which was mandated to draft a new health policy for Nepal in accordance with the new constitution and the federal restructuring of the Nepali state—and I also got to be here at Boston University and have this homecoming, and receive this award, and visit my old friends and teachers. That makes me very happy.